Prevalence of Panton Valentine Leucocidin gene containing Staphylococcus aureus in pus samples from Paediatric patients.

Staphylococcus (Staph) aureus containing Panton Valentine Leucocidin (PVL) gene are spreading in the whole world. This gene encodes PVL toxin that has lytic effect on WBCs contributing to the low immunity of the body. It also causes pus formation in various places of the body. This study was conducted to understand the effect of PVL positive Staph aureus in causing purulent infections in children between the age of one day to 15 years. Pus samples from various sites of the body from children between the age of one day to 15 years were taken. The number of pus samples containing Staph aureus was 45. These were collected over a period of one year, from October 2, 2017 to September 30, 2018, at the Shaikh Zayed Hospital, Lahore. A total of 27 (60%) PVL samples were positive Staph aureus. Prevalence of PVL gene was noted to be high in MSSA 9(64%), wound swabs 18(75%), in isolates from orthopaedic department 6(75%), indoor 21(63%), and in males 18(66%). Our study showed that most of the Staph aureus samples that were obtained from pus samples from children had PVL gene in their genome. This percentage is very high. To control its spread, we need to treat not only the patients but also their close contacts. The main objective to conduct this study was to assess the prevalence of PVL positive Staph aureus strain in our local setup. Paediatric age group was selected because it is the most vulnerable group and pus samples were chosen because this strain causes recurrent purulent infections.

Coagulase negative staphylococci - a fast emerging threat.

OBJECTIVE: To determine the frequency of isolation of coagulase-negative staphylococci and their resistance to methicillin over a period of time. METHODS: The descriptive cross-sectional study was carried out at Army Medical College, Rawalpindi, from June 2009 to May 2012, and comprised clinical samples mostly from patients admitted to the intensive care unit. They were inoculated onto appropriate culture media depending upon the specimen. After 24-hour incubation at 35°C, coagulase-negative staphylococci were identified on the basis of colony morphology, gram staining, a positive catalase and a negative tube coagulase test.Methicillin resistance among the isolated staphylococci was determined using a 30µg Cefoxitin disc as per the Clinical and Laboratory Standards Institute protocol. Number of coagulase-negative staphylococci for each year and their methicillin resistance rates were calculated. A comparison was made with methicillin resistant staphylococcus aureus) isolated during the same period. RESULTS: Of the total 1331 specimens studies over three years, 581(43.65%) were coagulase-negative staphylococci. The rate of coagulase-negative staphylococci and methicillin resistance was higher each year; 110(26.6%) in May 2009-Jun 2010, 134(36.5%) in 2011, and 337(61%) in 2012. Methicillin resistance rates also increased from 25(22.7%) to 46(34.3%) and then to 201(59.6%) in 2012.Maximum isolated specimens came from blood 311(53.5%), followed by pus/swabs 204(35.1%). CONCLUSIONS: The frequency of isolation of coagulase-negative staphylococci and its methicillin resistance among hospitalised patients is on the rise.

The prevalence of inverse recurrent suppuration: a population-based study of possible hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving inverse recurrent suppuration (IRS). The epidemiology of the disease is not well described, with previous studies reporting prevalence estimates from 0·00033% to 4%. OBJECTIVE: To determine the prevalence of IRS in a large population-based survey. METHODS: Data were obtained from a general cross-sectional population study in Denmark. A validated self-administered questionnaire was used to identify IRS. Persons with the combination of outbreaks of 'boils' during the last 6 months in predefined areas and a minimum of two boils were identified. RESULTS: A total of 16 404 adults aged 30-89 years provided data and the overall prevalence of IRS was found to be 2·10% [95% confidence interval (CI) 1·88-2·32]; in men it was 1·58% (95% CI 1·29-1·86) and in women 2·56% (95% CI 2·21-2·86). No data for adults aged 20-29 years were included. The prevalence declined with age. The majority of cases (72·9%) had a body mass index of ≥ 25 kg m(-2) and 77·7% were current or ex-smokers. The mean number of inflamed lesions was 6·5 (range 2-67) during the last 6 months. The lesions affected mostly the genitalia (43·4%) and groin (39·8%) for women and 'other places' (not specified) (78·8%) for men. CONCLUSIONS: Data on IRS suggest that HS may be more prevalent than previously suggested, and the prevalence may be comparable to other major dermatoses, e.g. psoriasis. However, as no physician examination was done, the risk of recall and information bias is a major limitation.

