Rapid detection of methicillin resistant staphylococci from the nasal screening swabs by mannitol salt agar with cefoxitin and oxacillin disks

To assess the reliability of Manitol salt agar [MSA] for directly identifying Methicillin Resistant Staphylococcus aureus [MRSA] and Methicillin Resistant Coagulase negative Staphylococci, [MRCoNS] in nasal swabs for screening purposes using cefoxitin and oxacillin disks. Descriptive and Quasi-experimental. The study was done in the two surgical units of Combined Military Hospital, Rawalpindi and all the samples were processed at the Department of Microbiology, Armed forces Institute of Pathology, Rawalpindi during July 2007. A total of eighty four duplicate swabs were taken from the anterior nares of various staff members of the two surgical units and were directly inoculated on Mannitol salt agar with Cefoxitin disc 30 micro g [MSAFOX] and oxacillin disc 1 micro g [MSAOX]. All the samples were simultaneously inoculated on blood and MacConkey agar for conventional testing, using standard conditions, and confirmed as MRSA or MRCoNS by oxacillin disk diffusion technique. The staphylococcal isolates were later confirmed as MRSA/MRCoNS by polymerase chain reaction [PCR] for mec A gene analysis. There were 45 staphylococci which revealed mec A gene [40 MRCoNS and 5 MRSA] by PCR. Both the disks with MSA effectively identified the methicillin resistance. MSA with cefoxitin could identify 40 methicillin resistant staphylococci [35 MRCoNS and 5 MRSA] where as MSA with oxacillin could identify 39 methicillin resistant staphylococci [34 MRCoNS and 4 MRSA]. There was no significant difference between the two disks in sensitivity, specificity, positive and negative predictive values and overall efficacy of the procedures. MSA with cefoxitin 30 micro g and oxacillin 1 micro g appear to be highly accurate, easy to perform and beneficial for quick and reliable detection of methicillin resistant staphylococci from the nasal carriers in a routine microbiology laboratory

Invasive infection in a young immunocompetent soldier caused by scytalidium dimidiatum

Scytalidium dimidiatum is mainly responsible for human skin and nail infections but the mould has also been reported for invasive infections in immunocompromised individuals. We report a young immunocompetent individual diagnosed with invasive non-traumatic Scytalidium dimidiatum infection involving the left orbital cavity and maxillary sinus

Comparison of two different sensitivity testing agars for detecting methicillin resistance in Staphylococcus aureus

To compare the accuracy of Mueller-Hinton agar and Isosensitest agar using cefoxitin disc for detecting methicillin resistant Staphylococcus aureus using mecA gene PCR assay as gold standard. Comparative study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from May 2006 to January 2007. One hundred clinical isolates of Staphylococcus aureus were evaluated; 64 MRSA [methicillin resistant Staphylococcus aureus] and 36 MSSA [methicillin sensitive Staphylococcus aureus] by mecA PCR assay All the isolates were tested with cefoxitin 30 micro g disc using semi-confluent growth on Mueller-Hinton agar as well as on Iso-sensitest agar in ambient air at 35-37°C after an overnight incubation as per recommendations of Clinical and Laboratory Standard Institute. Following diameters provided the best sensitivity and specificity without substantial overlapping between the zones of resistant and sensitive isolates; Mueller-Hinton agar: R /= 22 mm [sensitivity 97.2% and specificity 100%], and Iso-sensitest agar: R /= 26 mm [sensitivity 100% and specificity 100%]. High accuracy was obtained with cefoxitin disc on both media. Performance of both media was equally convincing for reliable prediction of methicillin resistance in Stapfylococcus aureus by placing cefoxitin 30 micro g disc on either of these in routine susceptibility testing

CD5-positive acute lymphoblastic leukemia

CD5-positive B-ALL is a rare variant of Acute Lymphoblastic Leukenia [ALL]. In literature, only three cases have been reported so far. This fourth case report describes a young lady who was diagnosed as ALL [L-2] ib bibe marrow examination and was found to be CD5 positive B-cell acute lymphoblastic leukemia on immunophenotyping. Cytogenetic analysis revealed translocation t[9:22]

CTX-M ESBL enzyme in Escherichia coli from urology patients in Rawalpindi, Pakistan

To detect CTX-M phenotype utilizing disc diffusion and MIC testing in Escherichia coli isolated from a tertiary care urology setting. Fifty single, non duplicate ESBL producing isolates from a tertiary care urology hospital were evaluated for the presence of CTX-M phenotype. Initially all the urinary isolates were tested for ESBL production. The isolates were identified by using API 20E galleries and screened for ESBL production by combination disc. Representative 4 ESBL isolates were sent to Antibiotic Resistance Monitoring and Reference Laboratory [ARMRL], Health Protection Agency, Colindale, London, UK where those were further subjected to MIC testing by agar dilution and E-test strips. A total of 4 ESBL producing E. coli isolates were characterized to be CTX-M on phenotypic characterization. The overall yield of CTX-M phenotypes was 75%.The emergence of CTX-M from Pakistan is alarming; however, further studies are required to study the epidemiology and genetic characterization of CTX-M types of ESBLs

8[th] October 2005 earthquake - an experience of diagnostic laboratory services in disaster

An earth quack measuring 7.6 on Richter scale with its epicenter located at 19 km north east of Muzaffarabad struck eight districts of northern areas of Pakistan, and adjacent areas of India. An estimated death toll of about 73,338 was reported. Around +3.5 million people were affected by natural disaster. Such a large number of population required special attention in the form of winterized shelters, heating, medical care, food, water and sanitation. This situation posed a unique challenge for health services including provision of diagnostic laboratory services for short term as well as long term basis. Laboratory services were established at various locations as a part of medical care to provide diagnostic facilities as well as blood transfusion services. This article presents few important lessons learnt in this aspect of medical care

Myocardial imaging agent [Tc-99m-2-methoxy isobuty sonitrile [MIBI]] synthesis, myocardial uptake, biodistribution in the animal and human models [a preliminary report]

2-methoxy isobutyl isonitrile [MIBI] was synthesized following Subramanian procedure and formulated into 'instant kits'. The quality control of the kits showed 97.5% radio chemical purity and 98% stability at 6 hr, with shelf half life of more than 6 months. In the animal model, blood activity [TC-99m MIBI] gradually decreased from 21.4% at 5 mins to 2.1 +/- 1% at 60 min. The organ distribution at 60 min showed, liver 70 +/- 5%, heart 21 +/- 6%, kidney 52 +/- 2% and lungs 33.4 +/- 6%. The heart to organ ratio was heart/liver 0.3, heart/lung 0.6, heart/spleen 0.36 and heart/kidney 0.4. On human model, blood activity of injected dose [[ID], 29.2 +/- 3% at 30 sec and 2.1 +/- 1% at 60 min. The organ activity at 60 min, liver 62 +/- 3%, heart 24 +/- 4%, spleen 57 +/- 3% and lung 44.5 +/- 6%. The heart to organ ratio, heart/liver 1.3 +/- 0.2, heart/lung 2.1 +/- 0.3 and heart/spleen 2.6 +/- 0.8. The study provided first reported evaluation of Tc-99m MIBI in experimental and clinical trials in Pakistan. The results confirmed that the distribution of the MIBI remained relatively fixed in experimental studies, no significant redistribution accrued. Moreover, the images obtained are of high technical quality