Sensitivity Pattern of Second Line Anti-Tuberculosis Drugs against Clinical Isolates of Multidrug Resistant Mycobacterium Tuberculosis

Objective: To determine the current sensitivity pattern of second line anti-tuberculosis drugs against clinical isolates of Multidrug Resistant Mycobacterium tuberculosis [MDR-TB]. Study Design: A cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from November 2011 to April 2013. Methodology: Samples received during the study period were processed on BACTEC MGIT 960 system for Mycobacterium tuberculosis [MTB] culture followed by first line drugs susceptibility testing of culture proven MTB isolates. On the basis of resistance to rifampicin and isoniazid, 100 clinical isolates of MDR-TB were further subjected to susceptibility testing against amikacin [AMK], capreomycin [CAP], ofloxacin [OFL] and ethionamide [ETH] as per st and ard BACTEC MGIT 960 instructions. Results: Out of 100 MDR-TB isolates, 62% were from male patients and 38% from female patients. 97% were sensitive to AMK, 53% to OFL, 87% to CAP; and 87% were sensitive to ETH. Conclusion: The majority of the MDR-TB isolates showed excellent sensitivity against AMK, CAP and ETH. However, sensitivity of MDR-TB isolates against fluoroquinolones like OFL was not encouraging. Key Words: Multidrug resistant tuberculosis. Mycobacteria growth indicator tube. Second line anti-tuberculosis drugs. Amikacin. Capreomycin. Ethionamide

Bone marrow infection with Mycobacterium fortuitum in a diabetic patient

Incidence and prevalence of Mycobacterium fortuitum infection vary greatly by location and death is very rare except in disseminated disease in immunocompromised individuals. We present what we believe is the first case of bone marrow infection with Mycobacterium fortuitum in an HIV negative patient. Bone marrow examination revealed presence of numerous acid fast bacilli which were confirmed as Mycobacterium fortuitum on culture and by molecular analysis. Patient was managed successfully with amikacin and ciprofloxacin

Evaluation of BACTEC MGIT 960 system for recovery of Mycobacterium tuberculosis complex in Pakistan

We evaluated the performance of MGIT 960 system in terms of recover rate, detection time of mycobacteria and contamination rate from various human clinical specimens and compared it with already in use BACTEC 460 TB system and conventional LJ medium. This is the first reported study on MGIT 960 and its comparison with BACTEC 460 system in Pakistan. A total of 260 different clinical specimens received for the culture of mycobacteria were dealt during the six months study period. All the specimens were digested and decontaminated according to the standard N-acetyl-Lcysteine NaOH method. All the processed specimens were inoculated on both the liquid systems and solid medium and incubated for six weeks and eight weeks consecutively. A total of 44 mycobacterial isolates (Mycobacterium tuberculosis, n=43; Mycobacteria other than tuberculosis, n=1) were recovered from 260 clinical specimens. The recovery rate of M. tuberculosis complex was 97.6% on BACTEC MGIT 960 system and 93.0% on BACTEC 460 system and 83.7% on LJ medium. The mean detection time of mycobacteria on BACTEC MGIT 960 system was 11.2 days in smear positive cases, 14.2 days in smear negative cases and 14.8 days in smear positive cases on BACTEC 460 system. Contamination rates were 9.6% and 5.6% and 3.4% for BACTEC MGIT 960, BACTEC 460 system and LJ medium respectively. The non-radiometric, fully automated BACTEC MGIT 960 system has better diagnostic ability as compared with radiometric, semi-automated BACTEC 460 system and LJ medium, so it can be used as a reliable alternative in over burden laboratories.

