Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 8 Articles
Background: Lack of rapid and reliable susceptibility testing for second-line drugs used in the treatment of\r\nmultidrug-resistant tuberculosis (MDR-TB) may limit treatment success.\r\nMethods: Mycobacterium tuberculosis isolates from patients referred to Kibong�oto National TB Hospital in Tanzania\r\nfor second-line TB treatment underwent confirmatory speciation and susceptibility testing. Minimum inhibitory\r\nconcentration (MIC) testing on MYCOTB Sensititre plates was performed for all drugs available in the second-line\r\nformulary. We chose to categorize isolates as borderline susceptible if the MIC was at or one dilution lower than\r\nthe resistance breakpoint. M. tuberculosis DNA was sequenced for resistance mutations in rpoB (rifampin), inhA\r\n(isoniazid, ethionamide), katG (isoniazid), embB (ethambutol), gyrA (fluoroquinolones), rrs (amikacin, kanamycin,\r\ncapreomycin), eis (kanamycin) and pncA (pyrazinamide).\r\nResults: Of 22 isolates from patients referred for second-line TB treatment, 13 (59%) were MDR-TB and the\r\nremainder had other resistance patterns. MIC testing identified 3 (14%) isolates resistant to ethionamide and\r\nanother 8 (36%) with borderline susceptibility. No isolate had ofloxacin resistance, but 10 (45%) were borderline\r\nsusceptible. Amikacin was fully susceptible in 15 (68%) compared to only 11 (50%) for kanamycin. Resistance\r\nmutations were absent in gyrA, rrs or eis for all 13 isolates available for sequencing, but pncA mutation resultant in\r\namino acid change or stop codon was present in 6 (46%). Ten (77%) of MDR-TB patients had at least one\r\nmedication that could have logically been modified based on these results (median 2; maximum 4). The most\r\ncommon modifications were a change from ethioniamide to para-aminosalicylic acid, and the use of higher dose\r\nlevofloxacin.\r\nConclusions: In Tanzania, quantitative second-line susceptibility testing could inform and alter MDR-TB\r\nmanagement independent of drug-resistance mutations. Further operational studies are warranted....
Background: Tuberculosis continues to be one of the leading causes of death worldwide and in the American\r\nregion. Although multidrug-resistant tuberculosis (MDR-TB) remains a threat to TB control in Panama, few studies\r\nhave focused in typing MDR-TB strains. The aim of our study was to characterize MDR Mycobacterium tuberculosis\r\nclinical isolates using PCR-based genetic markers.\r\nMethods: From 2002 to 2004, a total of 231 Mycobacterium tuberculosis isolates from TB cases country-wide were\r\nscreened for antibiotic resistance, and MDR-TB isolates were further genotyped by double repetitive element PCR\r\n(DRE-PCR), (GTG)5-PCR and spoligotyping.\r\nResults: A total of 37 isolates (0.85%) were resistant to both isoniazid (INH) and rifampicin (RIF). Among these 37\r\nisolates, only two (5.4%) were resistant to all five drugs tested. Dual genotyping using DRE-PCR and (GTG)5-PCR of\r\nMDR Mycobacterium tuberculosis isolates revealed eight clusters comprising 82.9% of the MDR-TB strain collection,\r\nand six isolates (17.1%) showed unique fingerprints. The spoligotyping of MDR-TB clinical isolates identified 68% as\r\nmembers of the 42 (LAM9) family genotype.\r\nConclusion: Our findings suggest that MDR Mycobacterium tuberculosis is highly clustered in Panama�s metropolitan\r\narea corresponding to Panama City and Colon City, and our study reveals the genotype distribution across the country....
diseases and their transmission, however statements of incubation period in the literature are often uncited,\r\ninconsistent, and/or not evidence based.\r\nMethods: In a systematic review of the literature on five enteric viruses of public health importance, we found 256\r\narticles with incubation period estimates, including 33 with data for pooled analysis.\r\nResults: We fit a log-normal distribution to pooled data and found the median incubation period to be\r\n4.5 days (95% CI 3.9-5.2 days) for astrovirus, 1.2 days (95% CI 1.1-1.2 days) for norovirus genogroups I and II, 1.7 days\r\n(95% CI 1.5-1.8 days) for sapovirus, and 2.0 days (95% CI 1.4-2.4 days) for rotavirus.\r\nConclusions: Our estimates combine published data and provide sufficient quantitative detail to allow for these\r\nestimates to be used in a wide range of clinical and modeling applications. This can translate into improved prevention\r\nand control efforts in settings with transmission or the risk of transmission....
Background: The screening of both healthcare workers and students attending teaching hospitals for latent\r\ntuberculosis infection (LTBI) is recommended in hospitals of many countries with a low-incidence of TB, including\r\nItaly, as a fundamental tool of tuberculosis (TB) control programs. The aim of the study was to estimate the\r\nprevalence of LTBI and evaluate the main risk-factors associated with this condition in a cohort of healthcare Italian\r\nstudents.\r\nMethods: In a cross-sectional study, performed between January and May 2012, 881 undergraduate students\r\nattending the Medical, Nursing, Pediatric Nursing and Midwifery Schools of the University of Genoa, trained at the\r\nIRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the Tuberculin Skin Test (TST).\r\nAll the TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis\r\nof LTBI. A standardized questionnaire was collected for risk-assessment analysis.\r\nResults: Seven hundred and thirty-three (83.2%) subjects underwent TST testing. The prevalence of TST positives\r\nwas 1.4%, and in 4 (0.5%) out of 10 TST positive cases LTBI diagnosis was confirmed by IGRA. No difference in the\r\nprevalence of subjects who tested positive to TST emerged between pre-clinical (n = 138) and clinical (n = 595)\r\nstudents. No statistically significant association between TST positivity and age, gender, and BCG vaccination was\r\nobserved. The main independent variable associated with TST positivity was to be born in a country with a high TB\r\nincidence (i.e., =20 cases per 100,000 population) (adjusted OR 102.80, 95% CI 18.09-584.04, p < 0.001).\r\nConclusions: The prevalence of LTBI among healthcare students resulted very low. The only significant association\r\nbetween TST positivity and potential risk factors was to be born in high TB incidence areas. In countries with a low\r\nincidence of TB, the screening programs of healthcare students before clinical training can be useful for the early\r\nidentification and treatment of the sporadic cases of LTBI....
