Showing papers by "Sadia Shakoor published in 2015"

Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

Abstract: We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

Fluoroquinolone resistance in Mycobacterium tuberculosis isolates from Pakistan 2010-2014: Implications for disease control.

Abstract: Introduction Fluoroquinolones (FQ) are an essential component of current and new regimens for the treatment of tuberculosis (TB). The 2014 Global TB report indicates a FQ resistance rate of 17% amongst multidrug-resistant (MDR) strains of Mycobacterium tuberculosis (MTB) tested in 2013. There is, however, a paucity of FQ-resistance data from high burden countries. In this study the trend of FQ-resistance amongst MDR–MTB and non-MDR–MTB is analyzed over a four-and-a-half-year period (January 2010–July 2014). Methods This study was conducted at the Aga Khan University laboratory, a technical partner of the Pakistan National TB Program and part of the World Health Organization (WHO) Supra-national Laboratory Network for TB. The laboratory receives specimens from across the country through its peripheral collection units. MTB was isolated using standard methods. Susceptibility testing was performed using the agar proportion method with drug concentrations as recommended by Clinical Laboratory Institute Standards (CLSI). FQ susceptibilities were determined using ofloxacin (2 μg/ml). MTB H37Rv was used as a control with each batch of susceptibility testing. MDR was defined as resistance to both isoniazid (0.2 μg/ml) and rifampicin (1.0 μg/ml). Results During the study period 14,711 MTB strains were isolated. Of these, 6403 (43.5%) were MDR and 8308 were non-MDR. FQ resistance in MDR strains ranged between 54% and 58%. Amongst non-MDR MTB strains, FQ resistance increased from 214/2059 (10.3%) in 2010 to 180/1049 (17.1%) in 2014. The proportion of FQ mono-resistant TB strains averaged at 10.5% of the non-MDR isolates during this period. Conclusions FQ resistance in non-MDR–MTB strains with a considerable proportion of FQ mono-resistant strains in Pakistan is alarming. These data highlight the limited potential of empirical FQ usage for TB treatment in both MDR and non-MDR cases and the need to implement regular surveillance for FQ-resistance in MTB in the country. High FQ resistance amongst MTB isolates further emphasizes the importance of stewardship and the responsible use of FQs in particular, and antimicrobials in general in the country.

Are TB control programmes in South Asia ignoring children with disease? A situational analysis

Abstract: Paediatric tuberculosis (TB) has long been an evasive entity for public health practitioners striving to control the disease. Owing to difficulty in diagnosis of paediatric TB, incidence estimates based on current case detection fall short of actual rates. The four high-burden countries in South Asia (SA-HBC)—Afghanistan, Pakistan, India and Bangladesh—alone account for >75% of missed TB cases worldwide. It follows that these countries are also responsible for a large although unmeasured proportion of missed paediatric cases. In view of current Millennium Development Goals recommending a scale-up of paediatric TB detection and management globally, there is a dire need to improve paediatric TB programmes in these high-burden countries. Inherent problems with diagnosis of paediatric TB are compounded by programmatic and social barriers in SA-HBC. We have reviewed the current situation of TB control programmes in SA-HBC countries based on published statistics and performed a strengths, weaknesses, opportunities and threats situational analysis with a view towards identifying critical issues operant in the region posing barriers to improving paediatric TB control.

Abdominal Lymphonodular Cryptococcosis in an Immunocompetent Child.

Abstract: We describe our experience with an apparently immunocompetent child presenting with pyrexia of unknown origin without focal signs. Investigations revealed lymphadenopathy at lung hila, mesentery, and porta hepatis. The child had received at least two months of empiric antituberculous therapy (ATT) before she came to us. A CT-guided biopsy revealed granulomatous inflammation. PAS stain showed yeasts which stained blue with Alcian blue, suggesting C. neoformans.

High proportion of multidrug resistant Mycobacterium tuberculosis among children in Pakistan

Abstract: Aims and objectives Tuberculosis (TB) in children is an important predictor of ongoing transmission within a population. Pakistan has a high TB and multidrug resistant (MDR) TB burden, putting children at high risk for acquiring the disease. Despite this high MDR burden status, MDR TB rates have not been reported in children from Pakistan. Methods Aga Khan University mycobacteriology laboratory TB culture and susceptibility records have been reviewed for samples received from children 0–14 years of age from all over Pakistan. Specimens were further segregated by age, site (pulmonary vs. extrapulmonary), and drug resistance profile. Results Of 50,048 specimens received for culture between 2009 and 2012, only 2.1% ( n = 1059) were obtained from children. Culture positivity rate among children was 1.5 times higher than that seen in adults (37.7% vs. 24.2%). Of 399 positive cultures, 72.9% ( n = 291) were pulmonary, while 37.1% ( n = 108) were extrapulmonary, and 73.9% ( n = 295) were obtained from females, while 26.1% ( n = 104) were obtained from males. Susceptibility testing revealed 41.4% ( n = 164) of isolates to be MDR, 89.1% ( n = 147) of which had a pulmonary source (i.e., gastric aspirates, bronchial washings, or sputa). MDR TB also showed an older-age predominance where 89.1% ( n = 147) of MDR was seen in the 10–14 age group. About half (50.9%; n = 203) of all Mycobacterium tuberculosis isolates from children were isoniazid mono-resistant. Conclusions Although pediatric specimens comprise only a small proportion of specimens received for mycobacterial culture, the culture positivity rate is much higher among children than in adults, reflecting a need to encourage culture testing of suspected pediatric TB patients. Predominance of positive cultures among female children and MDR TB in the older age groups highlights the need for focus on control efforts among this demographic.