Extrapulmonary tuberculosis among females in South Asia-gap analysis

The percentage of extrapulmonary tuberculosis [EPTB] among new and relapse tuberculosis cases in South Asia [Afghanistan, Pakistan, India, and Bangladesh] ranged from 19% to 23% in 2014. While tuberculosis was reportedly more prevalent in males, a higher preponderance of EPTB was observed in females. National tuberculosis control programs are highly focused on pulmonary tuberculosis. This creates gaps in the surveillance, diagnosis, and study of EPTB among females, which is especially pronounced in the South Asian setting. We have reviewed recently published literatures from January 2010 to June 2016 reporting EPTB in females with a view to evaluate the current epidemiology, risk factors, diagnostic modalities, and treatment outcomes. We report significant gaps in the surveillance of EPTB among women in South Asia, emphasizing the need for greater focus on EPTB in females to overcome current surveillance and knowledge gaps

Mycobacterial contamination of bronchoscopes: challenges and possible solutions in low resource settings

The use of bronchoscopes has increased in tuberculosis [TB] diagnostics to circumvent the diagnostic challenges that are associated with low sputum volume and smear-negative TB. In healthcare facilities situated in low income countries that have a high burden of TB, adequate decontamination of bronchoscopes is a challenge and often overlooked to save on time and costs. This amplifies the risk of outbreaks and pseudo-outbreaks due to Mycobacterium tuberculosis and nontuberculosis mycobacteria. In this minireview, we review published literature of contaminated bronchoscopes causing pseudo-outbreaks of M. tuberculosis and nontuberculosis mycobacteria in an effort to determine common sources, and possible mitigation strategies in low-resource settings

Primary drug resistance to anti-tuberculous drugs in Karachi

To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi. Multicentric study involving various TB clinics and treatment centres of Karachi between. April to December 2005. The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method. Fifteen [11.5%] samples in 130 eligible patients showed primary resistance to one or more drugs. Ten [7.6%] of the isolates tested were resistant to a single drug, none were resistant to 2 drugs, 4 [3.0%] to 3 drugs and 1 [0.76%] to 4 drugs while 1 [0.76%] to all 5 first line agents. Resistance to streptomycin [10 ug/ml] was seen in 8 [6.1%], isoniazid [1ug/ml] in 12 [9.2%], Rifampicin [5 ug/ml] in 4 [3.0%], ethambutol [10 ug/ml] in 1 [0.76%] and pyrazinamide in 6 [4.6%] samples. Primary Multi-Drug Resistance [PMDR] was found in 2 [1.5%] patients. [Isoniazid 1 ug/ml, rifampicin 5 ug/ml with or without other drugs]. In the studied patients, primary drug resistance to at least one anti-tuberculosis drug was 11.5%. It requires an efficiently working anti-tuberculosis programme to prevent escalation including resistance

Incidence of acute respiratory infections in children 2 months to 5 years of age in periurban communities in Karachi, Pakistan

To measure the incidence of acute respiratory infections and burden of respiratory pathogens in children aged two months to five years. Four periurban communities in Karachi were selected for the study. The children, identified with fever and cough during community surveillance at regular intervals, were referred to especially established study clinics. These children were diagnosed to have no pneumonia, pneumonia and 'severe pneumonia' as per IMCI guidelines. To identify the causative organisms, children with pneumonia and severe pneumonia were investigated with oropharyngeal swabs and blood culture. Acute respiratory infection was seen in 5884 children during 1st February 2002 to 31St January 2003. Of these, 1097 children had pneumonia and severe pneumonia, with an incidence 440.3/1000 children per year for Acute Respiratory Infections and 82.1/1 000 children per year for pneumonias. Haemophilus influenzae, Streptococcus pneumoniae and Klebsiella pneumoniae were isolated from 10.9%, 3.7% and 8.5% of oropharyngeal swabs respectively. Extrapolating from the results of this study, the total number of cases of pneumonias in children aged less than five years in Pakistan is estimated to be 213,116 per year due to H. influenzae, and 71,864 per year due to S. pneumoniae. Incidence of acute respiratory infections in children varies in different communities and is a common cause of morbidity

Frequency and sensitivity pattern of extended spectrum beta lactamase producing isolates in a tertiary care hospital laboratory of Pakistan

To determine frequency, distribution and sensitivity pattern of Extended-Spectrum 6 Lactamase [EBSL] producing organism at a tertiary care hospital in Pakistan. All members of enterobacteriacae isolated between April and August 2002 were studied. Isolates were speciated according to standard biochemical tests. Susceptibility testing was performed by Kirby-Bauer method. ESBL was detected using double disc method using cefotaxime versus cefotaxime plus clavulanate according to NCCLS. Statistical analysis was performed by SPSS version 10. Test of significance were calculated using chi-square test. Results : During the study period, 1137/2840 [40%] of the isolates tested were found to be ESBL producing. ESBL positivity was detected in 50% Enterobacter sp., 41% E.coli and 36% K.pneumoniae. ESBL production was noted in 52% of nosocomial isolates tested [415/799]. ESBL was more frequent in patients at the extremes of ages [under 5 years and more than 60 years]. Cross-resistance to non-beta lactam antibiotics [flouoroquinolones, aminoglycosides and co-trimoxazole] was also more frequent in ESBL producing organisms [p<0.05]. A high frequency of ESBL positivity amongst our isolates is documented which is alarming in low-income settings where expensive second line agents are unavailable. Our data supports urgent need for regular screening and surveillance for these organisms

Nalidixic acid screening test in detection of decreased fluoroquinolone susceptibility in stalmonella typhi isolated from blood

To determine the validity of nalidixic acid screening test in the detection of high MICs of fluoroquinolone against Salmonella[S.] typhi isolated from blood and correlate zone diameters of ofloxacin with that of MIC value for nalidixic acid sensitive and resistant strains. Cross-sectional analytical study. Clinical Microbiology Laboratory of the Aga Khan Hospital, Karachi from January 2002 to December 2003. Two hundred S. typhi isolates from blood were included for nalidixic acid screening and ofloxacin susceptibility. Antibiotic susceptibilities for both the antibiotics were obtained by disc diffusion method whereas MICs were determined by standard agar dilution method as recommended by NCCLS guidelines. Sensitivity, specificity and correlation between both antimicrobial susceptibility methods were calculated and results expressed as scattergrams. The results broadly classify S. typhi isolates into nalidixic acid resistant strains with no zone of inhibition around 30 micro g nalidixic acid disc and nalidixic acid sensitive strains with mean zone of inhibition of 24.9mm. All S. typhi isolates with ofloxacin MIC of >/= 0.125 micro g/ml were found to be nalidixic acid resistant [MIC >/= 32 micro g/ml] whereas the isolates with ofloxacin MIC /= 0.125 micro g/ml]. Nalidixic acid resistance as a screening method is proved to be significant in identifying S. typhi isolates with reduced susceptibility to fluoroquinolones. It is also suggested that inhibition zone of

Frequency and sensitivity pattern of extended spectrum beta lactamase producing isolates in a tertiary care hospital laboratory of Pakistan

To determine frequency, distribution and sensitivity pattern of Extended-Spectrum