Evaluating clinical course of BCG lymphadenitis and factors affect on it during a 5-year period in Kerman, Iran.

INTRODUCTION: One of the preventive methods of pulmonary tuberculosis is bacillus Calmette-Guérin (BCG) vaccination and one of the common complications of vaccine is lymphadenitis. We aimed to evaluate clinical course of BCG lymphadenitis in children of Kerman Province, Iran. METHOD: 314 children with BCG lymphadenitis were enrolled in study. Patients were followed up monthly regarding clinical improvement and complications. RESULTS: BCG lymphadenitis was improved in many patients during follow up; during 6 months 23.7% of patients had spontaneous regression. Only the primary size of lymphadenitis had significant effect on clinical course of lymphadenitis and developing complication (p = 0.0540). CONCLUSION: Many patients improved without any intervention. The primary size of lymphadenitis may affect clinical course of lymphadenitis and dispose person to abscess and fistula. To confirm this result and evaluate efficiency of preventive surgery instead of observation further study is recommended.

Intracranial suppurations in the African child: a severe but preventable complication.

INTRODUCTION: Intracranial suppurations (ICS) are collections of pus of infectious origin in the skull. The authors present their experience. PATIENTS AND METHOD: All children operated for ICS at the Central Hospital of Yaoundé from January 2000 to December 2008 were retrospectively included. RESULTS: Thirty-five patients were recruited: 26 (74.29 %) males and 9 (25.71 %) females. These represent 82.9 % of all ICS operated in our institution. ICS represented 14.3 % of intracranial space-occupying lesions. The mean age was 8.34 years. They presented with headaches (80.77 %), altered consciousness (20 %), convulsions (76 %), vomiting (20 %), unilateral motor deficit (69.23 %), speech disorders (12 %), and fever (89.29 %). Bergman's triad (51.86 %) was frequent. The primary infection was: meningitis, eight cases (22.85 %); sinusitis, six cases (17.14 %); head trauma, five cases (14.28 %); otitis media, one case (2.85 %); suppurations of the face, three cases (8.56 %); cardiopathy, one case (2.85 %); and craniotomy, one case (2.85 %). In seven cases (20 %), the origin was unknown. The lesions were empyema in 23 cases (65.71 %), cerebral abscess in 8 cases (22.85 %) and pyoventriculitis in 2 cases (5.72 %). The surgical procedures were burr holes (88.89 % of empyemas) and trepano-puncture-aspiration (75 % of abscesses). The mortality (21.42 %) and morbidity (42.85 %) were recorded. CONCLUSION: ICS are frequent but preventable (early treatment of the primary infection) pathologies of childhood in developing countries. Burr hole drainage (empyemas) and puncture-aspiration (abscesses) are simple, safe, and effective techniques.

Epidemiological, bacteriological and molecular studies on caseous lymphadenitis in Sirohi goats of Rajasthan, India.

Corynebacterium pseudotuberculosis is the causative agent of caseous lymphadenitis (CL), a chronic debilitating disease of goats. In the present study, a total of 575 goats of Sirohi breed on an organized farm situated in the semi-arid tropical region of Rajasthan, India were clinically examined. Pus samples from superficial lymph nodes of 27 (4.7%) adult goats presenting clinical lesions suggestive of CL were collected for bacteriological and molecular analyses. Of these goats, 51.9% yielded C. pseudotuberculosis on the basis of morphological, cultural and biochemical characteristics. A polymerase chain reaction (PCR) assay targeting proline iminopeptidase gene specific to C. pseudotuberculosis was developed that confirmed all 14 bacterial isolates. The specificity of the PCR product was confirmed by sequencing of the 551-bp amplicon in both senses, showing 98-100% homology with published sequences. Thus, overall prevalence rate based on clinical, bacterial culture and PCR assay were found to be 4.7%, 2.4% and 2.4%, respectively. The PCR assay developed in this study was found to be specific and rapid, and could be used for confirmation of CL in goats as an alternative method to generally cumbersome, time-consuming and less reliable conventional methods.