Background: Population based prevalence survey is an important epidemiological index to measure the burden of\r\ntuberculosis (TB) disease and monitor progress towards TB control in high burden countries like Ethiopia. This study\r\nwas aimed to estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) in the Tigray\r\nregion of Ethiopia.\r\nMethods: Sixteen rural and urban villages were randomly selected in a stratified multistage cluster\r\nsampling. Individuals aged 15 years and older were screened by symptom inquiry for PTB. Those individuals\r\nwho were symptomatic of PTB provided two sputum samples for smear microscopy, culture and molecular\r\ntyping.\r\nResults: The study covering 4,765 households screened a total of 12,175 individuals aged 15 years and above. The\r\noverall weighted prevalence of bacteriologically confirmed PTB in the Tigray region of Ethiopia was found to be 216/\r\n100,000 (95% CI: 202.08, 230.76) while the weighted prevalence of smear-positive PTB was 169/100,000 (95% CI: 155.53,\r\n181.60). The prevalence of bacteriologically confirmed TB was higher amongst males (352/100 000; 95% CI: 339.05,\r\n364.52) than females (162/100 000; 95% CI: 153.60, 171.17) and among rural (222/100,000; 95% CI: 212.77-231.53) as\r\ncompared to urban residents (193/100,000; 95% CI: 183.39-203.59).\r\nConclusions: This study found a relatively higher prevalence smear-positive PTB in the region than in a same period\r\nnationwide survey and identified a significant number of undetected PTB cases. The urgency for improved TB case\r\ndetection and intensified community awareness is emphasized....
The alarming fact is that the average extent of inpatient admissions was decreased while the occurrence of nosocomial infections was increased. Nosocomial infections are imperative health problem and the knowledge and practices of the health care professionals about nosocomial infection and their prevention play a vital role in declining the rate of these infections. Descriptive study was conducted in the Rajiv Gandhi Institute of Medical Sciences for the period of one month to assess the knowledge of health care professionals regarding these infections and their prevention. Data was collected with the help of questionnaire. Formal administrative permission was obtained wherever required. 82 members were eligible to participate in study, in which 51 were doctors from diverse departments, 24 were nurses and 7 were pharmacists. It was found that health care professionals have weak knowledge about commonly occurring blood born nosocomial infections and its prevention. The study made known that the health care professionals had adequate knowledge regarding nosocomial infections and its prevention but firm weaknesses were pragmatic. The teaching of hospital personnel is an essential element in the prevention and control of nosocomial infections....
Background: Physicians depend on reliable information on the local epidemiology of infection and antibiotic\r\nresistance rates to guide empiric treatment in critically ill patients. As these data are scarce for Central Africa, we\r\nperformed a retrospective analysis of microbiological findings from a secondary care hospital in Gabon.\r\nMethods: Microbiological reports from 2009 to 2012 were used to assess the non-susceptibility rates of the three\r\nmost common isolates from six major types of infections (bloodstream, ear-eye-nose-throat, surgical site, skin and\r\nsoft tissue, urinary tract and wound infection).\r\nResults: A high diversity of pathogens was found, but Staphylococcus aureus was predominant in the majority of\r\ninfections. Overall, the three most prevalent pathogens in children were S. aureus (33.7%), Streptococcus pyogenes (8.1%)\r\nand Escherichia coli (4.5%) and in adults S. aureus (23.5%), E. coli (15.1%) and Klebsiella pneumoniae (7.4%). In total, 5.8%\r\n(n = 19) of all S. aureus isolates were methicillin resistant. The proportion of extended-spectrum beta-lactamase (ESBL)\r\nproducing Enterobacteriaceae was 15.4% (n = 78), 49.4% of all K. pneumoniae were ESBL-producer (n = 42).\r\nConclusion: The high diversity of potential pathogens and high resistance rates in Gram-negative bacteria challenge a\r\nrational empiric use of antibiotics. Countrywide continuous sentinel surveillance is therefore urgently needed...
A urinary tract infection is an infection can occur anyplace along the urinary tract and caused by bacteria such as E.coli. It is the most common infectious diseases; nearly 10% of people will experience a urinary tract infection during their lifetime. It had been estimated that about six million patients visit outpatient departments and about 300,000 are treated in the wards every year worldwide. Around, 10% of human population gets urinary tract infections at some stage during their lives. It is more common in females as compared to males. Ineffectively treated urinary tract infections may lead to significant morbidity and even mortality. The choice of treatment for complicated urinary tract infections is antibiotics. In all cases of urinary tract infections, empirical antimicrobial treatment starts before the laboratory results of urine culture are available; consequently antibiotic resistance may increase in uropathogens due to frequent use of antibiotics. It was necessary to have knowledge of distribution of uropathogens and their susceptibility to antibiotics. The present review concluded that urinary tract infections are caused by E.coli, mainly encountered in the age group of 22-49 years and higher rate was observed in females. Higher susceptibility to imipenam, cefotaxim and ciprofloxacin....
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