Significance of invitro isolation of Alternaria alternate from Onychomycotic patients

Objectives: To determine the isolation rate of Alternaria alternata in patients with clinical Onychomycosis

Study Design: Descriptive [cross sectional] study

Place and Period of Study: Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from August 2011-April 2012

Material and Methods: Sample size; 200 nail samples, Sampling Technique; Non probability convenience sampling. Nail clippings and nail scrapings were obtained from affected nails of patients clinically having onychomycosis. Direct microscopic examination with 30% potassium hydroxide mounts and culture on Sabouraud's dextrose agar [SDA], SDA containing Chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification

Results: Out of 200 nail specimens, 94 [47%] yielded positive fungal growth, while 106 [53%] nail specimens were found negative on culture. Non-dermatophyte moulds [NDMs] accounted for 62 [66%] of total culture positive cases, out of which Alternaria alternata was the commonest species [29%]. Dermatophytes were isolated from 20 [21%] all belonging to genus Trichophyton spp. and 12 [13%] were yeast

Conclusion: Study has yielded high number of NDMs especially Alternaria alternata, hence large scale multicenter clinical studies are required to ascertain the clinical significance of Alternaria alternata as pathogen particularly in patients with immunosuppression, as a causative agent of onychomycosis. Moreover, clinical trials to see the treatment outcome of NDMs isolated from these patients, will further help to unfold the clinical significance of this study

metabolic syndrome and inflammation: role of insulin resistance and increased adiposity

We sought to determine the role of obesity and insulin resistance [IR] in the pathogenesis of inflammation in metabolic syndrome [MetS]. Our study included 100 patients with MetS and 100 age and gender matched control patients who attended a tertiary care laboratory in Rawalpindi, Pakistan. Anthropometric data was obtained including height and weight to calculate body mass index. A record of patient's blood pressure [BP], waist circumference [WC] and hip circumference [HC] was made. Biochemical analysis included measurements of fasting glucose, triglycerides [TG], high-density lipoprotein cholesterol [HDL-c], insulin, and high-sensitivity C reactive protein [hsCRP]. IR was determined by the homeostasis mode assessment insulin resistance [HOMA-IR] method. The levels of hs-CRP were found to be elevated in all patients with MetS where it correlated significantly with all its components including measures of obesity, fasting insulin and glucose levels, IR, TG and HDL-c. However, on linear regression analysis only WC, fasting insulin, and HOMA-IR remained significantly correlated with hs-CRP. MetS is a condition characterized by chronic low-grade inflammation, which arises because of increased abdominal adiposity and IR. Large multicenter studies are needed to gain insight into its pathogenesis and derive treatment strategies

Ambu bag as a source of Acinetobacter baumannii outbreak in an intensive care unit

This case report describes an outbreak of multidrug resistant Acinetobacter baumannii in the intensive care unit of a tertiary care hospital. Three patients were infected on the same day from an Ambu bag which was used on all the patients. The outbreak was immediately identified and the source was traced within one week. Appropriate measures were taken and a continuous surveillance was carried out resulting in reporting of no such case from the intensive care unit in the last 6 months

Non-dermatophyte moulds as pathogens of onychomycosis

To determine the role and pattern of non-dermatophyte moulds as causative agents of onychomycosis. Case series. Department of Microbiology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from November 2009 to July 2010. Nail clippings and nail scrapings were obtained from abnormal looking nails with treatment and detection failure for onychomycosis. Microscopic [40% potassium hydroxide mounts] examination and culture on Sabouraud's dextrose agar [SDA], SDA containing chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification. Non-dermatophyte moulds were isolated from 32 out of the total 47 culture positive cases [68%]. Alternaria alternata was the commonest species [46%]. Dermatophytes were isolated from only 7 patients [15%] belonging to genus Trichophyton. Yeasts were isolated in 8 [17%]. There was no fungal growth in 53% of cases. The non-dermatophytes should be considered important in evaluating the culture negative cases for dermatophytes as well as those cases ending up in treatment failure after empirical treatment for dermatophyte infections

In vitro efficacy of piperacillin/sulbactam, piperacillin/ tazobactam and cefoperazone/sulbactam against clinical isolates of pseudomonas aeruginosa - a comparative study

To determine the in vitro efficacy of Piperacillin/Sulbactam, Piperacillin/Tazobactam and Cefoperazone/Sulbactam against clinical isolates of Pseudomonas aeruginosa. Cross-sectional study Department of Microbiology, Armed Forces Institute of Pathology from January 2010 to September 2010. A total of 287 isolates of Pseudomonas aeruginosa recovered from various clinical specimens were taken under consideration. Routine microbiological methods were used to identify the organism. Susceptibility of the isolates was carried out by modified Kirby-Bauer disc diffusion method against piperacillin 100/sulbactam 30 [SPR130micro g], cefoperazone 75/sulbactam 30 [SCF105micro g] and piperacillin 100/tazobactam 10 [TZP110micro g], according to the guidelines provided by Clinical and Laboratory Standards Institute [CLSI]. The highest numbers of Pseudomonas aeruginosa isolates were found in pus swabs, followed by urine and endobronchial washings. Seventy five percent of clinical isolates of P. aeruginosa were susceptible to tazobactam/piperacillin, 71% to piperacillin/sulbactam and 70% to cefoperazone/sulbactam. The difference between the susceptibility of isolates to these three antimicrobials was statistically not significant [p>0.05]. We conclude that there was very little difference in the antimicrobial susceptibility of P. aeruginosa to the three beta-lactam/beta-lactamase inhibitor combination drugs studied. Periodic susceptibility testing should be carried out over a period of two to three years, to detect the current resistance trends. Moreover, a rational strategy on the limited and prudent use of anti-Pseudomonal agents is urgently required