Pattern of dermatophytes among dermatological specimens at AFIP, Rawalpindi

To determine the types and prevalence of dermatophytes from the clinical specimens received at Armed Forces Institute of Pathology [AFIP]. Study design is descriptive. The study was carried out at the Department of Microbiology, AFIP Rawalpindi from June 2009 to May 2010. Total of 400 different clinical specimens were dealt during the study period. After direct microscopy, they were inoculated on Sabouraud's dextrose agar with and without antimicrobials. The plates were incubated at 220C and examined twice weekly up to four weeks for any fungal growth. Species identification was done through colony morphology and microscopic examination of lactophenol blue preparation. Out of total specimens, 221[55.25%] yielded fungal growth. The overall yield of dermatophytes from different specimens was in the order of nail [78%], followed by skin [18.3%] and hair [3.3%]. Mycological infections have growing importance because of the increasing population of immune-compromised patients warranting a high index of suspicion

Ambu bag as a source of Acinetobacter baumannii outbreak in an intensive care unit

This case report describes an outbreak of multidrug resistant Acinetobacter baumannii in the intensive care unit of a tertiary care hospital. Three patients were infected on the same day from an Ambu bag which was used on all the patients. The outbreak was immediately identified and the source was traced within one week. Appropriate measures were taken and a continuous surveillance was carried out resulting in reporting of no such case from the intensive care unit in the last 6 months

Extended-spectrum beta-lactamase production in sbigella flexneri

Emergence of multidrug-resistant strains of Shigella is a growing concern across the globe. Third-generation cephalosporins are used for treating infections caused by multidrug-resistant Shigellae. However, resistance to these cephalosporin antibiotics due to extended-spectrum beta-lactamases, has emerged as a new problem. So far extended-spectrum beta-lactamases producing Shigella has not been reported from Pakistan. We report such a case in Shigella flexneri from an 8-year old girl with acute dysentery

Vancomycin resistant enterococcal sepsis in an acute myeloid leu kemic patient

Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloid leukemia. Patients with acute myeloid leukemia are at increased risk of acquiring vancomycin resistant enterococcal infection and its treatment remains problematic. Vancomycin therapy for more than 7 days is usually associated with inducible vancomycin-resistant enterococcal infections. We report a case of vancomycin resistant enterococcal sepsis in a patient of acute myeloid leukemia

Changing trends in frequency of extended spectrum beta lactamase producing gram negative bacilli in intensive care units of a tertiary care hospital

To determine the frequency of isolation of extended spectrum beta lactamase [ESBL] producing Gram negative bacteria from intensive care units [ICUs] of a tertiary care hospital. Retrospective descriptive study. The study was carried out at the department of microbiology Army Medical College Rawalpindi from Dec 2003 to Nov 2007. This study was carried out from Dec 2003 to Nov 2007. A total of 590 consecutive Gram-negative bacilli were recovered during the four year study period from various samples including urine, blood, pus, sputum, high vaginal swabs [HVS], ascitic fluid, central venous lines [CVP], chest tubes, catheter tips, NBL [nasobronchial lavage], CSF, tissue, endotracheal tube [ETT] tip and pleural fluid in ICUs. Extended spectrum Beta-lactamase detection in these isolates was carried out by Kirby- Bauer double disc synergy method. The frequency of ESBL producing organisms was 84 [66%] [December 03 to November 04], 80[54%] [December 04 to November 05], 80[57%] [December 05 to November 06] and 82 [47%] [December 06 to November 07] [p<0.0001] Our study shows a decrease in the frequency of ESBL producing organisms. However there is an increase in the resistant organisms having same resistance pattern, but not detected as ESBL producers, therefore we need to improve the methods for ESBL detection

Frequency of extended spectrum beta-lactamases [ESBL] producing nosocomial isolates in a tertiary care Hospital in Rawalpindi

