by Dr. Kamal Fahmy
and his colleagues.
__________________________________________
Glycopeptide Resistant Enterococci: An Emerging Clinical Problem
(The Egyptian Journal of Medical Microbiology
Vol. 12, No. 3, July 2003)
Awny A Gawish, Somaya H Sammour,
Awny A Gawish, Somaya H Sammour,
Kamal F Mohammed and Awatef M Nawara
Microbiology and Immunology Department,
Microbiology and Immunology Department,
Faculty of Medicine, Zagazig University
Abstract
Vancomycin resistant Enterococci is a worldwide problem. In a trial to determine the extent of the problem of vancomycin resistant enterococci (VRE) in Zagazig University hospitals, this study was conducted on 960 patients from different hospital wards. One hundred enterococcal strains (10.4%) were isolated from urine, wound and blood samples. The incidence of resistance of enterococci to vancomycin was 12%, species identification of VRE revealed 75% E. faecium and 25% E. faecalis. All VRE isolates were sensitive to imipenem, but were resistant to other B – lactams, gentamicin and ciprofloxacin. The highest percentage of VRE infection was found in patients of oncology department. VRE recovered were more predominantly in old age (83.3 % were > 50 years), in patients with prolonged hospitalization (>25 days) and in those exposed to broad spectrum antibiotics. The plasmid profile of VRE isolates showed that all the strains had at least one plasmid and most of the strains had multiple plasmids ranging from 2-60 kb. Conclusion: The incidence of antimicrobial resistance among enterococci is high especially VRE. Imipenem is still an effective antibiotic against VRE. Prolonged antibiotic intake and hospital stay are important risk factors for infection with VRE. The plasmid of VRE is often unstable thus other means for typing of these organisms are needed.
====================
Hospital and Community Acquired Methicillin Resistant Staphylococcus aureus Infections & Their Association with Panton-Valentine Leukocidin Gene
(The Egyptian Journal of Medical Microbiology,
Vol. 16, No. 3, July 2007 )
El Sayed M. Ezzat, Kamal Fahmy, Ahmed Amer
El Sayed M. Ezzat, Kamal Fahmy, Ahmed Amer
and Raghdaa Abdel-Aziz
Microbiology & Immunology Department,
Microbiology & Immunology Department,
Faculty of Medicine, Zagazig University
Abstract
Methicillin resistant S. aureus (MRSA), besides having established itself as a major hospital pathogen, is now beginning to prevail in the community. However, several notable differences were found to exist between hospital acquired strains (HA-MRSA) and community acquired strains (CA-MRSA). Panton-Valentine leukocidin gene (PVL) is a cytotoxin which was found to represents an important virulence factor in some strains of S. aureus which cause some sorts of severe infections. The aims of this study were to assess the association of PVL gene with HA-MRSA and CA-MRSA and the role of this gene in pathogenesis of these infections. Methods: Two groups of patients with different types of infections were included in this study: the first group included 150 patients with hospital acquired infections and the second group included 85 patients with community acquired infections. All isolated S. aureus strains were tested for methicillin resistance by determination of MIC (minimum inhibitory concentration) using agar dilution method. All the detected MRSA isolates were tested for the presence of PVL gene by polymerase chain reaction (PCR). Results: within the isolated CA S. aureus strains, MRSA isolates were found to be significantly higher compared to MRSA isolates from HA S. aureus infections (30/52: 57.7 % and 25/74: 33.7 % respectively). PVL gene was detectable in 16/30 (53.3%) of CA-MRSA isolates while this gene was not found in any of HA-MRSA (0/25: 0 %). In CA-MRSA isolates, PVL gene was found in 2/2 (100%) of cases with pneumonia, 8/10 (80%) of cutaneous abscesses, 4/4 (100%) of cases with furunclosis, 1/3 (33.3%) of finger pulp infections, 1/2 (50%) of breast abscesses while no isolates from cases with cellulites, impetigo or osteomyelitis harbored the PVL gene. Conclusion: our results revealed that PVL gene is strongly associated with CA-MRSA while it is not associated with HA-MRSA. PVL gene is mostly associated with primary necrotic infections (abscesses, furunclosis and Pneumonia), but not with invasive and secondary infections commonly encountered in HA S. aureus infections. The results of this study drive the attention to the current increase of CA-MRSA in Egypt which makes implementation of infection control guidelines of great concern to prevent more dissemination of MRSA in the community or to hospitals. A wide scale study of CA and HA-MRSA is recommended on the national level in Egypt to investigate the general prevalence rate, pathogenesis and the changes in antibiotic resistance and their relations to PVL gene and other genetic and virulence factors which may allow better management and control of these infections.
