Nazish Fatima

Mediastinal hydatid cyst rupturing into the pleural cavity associated with pneumothorax: case report and review of the literature.

Hydatid disease remains a serious health problem in Mediterranean countries. Living in a rural area is an important risk factor for the disease. Hydatid cysts are usually located in the liver, lungs and brain. Mediastinal hydatid disease is very rare and has been noted only anecdotally in the literature. The present article reports a case of a mediastinal hydatid cyst rupturing into the pleural cavity, which was associated with pneumothorax of the same side. The patients previous chest x-rays (posteroanterior and left lateral views) showed a well-defined mediastinal mass on the left side, and contrast-enhanced computed tomography of the thorax (taken a few days after the chest x-ray) showed multiple round-to-oval soft tissue opacities with partial collapse of the left lung. An indirect hemagglutination test for echinococcus was positive. Even after two weeks of intercostal tube drainage, the patients condition did not improve. During thoracotomy, multiple daughter cysts were found in the pleural cavity, and the diagnosis of a hydatid cyst was confirmed after histopathological examination.

Profile of Fungal Lower Respiratory Tract Infections and CD4 Counts in HIV Positive Patients

One hundred and sixty symptomatic confirmed human immunodeficiency virus (HIV)-positive patients, of both sexes with lower respiratory tract infection were taken as a study population, and the clinicomycological profile was correlated with the immunological status of the patients with particular reference to CD4 counts. Relevant samples were collected and subjected to direct microscopy, fungal culture and antigen detection.

Rapid development of IRIS in the form of cryptococcal meningitis after beginning ART

Around one fourth of patients infected with human immunodeficiency virus (HIV) and given antiretroviral therapy (ART) experience inflammatory or cellular proliferative disease associated with a preexisting opportunistic infection. Many such infections are subclinical or quiescent before the patient begins ART. Cryptococcal immune reconstitution inflammatory syndrome may present as a clinical deterioration or new presentation of cryptococcal disease following initiation of antiretroviral therapy (ART) and is believed to be caused by recovery of Cryptococcus-specific immune responses. In the following report we present a case of expeditious developed IRIS in the form of cryptococcal meningitis.

Changes in serum levels of TNF-α & IL-4 among new, under-treatment & MDR TB patients.

Introduction: Tuberculosis (TB) remains a significant public health problem with an estimated onethird of the world’s population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at cellular level. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. This study was aimed to evaluate the levels of TNF-α & IL4 in new, underOriginal Research Article Fatima et al.; BMRJ, 7(4): 159-166, 2015; Article no.BMRJ.2015.107 160 treatment (UT) and multidrug resistant (MDR) pulmonary and extra-pulmonary cases. Methodology: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Levels of TNF-α and IL-4 were measured in 76 serum samples from TB patients by ELISA kit (Diaclone France) along with 10 BCG vaccinated control. A complete clinical, radiological & treatment data was collected on questionnaire forms of each patients. Results: TNF-α levels were elevated in new (P 0.05). TNF-α and IL-4 levels showed no significant variations according to site of involvement in pulmonary vs. extra-pulmonary TB cases. Conclusion: An understanding of the development of this response may lead to insight into pathogenesis and novel therapies for TB.

A Clinico-Mycological Study of Superficial Mycoses from a Tertiary Care Hospital of a North Indian Town

