Comparative study between conventional blood culture method versus polymerase chain reaction assay for diagnosis of neonatal septicemia

Neonatal septicemia represents a major clinical problem in neonatology with high morbidity and mortality rates despite the progress in neonatal intensive care and antibiotics. Clinical diagnosis of septicemia in newborn infants is not easy and there is no laboratory test with 100% specificity and sensitivity with the exception of blood culture, the results of which are not available for at least 48-72 hours. The purpose of this study was to compare the utility of a 16S rRNA PCR assay to that of the conventional blood culture for detecting bacteria in blood obtained from neonates suspected of having septicemia. The present work included 50 neonates with provisional diagnosis of neonatal septicemia and 25 non infected neonates as control group. For each neonate the following was done: Full history taking, full clinical diagnosis, routine investigations including complete blood cell count and C-reactive protein [CRP], conventional blood culture for isolation of the causative organism and its identification and lastly the polymerase chain reaction for detection of the 16S rRNA gene from blood of septicemic neonates. The results of this study showed that: Only thirty nine neonates [78%] of those diagnosed as having or suspected to have septicemia on clinical backgrounds had given positive blood culture results. The most common isolated organisms were Klebsiella pneumonia [41.02%], coagulase negative staphylococci [CoNS] [20.51%], E. coli [10.26%] and S. aureus [10.26%]. K. pneumonia was the commonest isolated organism in early onset infection while CoNS was the commonest in late onset infection. Thirty eight of cases with positive blood culture [97.44%], two cases with negative blood culture [18.18%] and one of the control group [4%] were positive by 16S rRNA PCR. The sensitivity, specificity, positive and negative predictive values for 16S rRNA PCR in relation to blood culture were 97.4, 91.7, 92.7 and 97.1%, respectively and the accuracy was 94.7%. These values were superior to that of CRP [89.7, 83.3, 85.4 and 88.2%, respectively with accuracy of 86.7%]. Our results suggested that 16S rRNA PCR is a rapid, sensitive and specific diagnostic test for ruling out neonatal septicemia

Dose down regulation of tumor necrosis factor - prevent preterm labor?

Labor at term is thought to result from physiologic activation of anatomic, biochemical, and endocrine pathways. Whereas preterm labor result from pathologic activation of such events. The purpose of this study was to determine whether physiologic and pathologic activation could be described by the analysis of a cytokine-receptor signaling system. Tumor necrosis factor alpha [TNF-alpha.] and its soluble receptors [TNF-R1 and TNF-R2] were used as probes because of their role in the regulation of several processes activated during parturition.The in vivo concentrations of TNF-alpha and its soluble receptors were assayed in amniotic fluid obtained from 150 women, classified into 5 groups [each includcd 30]: Group-A consisted of women at term with intact memberanes not in labor, group B women with intact memberanes and in labor, group I women with preterm labor and intact. memberanes who delivered at term with no evidence of infection, group 2 women with preterm labor who delivered prematurely in the absence of chorio-amnionitis, and group 3 consisted of women with preterm labor and proven microbial invasion of the amniotic cavity who delivered preterm neonates women in spontaneous term labor [group-B] had significantly higher median concentrations of TNF-alpha a lower TNF-R1 and TNF-R2 than those at term not in labor [group-A]. Meanwhile, women with preterm labor leading to preterm delivery [group 2] had significantly higher concentrations of TNF-alpha. TNF-R1 and TNF-R2 than those with premature labor leading to term delivery [group 1]. On other hand, microbial invasion of the amniotic cavity [group 3] was associated with dramatic increases in the concentration of TNF-alpha and its soluble receptors than in those with preterm labor who delivered at term and those who delivered preterm but were not infected. It is concluded that levels of TNF-alpha and its soluble receptors, in the amniotic fluid, are different in term and preterm parturition, and that preterm parturition and/or microbial invasion of the amniotic cavity are pathologic conditions associated with increased TNF-alpha receptors which attenuate the deleterious effects of TNf-alpha found in. pathologic labor. It is concluded that the administration of TNF-alpha receptors to mothers at risk of pathologic preterm labor may be beneficial

Pregnancy outcome in recurrent miscarriage due to antiphospholipid syndrome: a comparative study of intravenous immunoglobulins versus low-dose aspirin plus low-dose heparin

The objective was to compare the use of intravenous immunoglobulins [IVIG] with low-dose aspirin plus low-dose heparin in treating pregnant women with a history of recurrent fetal loss, having the antiphospholipid antibodies [aPLs] due to antiphospholipid syndrome [APS], in terms of live-birth rate and maternal and perinatal morbidity. One hundred women [median age 32 years [range 22-42]] with a history of recurrent miscarriage [median number 4 [range 2-12]] and persistantly positive results for aPLs. When fetal heart activity was seen on ultrasonography, 50 women started on IVIG and 50 women were kept on low-dose aspirin and heparin, until 34 weeks gestation or at the time of miscarriage. There was no significant difference in the two groups in age or the number and gestation of previous miscarriages. The rate of live-births with IVIG therapy was 72% [36/50 pregnancies] and 44% [22/50 pregnancies] with low-dose aspirin and heparin. More than 90% of miscarriages occurred in the first trimester. There was no difference in outcome between the two treatments, in pregnancies that advanced beyond 13 weeks gestation. It is concluded that treatment with IVIG leads to a significantly higher rate of live-births in women with a history of recurrent miscarriage associated with aPLs, due to APS, than that achieved with low-dose aspirin plus low-dose heparin

Auto-antibodies in Toxanemic pregnancy

The total immunoglobulins levels: IgG, IgM, IgA and IgE and some autoantibodies namely antiunclear [AN], antismooth muscle [ASM] and Anticardiolipin [ACL] antibodies were assayed in 26 patients with mild preeclamptic toxaemia [PET] and 21 patients with severe PET and 25 normotensive pregnant females. Concentration of IgG, IgM and IgA was slightly decreased in mild and severe PET, whereas in normal pregnancy, it showed no change. Concentration of IgE was higher in mild and sever PET than in control group. All cases of mild PET and control group were negative as regards ANA detection and only one case of severe PET group was positive [4.8%]. The level of ASMA and ACLA was significantly high in mild and severe PET groups. There was a significant relationship between the presence of ASMA and ACLA in maternal serum and the following: the severity of preeclampisa, the presence of heavy proteinuria and the presence of subjective symptoms indicating emminent eclampsia

Prevalence of shigella subgroups and their antibiotic susceptibility pattern among recruits

This work was done on 300 samples of stools, 150 samples from diarrheal cases presented at El-Kobba Military Hospital and 150 samples from the control group. Out of the 150 diarrheal samples 15 shigella subgroups were isolated [10%], while 3 strains were isolated from the control group [2%]. Biotyping was done by the conventional methods and API and also serotyping was done. Shigella dysenteriae constituted the majority of shigellae isolated from patients [6.66%], followed by Shigella sonnei [2.66%]. A comparison was done on different culture media used for isolation of shigellae. It was found that Desoxycholate citrate agar [DCA] and Macconkey's agar were highly selective medium for the isolation, while selenite enrichement media inhibits many isolates of shigella strains. This work shows a change in antibiotic resistance pattern of most isolated strains. All the isolated shigella strains were resistant to tetracyclin and streptomycin and 86.66% were resistant to trimethoprim