DocumentsDate added
Original article
Mishra Prakash K1*,Singh Narendra P2,Batra Prerna3,Kaur Iqbal R4
1MBBS, MD, Senior Resident, Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital,Dilshad Garden, 110095, Delhi, India
2MBBS, MD, Professor, Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital,Delhi, India
3 MBBS, MD, Department of Pediatrics,University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
4 MBBS, MD Professor and HOD,Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
Address reprint requests to
*Dr. Prakash Kumar Mishra (MBBS,MD),
Senior Resident, Department of Microbiology, University College of
Medical Sciences and Guru Teg Bahadur Hospital, 90-D, Pocket-A, Dilshad Garden,110095, Delhi, India
Article citation: Prakash KM, Narendra PS,Prerna B, Iqbal RK. Bacteriological profile of acute pyogenic meningitis in pediatric age group from a tertiary care hospital of east Delhi. J Pharm Biomed Sci 2016;06(03):174–178. Available at www.jpbms.info
ABSTRACT
Background and Objectives Laboratory surveillance of causative microorganism is crucial to formulate rational empirical treatment and preventive strategies for potentially fatal acute pyogenic meningitis (APM). This study was aimed to identify the causative microorganism of APM in children admitted in a tertiary care hospital of east Delhi.
Materials and Methods Cerebrospinal fluid (CSF) was collected from 300 suspected cases of APM and subjected to cytology, gram staining, biochemical analysis and culture.
Every fifth CSF sample was also subjected to antigen detection by latex agglutination test (LAT) for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Escherichia coli, group B Streptococcus and Taqman probe-based real time polymerase chain reaction (RTPCR) for S. pneumoniae, H. influenzae and N. meningitidis. Simultaneously, blood culture was also done from all these 300 cases.
Result From CSF, 19 microorganisms were isolated in which hospital-acquired multidrug resistant Acinetobacter baumannii (9) was most common. S. pneumoniae, H. influenzae, group B Streptococcus, E. coli, Staphylococcus aureus and Klebsiella were also identified
as a causative agent of APM. LAT detected microorganism in nine culture negative samples,
whereas RTPCR detected two additional microorganisms which were missed by LAT.
Conclusion This study highlights the emergence of MDR A. baumannii as a common agent of APM in hospital setting and emphasise on judicious use of antibiotics to prevent resistance.
KEYWORDS acute pyogenic meningitis, bacteriological profile, pediatric age group
REFERENCES
1.Laboratory methods for the diagnosis of meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. World Health Organization. (WHO/CDS/CSR/EDC/99.7) available from http://www.who.int/csr/resources/publications/meningitis/whocdscsredc997.pdf
2.Tang LM, Chen ST, Hsu WC, Lyu RK. Acute bacterial meningitis in adults: a hospital- based epidemiological study. QJM.1999;92:719–725.
3.Collee JG, Marr W, Fraser AG, Marmion BP, Simmons A. Mackie & McCartney Practical Medical Microbiology, 14th ed. Delhi:Churchill Livingstone; 1996.
4.Cockerill FR, Wikler MA, Bush K, Dudley MN, Eliopoulos GM,Hardy DJ, et al. Performance standards for antimicrobial susceptibility testing. CLSI. 2010;30(1):40–104.
5.Corless CE, Guiver M, Borrow R, Jones VE, Fox AJ, Kaczmarski EB.Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol.2001;39(4):1553–1558.
6.Gaegas N, Hafed K, Aziz Al Khawlly M, Robenz GB, Gotshelish A.Bacterial meningitis in Egypt: serotyping of the isolated bacteria from CSF samples of the patients in tow hospitals of Cairo,1977–1978. Bull World Health Organ. 1983;61:501–512.
7.Salih MA, Khaleefa OH, Bushara M, Taha ZB, Musa ZA, Kamil I et al. Long-term sequelae of childhood acute bacterial meningitis in developing country. Scand J Infect Dis. 1991;23:175–182.
8.Muenchhoff M, Goulder PJR. Sex differences in pediatric infectious diseases. J Infect Dis. 2014;209(3):120–126.