The rate of adverse events following BCG vaccination in Poland.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the capacity of the surveillance system to respond to the schedule changes in the view of TB vaccination uptake. Complications of Bacillus Calmette-Guerin (BCG) vaccination in Poland are as elsewhere uncommon. In Poland, BCG vaccination with a vaccine produced with Mycobacterium bovis BCG Moreau has been a part of the National Immunization Program since 1955. In the beginning the immunization schedule involved several BCG revaccinations in children and youths, with the first dose given to neonates up to 1 month old followed by revaccinations at 2, 4, 7, 12, 15, and 18 years of life. In 90s, the number of BCG doses was reduced and since 2006, according to recommendations made by the WHO, a single BCG dose is given to neonates only. METHODS: In the study we have analyzed data on adverse events following BCG vaccination registered within a period of 1994-2010, with attention to the periods before and after 2006, when different BCG vaccination schedules were used for immunization. RESULTS: The frequency of adverse events following BCG vaccination in Poland oscillated within 1994-2000 and 2001-2010 periods around 0.2 per thousand and 0.6 per thousand respectively, and in half consisted of local lesions at the injection sites and in half--appeared in the form of the regional lymphadenopathy. The analysis of surveillance data revealed similar rates of adverse events following BCG vaccination in the periods of different BCG vaccination schedules, eg. before and after 2006. CONCLUSIONS: Improvements in the data collecting manner from passive to active one and the introduction of the routine laboratory confirmation of the infection might evaluate the real prevalence of Mycobacterium bovis BCG infections and improve the treatment of adverse events following BCG vaccination cases.

Incidence of Acute Suppurative Sialadenitis in End-Stage Cancer Patients: A Retrospective Observational Study.

CONTEXT: Acute suppurative sialadenitis (hereafter referred to as sialadenitis) is accompanied by pain and fever and can diminish the quality of life in end-stage cancer patients; however, its incidence is not clear. OBJECTIVES: We conducted this study to elucidate the incidence of sialadenitis in end-stage cancer patients. METHODS: Retrospective review and observational study based on patients' medical records. SUBJECTS: About 726 consecutive cancer patients who died on the palliative care unit of our hospital between April 2012 and November 2016 were included. MEASUREMENTS: Median duration between sialadenitis onset and death, concomitant treatment, average infusion volume per day, site of onset, symptoms, effectiveness of antibiotic treatment, and mean duration until symptomatic relief. RESULTS: The incidence of sialadenitis was 2.9% (21 of 726 cases). The median duration from onset to death was 20 days (range 2-112); concomitant treatment included opioids in 11 patients (55%), anticholinergic drugs in six patients (28%), steroids in three patients (14%), and oxygen inhalation in five patients (23%); average infusion volume per day was 588 ± 307 mL; site of onset was submandibular gland in 12 patients (57%) and parotid gland in nine patients (42%); and symptoms were pain in 18 patients (85%) and fever in 13 patients (61%). Antibiotic treatment was administered in 18 patients (85%), and the mean duration until symptomatic relief was 4.0 ± 1.5 days. CONCLUSION: Sialadenitis is a rare complication in end-stage cancer patients; however, it is important to recognize that it can be associated with severe symptoms, including fever and pain.

Do subcutaneous sutures increase risk of laparotomy wound suppuration?

REASONS FOR PERFORMING STUDY: Incisional drainage and suppuration occurs commonly following exploratory laparotomy; any technique with the potential to reduce the incidence of this complication warrants investigation. OBJECTIVES: To determine if abandoning the use of subcutaneous sutures in laparotomy wound closure is safe and whether it reduces the risk of suppuration. METHODS: A randomised controlled study was carried out at 2 referral hospitals in the UK, involving 309 horses undergoing exploratory laparotomy; 150 horses underwent '2-layer' closure without a subcutaneous suture, while 159 underwent conventional '3-layer' closure. Information regarding degree of oedema and gross types of discharge was recorded daily; suppuration was defined as discharge of pus. Telephone follow-up was carried out 30 days after hospital discharge to identify those complications occurring after that date and, thereafter, every 3 months. The influence of closure method on risk of wound suppuration was assessed by Chi-squared analysis and by logistic regression. Time to suppuration was modelled using a Cox proportional hazards model. RESULTS: No catastrophic failures of 2-layer closures were recorded. Prevalence of suppuration was not significantly different, being 18.7% and 23.9% for 2- and 3-layer closures, respectively (OR = 1.37, 0.79-2.37, P = 0.263). CONCLUSIONS AND POTENTIAL RELEVANCE: This study found no significant difference in prevalence or rate of wound suppuration in 2-layer closures compared to conventional 3-layer closure. Two-layer closure is recommended as a safe alternative means of achieving ventral midline abdominal closure in horses.

