Evaluation of rK39 strip test for the diagnosis of visceral leishmaniasis in infants

This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears [the gold standard] in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses [tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis] were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities

In-vitro susceptibility of infective keratitis causative bacteria to topical povidone iodine

Purpose: To evaluate the in-vitro susceptibility of bacterial isolates from the cases of corneal ulcer to povidone iodine. Setting: Department of ophthalmology, and clinical microbiology research center, Shiraz University of Medical Sciences, Shiraz, Iran. Patients and The in-vitro susceptibility and Minimum Inhibitory Concentration [MIC] of the bacteria isolated from the cornea of 50 cases of bacterial corneal ulcer to povidone iodine was determined by broth dilution method. Concentrations of 1%, 2%, 5% and 10% of povidone iodine were tested. Bacterial isolates included 50% S. epidermidis, 20% P. aerogenosa, 10% S. aureus, 4% Acintobacter, 4% S. pneumoniae, 4% E-coli, 2% Proteous, 2% S. viridance, 2% Diphtheroid and 2% Bacillous. Povidone iodine bactericidal efficacy for gram positive bacteria was at least 82.36%, 91.2%, 100% and 100% in 1%, 2%, 5% and 10% concentrations after 5 minutes exposure time. The bactericidal efficacy of this agent over the gram negative bacteria was at least 62.5%, 87.5%, 100% and 100% in 1%, 2%, 5% and 10% concentrations after 5 minutes exposure time, respectively. Povidone iodine was shown to have a broad spectrum in- vitro bactericidal efficacy in cases of bacterial keratitis. If further invivo studies confirm the efficacy of this agent over the bacterial keratitis, it would be suggested as a broad spectrum medication for the treatment of these cases

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups: 6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody [Ab] decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% [14 months], 89.4% [18 months], 60.8% 96 years], 45.0% [10 years] and 96.8% [15 years].To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age

Menstrual abnormalities and pain after five tubal sterilization methods: a randomized controlled trial

Background and Tubal sterilization is the most popular method of permanent female contraception, yet there is considerable debate concerning the influence of this procedure on the women's health and menstrual pattern. We randomized 1358 women to one of the five methods of tubal sterilization; unipolar electrocauterization, bipolar electrocauterization, minilaparatomy, Pomeroy method, Falope ring, and Hulka clips to evaluate the effect of each method on menstrual pattern. Each woman was interviewed before sterilization and followed for 3 years. 850 women who did not undergo sterilization served as control group and were interviewed and followed. 248 women of study group and 503 cases of the control group did not fulfill the study criteria and were excluded. Menstrual indices were significantly different between the control group and those women who were sterilized by unipolar, ring, and Pomery methods. The amount of bleeding, was increased by 28.3% in unipolar group [p=0.001], 19.9% in ring group [p=0.001], and by 23.9% in Pomeroy group [p=0.0001]. Significant menstrual pain lasted for a maximum of 18 months was noted in unipolar coagulation group [p=0.0001]. Sterilization methods which destroy the vascular communications along and immediately subjacent to the tube and that also disturb the countercurrent exchange of biologically active factors between the uterus and ovaries, are more likely to cause menstrual abnormalities

Prevalence of antibody to Brucella species in butchers, slaughterers and others

Brucellosis is being reported with increasing frequency in the Islamic Republic of Iran. Serum antibodies in high-risk and general populations help to define cut-off levels and can be used as a simple and rapid diagnostic tests in infected areas. We performed the rose Bengal test [RBT], serum agglutination test [SAT] and 2-mercaptoethanol [2ME] titre determination on 415 healthy individuals including butchers, slaughterers and others. Positive results were found by RBT, SAT titre [1:80] and 2ME titre >/= 1:20 in slaughterers [10%, 20% and 6% respectively], butchers [6%, 4% and 1% respectively] and the general population [1%, 2% and < 1% respectively]. A single SAT titre >/= 1:80 in the presence of 2ME titre >/= 1:20 can be diagnostic in this region

