Antibiotic resistance and cagA gene correlation:A looming crisis of Helicobacter pylori

AIM:To determine antibiotic resistance of Helicobacter pylori(H.pylori) in Pakistan and its correlation with host and pathogen associated factors.METHODS:A total of 178 strains of H.pylori were isolated from gastric biopsies of dyspeptic patients.Susceptibility patterns against first and second-line antibiotics were determined and trends of resistance were analyzed in relation to the sampling period,gastric conditions and cagA gene carriage.The effect of cagA gene on the acquisition of resistance was investigated by mutant selection assay.RESULTS:The observations showed that monoresistant strains were prevalent with rates of 89% for metronidazole,36% for clarithromycin,37% for amoxicillin,18.5% for ofloxacin and 12% for tetracycline.Furthermore,clarithromycin resistance was on the rise from 2005 to 2008(32% vs 38%,P = 0.004) and it is significantly observed in non ulcerative dyspeptic patients compared to gastritis,gastric ulcer and duodenal ulcer cases(53% vs 20%,18% and 19%,P = 0.000).On the contrary,metronidazole and ofloxacin resistance were more common in gastritis and gastric ulcer cases.Distribution analysis and frequencies of resistant mutants in vitro correlated with the absence of cagA gene with metronidazole and ofloxacin resistance.CONCLUSION:The study confirms the alarming levels of antibiotic resistance associated with the degree of gastric inflammation and cagA gene carriage in H.pylori strains.

Microbial Agents Responsible for Diarrheal Infections in Flood Victims: A Study from Karachi, Pakistan

The present study was aimed to determine the frequency of water borne diarrheal infections and gastroenteritis in two of the flood affected camps of Karachi and nearby areas. Each year approximately, 579,732 people are adversely affected by this phenomenon, putting Pakistan 9th in terms of flood-affected countries worldwide. Patients and Methods: All patients suffering from diarrhea (more than 3 stools per day for the last 2 days), abdominal pain, vomiting or fever who were residing in the camps were included in the study. After taking consent, a fresh stool sample for D/R and C/S, and 5 ml of venous blood sample for CP and ALT and other viral markers were collected from each patient suffering from any of the symptoms like jaundice, diarrhea, vomiting, fever and abdominal pain during past 2-3 days. Direct microscopy of the stools was done to see any protozoal or bacterial infection. Culture of stool was also set up simultaneously. Hemoglobin % age was noted for each patient. Serology of Hepatitis E and A virus using ELISA (Anti HEV-IgM, and anti HAV IgM) was done in those with more than 2 times raised ALT level. Results: A total of 500 samples collected from refugee camps of flood affected areas near Karachi were included in this study. All patients were mal nourished, having below normal Hb% ages, and were suspected cases or patients of diarrhea with elevated ALT (Alanine Transaminase) values. Occult blood was found positive in 40% (200) specimens;protozoa were also seen i.e., trophozoit stage of Giardia lamblia in 45% (225) of specimens;Entamoeba coli in 95% (475) and Balantidium coli in 20% (100) of stool specimens, while cyst forms of Entamoeba histolytica were present in 35% (175) specimens. Bacteriological analysis showed high bacterial prevalence of E. coli with 63% (315), followed by Enterobacter specie with 55% (275), then 20% (100) and 12% (60) of Klebseilla oxytoca and Klebseilla pneumoniae respectively. Proteus vulgaris and Citrobacter freundii found in the same ratio of 8% (40, 39) with 2% (10) specimens of no microbial growth. Overall <0.05 P value and 95% of confidence interval level was observed. Further serological evidences for water associated viral hepatitis revealed 4% (20) positive specimens for anti-HEV IgM antibodies, and 2.6% (13) positive specimens of anti-HAV IgM antibodies. Conclusion: The present study reveals the presence of HEV and HAV associated viral diarrhea along with the presence of protozoal and bacterial infections in the flood relief camps. It is suggested that there is a strong need of natural disaster associated awareness program for general population in order to minimize the mortality and morbidity ratio associated with diseases, which can be easily controlled by managing proper sanitary conditions and supply of safe and clear water.

Hepatitis C Status in Karachi, Pakistan, a Five-Year Survey at Civil Hospital, Karachi, Pakistan

Hepatitis C virus is associated with Hepatitis C which can be acute or chronic. Acute hepatitis C is usually short term illness that can lead to chronic infection, while chronic hepatitis C is a chronic liver disease leading to cirrhosis, hepatocellular carcinoma and even death. The mode of transmission is mainly parenteral and vertical. Hepatitis C is the leading cause of morbidity and mortality and a serious public health problem, worldwide as well as in Pakistan. There is no vaccine available for hepatitis C so the only way to prevent hepatitis C is by changing behaviors which can spread the disease. Pakistan is also facing a huge burden of this disease. In Pakistan, the frequency of hepatitis C virus infection ranges from 8% - 15% in the general population with variations in different parts of the country. The general method of detecting infection with HCV is to observe the presence of antibodies to the virus. The aim of this study was to determine frequency of hepatitis C among general population and to see the increasing frequency in our part. Selection of Patients: All patients visiting outpatient clinics, Hepatitis clinic and indoor patients at Civil Hospital Karachi, Pakistan from January 1, 2010 to December 31, 2014 were screened for anti HCV. Methods: Blood samples were collected from the patients in Red Topped vaccutainers and allowed to clot, then centrifuged and serum was screened for anti HCV by Immunochromatography (ICT) method. Results: A total of 156,990 patients were screened for anti-HCV, 23,511 (14.98%) patients were reported positive. During the year 2010, total 11,058 patients were screened for anti HCV, 1791 (16%) were positive, while in the year 2011 total 26,921 were screened and 3908 (14.5%) were positive, during the year 2012, total 23,321 were screened, 3036 (14%) were positive, in the year 2013 we screened total 40,483 patients 6070 (15%) were positive, while in 2014, total 55,484 patients were screened and 8584 were positive (15.5%). The most affected age group is between 21 - 40 years and males are affected more than females. Conclusion: Hepatitis C in increasing in our population affecting the young generation between the age of 21 - 40 years and male population is affected more than females so a mass screening is needed to know the exact position of the disease as well as awareness programs should be started using media.

Inevitability of an Enhanced Monitoring Strategy to Reduce Water Borne Illness Combining Indicators of Sanitary Protection and Measuring Water Quality

Background: Diarrhoea is the second leading cause of childhood mortality in children under five years old. Water is a major contributing risk factor for this disease that is a common illness and a global killer. Material and Methods: Water samples from different areas of Karachi were collected and were processed by MPN technique to evaluate the presence of microbiological substances. Results: Out of the processed samples, 64% were positive for the presence of mix enteric pathogen from different areas of Karachi;from Bhens colony, 74% were positive for the presence of fecal coli forms, among which 4% were positive for EHEC isolated from storage tank and water tank. Conclusion: The abovementioned results reflect the presence of organisms of public health importance in different sources of drinking water. According to WHO guidelines, there should be zero tolerance of these organisms in water.

A Survey on Biosafety Practices in Lab Personnel in 12 Selected Areas of Karachi,Pakistan

The objective of this study was to realize the degree of biosafety precautions and measures recorded among different Private Hospitals and Diagnostic labs personnel situated in different areas of Karachi,Pakistan.One thirty two private hospital based laboratory technicians were selected from all 12 selected areas in Karachi.The laboratory technicians were interviewed then a survey form was completed by the interviewer.The survey was conducted in 3 months duration from May 2017 to July 2017.The total number of members in this study was 132,of which 85 were males and 47 were females.Results presented that 65%of the laboratory technicians did not use any type of PPE and 35%of the respondents recapped used syringes frequently while 25%recapped occasionally.For avoiding the reuse of syringes,Pakistani governments recommend that they be cut before discarding;however,only 65%of the respondents followed the given procedure.Even though mouth pipetting is considered outdated,45%of the technicians continue to do so for numerous purposes.Results of this survey established an absence of awareness about good and proper lab practices and lab biosafety measures among lab technicians in Karachi,Pakistan.