9.Ahmed AA, Saleh MA, Ahmed HS. Post-endemic acute bacterial meningitis in Sudanes children. East Afr Med J. 1996;73:527–532.
10.Almoneef MJ, Memish Z, Khon Y, Kagall WA, Shaalan M.Childhood meningitis in Saudi Arabia. J Infect. 1998;2:157–160.
11.Garges HP, Moody MA, Cotton CM, Smith PB, Tiffany KF,Lenfestey R, et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics. 2006;117:1094–1100.
12.Steele RW, Marmer DJ, O’Brien MD, Tyson ST, Steele CR.Leukocyte survival in cerebrospinal fluid. J Clin Microbiol.1986;23:965–966.
13.Neuman MI, Tolford S, Harper MB. Test characteristics and interpretation of cerebrospinal fluid gram stain in children. Pediatr Infect Dis J. 2008;27(4):309–313.
14.Kabra SK, Praveen Kumar, Verma IC, Mukherjee D, ChowdharyBH, Sengupta S, et al. Bacterial meningitis in India: an IJP survey. Indian J Pediatr. 1991;58:505–511.
15.Das BK, Gurubacharya RL, Mohapatra TM, Mishra OP. Bacterial antigen detection test in meningitis. Indian J Pediatr. 2003;70:799–801.
16.Sonavane A, Baradkar VP, Mathur M. Bacteriological profile of pyogenic meningitis in adults. Bombay Hosp J. 2008;50(3):452–455.
17.Saleem AF, Ahmed I, Mir F, Ali SR, Zaidi AK. Pan-resistant Acinetobacter infection in neonates in Karachi, Pakistan. J Infect Dev Ctries. 2009;4(1):30–37.
18.Talbot GH, Bradley J, Edwards JE Jr., Gilbert D, Scheld M, Bartlett JG. Bad bugs need drugs: an update on the development pipeline from the Antimicrobial Availability Task Force of the Infectious Diseases Society of America. Clin Infect Dis. 2006;42:657–668.
19.Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev.2008;21:538–582.
20.Mirza IA, Hussain A, Abbasi SA, Malik N, Satti L, Farwa U. Ambubag as a source of Acinetobacter baumannii outbreak in an intensive care unit. J Coll Physicians Surg Pak. 2011;21(3):176–178.
21.Jaiswal N, Singh M, Thumburu KK, Bharti B, Agarwal A, Kumar A, et al. Burden of invasive pneumococcal disease in children aged 1 month to 12 years living in South Asia: a systematic review. PLoS One. 2014;9:e96282.
22.Song JH, Lee NY, Ichiyama S, Yoshida R, Hirakata Y, Fu W,et al. Spread of drug- resistant Streptococcus pneumoniae in Asian countries: Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study. Clin Infect Dis. 1999;28:1206–1211.
23.Wilder-Smith E, Chow KM, Kay R, Ip M, Tee N. Group B Streptococcal meningitis in adults: recent increase in Southeast Asia. Aust N Z J Med. 2000;30:462–465.
24.John AJP, Lalitha MK, Cherian T, Pai R, Thomas K, Steinhoff MC.A polymerase chain reaction-enzyme immunoassay for diagnosis of pneumococcal meningitis in children and adults. Indian J Med Res. 2001;113:48–52.
25.Wiswell TE, Baumgart S, Gannon CM, Spitzer AR. No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed? Pediatrics. 1995;119:803–806.
26.Johnson CE, Whitwell JK, Pethe K, Saxena K, Super DM. Term newborn who are at risk for sepsis: are lumbar punctures necessary? Pediatrics. 1997;99(4):E10.
Statement of originality of work: The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and that each author believes that the manuscript represents honest and original work.
Sources of funding: None.
Competing interest / Conflict of interest: The author(s) have no competing interests for financial support, publication of this research, patents, and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Disclaimer: Any views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of Defense.