In vitro susceptibility of fungal isolates of keratomycosis to antiseptic agents

Fungal corneal ulcer is the most dangerous and challenging type of infective keratitis. Since most of the ophthalmic antifungal drops are scarce and expensive in developing countries, attempts have been made to study fungicidal property of some readily available antiseptic agents as a substitute. Povidone iodine [PI] and chlorhexidine gluconate [CHx] has been postulated to be effective against fungi. To study in vitro antifungal efficacy of PI and CHx. Fungi isolated from cases of keratomycosis were entered in a prospective study from June 2001 to March 2002. In vitro susceptibility of these fungi was tested by broth dilution method of NCCLS Standard to PI [1%, 2%, 5%, 10%] and CHx [0.04%, 0.1%, 0.2%] after 5 minutes, 1 hr, 24 hrs and 48 hrs exposure times. From a total of 16 culture-proven cases of fungal keratitis, the isolated fungi were 8 Aspergillus sp, 3 Fusarium sp, 2 sterile hyphae, 1 Candida sp, 1 Drechslera sp, 1 Rhodotorula sp. PI showed 100% fungicidal effect with all tested concentrations, after 5 minutes of exposure to all fungal species. CHx. 0.1% and 0.2% after 1 hr exposure were as effective as PI [p>0.34]. The fungicidal efficacy of CHx 0.1% and 0.2% was significantly less than PI after 5 minutes [p<0.001]. Both PI and CHx have strong in vitro fungicidal effect. The kill rate of CHx, however, is less than PI. Since in vitro efficacy of topical ophthalmic preparations is affected by multiple factors, our study provides a good idea for further in vivo investigations about this subject

Cytokine gene polymorphism in BCG lymphadenopathy

Tumor necrosis factor-beta or lymphotoxin-alpha [LT-alpha], IL-4 and IL-10 are determining factors in immunity against BCG. Allelic polymorphisms in the regulatory regions of their genes affect the rate of cytokine production and therefore, the host's ability in BCG containment. To study the prevalence of -590 [C/T] and -592 [C/A] allelic distribution of IL-4 and IL-10 promoter regions, respectively, and +282 [G/A] polymorphism in the first intron of LT-alpha in BCG vaccinees with lymphadenopathy comparing to those of controls. Polymorphisms in the promoter region of IL-4 and IL-10 were determined by primer induced restriction site PCR and the polymorphism in the first intron of LT-alpha was investigated using PCR-RFLP method. Forty patients with BCG adenitis and 42 healthy age-matched infants without reactions were included in this study. No significant differences existed between allele and genotype frequencies of IL-4 or LT-alpha genes from patients as compared to the controls. A significant difference in genotype distribution of the IL-10 -592 C-to-T polymorphism was observed between patients and controls [p<0.05]. In this respect, the AA and AC genotypes with lower ability in IL-10 production were found more frequently in the control group. The lower frequency of AA genotype at position -592 of IL-10 promoter region in patients may have resulted in more IL- 10 production leading to weaker immune response that allows bacterial burden and occurrence of lymphadenitis

Prevalence and pattern of antibiotic sensitivity of methicillin-sensitive and methicillin-resistant staphylococcus aureus in Shiraz-Iran

There is a growing concern about the rapid rise in resistance of Staphylococcus aureus to antimicrobial agents. To determine the prevalence and pattern of antibiotic sensitivity among methicillin-resistant and -sensitive S.aureus in Shiraz, south of Iran. One hundred and six S. aureus isolates from patients with staphylococcal infections were collected. The isolates were screened for methicillin-resistance by minimum inhibitory concentration [MIC] determination and agar screen plate. Detection of acquired resistance was accomplished by addition of a beta -lactamase inhibitor to the test media. Tolerance was detected by determination of minimum bactricidal concentration [MBC]/MIC ratio. The frequency of intrinsic-resistant S. aureus was 33.0% [90% in isolates from burn unit patients]. Acquired-resistant and tolerant isolates comprised 4.7% and 0.9% of all isolates respectively. None of the isolates showed MOD-type resistance [for "modified" penicillin binding proteins [PBPs]]. The pattern of resistance to 13 antibiotics were determined by disk diffusion method. None of the intrinsic-resistant isolates were resistant to vancomycin or rifampin but the frequency of resistance to other compounds was high. The methicillin-sensitive and acquired-resistant isolates were highly sensitive to all tested antibiotics except penicillin. In this study, methicillin-resistance proved to be a useful marker in selecting appropriate antimicrobial agents for treatment of infections caused by S. aureus. Changing pattern of resistance of S.aureus makes its periodic surveillance [each 3 to 4 years once] mandatory

