RESUMEN
Influenza virus infections affect patients in all age groups. However, complications of influenza virus infections are often seen in very young individuals, immunocompromised individuals, and elderly individuals. Influenza virus infections are often underdiagnosed. This 'work aimed to assess diagnosis of influenza virus infection in different age groups comparing rapid antigen detection test [RAT] and multiplex reverse transcription PCR [mRT-PCR] -with virus isolation [the standard test) with regard to time between appearance of clinical symptoms and laboratory investigations. Fifty three Nasopharyngeal wash [NPW] were collected from 2- 72 years old patients with acute respiratory illness. Twenty nine [54.7%] were positive for influenza virus by virus isolation technique, 21 [76.4%] were influenza virus type A and 8 [27.6%] influenza virus type B. In comparing with virus isolation rapid antigen detection [RAT] detected 24 out of 29 true positive samples. RAT test was 75.9% sensitive, 91.7% specific, positive predictive value 91.7% and negative predictive 75.9%. The total sensitivity, specificity, PPV, and NPV of mRT-PCR were 96.6%, 95.8%, 96.6% and 95.8%, respectively. The most appropriate time frame of sample collection for the detection of influenza virus was 48 to 72 h after the first clinical symptoms appeared. A reliable rapid laboratory diagnosis can be achieved in young children [Median 8.5 years] by RAT in comparison to older patients [P 0.01]. However application of an mRT-PCR assay is necessary for the sensitive and rapid detection of influenza A and B viruses in NPW specimens obtained from older patients. We recommend increasing surveillance of influenza as global attention is focused on the potential of another influenza virus pandemic?
RESUMEN
Adenovirus [AdV] has been increasingly shown to play a role in the morbidity and mortality of immunosuppressed patients. This work aimed to detect AdV in urine samples of immunocompromised patients of both pediatric and adult oncology units and study some factors that may associate with increased risk of AdV infections and subsequent detection in urine samples. This study was conducted from December 2009 to December 2010 in Medical Micro6iolog]i and Immunology Department Faculty of Medicine Zagazig University. Urine samples were collected from 100 patients in oncology wards of both Pediatric and Internal Medicine Departments [50 from each department] in Zagazig University Hospitals. Each sample was subjected to PCR detection of AdV. The characteristics ofpediatric and adult immunocoinpromised patients in whom AdV was detected in urine were comparecl. Twenty [20%] out of 100 urine samples were positive for AdV by PCR, 15 [30%] out of 50 pediatric and 5 [10%] out of 50 adult immunocompromised patients. The difference was statistically significant [P=0.01]. Pediatric patients diagnosed as cases of leukemia were significantly associated with AdV detection in urine [P=0.01].The use of intmunosuppressive therapy is significantly associated with AdV detection in urine in both pediatric and adult patients [P=0.02 and 0.05 respectively]. In conclusion Adenovirus infection is an important cause of morbidity and mortality in immunocompromised patients, particularly who are receiving immunosuppressive therapy. The need for rapid method of diagnosis and an effective, nontoxic antiviral therapy is apparent
RESUMEN
Objectives: this study aimed to compare polymerase chain reaction [PCR] and IgM detection using enzyme linked immune-sorbent assay [ELISA] in diagnosis of congenital cytomegalovirus [CMV] infection
Methods: this study was conducted from May 2009 to December 2010. Urine and blood samples were collected from 94 neonates with suspected congenital CMV infection. Serum and part of urine samples were stored at -20 degreeC freezer, until the serologic and PCR tests were achieved. A 94fiesh urine samples were processed for cell culture. Nineteen [20.2%].out of 94 urine samples were proven positive for CMV infection by viral culture. For comparing PCR and IgM ELISA we used tissue culture technique as a reference, the 19 positive samples on culture [CMV group] and 20 negative samples [control group] were included in the comparison. Some characteristics of CMY and control groups were compared including sex, age, birth weight, gestational age <37 and small for gestational age. Clinical and laboratory abnormalities were also compared in both groups
Results: this study showed that the sensitivity and specificity of PCR in relation to viral culture were 100% and 100% respectively, there was excellent agreement between both tests [Kappa coefficient was I and P=0.000]. On the other hand, the sensitivity of lgM CMV ELISA in relation to viral culture was 63.2% and the specificity was 85%. There was good agreement between both rests [Kappa coefficient was 0.48 and P=0.002]. By comparing CMV and control groups, there were high statistically significant differences between both groups as regard the birth weight, gestational age < 37 and small for gestational age items [P= 0.00, 0.03 and 0.01 respectively]. There were statistically insignificant differences as regarding the clinical and laboratory abnormalities detected for neonates of both groups. In this study jaundice [63%] and hepatosplenomegaly [42%] were the most common clinical signs in both groups
Conclusion: PCR is more sensitive and specific technique for detection of congenital CMV infection than CMV IgM ELISA. Being more cost effective, less cumbersome and less time consuming in relation to viral culture, PCR may be used in detection of congenital CMV infection
RESUMEN
