Frequency of bacterial contamination in platelet concentrates in a tertiary care cardiac hospital in Rawalpindi, Pakistan.

Bacterial contamination of platelets concentrates (PCs) can result in transfusion transmissible infection. Storage temperature for platelets provides favourable environment for the bacterial growth. This study was conducted at Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan from May, 2016 to July 2016. A total of 200 (48 hours stored) whole blood derived PCs collected were selected for the study. Sample were inoculated into Oxoid Signal blood culture bottles and incubated at 36±1°C for 07 days. Signal culture bottle with positive signals and visual appearance of turbidity were sub-cultured. Bacterial growth identification was carried out by standard reference methods. Out of 200 platelets concentrates, 63 suspected turbid and 02 with positive signal culture device were sub-cultured and identified. Staphylococcus aureus was identified in 02 bottles. The overall frequency of bacterial contamination in PCs was found to be 1%. The frequency of bacterial contamination in PCs found is very high as compared to developed counties. There is need of strict adherence to standard protocols for the prevention, early detection, and reporting of bacterial contamination in the PCs in Pakistan.

Frequency of parasitic infestation in faecal specimens.

BACKGROUND: Parasitic infestation is very common in developing countries. Major factors of worm infestation are poor socio-economic status, large family size, low educational level, and poor hygiene and sanitation. These parasites lead to nutritional deficiencies and various diseases. A few studies have been carried out in Pakistan and this study tries to find out the frequency of parasitic infestation in our setup. METHODS: A cross sectional study was carried out from December 2011 to February 2012 in Pakistan Aeronautical Complex (PAC) Hospital Kamra. Patients were asked to pass stool specimen in a universal container provided to them from the laboratory. Stool specimens were examined within half an hour by direct light microscopy of faecal smears in normal saline. The laboratory diagnosis was based on the demonstration of ova/cysts or trophozoites. Data were analysed by SPSS-10 and frequency of various parameters was determined. RESULTS: A total of 543 faecal specimens were tested. Specimens found positive for ova/cysts were 295 (54%). Ascaris lumbricoides was the most frequent parasitic infestation in all faecal specimens followed by Taenia saginata. Thirty percent of food handlers were harbouring different parasitic infections. Diarrhoea/dysentery, medical examination of food handlers and for secondment abroad was the most frequent indication for faecal examination. CONCLUSION: High frequency of parasitic infestation in our set up especially of Taenia species requires measures to improve hygiene, water and sanitation. Meat and its products should be obtained from medically fit animals and meat cooked thoroughly before being consumed.

Rare case report of infective endocarditis due to Kocuria kristinae in a patient with ventricular septal defect.

BACKGROUND: Infective endocarditis (IE) is an uncommon but life-threatening infection. It is commonly associated with diseased or damaged valves. Patients with congenital heart disease are more prone to getting IE than the general population. The typical organisms that cause IE include Staphylococcus , Coagulase-negative Staphylococcus, Streptococcus viridians and Enterococci. However, the importance of rare micro-organisms like Kocuria kristinae should not be underestimated especially when isolated from multiple blood cultures in patients suspected of IE. CASE PRESENTATION: We report a rare case of right-sided infective endocarditis due to K. kristinae in a young non-diabetic, non-addict female of low socioeconomic class who presented with undiagnosed fever for 1 year. She was investigated and treated for fever by several general practitioners without relief. Later on, she was diagnosed by a local cardiologist to have perimembranous ventricular septal defect with a small pulmonary valve vegetation. She was referred to a tertiary care cardiac hospital in Rawalpindi, Pakistan for further management. Transthoracic and transesophageal echocardiography confirmed IE secondary to preexisting congenital heart disease complicated with a small pulmonary vegetation. Her blood cultures yielded growth of K. kristanae, a rare micro-organism to cause IE. The patient responded to the antibiotic therapy. CONCLUSION: Clinicians should have a high index of suspicion for K. kristanae IE as a possible cause of a prolonged fever especially in the presence of congenital heart disease. Antibiotic susceptibility is required for adequate therapy.

First case report of post-operative infection due to Francisella tularensis after cardiac surgery.

BACKGROUND: Francisella tularensis is a rare zoonotic bacterium that spreads sporadically by various routes, including infected arthropod bites, ingestion of contaminated water and inhalation of contaminated dust. However, its occurrence in postoperative chest infection has never been reported. Pathogen isolation, serology and molecular detection methods are commonly used for the diagnosis of tularaemia. CASE PRESENTATION: We present the first case report of the isolation of F. tularensis from a patient with a chest infection (a boy in his teens) following cardiac surgery for closure of a ventral septal defect. It was isolated on blood and chocolate agar on the third day after the subculture of drain fluid collected in a blood culture bottle incubated in Bact T/Alert 3-D (bioMerieux, France). The organism was identified as F. tularensis by Vitek GN ID Cards (Vitek 2 Compact, bioMerieux, France). The patient made a smooth recovery with antibiotic therapy. CONCLUSION: F. tularensis can cause post-operative infection, especially in patients with a rural background.

Isolation of Shewanella putrefaciens in an elderly man with subacute intestinal obstruction & appendicitis.

Shewanella is Gram-negative motile bacillus, non fermentative and facultative anaerobe. Its natural habitat is all forms of water and soil, but has also been isolated from fish, dairy products, oils, and carcasses. Often found with microflora of the marine environment. Bacterial infections with Shewanella spp. are rare. The exposure to the marine environment, sea and diary food are considered as a risk factor for Shewanella spp. infection. Clinical infections seen are otitis, soft tissue infection, bacteremia, ear infection, eye infection, infective arthritis, osteomyelitis, infective endocarditis and peritonitis.