Glutaraldehyde test for the rapid diagnosis of pulmonary and extra-pulmonary tuberculosis in an area with high tuberculosis incidence

BACKGROUND Tuberculosis (TB) remains one of the leading causes of morbidity and mortality worldwide. The primary method for controlling TB is the rapid and accurate identification of infected individuals. Immune response exploitation represents one of the main methods used for early TB diagnosis; however, few studies have reported that whole blood originating from TB-infected patients gels faster in the presence of aldehyde than blood originating from healthy subjects, which is the focus of the current study. OBJECTIVES The study objectives are to determine the diagnostic value of a glutaraldehyde test (GT) in pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) and to assess its performance compared with light-emitting diode fluorescence microscopy (LED-FM). MATERIALS AND METHODS This study included 272 specimens (176 suspected PTB specimens and 96 suspected EPTB specimens). Of the 272 patients, 98 patients had TB infection confirmed by culture (64 PTB cases and 34 EPTB cases), and 174 patients had no TB infection. The gold standard technique (culture) was used as reference to verify the GT's performance. RESULTS The GT showed a high sensitivity (96.9%) and specificity (82.1%) for PTB with a good positive predictive value (PPV = 75.6%) and negative predictive value (NPV = 97.9%). For EPTB, the GT showed a sensitivity of 91.2% and a specificity of 77.4%, with PPV = 68.9% and NPV = 94.1%. LED-FM had lower sensitivities for PTB (65.6%) and EPTB (42.1%) and an excellent specificity of 100%, with PPV = 100% and NPV = 100%. CONCLUSION We concluded that GT is rapid, easy, simple and cost-effective and does not require qualified personnel with a specific background or sophisticated equipment like molecular biology or mycobacterium-specific genotyping techniques. These qualities make the GT attractive for use in low- and high-income countries in addition to other conventional methods, particularly culture, which continues to be the gold standard.

A New IgG Immunoblot Kit for Diagnosis of Toxoplasmosis in Pregnant Women

The determination of the accurate immune status of pregnant women is crucial in order to prevent congenital toxoplasmosis. Equivocal results with conventional serological techniques are not uncommon when IgG titers are close to the cut-off value of the test, so that a confirmatory technique is needed. For this purpose, we developed a homemade immunoblot (IB) using soluble extract of Toxoplasma gondii tachyzoites and assessed it by testing 154 positive, 100 negative, and 123 equivocal sera obtained from pregnant women. In order to select the more valuable bands in terms of sensitivity and specificity, we used the Youden Index (YI). The highest YIs were those given by the 32, 36, 98, 21, and 33 bands. The simultaneous presence on the same blot of at least 3 bands showed a much higher YI (0.964) and was adapted as the positivity criterion. The analysis of results showed that our homemade IB correlated well with the commercial LDBIO Toxo II IgG(R) kit recently recommended as a confirmatory test (96.7% of concordance).

[Comparative study of antibiotic resistance in bacteria isolated from the burned patients during two periods [2005-2008, 2008-2011] and in two hospitals [hospital Aziza Othmana, trauma and burn center]]

Continuous monitoring of the bacterial flora and antibiotic resistance of the main bacteria involved in nosocomial infections helps improve treatment and prevention strategies. To compare the bacteriological profile and antibiotic susceptibility of the main bacterial isolates within the burned patients over two periods of 3 years and in two hospitals. During two three-year periods: period 1 [P1]: 1/7/2005-30/6/2008 and period 2 [P2]: 1/7/2008-30/6/2011] and in two hospitals: Hospital Aziza Othmana [HAO] and the traumatology and burn center [CTGB], 2153 and 3719 non-repetitive strains were isolated from burn patients from different samples. The transfer of the intensive care unit was made on 01/07/2008 from the Hospital Aziza Othmana to CTGB. The study of antibiotic sensitivity was performed according to CA-SFM. During the period P1, Pseudomonas aeruginosa was the main bacteria isolated [18%] followed by Staphylococcus aureus [14%] and Acinetobacter baumannii [12%]. After the transfer of intensive care burn unit to the traumatology center, ecology bacterial varied with S. aureus [20%] in the first place followed by P. aeruginosa [15%] and Proteus mirabilis [11%]. The study of the evolution of antibiotic susceptibility showed an overall downward trend of resistance in the second half of 2008, immediately after the transfer of service in the new hospital structure. The rate of ceftazidim resistant Klebsilella pneumoniae decreased from 80.4% to 50%, Similary the resistance of P. aeruginosa to ceftazidime and imipenem decreased respectively from 61% to 39.4% and from 63.3% to 37.1%. Nevertheless, the reduction of resistance was followed by a rapid increasing during the year 2009 to reach overall rates of resistance previously observed in the hospital Aziza Othmana. Concerning S. aureus, the rate of MRSA [methicillin-resistant S. aureus] showed no significant variation throughout the study period: 60% versus 56.3% at HAO and CTGB. A. baumannii brings up the problem of mutir‚sistance: 92.7% of strains were resistant to ceftazidime and 63.9% to imipenem during P1 with an emphasis on resistance to imipenem during P2 increased to 89.3%.Resistance is a problem in the intensive care burn unit. Preventive measures have to be taken

