Characterization of Candida species causing nosocomial infections in Assiut University Hospital

1- To identify Candida species isolated from nosocomial infection cases and to determine their antifungal susceptibility patterns. 2-To describe the epidemiological features of nosocomial Candida infections [NCI] and the risk factors associated with such infections in our hospital. a total of 16095 patients hospitalized in Assuit University Hospital, during the period from October 2009 to May 2011. They were monitored for development of nosocomial infections. Clinical specimens were screened for isolation of Candida species. Candida isolates were identified by conventional phenotypic methods and seminested PCR [snPCR]. Antifungal susceptibility testing to fluconazole, amphotericin B, ketoconazole, itraconazole, nystatin, and voriconazole was determined by the disc diffusion method or the E-test. Risk factors and mortality rate were determined in association with Candida infections. Three hundreds and twelve [1.94%] patients had acquired nosocomial infections. One hundred and twenty seven Candida strains were isolated from various clinical specimens [blood, urine, endotracheal aspirate, sputum, oropharyngeal swabs, wounds, and bed sores] collected from 119 [38%] nosocomially infected patients. The nosocomial infection rate due to Candida spp. [16%] were the third common organisms isolated from nosocomially infected patients after Klebsiella spp. [29.5%] and MRSA [24%]. NCI occurred most frequently among patients sdmitted at the chest ICU [46%] and at the trauma ICU [25%]. Non-albicans Candida spp. isolates were frequently isolated [75%] in comparison to C. albicans [25%]. Frequent isolates were from urine [43.3%]. All Candida isolates were sensitive to amphotericin B and voriconazole, while resistance to fluconazole, ketoconazole, itraconazole, and nystatin was 6%, 13%, 32%, and 1% respectively. Binary logistic regression analysis of risk factors identified that older age [>/= 60 years] respectively. Binary logistic regression analysis of risk factors identified that older age [>/= 60 years] [Odds ratio [OR], 1.01: 95% Confidence interval [CI], 1.01-1.02, P value= 0.02] and surgical procedures [OR, 0.4; 95% CI, 0.2-0.2, P value= 0.01] were independently associated with NCI. The overall mortality rate among patients with NCI was 28%. Candida species are important nosocomial pathogens in the ICUs especially non-albicans Candida spp. which are frequent. The resistance to antifungal therapeutic agents is till low

Plasma levels of tumor necrosis factor-alpha and ammonia in patients with liver cirrhosis: correlation with severity of hepatic encephalopathy

The pathogenesis of hepatic encephalopathy [HE] is still incompletely understood, and the precise mechanisms causing brain dysfunction in liver failure are still not fully established. Several theories concerning the pathogenesis of HE have been previously suggested, including the ammonia theory, which received the most attention. Ammonia is still the most incriminated substance in the pathogenesis of HE. However, several problems exist with the ammonia theory. It is traditionally considered that circulating ammonia levels do not correlate well with severity of HE, and some patients with HE have normal circulating levels of ammonia. Another theory is that TNF-alpha is implicated in apoptosis of hepatocytes. This study aimed to determine the plasma levels of TNF-alpha and ammonia in patients with liver cirrhosis and their relation to hepatic encephalopathy [HE]. Circulating levels of TNF-alpha and ammonia were measured in 84 patients with liver cirrhosis [due to hepatitis C in 50 patients and due to hepatitis B in 34 patients], 21 of them had no HE and 63 had various clinical grades of HE [grades 1-4]. TNF-alpha concentrations were measured using commercially available solid-phase high sensitivity enzyme-linked immunosorbent assay. Ammonia levels were determined in venous plasma by the Berthelot reaction. Twenty four healthy controls with matched age and sex were included in the study. There were a statistically significant difference between plasma levels of TNF-alpha and ammonia in patients with liver cirrhosis compared to healthy controls. A significant positive correlation was found between circulating levels of TNF-alpha and those of ammonia [r=0.974, P< 0.0001], and also between circulating levels of both substances and severity of HE in all studied patients [r=0.950, P<0.0001, and r=0.900, P<0.0001 respectively]. TNF-alpha and ammonia were both significant independent predictors of severity of HE [P<0.0001 for both variables]. The results of this study demonstrate a significant positive relationship between TNF-alpha and ammonia in patients with chronic liver disease with HE and strengthen the suggestion that TNF-alpha could be strongly involved in the pathogenesis of HE which would stimulate the development of new treatment modalities to decrease this cytokine. This possibility needs further investigation and elucidation

Any role for chlamydia pneumoniae in ischemic stroke?

Stroke is the third leading cause of death and is an important cause of long term disability. Inflammatory processes have fundamental roles in stroke in both the etiology of ischemic cerebrovascular disease [CVD] and the pathophysiology of cerebral ischemia. Chronic infection with Chlamydia pneumoniae [C. pneumoniae], a common respiratory pathogen capable of infecting endothelium, arterial smooth muscle, and monocytes, is a recently proposed risk factor for atherosclerosis and first ischemic stroke. In the present study we tried to provide evidence for the presence of C. pneumoniae in peripheral blood mononuclear cells [PBMCs] by tissue culture confirmed immunofluroscence [IF], polymerase chain reaction [PCR] on PBMCs and enzyme linked immunosorbent assay [ELISA] for detection of immunoglobulin A [IgA] to C. pneumoniae in patients with first ischemic stroke. The study included 157 cases with first ischemic stroke and 50 aged and gender matched healthy controls. The mean of age +/- SD of all patients was 61.68 +/- 11 years old. The patients were divided into two groups according to the age of onset: early onset group with age < 65 years old and late onset group with age >/= 65 years old. Using the multiple logistic regression analysis between patients and control, there was significant association between smoking [odds ratio= 7.8 and 95% confidence interval [C.I.] = 2.5 - 23.9, P=0.0001] and diabetes mellitus [odds ratio= 3.29 and 95% C.I. = 1.2 - 8.3, P= 0.013] as risk factors for ischemic stroke. There was statistical significant difference between patients and control groups for the presence of C. pneumoniae by tissue culture, IF, PCR on PBMCs and ELISA for IgA to C. pneumoniae. A statistical significant differences was found between both patients groups and control group for C. pneumoniae by all used laboratory measures. But there was no significant statistical difference between both patients groups in the frequency of C. pneumoniae by all used laboratory measures. On the other hand, there was no significant statistical relation between risk factors and C. pneumoniae presence in patients with first ischemic stroke. Measuring the sensitivity and specificity of each laboratory technique for C. pneumonia, we found that tissue culture is more sensitive [97%] but less specific than IF, and PCR is the most specific [100%], but also less sensitive than IF, and ELISA is more sensitive [93%], less specific than IF. There was statistical significant positive correlation between ELISA IgA for C. pneumoniae and both IF and PCR. Conclusions it is concluded that C. pneumoniae could be one of the important sharing factors in fist ischemic stroke occurrence, it should be searched fore in those patients admitted with first ischemic stroke. Tissue culture confirmed by IF could be used as routine measure for diagnosis of C. pneumoniae, and if needed it could be confirmed by PCR on PBMCs. ELISA IgA for C. pneumoniae could be used for screening of these patients for C. pneumoniae because of the time consumed to carryover tissue culture or PCR. Treatment of patients with ischemic stroke with C. pneumoniae antimicrobial therapy is needed to eliminate the infectious risk factor that may contribute in this disease especially in young patients which may not have other risk factors