Detection of Uropathogens by Using Chromogenic Media (Hicrome UTI agar), CLED agar and other Conventional Media.

This study was undertaken to find media better than routinely used media in isolation of uropathogens.Three hundred urine samples having pus cells >_ 5/ HPF were enrolled for the study. Comparison of isolation and identification of uropathogens among HiCrome UTI Agar media, 5% Sheep Blood agar & MacConkey agar and CLED agar media were done. Among them 95(31.67%) samples showed single growth, 6 (2%) showed mixed growth and 199 (66.67%) showed no growth. Rate of presumptive identification of organisms in primary culture plate were high in HiCrome UTI agar media. For Escherichia coli, it was 94.20% whereas in CLED agar it was 79.71% and by Blood agar and MacConkey agar media in combination it was 82.61%. All the Enterococcus spp. were identified in HiCrome UTI agar media, 33.33% in CLED agar media but none in Blood agar and MacConkey agar media. Among the mixed growth, 100% organisms were identified on HiCrome UTI Agar media due to distinct colour produced by the different organisms, whereas in one (16.67%) sample (mixed Esch.coli and Pseudomonas spp.) organisms were identified on other three media.

Study on Time-related Changes in Aerobic Bacterial Pattern of Burn Wound Infection.

A prospective study was carried out in 50 burn patients admitted in Burn unit of Dhaka Medical College Hospital over a period of one year from January 2005 to December 2005 to evaluate time-related changes in aerobic bacterial colonization and their sensitivity pattern. Periodic swabs were taken from the burn wound on Day 0, Day 7, Day 14 and Day 21 to see the changing pattern of organisms during hospital stay of patients. In the present study burn injury was highest in the age group 11-20 yrs (34%). Male to female ratio was 1.38:1. The mean percentage of burn was 35.79% of total body surface area (TBSA). Fire was the major cause of burn (38%) followed by electric burn (20%). Among the 200 samples, single organism was isolated in 71% samples and mixed organism in 13.5% and no growth in 14.5%. Among single isolates Pseudomonas aeruginosa was leading (28%) followed by Escherichia coli (17.5%), Staphylococcus aureus (16%), coagulse negative Staphylococcus (4.5%) and Klebsiella (2%). Among mixed growth Pseudomonas aeruginosa was still leading (11%) follow by E. coli (9.5%) Staphylococcus (5.5%), Proteus (1%) and Klebsiella (0.5%).There were time -related changes in bacterial isolation from burn wound during hospital stay of patients. On admission 42% of the isolated organisms were Staphylococcus aureus and only 6% each Pseudomonas aerunginosa and E. coli were isolated. No growth was found in 28%. samples. These findings were gradually changing with time and on day 21 Staphylococcus aureus were only 4% whereas Pseudomonas aeruginosa were 40% and E. coli 28%. Antimicrobial sensitivity test showed that pseudomonas aeruginosa was highly resistant to antimicrobial agents. It was most sensitive to Imipenem (98.72%) followed by Aztreonam (33.44%), Ceftazidime (38.32%) and Gentamicin (19.23%). E. coli was also found most sensitive to Imipenem (98.15%) followed by Gentamicin (38.95%), Chloramphenicol (37.1%), Ciprofloxacin (35.25%) and ceftraixone (29.70%). Staphylococcus aureus was 100% sensitive to Vancomycin followed by Amoxiclav and Oxacillin (53.43% each), Gentamicin (44.70%) and Cloxacillin (39.52%). It is crucial for every burn institution to determine the specific pattern of burn wound microbial colonization, the time-related changes in dominant flora, and the antimicrobial sensitivity profiles. This would enable early treatment of septic episodes with proper empirical systemic antibiotics without waiting for culture results, thus improving overall infection related morbidity and mortality.

Comments on Evaluation of Endoscopic Findings and Detection of H. pylori Antibody by Serum IgG ELISA.

Bangladesh is a developing country with high prevalence of peptic ulcer disease and H. pylori infection. During the period of January 2007 to December 2007, a cross sectional study was conducted. In this study, serum samples were collected from 86 dyspeptic patients undergoing upper GIT endoscopy to determine anti-H. pylori IgG antibody by serum ELISA and was evaluated with endoscopic findings. Out of 86 study patients, gastro-duodenal mucosa was found normal in 58.14%, gastritis in 11.63%, duodenitis 2.33%, reflux oesophagitis 4.65%, peptic ulcer 17.44% and carcinoma of stomach 5.81%. Among 86 study population, 68 were serum IgG ELISA positive and 20 were negative.

Prevalence of Bacterial Vaginosis among the PID Patients in Bangladesh.

A cross sectional study was conducted on patients attending at the outpatient department of Gynaecology and Obstetrics of Dhaka Medical College Hospital, Dhaka during the period of July, 2007 to December, 2007. Two hundred sexually active female in the age group of 15-45 years, with vaginal discharge and itching, were selected for the study. Among them 143 having only vaginal discharge and itching without PID (Pelvic inflammatory disease) and 57 patients having vaginal discharge and itching with PID. A detailed history and a thorough clinical examination of all the cases were done. After making the clinical diagnosis of BV (Bacterial vaginosis) by Amsels criteria, diagnosis also carried out with Acridine orange staining, Gram stain Nugent criteria. Out of 200 women, 48 (24%) cases were diagnosed as having bacterial vaginosis by applying Amsel's clinical criteria. The rate of detection of bacterial vaginosis was 23% by Gram stain Nugent criteria and 24.5% by acridine orange staining. In this study BV was diagnosed in 31(54.39) cases among the PID patients and 17(11.89) among the women having only vaginal discharge and itching. This study shows the increased association of BV in PID patients of Bangladesh.