In Vitro efficacy of ethionamide and clarithromycin in mycobacterium tuberculosis isolates

To determine the sensitivity of clinical isolates of Mycobacterium tuberculosis isolates against ethionamide, and clarithromycin. Cross-sectional study. Department of Microbiology, Armed Forces Institute of Pathology [AFIP] Rawalpindi from June 2003 to June 2004. All routine clinical samples received for acid fast bacilli [AFB] culture and yielding positive growth on Lowenstien Jensen medium and Bactec 460 were included in the study. The isolates were from sputum [n=70], bronchioalveolar lavage [n=10], fine needle aspiration [n=6], lymph nodes [n=7], pleural fluid [n=4], endometrium [n=3]. After the identification of M. tuberculosis [MTB] sensitivity was performed against first-line antituberculosis drugs. Then susceptibility of M. tuberculosis isolates against ethionamide and clarithromycin was performed on LJ medium. Mycobacterium H37Rv was used as control strain. Results were interpreted using resistance ratio method. Out of 100 M. tuberculosis isolates, sensitivity to ethionamide was 93% and 9% to clarithromycin. Clarithromycin when used alone is ineffective as antituberculosis drug but its efficacy in combination needs to be tested. However ethionamide may be used as an alternative antituberculosis drug

Efficacy of amikacin and ciprofloxacin against clinical isolates of mycobacterium tuberculosis

Tuberculosis was a leading cause of death at the turn of the 20[th] century and continues to be one of the medical scourges of mankind. Before the availability of antimicrobial drugs the cornerstone of treatment was rest in the open air in sanatoria. The major breakthrough in treatment of tuberculosis came with the discovery of Streptomycin. Later, INH, Ethambutol, Pyrazinamide, Rifampicin were added to the arsenal. Objective of this study was to determine the sensitivity of clinical isolates of Mycobacterium tuberculosis against two second-line anti-tuberculosis drugs, Amikacin and Ciprofloxacin. This cross-sectional study was conducted at Department of Microbiology, Armed Forces Institute of Pathology [AFIP] Rawalpindi. All routine clinical samples received for acid fast bacilli [AFB] in the Department of Microbiology, AFIP, Rawalpindi were processed by modified Petroff's technique and inoculated on Lowenstein Jensen [LJ] medium and Bactec 460 Mycobacterium tuberculosis culture system. After identification of M. tuberculosis sensitivity was performed against first-line anti-tuberculosis drugs. Then susceptibility of M. tuberculosis isolates against Amikacin and Ciprofloxacin was performed on LJ medium. H37Rv was used as control strain. Results were interpreted using resistance ratio method. Out of 100 M. tuberculosis isolates, 98% were sensitive to Amikacin and 97% to Ciprofloxacin. Amikacin and Ciprofloxacin are very effective 2[nd] line anti-tuberculosis drugs against tuberculosis isolates in our set-up

Pattern of upper gastro intestinal malignancies in northern Punjab

To record the number of cases of carcinoma of stomach, geographical location and histological diagnosis presenting to a hospital in northern Punjab. This study was conducted at the department of medicine [GI unit] Fauji Foundation Hospital Rawalpindi. All the patients who underwent upper GI endoscopy and were found to have an upper GI malignancy on histopathology were reviewed for part of the gut involved. Patient demographics including age, sex, and place of residence, clinical presentation, and subsequent histologic diagnosis were recorded. During the study period, 302 cases of upper GI malignancy were seen at our institution, 83 [14.8%] were in patients 40 years of age or younger. Mean patient age was 58 years. The lesion was distal in 43%, proximal in 20% and 7% involved the entire stomach. In 9.8% of the cases, lesser curve was the site. The tumor was located in the upper third, middle third and lower third in 33, 22 and 34.6% respectively. The common presenting symptom in case of carcinoma of stomach was pain epigastrium. Dysphagia was the major subjective complaint in cases of esophageal carcinoma. The common malignant tumor in males was carcinoma of stomach and in females carcinoma of esophagus. Endoscopic screening in subjects suspected of upper gastrointestinal malignancy results in a significant yield of carcinoma. The gastric tumor in distal location [non cardia cancer] is still more common. Asian race is no different from other races as far as the ca stomach is concerned

Pulmonary cryptosporidiosis in a bone marrow transplant recepient

Cryptosporidium, a protozoan parasite of Phylum Apicomplexa, causes acute short term intestinal infection in immunocompetent individuals. However, in immunocompromised patients, it causes prolonged and life threatening watery diarrhea, rarely with extra-intestinal involvement. We present a case of Cryptosporidium parvum with pulmonary involvement who was managed with azithromycin and co-trimoxazole combination. This is the second reported case in the world in HIV negative patient undergoing bone marrow transplantation