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Naegleria fowleri amebae are thermophilic, free-living, and found in soil and fresh water, such as lakes, rivers, ponds, and untreated swimming pools. The ameba enters the brain through the nose [...]

Background: Acinetobacter baumannii has emerged as one of the leading causes of multidrug resistant nosocomial infections worldwide. It is able to survive in hospital environment and build up diverse resistance mechanisms making it difficult to treat with current antibiotics. Objective: It was to determine the frequency and patterns of Acinetobacter baumannii in intensive care units (ICU) settings. Methods: A cross sectional study was carried out in the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from 1st July 2017 to 30th June 2019. A total of 603 non-duplicate clinical specimens were received from intensive care units. Specimens yielding growth of multidrug resistant Acinetobacter baumannii, were evaluated as per standard protocol. The antimicrobial sensitivity testing was performed as per Clinical and Laboratory Standard Institute guidelines (2017-2018). Results: Among Acinetobacter baumannii (310 isolates), 5% were multidrug resistant, 93% extensively drug resistant and 1% pan drug resistant. Percentage of carbapenem resistant strains was 92%. In drugs like tigecycline and polymyxin, resistance was noted as 73% and 1% respectively. High yield of this superbug was mainly obtained from respiratory specimens (43.5%), whereas 24% were detected from wound infections and 29% from other samples. Conclusion: This study showed a rapidly increasing resistance in Acinetobacter baumannii. Therefore, polymyxin remains the only option in our intensive care units, but its usage as empirical therapy in our setting has led to the emergence of resistance to this drug. Implementing infection control practices, antimicrobial stewardship and restricted use of polymyxin can play a significant role in reducing health care burden. [ABSTRACT FROM AUTHOR]

Background: Emergence of resistance among Escherichia coli (E.coli) isolates against therapeutic options for UTIs (Urinary tract infections) has led to renewed interest in older antibiotics like Fosfomycin. In this study we evaluated diagnostic accuracy of Rapid Fosfomycin NP test based on glucose metabolism for rapid Fosfomycin susceptibility testing among urinary E.coli isolates. Methods: In a cross-sectional validation study conducted in the Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from 15th March to 15th September 2020, 149 consecutive urine specimens were included as per selection criteria. Rapid Fosfomycin NP test was performed as per protocol of Nordmann P et al on urinary E.coli isolates for detection of Fosfomycin resistance and results were compared with reference modified Kirby-Bauer disk diffusion method. Results: Out of total 149 E.coli isolates from 149 urine specimens, 80 were classified as Fosfomycin susceptible and 69 as Fosfomycin resistant by reference disk diffusion method. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of rapid Fosfomycin NP test was found to be 94.2%, 98.75%, 98.48%, 95.2% and 96.64%, respectively. In our study reliable results were achieved after 2.5 hours of incubation. Conclusion: The rapid Fosfomycin NP test is valid and user-friendly technique which can be performed with minimal technical expertise. It is less time consuming than disk diffusion and E- test strips and easy to perform as compared to agar dilution method. It can be useful as alternative to agar dilution in urinary E.coli isolates which would help in selecting appropriate therapeutic option for UTIs. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory illness caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) involved the whole globe within no time. Various studies published globally have shown variable severity of disease and mortality. The objective of our study was to describe clinical and epidemiological characteristics of the disease in our setup. Methods: in this descriptive case series, individuals with signs and symptoms of Coronavirus disease-19 (COVID-19) and asymptomatic patients with history of close contact to confirmed COVID-19 patients were considered for SARS-CoV-2 Polymerase chain reaction (PCR) assay. Epidemiological and clinical features of only PCR positive cases were recorded. Data regarding hospitalization status, exposure to known COVID-19 patients, clinical feature and clinical outcome of patients was collected and interpreted. Results: A total of 266 patients were found to be SARS-CoV 2 PCR positive which were included in the study. Mean age of patients was 39.45±31.9 years and majority of the patients in our study were male, i.e., 238 (89.5%). Most common clinical features among COVID- 19 symptomatic patients were fever and dry cough followed by myalgias and sore throat. Eighteen (7%) out of 266 died in our setup. Time duration of viral shedding after initial positive PCR varied between 11 days to up to more than 55 days. Conclusions: Coronavirus disease-19 (COVID-19) can present with wide range of clinical spectrum and disease can be life threatening. Severity of disease, requirement of ICU care and mortality were directly related to age of the patient and underlying comorbidities. Rigorous precautionary measures are of utmost importance particularly in this high-risk population. [ABSTRACT FROM AUTHOR]