A Comparative Study Among Different Invasive Methods For The Diagnosis Of Helicobacter Pylori.

H. pylori infection occurs worldwide. Approximately 50% of the world population is infected with this organism. A cross-sectional study was conducted on 81 dyspeptic patients attending at Dhaka Medical College Hospital, for diagnostic endoscopy. H. pylori infection was measured by three invasive methods: culture, rapid urease test & histopathology. Among study patients maximum (34.57%) H. pylori infected were in 21-30 years age group, bearing male female ratio 1: 92.86. Forty four (54.32%) out of 81 were culture positive, 61 (75.31%) were rapid urease test positive and 62 (76.54%) were histopathology positive. By using ‘gold standard’ definition, 64 (79.02%) were H. pylori infected, 17 were un-infected. Finally comparing among three invasive methods, all are highly sensitive and specific to diagnose H. pylori infection.

Kikuchi-fujimoto disease.

A 14 year-old Bangladeshi girl presented with high fever, painful swellings in the neck, anorexia, weight loss and night sweating. On examination she had multiple enlarged and tender cervical lymph nodes. Other systems were normal. Laboratory investigations for sepsis and autoimmune diseases were negative. Initial fine needle aspiration and cytology of affected lymph node was suggestive of tubercular lymphdenitis. But she did not respond to anti-tubercular treatment. Kikuchi-Fujimoto disease was diagnosed from the histopathological appearance of excised lymph node. She completely recovered with symptomatic treatment. Kikuchi-Fujimoto disease, also called Kikuchi's disease or histiocytic necrotizing lymphadenitis is a rare, benign but enigmatic disease of unknown aetiology. The disease is self-limited and has an excellent prognosis. Its recognition is crucial because it can be mistaken for systemic lupus erythematosus, malignant lymphoma, tubercular lymphadenitis or even, for metastatic adenocarcinoma. Clinicians' and pathologists' awareness of this disease may help prevent misdiagnosis and inappropriate treatment.

Comparative studies on IFAT, ELISA & DAT for serodiagnosis of visceral leishmaniasis in Bangladesh.

The purpose of the study was to estimate the specificity and sensitivity of different serological methods for the diagnosis of visceral leishmaniasis in Bangladesh. Blood samples from 155 suspected kala-azar patients together with 80 sick subjects and 50 healthy subjects from the endemic areas were collected. Out of the 155 suspected kala-azar patients, bone marrow were collected from 126 patients. All bone marrow samples were examined by direct microscopy. 92 bone marrow samples were also examined by culture method. Blood samples were examined by various serological tests. Out of 126 marrow samples, LD bodies were present by microscopy in 77 (61.1%) cases and out of 92 marrow samples, cultures for LD bodies were positive in 33 (35.9%) cases. All the three serological tests (IFAT, ELISA & DAT) were positive in all parasitologically positive kala-azar patients. They were also positive in seven (15.5%) out of 45 parasitologically negative cases and 10 (34.4%) out of remaining 29 cases in whom bone marrow samples were not available. Thus the serological tests proved to be simple, non-invasive, highly sensitive and specific methods for the diagnosis of visceral leishmaniasis. DAT is the simplest of these serological tests, although these tests did not differ in sensitivity and specificity.

Study on Mycobacterium tuberculosis: the primary drug resistance pattern.

The study was carried out to investigate the primary drug resistance pattern of tubercle bacilli isolated from the pulmonary tuberculosis patient attended in Shyamoli TB clinic, Dhaka. Sputum from 961 suspected tuberculous patients were randomly collected and stained by Ziehl-Neelsen (Z.N) stain. 135 were microscopically positive for Acid Fast Bacilli (AFB). Among them 30 patients were excluded from the study as they received antitubercular treatment before. So only 105 microscopically positive cases were cultured on Lowenstein-Jensen (L-J) media and 100 showed pure growth and rest 5 were contaminated with fungus. These 100 cases were studied on 4 antitubercular drugs. Out of these 100 isolates, 91 were M. tuberculosis and rest 9 in the nonchromogen group of mycobacteria other than tuberculosis (MOTT) species. Among 91 M. tuberculosis species, 89 (97.80%) to Isoniazid (INH), 73 (80.21%) to Rifampicin (RMP) and 91 (100%) to Streptomycin (SM) and Ethambutol (ETHM) were sensitive. Of the 9 MOTT species, 4 (44.44%) to SM, 7 (77.78%) to ETHM were sensitive and all (100%) were resistant to INH and RMP. Among the 100 isolates, 27 (18 M. tuberculosis and 9 MOTT) were resistant to 4 drugs either single or in combination. Of the 18 (66.67%) M. tuberculosis species, 16 (59.26%) to RMP, and 2 (7.41%) to RMP and INH were resistant. Of the 9 (33.33%) MOTT species, 4 (14.81%) to RMP and INH, 3 (11.11%) to RMP, INH and SM and 2 (7.41%) to RMP, INH, SM and ETHM were resistant.

Indirect fluorescent antibody test in the serodiagnosis of visceral leishmaniasis in Bangladesh.

Indirect fluorescent antibody test (IFAT) was found to be 100% sensitive and 100% specific when tested with sera from 125 parasitologically proven kala-azar patients, 100 healthy controls and 50 sick control cases. Promastigotes of both L. enriettii and L. donovani as well as amastigotes of L. enriettii were found equally satisfactory as antigen for IFAT. From the results of the present study, it is concluded that IFAT is a highly sensitive as well as specific serological test for the diagnosis of kala-azar.