To download the Full paper:
=====================
Comparison of PCR Assay to Culture for Detection of Vancomycin Resistant Enterococci Colonizing the Intestinal Tract of Hospitalized patients
(The Egyptian Journal of Medical Microbiology,
Vol. 14, No. 3, July 2005)
Manal A. Bahgat¹, Hanan M. El-Sayed¹, Kamal Fahmy¹
and Hoda S. Abd El-Rahman²
Microbiology & Immunology¹ and Internal Medicine² Departments,
Microbiology & Immunology¹ and Internal Medicine² Departments,
Faculty of Medicine Zagazig University
Abstract
The prevalence of vancomycin resistant enterococcus (VRE) nosocomial infection has dramatically increased in recent years. In this study 23 clinical isolates of enterococci were detected from 62 samples collected by rectal swabs (or fecal specimens) from long term hospitalized patients at Zagazig University Hospital. Identification of isolates was done by conventional methods including colonial morphology, gram stain, catalase test, bile esculin hydrolysis, sodium chloride test and API 20S streptococcus strips (Biomerieux) for species identification. The MICs of vancomycin and teicoplanin were determined for each isolate by the E-test (AB Biodisk, Solna, Sweden) method on Muller -Hinton agar. Direct multiplex PCR assay using van A and van B primers was done to all samples collected from patients. The result of this study showed that: E.faecalis was the predominant isolated species(n=18), followed by E.faecium(n=4). Among the 23 enterococcus isolates, 15 isolates were phenotyped as van A while 4 isolates were phenotyped as van B. Only 4 isolates were vancomycin and teicoplanin sensitive. Among the 16 E.faecalis isolates, one was van sensitive but genotyped as vanA, 13 were phenotyped and genotyped as vanA, one was phenotyped as vanB but genotyped as vanA and 2 were phenotyped and genotyped as vanB. For E.faecium, one isolate was van sensitive but genotyped as vanA, 2 were phenotyped and genotyped as vanA and one was phenotyped and genotyped as vanB Among the 62 samples, 19 were positive by both methods (VRE). Thirty five were negative by both methods. One was vanB by culture but vanA by PCR, 2 were van sensitive by culture but vanA by PCR, none were positive by culture only and 8 were positive by PCR only. PCR method was more sensitive than culture (27 of 62 versus 19 of 62) (P <>
To download the Full paper:
====================
Soluble L-selectin, Vascular Endothelial Growth Factor and Endothelin-1 in Patients with Ulcerative Colitis
(The Egyptian Journal of Medical Microbiology, Vol. 15, No. 3, October 2006
Manal A. Bahgat¹, Hanan M. El-Sayed¹, Ahmed Amer¹, Kamal Fahmy¹ and Mohamed Nasr El-Din Bekhit²
Microbiology & Immunology¹ and Tropical Medicine² Departments, Faculty of Medicine, Zagazig University
Abstract
Recent evidence increasingly suggests that ulcerative colitis (UC) is the result of dysfunctional immunoregulation manifested by an inappropriate production of mucosal cytokines. An abnormal microcirculatory system has also been implicated in its pathogenesis. The objective of this study was to assess serum concentrations of soluble L-selectin (sL-selectin) and vascular endothelial growth factor (VEGF) and the plasma level of endothelin-1(ET-1) in the patients with UC, compared with healthy controls, and to analyze the results depending on the stage of the disease.
This study was conducted on two groups of subjects, the patient group including 30 patients with active ulcerative colitis (UC), and the control group which included 15 healthy volunteers. We assessed serum sL-selectin, VEGF and Plasma ET-1 Level at the beginning of the study in patients and controls then measured again in patients after remission. The levels of sL-selectin, VEGF, and ET-1 were significantly higher in active UC than those in the controls (p < r=" 0.631,">
This study was conducted on two groups of subjects, the patient group including 30 patients with active ulcerative colitis (UC), and the control group which included 15 healthy volunteers. We assessed serum sL-selectin, VEGF and Plasma ET-1 Level at the beginning of the study in patients and controls then measured again in patients after remission. The levels of sL-selectin, VEGF, and ET-1 were significantly higher in active UC than those in the controls (p < r=" 0.631,">
To download the Full paper:
=========================
Assessment of T Helper 1 and T Helper 2 Cytokines and Their Correlations with Viral Load in HCV Patients Co-infected with S. mansoni
(The Egyptian Journal of Medical Microbiology,
Vol. 15, No. 3, July 2006)
Kamal Fahmy1, Manal Abdel-Tawab1, Hanan El-Sayed1, Hosam El-Sharkawy1,
Souzan Bakir1 and Ahmed Sakr2
Microbiology & Immunoloy1 and Tropical Medicine2 Departments,
Microbiology & Immunoloy1 and Tropical Medicine2 Departments,
Faculty of Medicine, Zagazig University
Abstract