Objective: To determine cut off value of Interferon Gamma Release Assay (IGRA) among Tuberculosis (TB) suspected patients and to compare median Interferon Gamma Release Assay value for Tuberculosis culture positive and culture negative patients. Study Design: Cross sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, from Oct 2015 to Apr 2016. Methodology: The study was conducted on patients with suspected tuberculosis. Quantiferon Tuberculosis Gold that has an important role in the immune response to Tuberculosis was performed by Enzyme Linked Immunosorbent Assay method and specimens were cultured on Mycobacterium Growth Indicator Tube 960 System (MGIT 960 system). Quantiferon Tuberculosis Gold values obtained by Enzyme Linked Immunosorbent Assay method were used to determine the sensitivity and specificity of this test. Results: A total of 240 suspected isolates of tuberculosis during the study period were subjected to culture using MGIT 960 system, as per recommended protocol for the method. These samples were also subjected to Quantiferon TB Gold (QTBG) to measure Interferon Gamma Release Assay release. Sensitivity and specificity of IGRA was determined keeping tuberculosis culture as gold standard for this study. Conclusion: Sensitivity and specificity values showed a significant p-value <0.001 with active tuberculosis. In TB endemic areas like Pakistan, new cutoff value must be kept in mind while interpreting results of IGRA. [ABSTRACT FROM AUTHOR]

Objective: To compare the in vitro disk diffusion method and agar dilution method for sensitivity of Polymyxin B against multi drug resistant Acinetobacter baumannii. Study Design: Comparative cross sectional. Place and Duration of Study: The study was carried out in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st Dec 2016 to 30th Dec 2017. Methodology: Total 253 clinical specimens received from intensive care units with yielded growth of multidrug resistant Acinetobacter baumannii were evaluated for Polymyxin B susceptibility. Both Kirby bauer disk diffusion and agar dilution methods were compared with a reference method, broth microdilution. Results: Among 253 multidrug resistant isolates, 180 (71%) were extensively drug resistant and 221 (87%) were carbapenem resistant. Comparison of the disk diffusion and the MIC method by Agar dilution showed 100% correlation. 251 isolates were sensitive and 2 were resistant to Polymyxin B with MICs and disk zone diameters within the range recommended by the CLSI (2014-17). MIC 50 and MIC 90 of Polymyxin B were found to be 0.5 and 1µg/ml with 99.2% susceptibility. Conclusion: Both disk diffusion and agar dilution can be used together as initial screening methods in low income countries for susceptibility reporting of polymyxins. They are simple, reliable and economical. Also hetero resistance shown by some Acinetobacter baumanii strains can easily be picked up by agar dilution method. [ABSTRACT FROM AUTHOR]