Background and objectives: viruses, including, Influenza viruses, Adenoviruses [ADV] and Respiratory syncytial virus [RSV] are a frequent cause of respiratory tract infections. This work aimed to identify Influenza [A and B], ADV and RSV as causes of Influenza- like illness, determination of their epidemiological data and seasonality and identification' of virus's specific clinical syndromes
Methods: a total of 651 nasopharyngeal swabs [NPSs] were collected from patients with influenza like illness [IL1] symptoms visiting Chest, Ear Nose and Throat [ENT] and Pediatric Departments' out patients clinics Zagazig University Hospitals Each sample was subjected to virus isolation in cell culture and typing of the isolates by indirect immunofluorescence. Demographic data of positive cases were studied
Results: out of the total samples collected, 246 [37.8%] were positive for at least one of the three viruses under investigation. As regard the remaining 405 [62.2%] samples, none of these viruses were detected. Children 39.5 degreeC [P =0.000] while other viruses were associated with mild fever. Also adenovirus infections were significantly associated with upper respiratory tract symptoms as tonsillitis and pharyngitis [P<0.001]. However RSV was the most common agent associated with bronchiolitis [P<0.05] compared with bronchiolitis caused by other viruses
In Conclusion: a better understanding of the epidemiology of respiratory viral infections may be used for determining specific antiviral therapy, prophylaxis and vaccination
RESUMEN
A Ventriculoperitoneal [VP] shunt infection is a cause of significant morbidity causing shunt malfunction and chronic ill health. This study was carried out to detect the causative pathogens associated with VP shunt infections, to assess the frequency of Coagulase negative Staphylococci [CoNS] as well as study their phenotypic resistance pattern to methicillin and different aminoglycosides [AGs], and genotypic pattern for gene encoding aminoglycosides modifying enzymes [AMEs] by multiplex PCR. This study was carried out in Medical Microbiology and Immunology and Neurosurgery Departments, Faculty of Medicine, Zagazig University during the period from June 2008 to June 2010. During this period 240 shunt procedures were carried on 175 infants and children with hydrocephalus. CoNS were identified using standard microbiological laboratory techniques. Antimicrobial susceptibility testing was performed using disc diffusion method with 4 aminoglycosides and methicillin. Multiplex PCR assay was used to identify AMEs encoding genes. 58 out of 240 shunt procedures cases showed shunt infections, [64%] caused by CoNS, [28%] by Gram negative rods [5%] by Staph aureus and [3%] by candida. 26 [70%] of CoNS isolates were methicillin resistant [MRCoNS]. 25 [67.5%] isolates of CoNS were resistant to at least one of the tested AGs and the highest resistance was to gentamicin and tobramycin [67.5%] for both followed by amikacin [27%] and streptomycin [19%]. As regard results of multiplex PCR aac [6'] le+aph [2' '] gene encoding for the bifunctional enzyme was the most common [54%] followed by ant[4]la gene encoding for the ANT[4'] - la enzyme [46%] and the aph [3']-llla gene encoding APH[3'] - Illa enzyme [40.5%]. In conclusion this study increased our knowledge about the causative pathogens of VP shunt infections, the phenotypic pattern of CoNS susceptibility to different AGs and the distribution of AMEs encoding genes in relation to methicillin susceptibility. The usage of appropriate antibiotic according to antimicrobial susceptibility testing at the probable time and the removal of the shunt apparatus are essential for successful treatment of VP shunt infection. Continued surveillance at both phenotypic and genotypic levels are recommended for monitoring the presence of other variant of the genes or new AGs resistance genes that may be produced within CoNS population
RESUMEN
Background and objectives: Metallo beta lactamase [MBL] producing Pseudomonas aeruginosa have been reported to be important cause of nosocomial infections. The appearance of MBL genes and their spread among bacterial pathogens is a matter of concern with regard to the future of antimicrobial therapy. The present study aimed to assess the susceptibility and cross-resistance of the widely used antimicrobials against P. aeruginosa and to study the prevalence of MBL enzyme by phenotypic and genotypic methods
Methods: A total of 45 isolates of P. aeruginosa from 120 different clinical specimens [37.5%] between May 2009 and January 2010 were subjected to susceptibility testing against various antibiotics by disc diffusion method. Imipenem and l or ceftazidime resistant isolates by MIC method were selected for detection of MBL production by disc potentiation test. All P.aeruginosa isolates were subjected to duplex polymerase chain reaction to detect IMP and VIM genes of transferable MBLs
Results: Out of 45 P. aeruginosa isolates, 21 [46.7%] were resistant to imipenem [IPM] and 45[100%] were resistant to cefepime. 18[62%] of ceftazidime [CAZ] resistant P. aeruginosa and 15[21%] of imipenem resistant P. aeruginosa were MBL producers by disc potentiation test. Among 45 P. aeruginosa isolates, 15 [33.3%] were positive by duplex PCR. All MBL producer P. aeruginosa were resistant to all tested antimicrobial agents. In comparing the results of disc potentiation test with PCR results IPM / EDTA disc potentiation test was highly sensitive and specific while CAZ/EDTA was highly sensitive but less specific
In conclusion: MBL- mediated IPM and /or CAZ resistance in P. aeruginosa is a cause for concern in therapy of critically ill patients, so there is a need to do surveillance to detect MBL producers