[Epidemiological profile and antibiotic resistance of pseudomonas aeruginosa isolates in burn and traumatology center in Tunisia over a three-year period]

Pseudomonas aeruginosa is a known opportunistic pathogen frequently causing serious infections in burned patients. To analyze the epidemiological profile of Pseudomonas aeruginosa isolated in a Tunisian burn unit. During a 3-year period [from 01 July 2008 to 30 June 2011], 544 non repetitive strains of P. aeruginosa were isolated from burn patients. Susceptibility to antibiotics was assessed according to CA-SFM guidelines. Serotypes were identified by slide agglutination test using P.aeruginosa O antisera [Biorad]. Producing carbapenemase was analyzed for 202 imipenem resistant isolates by EDTA test. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The most frequent sites of isolation were cutaneous infections and blood cultures [83.4%]. The percentages of resistant isolates were as follows: ceftazidime: 34%; imipenem: 37.1%, ciprofloxacin: 27.1% and amikacin: 29.6%. The most prevalent serotypes were: 011[51%], 06[17%], 03 [8%], 04[12%], 012[5%]. Among the 202 imipenem resistant strains, 58% expressed a metallocarbapenemase. All theses strains were resistant to all tested antibiotics except colistin and belonged to the serotype O11. The dissemination of carbapenemases strains must be contained by implementation of timely identification, strict isolation methods and better hygienic procedures

Hospital acquired outbreak of methicillin-resistant staphylococcus aureus infection initiated by a health care worker

Methicillin-resistant Staphylococcus aureus [MRSA] has become an increasingly important pathogen leading to hospital acquired infections. This study was done to confirm an outbreak of MRSA suspected at Charles Nicolle Hospital. From 26 April to 11 June 2002, six patients hospitalized in the dermatologic ward at Charles Nicolle hospital of Tunisia have developed infections caused by MRSA. An investigation of the outbreak has been detected a nasal carriage nurse. This carrier received topical mupirocin treatment to decolonize the anterior nares and the outbreak was stopped without further incident. Typing of the MRSA strains by pulsed field gel electrophoresis demonstrated the same pulsotype shared by all isolates showing that MRSA isolates belonged to a single clonal type responsible of outbreak. Colonized nurse was the source of MRSA dissemination. This report illustrates the risk of nosocomial outbreak linked to cares delivered by the staff personnel. More sensibilisation and the respect of strict hygienic measures should be emphasized

[Clinical, epidemiologic and bacteriological characteristics of urinary tract infections due to staphylococcus saprophyticus in the central part of Tunisia]

We assess the clinical, epidemiologic and bacteriological aspects of urinary tract infections due to S. saprophyticus through a sample collected in the central part of Tunisia. Retrospective study, related to 92 strains of S. saprophyticus, isolated among positive urinary specimens in 2006. Considered data were: sex, age, original departments, symptoms, type of urinary tract infection, diagnosis date and susceptibility of strains to antibiotics. Patients are young women in 98% [average age: 31.5 years] with cystitis in 99%. They are outpatients in 90%. S. saprophyticus represents 2.8% of all uropathogens; it is the first cocci with positive Gram [28.2%]. Any seasonal variation is noticed. S. saprophyticus has shown higher susceptibility to antibiotics than other staphylococci; cotrimoxazole, fluoroquinolons and nitrofurans represent the best treatment. S. saprophyticus is responsible of cystitis in young women. There is no seasonal variation in our area. This community staphylococci is very susceptible to antibiotics

Meningite purulente a Haemophilus influenzae chez l'adulte: chercher le facteur predisposant

We bring back an adult case of purulent meningitis to haemophilus influenzae. We insist on the particular aspects of the host of this meningitis type at the adult. These aspects must be searched every time that haemophilus influenzae is isolated in cerebrospinal fluid in adult's meningitis