Original article
Yekaterina E. Zueva1,2, Olga I.Illarionova3, Svetlana A. Pliasunova3, Ekaterina B.Rusanova4, Yelena A. Kustova5*, Natalia T. Urazalieva5
1 Department of Molecular Biology, Faculty of Natural Science, Ariel University, Ariel, Israel
2 Scientific and Methodological Center for Molecular Medicine, Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia
3 Diagnostic Laboratory, Federal Scientific Clinical Centre of Pediatric Hematology, Oncology and Immunology in memory of Dima Rogachev, Moscow, Russia
4 Laboratory of Clinical Immunology and Molecular Diagnostics, Department of Laboratory Diagnostics, Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg, Russia
5 Laboratory of Immunology, Scientific Center of Pediatrics and Children Surgery, Al-Farabi av. 146, Almaty, Kazakhstan
Address reprint requests to
*Yelena A. Kustova, Laboratory of Immunology, Scientific Center of Pediatrics and Children Surgery, Al-Farabi av. 146, Almaty 050040, Kazakhstan
Article citation: Zueva YE, Illarionova OI, Pliasunova SA, Rusanova EB, Kustova YA, Urazalieva NT. Acute megakaryoblastic leukaemia: experience of diagnostics at three clinical centers. J Pharm Biomed Sci 2016;06(03):193–198. Available at www.jpbms.info
ABSTRACT
Background Acute megakaryoblastic leukaemia (AMkL) is a rare hematologic clonal malignancy, characterised by the accumulation of abnormal myeloid blasts with megakaryoblastic differentiation in the bone marrow and/or extra-marrow hematopoiesis sites with marked clinical heterogeneity in children and adult populations. Owing to a low occurrence in the daily clinical practice, AMkL presents a difficulty for immunophenotypic diagnostics.
Purpose We present 36 cases of children and adult AMkL observed from 2007 through 2014 at the Federal Scientific Clinical Center of Children Hematology, Oncology and Immunology in memory of Dima Rogachev, Moscow, Russia (FSCCCHOI), Pavlov First Saint-Petersburg State Medical University, Russia (PFSPbMU), and Research Center for Paediatrics and Children Surgery, Almaty, Kazakhstan (SCPCS).
Methods A retrospective analysis of clinical and multicolour flow cytometry data of AMkL was diagnosed in two Russian and one Kazakhstan clinical centers during 8 years has been performed, and the applicability of the modern diagnostic criteria was evaluated.
Results From 2,867 cases of acute leukaemia, we identified 36 patients with AMkL (1.26% of all cases) including 30 children and 6 adults with disease age onset ranged from 2 days to 75 years. Trisomy 21 was detected in 19.4% of the samples. In the group of children under 3 years (23), trisomy of chromosome 21 was detected in 7 patients (30.4%).
Conclusion Most typical immunophenotypical features of AMkL and its rare variants allow diagnosing it in ethnically diverse populations. We describe specific details of the sample preparation and interpretation of multicolour flow cytometry data.
KEYWORDS acute megakaryoblastic leukaemia, multicolour flow cytometry, immunophenotype, CD marker expression, Down syndrome
REFERENCES
1.Hoffbrand AV, Moss PAH, Petit JE. Essential Hematology, 5th ed. Blackwell Publishing: Oxford; 2006.
2.Athale UH, Razzouk BI, Raimondi SC, Tong X, Behm FG, Head DR, et al. Biology and outcome of childhood acute megakaryoblastic leukemia: a single institution’s experience. Blood. 2001;97:3727–3732.
3.Bennett J, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, Sultan C. Proposals for the classification of the acute leukaemias.French–American– British (FAB) co-operative group. Br J Haematol. 1976;33(4):451–458.
4.Bene M, Castoldi G, Knapp W, Ludwig WD, Matutes E, Orfao A,van’t Veer MB. Proposals for the immunological classification of acute leukemias. European group for the immunological characterisation of leukemias (EGIL). Leukemia. 1995;9(10):1783–1786.
5.Giri S, Pathak R, Prouet P, Li B, Martin MG. Acute megakaryocytic leukemia is associated with worse outcomes than other types of acute myeloid leukemia. Blood. 2014;124(25):3833–3834.
6.Rubnitz JE, Inaba H. Childhood acute myeloid leukaemia. Br J Haematol. 2012;159:259–287.
