localized outbreak of cholera due to vibrio cholerae 01, ogawa resistant to tetracyclines

To study the clinical and laboratory parameters of a localized Cholera outbreak and determine the sensitivity pattern of the subtype involved. A descriptive study. Combined Military Hospital, Lahore. Two weeks. The study is about a localized outbreak of cholera in a group of soldiers, who consumed water from a single contaminated source of water. We are presenting here an account of the clinical and laboratory parameters of 39 hospitalized cases of cholera, who presented with profuse watery diarrhoea and vomiting. There vital signs, hydration status and systemic examination findings were recorded. Stool samples were sent for routine and microscopic examination and bacteriological culture. Blood samples were taken for complete blood count, serum sodium, potassium, urea and creatinine examination. SPSS 18 was used for statistical analysis of the results. The average age of thirty nine men studied in this outbreak was 24.9 +/- 6.9 years. There was no statistically significant difference between confirmed and suspected cholera cases on descriptive analysis of the clinical and laboratory parameters. Majority of patients showed pre-renal azotemia which improved within 48 to 72 hours of hospitalization. Stool cultures isolated Vibrio cholerae O1, subtype Ogawa, which was resistant to tetracyclines, cotrimoxazole and nalidixic acid but sensitive to fluoroquinolones and third generation cephalosporins. The outbreak was controlled when the contaminated water source was sealed and rectified. Multiple drug resistance strains of Vibrio cholera are causing large outbreaks which should be controlled by prevention of the disease and avoiding inappropriate use of antibiotics

2011 dengue haemorrhagic fever outbreak in Lahore - an account of clinical parameters and pattern of haemorrhagic complications

To describe the frequency and outcome of dengue haemorrhagic fever [DHF] cases and determine the association of clinical and laboratory parameters with haemorrhagic complications. A descriptive study. Combined Military Hospital, Lahore, from August to November 2011. Clinical profile and outcome of 640 adult patients hospitalized with a strong clinical suspicion of dengue fever [DF] was evaluated. Based on serological confirmation, these patients were divided into confirmed DF and probable DF cases. They were also categorized according to severity into dengue fever [DF], dengue haemorrhagic fever [DHF] and dengue shock syndrome [DSS] cases according to WHO guidelines. After detailed clinical evaluation, blood samples were taken for a complete blood count, urea, creatinine, sodium, potassium, bilirubin, alanine aminotransferase [ALT], prothrombin time [PT] and activated partial thromboplastin time [APTT]. Patients were managed according to standard protocols with intravenous fluids and symptomatic treatment. SPSS 18 was used for statistical analysis of clinical data. Comparison of features among the groups was made using chi-square or t-test with significance at p < 0.05. There was 359 probable DF and 281 confirmed DF cases. The development of DHF, neurological manifestations and overall mortality was more frequent in confirmed DF group. Comparison between DHF/DSS and DF cases revealed a significant difference in vomiting [p = 0.04], purpuric rash [p < 0.001], systolic blood pressure [p = 0.002], serum ALT [p < 0.001], hospital stay [p < 0.001], neurological involvement [p < 0.001] and coagulopathy [p < 0.001] between the two groups. Among 159 DHF patients, 108 [67.9%] had bleeding from gums and oral cavity, 73 [45.9%] had haemetemesis and 82 [51.5%] malaena, 41 [25.8%] had epistaxis, 12 [7.5%] developed intracranial bleeding, 18 [11%] had hematuria, 12 [7.5%] had fresh bleeding per rectum and 37 [23%] developed haemoptysis. Overall mortality was 3%, but mortality in DHF/DSS cases was 6% and 41.6% for DSS cases. Logistic regression analysis showed that abdominal pain, purpuric rash, ascites, thrombocytopenia, coagulopathy and raised ALT had a statistically significant predictability for developing DHF. A variety of manifestations including that abdominal pain, purpuric rash, ascites, thrombocytopenia, coagulopathy and raised ALT had a statistically significant predictability for developing DHF. A knowledge and understanging of these complictions would be useful for the management of patients if such outbreaks of DHF are encountered again

Validity of nalidixic acid screening in fluoroquinolone-resistant typhoid salmonellae

To validate the screening of low-level fluoroquinolone resistance in typhoid salmonellae by using nalidixic acid [30mg] disk providing an acceptable zone of inhibition. Quasi-experimental study. The Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from July 2002 to June 2003. Antimicrobial susceptibility of 225 clinical isolates of S. typhi [n=126] and S. paratyphi A [n=99] against nalidixic acid and ciprofloxacin was determined by the modified Kirby-Bauer disk diffusion and agar dilution techniques of NCCLS. The relationship between the zone sizes and the MICs of the two quinolones was plotted in the form of scattergrams and nalidixic acid MICs and zone of inhibition sizes were correlated with those of ciprofloxacin by regression analysis. One hundred and ninety-five isolates were nalidixic acid-susceptible [MIC <16 Mug/mL] and 30 were nalidixic acid-resistant [MIC >32 Mug/mL]. All the nalidixic acid-susceptible isolates had ciprofloxacin MIC of <0.064 Mug/mL. Among the nalidixic acid-resistant isolates 20 had ciprofloxacin MIC > 0.125 Mug/mL and 10 had ciprofloxacin MIC < 0.03- 0.064 Mug/mL. The diameter of inhibition zone around a 30 mg nalidixic acid disk of nalidixic acid-resistant isolates was <13 mm [range 6-16 mm, mean 10.3 mm + SD 3.5 mm], while among nalidixic acid-susceptible isolates it ranged from 14 to 30 mm [mean 23.8 mm + SD 2.2 mm]. The diameter of inhibition zone around a 5mg ciprofloxacin disk of nalidixic acidresistant isolates ranged from 26 to 35 mm [mean 29.8 mm + SD 3.1 mm], while in nalidixic acid-susceptible isolates it ranged from 32 to 42 mm [mean 36.6 mm + SD 1.9 mm]. With ciprofloxacin MIC Z WITH CARON0.125 mg/mL taken as a breakpoint, a zone of <33mm around a 5mg ciprofloxacin disk to detect low susceptibility strains had a sensitivity of 100% and a specificity of 82%. Screening for nalidixic acid resistance [inhibition zone diameter of <13 mm] in isolates with ciprofloxacin MIC Z WITH CARON 0.125 mg/mL using a 30 mg nalidixic acid disk yielded a sensitivity of 100% and a specificity of 95%. Screening for nalidixic acid resistance with a 30mg nalidixic acid disk is a reliable and cost-effective method for detection of low-level fluoroquinolone resistance in typhoid salmonellae

update on the diagnosis of tuberculosis

Tuberculosis [TB] continues to be the bane of mankind. Early diagnosis is the cornerstone of tuberculosis control strategies. Recent years have seen major advances in the fields of biotechnology and molecular biology with introduction of several new diagnostic techniques for tuberculosis and improvement in the existing ones. The new automated culture techniques have appreciably reduced the time required for detection and antimicrobial susceptibility testing. The molecular amplification techniques like the Polymerase Chain Reaction [PCR] have made the same-day diagnosis a reality. Improvements in serology and introduction of novel new techniques like the bacteriophage assays have also shown a lot of promise. However, most of these new techniques are too expensive and sophisticated to be of any practical benefit to the vast majority of TB patients living in underdeveloped countries like Pakistan for whom an early and inexpensive diagnosis remains as elusive as ever. In this article various existing modalities as well as the new advances in TB diagnostics are reviewed