We investigated an outbreak of Serratia marcescens (S. marcescens) in NICU of our hospital and are reporting the characteristics of this outbreak along with interventions leading to its resolution. In the month of September and November 2016, seven neonates were identified with blood cultures positive S. marcescens septicemia. To identify the source of the isolate surface swabs were taken from different environmental sources. All S. marcescens isolates were identified by Vitek automated identification system, API 20 E and their antibiogram pattern and further genotyping was done by pulse field gel electrophoresis. During surveillance, 25 blood cultures of newborns were analyzed, 32 environmental samples along with hand swabs of 10 healthcare workers (HCWs) were taken. Seven neonates had blood culture positive S. marcescens sepsis. Only one environmental source (water flasks) yielded S. marcescens with similar antibiogram suggesting the same strain which was further confirmed by pulse field gel electrophoresis. Timely delivery of culture and sensitivity results, good liaison and effective communication between neonatologist and microbiologist, targeted antimicrobial therapy helped in saving the life of six neonates suffering from S. marcescens septicemia. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections are one of the most common infections especially in young adults. Due to increase in fluoroquinolones use, empirical therapy in uncomplicated urinary tract infections with this group is now controversial. This study was aimed to see the efficacy of nitrofurantoin, ciprofloxacin and cotimoxazole (trimethoprim-sulphamethaxazol); the three most common drugs which can be used orally. Material & Methods: This descriptive study was carried out at the Department of Microbiology, Combined Military Hospital, Quetta, Pakistan from Januery 2014 to June 2014. A total of 270 urinary isolates (Outdoor 132, indoor 138) were cultured from urine specimens during the study period. Identification of isolates were performed by conventional methods and by using API 10S (Biomerieux, France). All the isolates were tested against nitrofurantoin, ciprofloxacin and cotimoxazole (trimethoprim-sulphamethaxazol) along with other routine antibiotics used for urinary pathogens. Results: Out of total 270 urinary isolates, Escherichia coli was the dominant isolate cultured in 158 (58.51%) cases, followed by Klebsiella pneumonia in 48 (17.77%) and enterococcus spp. In 16 (5.92%) cases. Out of total 132 outdoor isolates, percentages of sensitivities of nitrofurantoin, ciprofloxacin and cotimoxazole were 92.4, 47.1 and 62.1 respectively. In case of total 138 indoor isolates, percentages of sensitivities for these three drugs were 84.0, 34.7 and 28.9 respectively. Conclusion: Nitrofurantoin is very effective against both outdoor and indoor urinary isolates and can be used empirically for uncomplicated urinary tract infections. [ABSTRACT FROM AUTHOR]

Background: Tinea pedis is the most common fungal infection especially prevalent in certain groups. The objective of this study was to determine the frequency of tinea pedis and its predisposing factors in the military recruits. Material & Methods: This cross-sectional study was conducted at Combined Military Hospital, D.I.Khan, from March 2012 to September 2012. A random sample of 350 individuals was selected out of individuals who were undergoing initial military training. Clinical examination, microscopic examination of scrapings from suspected lesions to see fungal hyphae and subsequent culture was done for species identification. Findings were recorded on a performa. Data was analyzed using SPSS version 10.0. Results: The mean age of subjects was 18.57±1.02 (16-23) years. On clinical examination tinea pedis was suspected in 34 (9.71%) out of 350 subjects. A total of 10 (2.8%) individuals were found to have positive fungal hyphae while 14 (4%) were culture positive for trichophyton. Out of 14 positive cultures, 8 yielded growth of Trichophyton mentagrophytes, 5 Trichophyton interdigitale and one yielded Trichophyton rubrum. Predisposing factors were occlusive footwear for >8 hours/ day in (96%), history of excessive sweating in (7.7%), history of fungal infection of feet during last 6 months in (3.4%) and fungal infection of nails during the last 6 months in (2.8%). Conclusion: The prevalence of tinea pedis in Pakistani military recruits is low. Occlusive footwear for more than 8 hours a day is the major risk factor . Excessive sweating and history of previous fungal infection are also risk factors. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections are one of the most common infections especially in young adults and pregnant women. Due to increase in fluoroquinolones use, empirical therapy in uncomplicated urinary tract infections with this group is now controversial. In recent years, fosfomycin has emerged as an economical and effective single dose agent in uncomplicated urinary tract infections. The objective of this study was to evaluate the in-vitro sensitivity of fosfomycin against various urinary isolates. Material & Methods: This descriptive laboratory based study was carried out at the Department of Pathology, Combined Military Hospital, Dera Ismail Khan. A total of 120 clinical isolates cultured from urine specimens were processed from July 2012 through February 2013. All the isolates were checked for their susceptibility testing against fosfomycin and other routine antibiotics used for urinary pathogens. Results: Out of total 120 urinary isolates, percentages of sensitivities of fosfomycin against Escherichia coli, Klebsiella pneumoniae, Pseudomonas spp, Proteus spp, Enterobacter spp, Enterococcus spp, and Staphylococcus aureus were 97.2, 63.6, 80, 87.5, 71.4, 83.3, and 80% respectively. Conclusion: Our study suggests that fosfomycin has reasonably good in-vitro activity against common urinary isolates. Therefore it can reliably be used in uncomplicated urinary tract infections as empirical therapy. However, further studies are needed on larger specimen size to support our evidence. [ABSTRACT FROM AUTHOR]