Asymptomatic Giardia infection in children in a hyperendemic area

The morning stools of 590 randomly selected primary school children were examined with direct smear and formol-ether concentrate technique for Giardia infection. Giardia cysts were found in the stools of 158 [26.78%] children of which 151 were asymptomatic. No significant difference was observed between the two sexes. The weight and height of the infected and non-infected children did not differ significantly. Of all the infected children 133 were treated with a full course of metronidazole 123 of which were sampled two weeks after treatment. Of these, 17 were still infected [treatment failure: 13.82%]. Altogether, 52.73% of the children were positive for Giardia cysts within six months of therapy. The annual cumulative incidence was calculated to be 97.6% which means that 97.6% of the children will be reinfected within one year after successful treatment. We conclude that it may not be beneficial to treat asymptomatic giardiasis in hyperendemic areas

Etiology and antimicrobial sensitivity pattern of bacteria, causing summer diarrhea in children

During a four month period from July to November 1992, five hundred stool samples from children with acute diarrhea were examined for pus cells, parasites and cultured for pathogens including Salmonella, Shigella, Campylobacter, E. coli, and the ELISA test for Rotavirus. The isolated bacteria were then tested for antimicrobial sensitivity. Inflammatory cells were observed in 110 [22%] and correlated with positive culture in 65.5%. Giardia lamblia was isolated in 56 [11.2%] and Entamoeba histolytica in 8 [1.6%]. Bacteria were isolated in 148 [29.6%] samples and included, E. coli 96 [19.2%] Shigella 26 [5.2%], Campylobacter 25 [5%] and Salmonella 15 [3%]. Rotavirus was isolated in 140 of 419 [33.5%] samples and was accompanied by other agents in 34%. The isolated bacteria were sensitive to nalidixic acid in 99.6%, trimethoprim-sulfamethoxazole [TMP-SMZ] in 30% and ampicillin in 26%. The demonstration of pus cells in stool is an important indication of an invasive pathogen, isolation of rotavirus from stool does not necessarily implicate the virus as an etiologic agent of diarrhea. The majority of enteric bacteria are resistant to ampicillin, TMP-SMZ and moderately sensitive to first generation cephalosporin. The bacteria were highly sensitive to nalidixic acid

Autoantibodies and complement levels of Kala-Azar patients in the south of Iran

In a prospective study, serum and plasma samples from 50 patients with kala-azar were collected in Fars Province, Iran. The levels of complements C[3] and C[4], rheumatoid factor, antinuclear antibody [ANA], direct antiglobulin test [Coomb's test] and cold agglutinins were determined in these samples. The ANA, Coomb's test and cold agglutinins were negative in all patients. In 25% of the patients, C[3] population was reduced and in 42% [21 of 50] C[4] had increased, which was similar to the results of some reports, yet the opposite of others. Rheumatoid factor was positive in 34% [17 of 50] P< 0.0001 which indicates autoimmunity in the infantile type of kala-azar. The frequency of rheumatoid-factor seropositive patients in our study was less than in other reports. It is concluded that the age of the patient and/or the type of parasite in the infantile type of kala-azar may be an important factor in the production of autoantibodies

immune adherence hemagglutination: a new microimmunoassay for the serodiagnosis of visceral leishmaniasis

This report describes immune adherence hemagglutination as a new micro-immunoassay for the serodiagnosis of Leishmania donovani infection. Comparison of the results of immune adherence hemagglutination with those of indirect immunofluorescence assay, showed a close agreement between the two procedures. Sera from fifteen patients with confirmed parasitological evidence [positive splenic aspirate] of visceral leishmaniasis, as well as, fifteen sera from control children under 10 years of age and four normal adults were included in the study. Titers ranging from 128 to 2048 were obtained with immune adherence hemagglutination in patients and negative titers in the control children. The test appeared to be more discriminating with respect to the antigenic burden of the spleen and more sensitive than immunofluorescence assay. Compared with other conventional and sensitive laboratory tests for the serodiagnosis of leishmaniasis, the minimum requirement, rapidity, simplicity and local availability of reagents render the immune adherence hemagglutination a practical immunoassay for measuring specific antibody in those geographic locations where laboratory facilities are limited