[An analysis of main causes of low efficiency of rendering care for pyo-necrotic complications of syndrome of the diabetic foot].

In the city of Chelyabinsk during 1996 through 2003 there was growing incidence of necrotic complications of syndrome of the diabetic foot (SDF) from 26.0 up to 50.5 per 100 000 adults (p < or = 0.001). According to prognosis the incidence of SDF will grow by 2010 more than two times (R2 = 0.9849). Comparison of effectiveness of surgical treatment on Diabetological centers (1st group) and non-specialized institutions (2nd group) has shown that lethality in the first group was 4.2%, in the second group--9.7%. In the first group the frequency of high amputations decreased from 31.3% in 1996 to 12.3% in 2005 (p < 0.05). As a whole, organizational, diagnostic and medical defects of treatment were noted in 89.5 out of 100 patients in both groups, the errors in specialized institutions being made 5.7 times more rarely than in non-specialized ones, that speaks well to specialized Diabetological centers.

[Tuberculous pyopneumothorax: about 18 cases]. / Pyo-pneumothorax tuberculeux: à propos de 18 cas.

Tuberculous pyopneumothorax is a rare but serious complication of evolutive pulmonary tuberculosis. We report a series of 18 cases with tuberculous pyopneumothorax admitted to the Pneumo-Phthisiology Department of the Mohammed V Military Teaching Hospital in Rabat between January 2005 and December 2009. Our study included 15 men and 3 women, the average age was 35 ± 7 years. 4 patients were diabetic. Smoking was found in 9 cases. Right-sided pneumothorax was found in 13 cases. Chest radiograph showed cavitary lesions in 15 patients and extensive bilateral lesions in 8 cases. The search for Mycobacterium tuberculosis in the fluid from the gastric tube was positive in 16 cases. Chest drainage associated with antituberculosis treatment according to the 2SRHZ/7RH regimen and respiratory kinesitherapy were performed in all cases. The average duration of pleural drainage was 4 weeks. In 3 cases we noted persistent pleural suppuration requiring pleural toilet using thoracoscopy with pleurectomy and limited pulmonary resection to eliminate tuberculous parenchymal lesions and the persistence of a large pleural pocket with restrictive ventilatory defect that required surgery for pleural decortication in two cases. The outcome was favorable with minimal pachypleuritis as sequelae in the remaining cases. Tuberculous pyopneumothorax is a severe form, which is often associated with active cavitary tuberculosis. Evolution is generally progressive despite antituberculosis treatment and thoracic drainage, hence the need for early diagnosis and treatment of all forms of tuberculosis.

Prevalence of pus in radiologically diseased sinuses in patients undergoing surgery for chronic rhinosinusitis.

OBJECTIVE: To establish the prevalence of pus in radiologically diseased sinuses in patients undergoing sinus surgery and to correlate this with the bacterial load in the sinuses. STUDY DESIGN AND SETTING: A prospective study performed on adult patients with the diagnosis of chronic sinusitis undergoing endoscopic sinus surgery at an Adelaide group of academic hospitals. In 45 consecutive and unselected patients, a radiologically diseased sinus was surgically opened, and a specially designed suction aspirator was placed into the sinus under endoscopic control. These aspirates were Gram stained and cultured to quantify the polymorphonuclear neutrophil count, bacterial flora, and bacterial colony count. The CT scans of all patients were graded by using the Lund-Mackay scoring system. RESULTS: A variety of bacteria, most commonly staphylococci, were cultured from a radiologically diseased sinus in 88% of patients. There was no correlation between the bacterial colony count and presence of pus, and only 11% of patients had microscopic evidence of inflammation in sinus aspirates. There was no correlation between the Lund-Mackay CT score and the presence of pus in the sinus. CONCLUSIONS: The majority of patients undergoing surgery for chronic sinusitis did not have a purulent exudate, and there was no correlation with the bacterial load. The usefulness of antibiotics in the treatment of chronic rhinosinusitis, in the absence of macroscopic pus, is questionable.

Non-calculus suppurative cholangitis in Danish patients with inflammatory bowel disease.

BACKGROUND/AIMS: We examined the risk of non-calculus suppurative cholangitis in patients with inflammatory bowel disease in the entire Danish population. METHODOLOGY: The study included all patients discharged from Danish hospitals with a diagnosis of Crohn's disease or ulcerative colitis as registered in the Danish National Registry of Patients from January 1, 1977 to December 31, 1992. We compared the observed number of patients hospitalized with suppurative cholangitis with expected numbers on the basis of age, gender, and calendar-specific incidence rates in the general population. RESULTS: Overall, 15,317 eligible patients with inflammatory bowel disease were discharged during the study period. Among these were 52 cases of non-calculus suppurative cholangitis. The incidence rate of non-calculus suppurative cholangitis in the cohort with inflammatory bowel disease was 46.1 per 100,000 person-years. The standardized incidence ratio (SIR) for suppurative cholangitis was increased similarly for patients with Crohn's disease [SIR=6.7, 95% confidence interval (CI): 3.1-12.7] and for patients with ulcerative colitis (SIR=6.6, 95% CI: 4.7-9.1). The highest relative risk was found in male patients younger than 40 years of age, for both Crohn's disease and ulcerative colitis (SIR=70.5 and 78.7, respectively). CONCLUSIONS: Patients with inflammatory bowel disease have an increased risk of non-calculus suppurative cholangitis.

Causes of suppurative keratitis in Ghana.

AIMS: Suppurative keratitis is a serious problem in all tropical countries, but very little information is available about the causative organisms in Africa. The objectives were to identify the causative organisms and the proportion of cases caused by fungi in southern Ghana, and to determine whether correct decisions about treatment could be made on the basis of Gram stain in the eye clinic. METHODS: Scrapings were taken from corneal ulcers of consecutive new patients presenting at Korle Bu Hospital, Accra, and inoculated on 'chocolate' and Sabouraud's agars. Further scrapings were taken for Gram staining and interpretation in the eye clinic. Duplicate slides were assessed by an experienced microbiologist in the UK. RESULTS: One or more organisms were cultured from 114 of 199 patients (57.3%), the most common being Fusarium species, Pseudomonas aeruginosa, and Staphylococcus epidermidis. Fungi, alone or in combination, were isolated from 56% of the patients who had positive cultures. In total, 122 patients (61.3%) had their treatment either determined or altered based on the results of the microbiological diagnosis; in 87 of these solely on the basis of direct microscopic examination. CONCLUSIONS: Infection by filamentous fungi accounted for more than half of the ulcers from which cultures were obtained. Both training in technique and experience in interpretation are necessary for microscopy based diagnosis by staff in the clinic to be of greatest value. Direct microscopy was particularly useful for detecting fungi.

[Complications following duodenopancreatectomy in chronic pancreatitis]. / Komplikationen nach Duodenopankreatektomie bei chronischer Pankreatitis.

42 partial and 5 total duodenopancreatectomies performed during the last ten years are reported. Complications--fistula, abscess, bleeding, insufficiency--occurred in 21 cases (46.5%). In 11 patients reoperation becomes necessary (23.4%) 6 patients died (12.7%). The advantages of primary partial duodenopancreatectomy comparing to other surgical procedures are discussed. Some surgical techniques in reducing the complication rate are recommended.

[Epidemiological survey of nosocomial infections. Pierre Wertheimer hospital. Lyons 1986-1991. Proposition for antibioprophylaxis]. / Relevé épidémiologique des infections nosocomiales. Hôpital Pierre Wertheimer--Lyon 1986-1991. Proposition d'une antibioprophylaxie.

A prospective survey of post-operative infections, conducted since 1986 at the Pierre Wertheimer Neurology Hospital, revealed an annual rate of infection varying between 2.9 and 7.3%. Definition criteria for each infection were given, including episodes of aseptic meningitis. The most frequently encountered infections were suppurations at the surgical site and meningitis. Staphylococci and enterobacteriacae, the most frequently isolated germs, were generally sensitive to antibiotics with the exception of coagulase negative staphylococci, causative agents in foreign body infections. Based on the epidemiological data and the pharmacokinetic and economic characteristics of the different antibiotics, a second generation cephalosporin was proposed for antibiotic prophylaxis. Vancomycin is an alternative choice in cases of allergy and when there is a risk of coagulase negative staphylococci infection.

[Microflora of patients with purulent septic diseases in the Moscow region]. / Mikroflora gnoino-septicheskikh zabolevanii u bol'nykh v Moskovskoi oblasti.

The microflora of clinical material (blood, wound discharge, abdominal exudate, pleural exudate, milk in mastitis, as well as feces in dysbiosis of the large intestine), obtained from patients with purulent septic diseases in the Moscow region was studied. The study revealed the change of microflora from surface biotopes to closed cavities of the body. Gram-positive cocci, primarily coagulase-negative staphylococci, mainly epidermal, were shown to play the leading etiological role in the development of purulent septic diseases. The development of bacteriemia was found to be caused by the penetration of staphylococci from local pyoinflammatory foci (appearing in purulent mastitis, wounds, peritonitis, pleural empyema and pleuritis), as well as by the translocation of staphylococci and Escherichia coli from the large intestine in dysbiosis.

[The use of data on the composition and drug resistance of the causative agents of suppuration in a retrospective analysis of the epidemiological situation in a hospital]. / Ispol'zovanie dannykh o sostave i lekarstvennoi ustoichivosti vozbuditelei nagnoenii pri retrospektivnom analize épidemiologicheskoi situatsii v statsionare.

The analysis of bacterial 16,530 strains, dynamically isolated from 6,157 patients with purulent septic processes (PSP) in surgical, traumatological, burn, toxicological and resuscitation departments, was made. The computer processing of data on the spread of the causative agents of PSP, depending on their taxonomic classification and drug resistance spectra, was carried out, which made in possible to obtain information on the outbreaks of hospital infections. Correlation of the number of PSP cases and the spread of hospital resistovars was analyzed. The data on the composition and drug resistance of pyogenic microorganisms could be used in the retrospective analysis of the epidemiological situation in a hospital. 3-year observations revealed the tendency to a decrease in the spread of the hospital variants of the causative agents of PSP, multiresistant to antibacterial preparations, which was indicative of the effectiveness of the antiepidemic measures carried out during this period.

[The bases of epidemiological surveillance for postinjection complications]. / Osnovy épidemiologicheskogo nadzora za postin''ektsionnymi oslozhneniiami.

To carry out the epidemiological analysis of postinjection suppurations and to introduce the relevant prophylactic measures, the forms of registration and account for suppurative inflammatory diseases should be legitimized and the data on such cases per the number of injections made at therapeutic and prophylactic institutions and their branches should be calculated. The organization of centralized sterilization of instruments and the 100% provision of all institutions with these instruments can reduce the occurrence of postinjection suppurations.

[Etiology of purulent septic diseases and the antibiotic resistance of the isolated causative agents]. / Etiologiia gnoino-septicheskykh zabolevanii i antibiotikorezistentnost' vydeliaemykh vozbuditelei.

Among the causative agents of purulent septic diseases in the surgical hospital, 25 microbial species were isolated; of these, the prevailing species were Staphylococcus aureus (19.86 +/- 1.07%), Escherichia coli (16.5 +/- 0.99%) and Pseudomonas aeruginosa (10.06 +/- 0.8%). From environmental objects in the hospital 14 microbial species were isolated, among them bacteria of the genus Enterobacter (27 +/- 1.7%), E. coli (19.07 +/- 1.48%), S. aureus (14.7 +/- 1.31%), Klebsiella pneumoniae (13.73 +/- 1.31%), P. aeruginosa (7.33 +/- 0.98%). During 3 years of observation the isolation rate of K. pneumoniae from different environmental objects was found to increase threefold to 24.7 +/- 2.7%. The results of the study of the microbial picture in surgical hospitals, as well as the antibiotic resistance of circulating causative agents, should be borne in mind while taking epidemic control measures.