Community-acquired meningoencephalitis due to concomitant infection caused by Naegleria fowleri and Streptococcus pneumoniae from Karachi, Pakistan: A Case Report.

Naegleria fowleri causes acute fatal primary amoebic meningoencephalitis in adults and children with a history of exposure to aquatic activities. However, several cases of Primary Amoebic Meningoencephalitis (PAM) have been reported from Karachi with no history of aquatic recreational activities suggesting the presence of N. fowleri in domestic water. This study reports a case of co-infection of N. fowleri with Streptococcus pneumoniae in an elderly hypertensive male.

A Novel Deep Learning-Based Mitosis Recognition Approach and Dataset for Uterine Leiomyosarcoma Histopathology.

Uterine leiomyosarcoma (ULMS) is the most common sarcoma of the uterus, It is aggressive and has poor prognosis. Its diagnosis is sometimes challenging owing to its resemblance by benign smooth muscle neoplasms of the uterus. Pathologists diagnose and grade leiomyosarcoma based on three standard criteria (i.e., mitosis count, necrosis, and nuclear atypia). Among these, mitosis count is the most important and challenging biomarker. In general, pathologists use the traditional manual counting method for the detection and counting of mitosis. This procedure is very time-consuming, tedious, and subjective. To overcome these challenges, artificial intelligence (AI) based methods have been developed that automatically detect mitosis. In this paper, we propose a new ULMS dataset and an AI-based approach for mitosis detection. We collected our dataset from a local medical facility in collaboration with highly trained pathologists. Preprocessing and annotations are performed using standard procedures, and a deep learning-based method is applied to provide baseline accuracies. The experimental results showed 0.7462 precision, 0.8981 recall, and 0.8151 F1-score. For research and development, the code and dataset have been made publicly available.

Infection of a Ventricular Septal Defect Patch with Acremonium Species.

A ventricular septal defect (VSD) patch infection with Acremonium species isolated from vegetation and blood culture is described. Antifungal treatment was discontinued after 3 months and patient developed relapse. Surgery with prolonged oral voriconazole was instituted with recovery. We emphasize importance of surgery and prolonged therapy to treat such infections.

Dissemination and spread of New Delhi Metallo-beta-lactamase-1 Superbugs in hospital settings.

OBJECTIVE: To find out frequency of isolation of carbapenem-resistant enterobacteriaceae and the predominantly responsible metallo-beta-lactamasegene in a hospital setting. METHODS: The descriptive, cross-sectional study was conducted from May 2009 to June 2012 at the Aga Khan University Hospital, Karachi, and comprised non-duplicate clinical carbapenem-resistant enterobacteriaceae isolates obtained from different collection units across Pakistan. Kirby-Bauer disk diffusion screening of carbapenem-resistant enterobacteriaceae was confirmed by minimum inhibitory concentration using E-test. Polymerase chain reaction assay was performed to detect blaKPC, blaNDM-1, blaIMP, and blaVIM genes. In addition variable number tandem repeat typing was performed on selected cluster of New Delhi metallo-beta-lactamase-1-positive Klebsiella pneumoniae. RESULTS: Of the 114 carbapenem-resistant enterobacteriaceae isolates, 104(94%) tested positive for blaNDM-1 gene. At 68(66%), Klebsiella pneumoniae was the most frequent species isolated, followed by E.coli 33(31%). Moreover, 89(78%) of the blaNDM-1 gene positive Klebsiella pneumonia isolates were from the clinical samples of patients admitted to the critical care units and 75(66%) were from neonates and the elderly. Of the 65(67%) patients suffering from bacteraemia and sepsis, 32(57%) had expired, of which 22(60%) were aged <1 month. Variable number tandem repeat analysis of hospital-acquired New Delhi metallo-beta-lactamase-1-positive Klebsiella pneumoniae showed similarities between the isolates. CONCLUSIONS: New Delhi metallo-beta-lactamase-1-positive enterobacteriaceae was found widely disseminated in major hospitals across Pakistan. Patients at extreme ages and those in critical care units were found to be the most affected with fatal outcomes.

Mixed Salmonella infection: a report of two cases from the Aga Khan University Hospital, Karachi.

Enteric fever remains a major health problem in the developing world, including Pakistan. Poor sanitation and hygienic conditions are the major predisposing factors. Salmonella infection with different strains in the same patient has rarely been reported previously. We are reporting two cases of bacteraemia with simultaneous detection of two strains of Salmonella in a single episode of infection. In both the cases, 2 different serotypes of Salmonella were causing bacteraemia leading to fever. In highly endemic area, one must be aware of mixed Salmonella infections as inappropriate diagnosis of such infections may lead to treatment failure.