Introduction: Superficial mycoses refer to the diseases of skin and its appendages caused by fungi. Aims & Objectives: The present study was undertaken to find out the prevalence of different clinical types of Dermatomycoses including Dermatophytes, candida spp. and dermatomycotic mold infections of skin and its appendages and their etiological agents in and around Aligarh region of Northern India. Material and Methods: The study was conducted at the Department of Microbiology, JNMC,AMU, Aligarh, during the period of July 2011-July 2013. A total of 425 samples were collected including skin, nail and hair for a period of 5 years. Skin, nail scraping and clippings of infected hair from patients were collected. The samples were subjected to direct microscopy and culture. Results: Out of 425 samples, Dermatophytoses was manifested clinically more in the males between the age of 11-30 years. In our study, KOH positivity rate was 61.2% and culture positivity rate was 58.8%. 18.8% of samples were culture positive alone; while, 21.2% of specimens were positive on direct microscopy alone. Dermatophytoses was the commonest superficial fungal infection in 123 cases 28 (9.5%), followed by Dermatomycotic molds in 32 (7.2%) and candidiasis in 15 (3.5%). T.rubrum was the predominant pathogen followed by T. mentagrophytes. Conclusions: It is concluded that along with Dermatophytes, non-dermatophytic fungi are also emerging as an important cause of superficial mycoses.

Necessity of detection of extended spectrum beta-lactamase, AmpC and metallo-beta-lactamases in Gram-negative bacteria isolated from clinical specimens

Background: With increasing incidence of resistance to antibiotics carbapenems are used as the last resort because they are stable even in response to extended spectrum and AmpC beta-lactamases. However, Gram-negative bacilli producing the acquired metallo-beta-lactamases (MBL) are on the rise. Aim: The aim of the following study is to detect phenotypically the presence of extended spectrum beta-lactamase (ESBL), AmpC and MBL in Gram-negative bacteria isolated from clinical specimen. Materials and Methods: Gram-negative isolates from clinical samples were screened and confirmed for the presence of ESBLs by double disk synergy test (DDST), for AmpC by disk approximation assay and for MBL by Modified Hodge Test and imipenem-ethylenediaminetetraacetic acid DDST. Results: Among 251 isolates studied, 138 (54.98%) were ESBL producers, 49 (19.52%) were AmpC producers and 45 (17.93%) were MBL producers. Highest rates of ESBL detection was by Cefoperazone sulbactam (109/138) 78.98%. Out of 92 of the AmpC producing strains 20 (21.73%) were inducible and 72 were stably derepressed (78.26%). Out of 251 strains studied 45 (17.93%) were phenotypically identified as MBL producers, the highest no. being of Pseudomonas aeruginosa. Among the methods employed for detection of MBL production, Hodge test (62.22%) proved better than DDST (40%). Conclusions: High level of antibiotic resistance pattern exists in various clinical isolates. ESBL production should be looked for routinely in Gram-negative bacteria other than Escherichia coli and Klebsiella. A high percentage of derepressed AmpC mutants are noteworthy and alarming. We recommend phenotypic identification methods as routine practice in laboratories as genotypic methods are not cost-effective.

Aspergillus colonization in patients with bronchogenic carcinoma

Background Aspergillus antigens such as galactomannan antigen, a cell wall polysaccharide, can be detected in patient’s serum or bronchoalveolar lavage. To study the prevalence of Aspergillus infection in patients with bronchogenic carcinoma, we measured galactomannan antigen in serum and bronchoalveolar lavage samples of patients with bronchogenic carcinoma. Methods The study was conducted on 45 bronchogenic carcinoma patients. The diagnosis of lung cancer was confirmed by bronchoscopy, histopathological and radiological examinations. Bronchoalveolar lavage fluid collected from each patient by fiberoptic bronchoscopy was subjected to direct microscopy and culture on Sabouraud’s dextrose agar and Czapek-Dox agar, and Aspergillus galactomannan antigen was measured in serum and bronchoalveolar lavage samples. Results The majority of patients were male (93.3%) in the age group 51–60 years, 88.9% were addicted to gutka chewing, and 82.1% were addicted to smoking. Most patients complained of cough (73%) and shortness of breath (51.1%). Squamous cell carcinoma (64.4%) was the most common malignancy, followed by adenocarcinoma (13.3%). On culture of bronchoalveolar lavage samples, 35.5% showed growth of Aspergillus spp. (Aspergillus fumigatus in 17.8%, Aspergillus flavus in 13.3%, and Aspergillus niger in 4.4%). Galactomannan antigen was detected in 58.3% of bronchoalveolar lavage samples and 47.2% of serum samples. Conclusions There is a high prevalence of aspergillosis in patients with lung carcinoma, especially among smokers and gutka chewers.

