Etiological agents of CSOM and its sensitivity pattern

The present study was undertaken with the aim to detect bacteria and fungi as aetiological agent in CSOM and to see susceptibility pattern of bacterial isolates to different antibiotics and to determine the beta lactamase production by the bacterial isolates. Experimental Study. This study was conducted in the department of Microbiology, Basic Medical Sciences Institute, JPMC, Karachi, during the period of August 1998 to February 1999. During this period, 110 patients were seen, of them 62 were male and 48 were female with male to female ratio of 1.3:1. Two swabs were taken from each patients ear, one was put immediately in to Brain Heart Infusion [BHI] broth and the other was inoculated on Sabouraud Dextrose Agar [SDA] slant. BHI was incubated for 2-4 hours and subcultured on blood agar, chocolate agar and MacConkey's agar plates. The Chocolate agar was incubated in 5-10% CO[2] atmosphere in a candle jar and they were incubated for 24 hours at 37°C. SDA slant was incubated for 14 days at 37°C. Isolates were identified by Gram staining and then confirmed by biochemical test. Fungus growth was stained in Lactophenol Cotton blue [LPCB] and identified microscopically. Amongst bacterial isolates gram negative rods [41] and Pseudomonas aeruginosa [45] were predominant. 47 gram positive cocci were seen, of those 37 were Staphylococcus aureus. Fourteen fungal isolates were recovered, all of them were found to be Aspergillus species. Bacterial isolates were tested for beta-lactamase production the drug sensitivity was noted by disc diffusion method on Mueller Hinton agar. Ciprofloxacin and Enoxacin emerged as the most effective antibiotics. Tobramycin also showed good results against gram negative rods and Pseudomonas aeruginosa. Chloramphenicol, Clarithromycin and Minocycline showed good results against Staphylococcus aureus. And other gram positive cocci. Drug sensitivity of the fungi was not done. Micro-organisms showed least sensitivity to Ampicillin and Cotrimoxazole. It is concluded that to achieve the maximum benefits of antibiotics, we must use them with discrimination and with the understanding of microbial population and with the knowledge of their indications and limitations. The indiscriminate, haphazard and halfhearted use of antibiotics and poor follow up of patients causes more harm than good

Comparison between auramine-rhodamine [AR] and Ziehl-Neelsen [ZN] staining in cases of chronic granulomatous lymphadenopathy

Experimental study. This study was conducted at various hospitals of Quetta. This study includes 103 cases of chronic granulomatous lymphadenitis, with 101 cases of tuberculosis lymph nodes amongst a total of 200 cases of non-neoplastic lymphadenopathy.Their ages ranged from 2 to 79 years. Maximum number of cases were in 10-29 years age group. Females [69.31%] were affected more as compared to males. The commonest presenting symptom was fever. Cervical lymph nodes [83 cases] were the commonest site of involvement whereas 18 cases showed multiple site involvement. Fluorescent staining of histopatholigical sections from 103 chronic granulomatous lymphadenitis gave positive results in 76 out of 103 [73.78%] cases, however Ziehl-Neelsen staining was positive only in 29 out of 103 [28.15%] cases. The yield of mycobacteria on fluorescent staining was higly significant [p<0.00l] as compared to Ziehl-Neelsen staining thereby providing the superiority of fluorescent stain. In a total of 200 cases of non-neoplastic lymphadenopathy 101 cases showed granulomatous lesions, histologically consistant with tuberculosis. Other causes of lymphadnopathy were chronic non-specific lymphadenitis [n=87] viral lymphadenitis [n=8], fungal lymphadenitis [n=2] and acute bacterial lymphadenitis [n=2]. Fluorescent staining of histopathological sections from 103 chronic granulomatous lymphadenitis gave positive results in 76 out of 103 [73.78%] cases, however Ziehl-Neelsen staining was positive only in 29 out of 103 [28.15%] cases. In 101 cases, the finding were consistent with the diagnosis of tuberculous lymphadenopathy. In our study, significantly greater number of cases, 78 out of 101 [P<0.001] diagnosed as tuberculous lymphadenitis were in age groups 10-29 years. Female [69.31%] were more affected than males [30.69%]. The common presenting symptom was fever. Cervical lymph nodes were commonest site of biopsy. Haemoglobin estimation in 98 cases revealed anaemia in 65 out of 101 [66.32%] patients of tuberculous lymphadenopathy. Erythrocyte sedimentation rate was performed in 63 cases and was raised in 52 [82.53%] cases. In a total of 80 cases in whom X-ray chest was performed, 14 [15.5%] cases revealed foci of tuberculosis. Thus, in conclusion, this study has highlighted the superiorty of fluorescent stain over ZN stain

clinicomorphological study of non-neoplastic lymphadenopathy

The Clinico Morphological Changes in 150 Cases of Non-neoplastic lymph adenopathy were studied at BMC Complex Hospital Quetta. The ages of these patients ranged from 2 years to 80 years. Maximum number of patients with lymphadenopathy [65 out of 150] 43.3% cases were in 11-20 years ago group. Females [56%] presenting with lymph node enlargement were more affected than males [44%]. The commonest presenting complaint was fever [67%]. Cervical lymph nodes [82.6%] were the commonest site of involvement. On histopathological examination, four morphological groups were highlighted; tuberculous lymphadenitis [50%], chronic non-specific lymhadenitis [44%], viral lymphadenitis [4%] acute bacterial lymphadenitis [2%]. The study also highlights the yield of Mycobacteria on fluorescent staining as highly significant [P<0.001] as compared to Ziehl-Neelsen staining, there by proving the superiority of fluorescent stain