To find out the frequency of extended spectrum beta-lactamases [ESBL] producing organisms among Gram negative rods from clinical specimens. This was a descriptive study. The study was carried out in the Microbiology Department of Army Medical College, Rawalpindi from 1 Jan 03 to 31 Dec 03 on clinical samples received from admitted patients in Military hospital, Rawalpindi. It was carried out on clinical specimens of urine, blood, pus, catheter tips, fluids including CSF, sputum, chest tube, HVS and i/v canula/CVP line obtained from admitted patients in Military Hospital, Rawalpindi. The organisms were identified by standard techniques. Confirmation to the species level was done by API 20 E and API NE where required. Sensitivity testing was carried out by Modified Kirby Bauer disc diffusion method on Mueller Hinton agar incubated at 35o C in ambient air for 24 hrs. ESBL producing strains were identified by double disc diffusion method test according to Jarlier et al. Clavulanate was applied as the inhibitor of beta lactamases [AMO/CLAV disc]. The results were tabulated as frequencies. Forty three percent of clinical isolates yielded ESBL producing gram negative rods. Enterobacter cloacae [76%], Klebsiella oxytoca [68%] Acinetobacter baumanni, [63%] and Aeromonas hydrophila [50%] were the most frequent ESBL producing bacteria. Production of ESBL among Gram negative rods is frequent in Military Hospital, Rawalpindi. Infection control measures are required to control their spread

Pneumocystis carinii and Trichosporon beigelii pneumonia following allogeneic haemopoeitic stem cell transplantation

Pneumocystis Carinii and Trichosporon beigelii are opportunistic infections in immunocompromised patients. We report a case of a young lady who underwent haemopoeitic stem cell transplantation for relapsed acute lymphoblastic leukemia. This 25 years old female developed fever, dry cough and rapidly progressive dyspnoea during post transplant neutropenia and was found to be suffering from Pneumocystis carinii pneumonia. She was successfully treated with Co-trimoxazole. The patient again presented with similar symptoms on day 55 post transplant. This time Trichosporon beigelii was isolated from bronchoalveolar lavage and she responded to prompt antifungal therapy. Other complications encountered during the subsequent course were extensive subcutaneous emphysema and spontaneous pneumothorax that required chest intubation and brief hospitalization. The patient is presently nine months post transplant and is asymptomatic

Peripheral blood-based polymerase chain reaction in diagnosis of pulmonary tuberculosis

The rapid diagnosis of infectious diseases, particularly those that represent a public health problem, like tuberculosis, is a challenging problem. By using nucleic acid amplification techniques like PCR, one may be able to diagnose, the disease on the day of arrival of specimen in the laboratory. For diagnosis of tuberculosis by direct methods like PCR, specimens from site of infection are required. In certain cases it is difficult to get the specimens from site of infection and in such situations; some researchers have tried to detect the DNA of Mycobacterium tuberculosis complex from blood of these patients. The purposive of this study is to determine the diagnostic efficacy of peripheral blood-based polymerase chain reaction for diagnosis of pulmonary tuberculosis. This was a simple descriptive study, carried out in Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi from Jan 2004 to Dec 2004. Sputum and blood samples were collected from 96 suspected patients of pulmonary tuberculosis. Sputum samples processed for ZN staining and AFB culture [gold standard] and blood samples processed for PCR. Out of 96 cases, 60 [62.5%] were culture positive. PCR was positive in 14 [14.5%]. AFB smear positive were 34 [35.4%]. The overall sensitivity and specificity of the PCR assay was 20% and 94.4% respectively and the positive and negative predictive values were 85.71% and 41.46% respectively. The overall efficiency of the test was 47.91%. Due to low sensitivity; a negative PCR assay does not rule the disease. However, this test may be helpful in cases where specimens from the site of infection are not available

Six month follow-up study on Salmonella typhi and Salmonella paratyphi. A infections for carrier state

Humans are the only natural reservoir of Salmonella typhi and Salmonella paratyphi A., therefore, the disease can be acquired through proximity with a person who is a chronic carrier. Most often this involves acquisition of organisms via ingestion of food or water contaminated with human excreta. A follow up study was carried out at the Armed Forces institute of Pathology [AFIP] Rawalpindi on 22 patients at two monthly intervals over a period of six months, with the objective to detect Salmonella typhi and Salmonella paratyphi A carrier state among these patients. Follow up investigations included stool cultures for both salmonella infections. None of our cases terminated as chronic carrier for Salmonella typhi and S. paratyphi A