Evaluation of genotype MTBDRplus line probe assay in detection of rifampicin and isoniazid resistance in comparison to solid culture drug susceptibility testing in a tertiary care centre of western Uttar Pradesh

Background: Isoniazid (INH) and rifampicin (Rif) are the key first-line antituberculosis drugs, and resistance to these drugs i.e., multi-drug-resistant tuberculosis (MDR-TB), is likely to result in treatment failure and poor clinical outcomes. India has the highest burden of TB and MDR-TB in the world, disproportionately high even for Indias population. The GenoType® MTBDRplus molecular method allows rapid detection of Rif and INH resistance. Aim: The present study was done to compare the performance of line probe assay test (GenoType® MTBDRplus) with solid culture method for an early diagnosis of MDR-TB. Methods: Totally 1503 sputum samples of MDR-TB suspects were subjected to fluorescent microscopy. Decontamination was done by N-acetyl-L-cysteine and sodium hydroxide method. Fluorescent microscopy-positive samples were subjected to GenoType® MTBDRplus (HAIN Lifescience) assay. Sixty-two random samples were compared with phenotypic drug susceptibility testing (DST) (1% proportion method) using solid culture method by Lowenstein–Jensen media. Results: The sensitivity, specificity, positive predictive value and negative predictive value for detection of resistance to Rif were 94.74%, 95.35%, 90% and 97.62% and to INH were 92.00%, 91.89%, 88.46% and 94.44%, respectively, in comparison with the phenotypic DST. Conclusion: GenoType® MTBDRplus has good sensitivity and specificity in detecting MDR-TB cases with a significantly lesser turnaround time as compared to conventional DST method and simultaneous detection of Rif and INH resistance. This technique saves several weeks of time required for culture and DST.

Alteration of serum inflammatory cytokines in active pulmonary tuberculosis, following antitubercular treatment

Introduction: Mycobacterium tuberculosis (Mtb) infects one third of the world population. Despite advance in therapy, tuberculosis (TB) remains responsible for 2-3 million deaths annually. During TB, cytokines play a role in host defense. Many cytokines are produced during TB with a predominance of Th1 cytokines during the early stage and Th2 cytokines in the later stages of the infection. The present study aims to screen tumor necrosis factor-alpha (TNF-α), interferon gamma (IFN-γ), interleukin (IL)-12p70, IL-4, IL-6, and IL-1β among TB patients and controls. Materials and Methods: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Different cytokine levels were measured in 65 samples of TB patients of whom 30 (46.1%) were new TB cases and 35 (53.8%) were suspected multidrug-resistant (MDR)-TB cases along with 15 bacille Calmette-Guérin (BCG) vaccinated healthy controls by enzyme-linked immunosorbent assay (ELISA) (Diaclone, France). Complete clinical, radiological, and treatment data were collected. Informed consent was taken from all subjects. Study was approved by the Institutional Bioethical Committee, Jawahar Lal Nehru Medical College. Statistical analysis had been performed by using Sigma plot (10.0). Results: The serum concentration of TNF-α, IFN-γ, IL-12p 70 , IL-1β, and IL-6 in patients with active TB and MDR-TB was elevated than in patients after anti-TB treatment (P < 0.001), in contacts (P < 0.001) and in controls (P < 0.001). It was found that IL-6 seems critical in resistance to TB. IL-4 concentration increased only in MDR-TB patients (P < 0.001) as compared to controls. All these cytokines showed no significant variations according to the site of involvement in pulmonary versus extrapulmonary TB cases. Conclusions: Measuring the serum levels of several cytokines may be useful for evaluating the activity of TB disease and monitoring the clinical effects of anti-tubercular treatment (ATT). The serum TNF-α, IFN-γ, IL-12p 70 , IL-1β and IL-6 level can be a useful marker to diagnose the effectiveness of therapy in the patients.