The aim of this study was to investigate the effect of infection with S. mansoni on the balance between Th-1 and Th-2 cytokines in patients with chronic hepatitis C virus (HCV) infection and to show the relations between these two groups of cytokines to the degrees of viral load in these patients. Methods: 44 individuals were classified into 4 groups: group I of control subjects (n=10), group II of patients with S. mansoni mono-infection (n=9), group III of patients with chronic HCV mono-infection (n=13) and group IV of patients with both S. mansoni and HCV co-infection (n=12). For individuals of all studied groups, interferon-γ & IL-2 (cytokines of Th-1 cells) and IL-4 & IL-10 (cytokines of Th-2 cells) were measured. Viral load was measured for patients of group III (HCV mono-infection) and group IV (co-infected patients). The results showed that Th-1 cytokines (IFN-γ and IL-2) were significantly higher in HCV mono-infection patients and significantly lower in patients co-infected with HCV and S. mansoni compared to normal subjects group. In S. mansoni mono-infection group, IFN-γ was decreased while IL-2 was normal compared to normal control group. Th-2 cytokines (IL-4 and IL-10) were significantly higher in the three patients groups compared to the control group but the degree of increase of IL-4 showed no significant difference between S. mansoni mono-infection patients and HCV mono-infection patients while the degree of increase of IL-10 was higher in S. mansoni mono-infection patients compared to HCV mono-infection patients. The degree of increase of both IL-4 and IL-10 was significantly higher in the co-infection patients -compared to the HCV mono-infection patients. Viral load was significantly higher in the co-infected group compared to HCV mono-infection group and in both groups the viral load was positively correlated with Th-2 cytokines and negatively correlated with Th-1 cytokines (except IL-2 in the group of HCV mono-infection patients). In conclusion, these results suggest that HCV patients co-infected with S. mansoni suffer from strong activation of Th-2 cells and so increase of Th-2 cytokines that suppress Th-1 cells and related cytokines which is the type of immune response needed in face of HCV. This Th-1/Th-2 imbalance allow more viral replication and higher viral load in these patients compared to HCV patients who are not co-infected with S. mansoni and this may give an explanation to the rapid hepatic deterioration of these co-infected patients.
To download the Full paper:
http://www.mediafire.com/download.php?h1ijn5z2yzm
http://www.mediafire.com/download.php?h1ijn5z2yzm
====================
Lymphocytes Subsets Alterations in Cases of Co-infection with Both Hepatitis C Virus and S. mansoni
(The Egyptian Journal of Medical Microbiology,
Vol. 16, No. 2, April 2007)
Kamal Fahmy (1) and Esam N. Mohamed (2)
Microbiology & Immunology (1)and Internal Medicine (2) Departments,
Kamal Fahmy (1) and Esam N. Mohamed (2)
Microbiology & Immunology (1)and Internal Medicine (2) Departments,
Faculty of Medicine, Zagazig University
AbstractThe aim of this study was to investigate the presence of any possible alterations in different lymphocytes subsets in patients co-infected with HCV and S. mansoni which may be responsible for higher rate of viral persistence and aggressive course of hepatitis and liver fibrosis in these co-infected patients. Methods: 42 individuals were divided into four groups: Group I of normal control (n=10), Group II of patients with HCV mono-infection (n=9), group III of patients with S. mansoni mono-infection (n=11) and group IV of patients with HCV and S. mansoni co-infection (n=12). For all subjects included in this study, count of lymphocytes subsets in the peripheral blood was done by flowcytometry applying a two color immuno-fluorescence technique using pairs of monoclonal antibodies conjugated with both fluorescein isothiocyanate (FITC) and phycoerythrin (PE). Results: B lymphocytes (CD19+) showed no significant alterations in all groups while T lymphocytes (CD3+) showed a significant increase in both HCV mono-infection group and S. mansoni mono-infection group and a highly significant increase in the co-infection group. Natural killer (NK) cells (CD16+ and/or CD56+) showed a significant decrease in the group of HCV mono-infection patients, no significant alterations in the S. mansoni mono-infection group and a highly significant decrease in the co-infection group. T helper (CD4+) cells showed a significant increase in HCV mono-infection patients and in the co-infection group but with no significant alteration in S. mansoni mono-infection group while T cytotoxic (CD8+) cells showed a significant increase in both HCV mono-infection group and S. mansoni mono-infection group and a highly significant increase in the co-infection group. Activated T lymphocytes (CD3+ HLA-DR+) showed a highly significant increase in HCV mono-infection patients with no significant changes in S. mansoni mono-infection group and a significant increase in the co-infection group. The degree of increase of activated T lymphocytes was significantly higher in the HCV mono-infection patients compared to those co-infected with S. mansoni. In conclusion, results of this study suggest that co-infection of HCV patients with S. mansoni is associated with some immune system alterations that may explain the increased persistence and severity of HCV infection in these patients. Also, these findings suggest that there is an urgent need to introduce new therapeutic approaches that stimulate strong cellular immune responses which might limit the progression and severity of HCV infection in these co-infected patients.
To download the full paper:
