Nasopharyngeal Carriage and Antibiotic Resistance of Haemophilus Influenzae, Streptococcus Pneumoniae and Moraxella Catarrhalis
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86 Indian Journal of Medical Microbiology vol. 27, No. 1 BD for 4 weeks. He responded well to treatment and became The Indian subcontinent has been plagued by resistance afebrile after 10 days, with marked regression in the size of to classical antileishmanial drugs and the approval of the liver and spleen. Repeat investigations performed after miltefosine in this regard has been a signiÞ cant milestone in 8 weeks showed near normal haemogram, normal liver the treatment due to ease of administration, few toxic effects function tests and normal size portal vein on ultrasound and and excellent cure rate.[4,5] the bone marrow smear became negative for LD bodies. IFAT titre (1:400) and proteinuria (476 mg/24 h) decreased References signiÞ cantly. 1. Prakash A, Singh NP, Sridhara G, Malhotra V, Makhija A, Garg D, et al. Visceral leishmaniasis masquerading as chronic Our patient had evidence suggestive of signiÞ cant liver liver disease. J Assoc Physicians India 2006;54:893-4. disease in view of hepatosplenomegaly, elevated serum 2. Aggarwal P, Wali JP, Chopra P. Liver in kala-azar. Indian J alkaline phosphatase, marked hypoalbuminaemia, impaired Gastroenterol 1990;9:135-6. PT/aPTT, transudative ascites and ultrasonographic evidence 3. Salgado Filho N, Ferreira TM, Costa JM. Involvement of the of hepatosplenomegaly, ascites and borderline portal renal function in patients with visceral leishmaniasis (kala hypertension along with deÞ nitive evidence of Kala-azar. azar). Rev Soc Bras Med Trop 2003;36:217-21. Most of these Þ ndings did revert after successful treatment 4. Sundar S, Jha TK, Thakur CP, Engel J, Sindermann H, Fischer C, et al. Oral miltefosine for Indian visceral leishmaniasis. N with oral miltefosine. Engl J Med 2002;347:1739-46. Although liver involvement is not unusual in Kala- 5. Bhattacharya SK, Sinha PK, Sundar S, Thakur CP, Jha TK, Pandey K, et al. Phase 4 trial of miltifosine for the treatment azar, presentation as cirrhosis, portal hypertension and of Indian visceral leishmaniasis. J Infect Dis 2007;196:591-8. chronic liver disease is always a curiosity. Extensive literature search revealed only one case report with R Avasthi, *SC Chaudhary, S Khanna visceral leishmaniasis along with histological evidence of leishmanial hepatitis and portal hypertension.[1] On Department of Medicine, University College of Medical the contrary, a series of 60 Kala-azar cases did not have Sciences (University of Delhi) and GTB Hospital, any case of chronic liver disease, although one quarter Delhi-110 095, India [2] of the patients had biochemical evidence of hepatitis. *Corresponding author Our patient also had non-nephrotic range proteinuria at (email: <[email protected]>) the time of diagnosis, which is a common Þ nding usually Received: 10-03-2008 reported as a late complication.[3] Accepted: 11-05-2008 Nasopharyngeal Carriage and Antibiotic Resistance of Haemophilus infl uenzae, Streptococcus pneumoniae and Moraxella catarrhalis in Healthy School Children in Turkey Dear Editor, on chocolate agar supplemented with 19.8 U/mL bacitracin for the selective isolation of H. inß uenzae. The capsular The nasopharyngeal colonization of Haemophilus typing of H. inß uenzae was done by slide agglutination inß uenzae, Streptococus pneumoniae and Moraxella with type-speciÞ c antiserums a to f (Difco, Detroit, USA). catarrhalis is a basic condition for the development of Susceptibility testing was performed by the agar dilution [1-3] community-acquired respiratory tract infections. As the method according to NCCLS standards.[4] The production surveillance of nasopharyngeal carriage of resistant strains of β-lactamase was detected by a nitroceÞ n disc (Becton is important for initiating adequate empirical antimicrobial Dickinson Microbiology Systems, NJ, USA). H. inß uenzae therapy, in this study we determined the nasopharyngeal ATCC 49247 and S. pneumoniae ATCC 49619 were used carriage rates and the in vitro antimicrobial resistance of as quality control organisms. The data were evaluated these three respiratory tract pathogens isolated from healthy statistically by the Chi-square test. school children in Istanbul, Turkey. The prevalence of resistance in these pathogens is Nasopharyngeal samples of 330 Turkish children aged known to vary widely around the world, with patterns 6–10 years were collected. Samples were cultured on sheep dependent on geographical area. The nasopharyngeal blood agar and on chocolate agar (Oxoid, Hampshire, UK) carriage rate of H. inß uenzae was determined as 32.4%, for the isolation of S. pneumoniae and M. catarrhalis, and being 7.2% type b, 7.6% other capsulated and 33.9% www.ijmm.org January-March 2009 Correspondence 87 Table: The antimicrobial susceptibilities of nasopharyngeal H. infl uenzae, S. pneumoniae and M. catarrhalis strains and minimum inhibitory concentration determinations of the antimicrobial agents Bacteria (n) and MIC (μg/mL) S (%) I (%) R (%) antibiotics Range MIC 50 MIC 90 H.inß uenzae(107) Ampicillin 0.03-8 0.25 2 87.1 0 12.9 Ampi+sulbactam 0.03-8 0.25/0.5 0.5/1 99.1 0 0.9 Cefuroxime 0.03-16 1 2 98.5 0 1.5 Cefotaxime 0.03-16 0.5 1 100 0 0 Ceftriaxone 0.02-05 0.5 1 100 0 0 Azithromycin 0.06-32 1 4 99.5 0 0.5 Ciproß oxacin 0.03-0.5 0.12 0.25 100 0 0 İmipenem 0.03-0.5 0.12 0.25 100 0 0 Co-trimaxazole 0.06/1.4 -16/304 0.25/4.75 2/38 71.4 0 28.6 S.pnemoniae (96) Penicillin 0.06-4 0.06 1 75 18 7 Erythromycin 0.25-64 0.25 16 58 0 42 Clindamycin 0.03-32 0.25 8 55 11 34 Cefotaxime 0.03-4 0.06 1 72.5 20 7.5 Tetracycline 0.03-32 1 8 64 10 30 Ciproß oxacin 0.06-4 0.5 0.5 99 0 1 Vancomycin 0.03-0.5 0.12 0.25 100 0 0 Co-trimaxazole 0.06/1.4-16/304 0.25/4.75 4/76 47 45.5 7.5 M.catarrhalis (79) Ampicillin 1.0-16 8 16 16 0 84 Ampi + sulbactam 0.125-0.5 0.125 0.25 100 0 0 Azithromycin 0.25-0.5 0.25 0.25 100 0 0 Ceftriaxone 0.016-2 0.5 1 100 0 0 Ciproß oxacin 0.06-0.5 0.5 0.5 100 0 0 Co-trimaxazole 0.06/1.4-16/304 0.25/4.75 2/38 80 0 20 non-capsulated strains, with a carriage peak between 6 pneumoniae and M. catarrhalis could be predicted on the and 7 years (36.2%). Overall, 12.9% of the H. inß uenzae basis of the antimicrobial susceptibilities of pharyngeal isolates were fully resistant to ampicillin with the isolates. However, the clinical use of antimicrobial agents presence of β-lactamase except one strain that did not must be restricted to avoid the increase in resistant strains. react with nitroceÞ n and was identiÞ ed as a β-lactamase –negative ampicillin resistant (BENAR) strains. In our References country, there are no comprehensive epidemiological 1. Murphy TF. Haemophilus infections. In: Mandell GL, studies on the carriage rate of S. pneumoniae and its Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett’s antibiotic resistance. The majority of the studies deal with Principles and Practice of Infectious Diseases. 6th ed. Elsevier, antibiotic resistance of the strains isolated from patients Churchill Livingstone; 2005. p. 2661-9. with clinical diseases. In our study, the nasopharyngeal 2. Bou R, Dominiguez A, Fontanals D, Sanfeliu I, Pons I, Renau carriage rate of S. pneumoniae and M. catarrhalis was J, et al. Prevalence of H.inß uenzae pharyngeal carriers in the school population. Eur J Epidemiol 2000;16:521-6. determined as 29.1% and 23.9% respectively. A carriage 3. Akçakaya N, Torun MM, Söylemez Y, Sevme R, Cokuğraş peak between 6 and 7 years was found as 32.8% for S. H, Ergin S, et al. H. Inß uenzae in a day-care center. Turk J pneumoniae and as 25.0% for M. catarrhalis. Twenty- Pediatr 1996;38:289-93. Þ ve per cent of S. pneumoniae isolates showed decreased 4. National Committee for Clinical Laboratory Standards susceptibility to penicillin (18% intermediate, 7% fully Performans Standards for antimicrobial susceptibility resistant) and 84% of M. catarrhalis strains produced testing: Approved Standard 2004, NCCLS, M-100 S14. β-lactamase (Table). Wayne, PA. As a conclusion, the resistance of H. inß uenzae, S. *MM Torun, N Namal, M Demirci, H Bahar www.ijmm.org 88 Indian Journal of Medical Microbiology vol. 27, No. 1 Department of Microbiology and Clinical Microbiology, Istanbul University (MMT, MD, HB), Department of Public *Corresponding author (email: <[email protected]>) Health, Cerrahpaşa School of Medicine, Istanbul University, Received: 18-3-2008 (NN), 34303 Cerrahpaşa, Istanbul, Turkey Accepted: 13-5-2008 In Vitro Interactions Between Cotrimoxazole and Doxycycline in Burkholderia Pseudomallei: How Important is this Combination in Maintenance Therapy of Melioidosis? Dear Editor, guidelines of the NCCLS.[4] For doxycycline susceptibility, MICs ranged between 0.5 and 2 µg/mL. Experiments were Melioidosis is a serious community-acquired infection conducted using a method modiÞ ed from the time–kill endemic in Southeast Asia and northern Australia, and is study described by Smith et al.[5] A bacterial suspension was particularly prevalent in northeast Thailand. The treatment prepared from an overnight broth culture in 30-mL culture of septicaemic melioidosis is problematic having not only bottles containing 10 mL pre-warmed cation-adjusted a 40% fatality rate but also a 23% relapse rate after the Mueller–Hinton broth with the required concentration of [1,2] completion of antibiotic therapy.