7.Boztug H, Schumich A, Pötschger U, Mühlegger N, Kolenova A, Reinhardt K, Dworzak M. Blast cell deficiency of CD11a as a marker of acute megakaryoblastic leukemia and transient myeloproliferative disease in children with and without Down syndrome. Cytometry B Clin Cytom. 2013;84(6):370–378.
8.Weinberg O, Seetharam M, Ren L, Seo K, Ma L, Merker JD, Gotlib J,Zehnder JL, Arber DA. Clinical characterisation of acute myeloid leukemia with myelodysplasia-related changes as defined by the 2008 WHO classification system. Blood. 2009;113(9):1906–1908.
9.Bozkurt SU, Berrak SG, Tugtepe H, Canpolat C, Palanduz S, Tecimer T. Acute megakaryoblastic leukemia mimicking small round cell tumour with novel t(1;5)(q21;p13). APMIS. 2008;116(2):163–166.
10.Niino D, Tsuchiya T, Tomonaga M, Miyazaki Y, Ohshima K.Clinicopathological features of acute megakaryoblastic leukaemia:relationship between fibrosis and platelet-derived growth factor. Pathol Int. 2013;63(3):141–149.
11.Duchayne E, Fenneteau O, Pages MP, Sainty D, Arnoulet C,Dastugue N, Garand R, Flandrin G. Groupe Français d’hématologie cellulaire; Groupe Français de cytogénétique hématologique.Leuk Lymphoma. 2003;44(1):49–58.
12.Torres L, Lisboa S, Vieira J , Cerveira N, Santos J, Pinheiro M,Correia C, Bizarro S, Almeida M, Teixeira MR. Acute megakaryoblastic leukemia with a four-way variant translocation originating the RBM15–MKL1 fusion gene. Pediatr Blood Cancer. 2011;56:846–849.
13.Gorczyca W, Weisberger J, Emmons FM. Atlas of Differential Diagnosis in Neoplastic Hematopathology. Taylor & Francis:Washington, DC; 2004. p 424.
14.Craig FE, Foon KA. Flow cytometric immunophenotyping for hematologic neoplasms. Blood. 2008;111:3941–3967.
15.Boztug H, Schumich A, Pötschger U, Mühlegger N, Kolenova A, Reinhardt K, Dworzak M. Blast cell deficiency of CD11a as a marker of acute megakaryoblastic leukemia and transient myeloproliferative disease in children with and without Down syndrome. Cytometry B Clin Cytom. 2013;84(6):370–378.
16.Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ,Porwit A, et al. The 2008 revision of the WHO classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114(5):937–951.
17.Karandikar NJ, Aquino DB, McKenna RW, Kroft SH. Transient myeloproliferative disorder and acute myeloid leukemia in Down syndrome. An immunophenotypic analysis. Am J Clin Pathol. 2001;116(2):204–210.
18.Lichtman MA, Segel GB. Uncommon phenotypes of acute myelogeneous leukemia: basophilic, mast cells, eosinophilic and myeloid dendritic cells subtypes: a review. Blood Cells Mol Dis. 2005;35:370–383.
19.Swerdlow SH, Campo E, Harris NL. eds. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC; 2008.
20.Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ,Porwit A, et al. The 2008 revision of the WHO classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114(5):937–951.
21.Wang L, Peters JM, Fuda F, Li L, Karandikar NJ, Koduru P, Wang H, Chen W. Acute megakaryoblastic leukemia associated with trisomy 21 demonstrates a distinct immunophenotype.Cytometry B Clin Cytom. [Epub ahead of print]
22.Cetin N, Lorsbach RB. Pan myeloid antigen-negative pediatric acute megakaryoblastic leukemia. Pediatr Blood Cancer. 2014;61(11):2089–2091.
23.Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization Classification of Tumours. Pathology and genetics of tumors of haematopoietic and lymphoid tissues. Lyon:IARC; 2001.
Statement of originality of work: The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and that each author believes that the manuscript represents honest and original work.
Sources of funding: None.
Competing interest / Conflict of interest: The author(s) have no competing interests for financial support, publication of this research, patents, and royalties through this collaborative research.
All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Disclaimer: Any views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of Defense.