Background: To determine the frequency and resistance pattern of Mycobacterium tuberculosis in our settings. Methods: This study was carried out in Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from January 2007 through December 2009. A total of 4159 specimens were received during the three years study period. All specimens were cultured on conventional LJ medium, BACTEC 460 system and fully automated MGIT 960 system. Sensitivity testing was performed on BACTEC 460 and MGIT 960 system. Results: Most of the specimens were received from hospitalized patients. Out of total 4159 specimens, 693 were culture positive and out of them 262 were multi drug resistant (MDR). Percentage of MDR isolates in 2007 till 2009 were 33, 42.1 and 40.4% respectively in AFIP. Maximum number of MDR isolates was recovered in 2008. Conclusion: The rising pattern of MDR tuberculosis is of great concern. There is an urgent need for the early diagnosis, drug susceptibility testing and isolation of patients with MDR tuberculosis. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae has played an important role as a cause of infection in the neonatal high risk units around the globe. The widespread use of broad-spectrum antibacterial agents has led to an increase in the emergence of resistance to broad-spectrum cephalosporins and carbapenems. We report an outbreak caused by a strain of Klebsiella pneumoniae that was susceptible only to ciprofloxacin and tigecycline and that affected neonates hospitalized in neonatal intensive care unit of Combined Military Hospital Rawalpindi during October 2010. Outbreak investigation was carried to find out the possible source of infection which turned out to be suction tubing of resuscitation table, emergency tray and scissors. The outbreak was resolved by temporarily closing down the nursery and using remedial measures such as disinfection, reinforcing the use of antiseptic techniques and timely treatment of neonates with ciprofloxacin. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative otitis media is a common infectious disease. The micro-organisms commonly associated with it and their antibiotic sensitivity pattern is important for its treatment. This study was conducted to identify the common microorganisms involved and their antibiotic sensitivity pattern in patients with chronic suppurative otitis media. Material & Methods: This descriptive study was carried out from January 2011 to August 2011 at Department of ENT, DHQ Teaching Hospital and Microbiology Department, CMH, D.I.Khan. A total of 190 patients with unilateral or bilateral active chronic suppurative otitis media attending the out patient clinic were included in the study. Pus samples were collected from the discharging ears and sent for microbiology. Results: From 190 specimens, 174(91.6%) were positive, and 16(8.4%) culture negative. There were 167(87.9%) bacterial isolates and 7(3.7%) fungi. Pseudomonas aeruginosa 80(45.9%) was the dominant isolate, followed by Staphylococcus aureus 46(26.4%) including 10 isolates of Methicillin resistant Staphylococcus aureus (MRSA). Antibiotic sensitivity pattern of Pseudomonas aeruginosa showed that piperacillin/tazobactum was active against 100% isolates of Pseudomonas aeruginosa and all Staphylococcus aureus except MRSA. Conclusion: Pseudomonas aeruginosa is the most common isolate followed by Staphylococcus aureus from the culture specimens of chronic otitis media. Both of these are sensitive to tazocin except MRSA. Pseudomonas aeruginosa is increasingly becoming more resistant to the commonly used antibiotics like quinolones. [ABSTRACT FROM AUTHOR]