Hydatid cyst in children: A 10-year experience from Iran

Background: Hydatid disease is one of the major world-wide health  problems especially in endemic countries. Due to lack of statistics about this disease, various aspects of hydatidosis in children in North-West of Iran have been studied in this study.Materials and Methods: We studied 59 children with hydatidosis referring Tabriz Children Hospital, Tabriz, Iran from 2001 up to 2011. We surveyed chief complaint of patients, number, size and location of cysts in children and also we studied cysts as if they are infected or ruptured or not. Results: Average age of 59 patients (32 [54.2%] males and 27 [45.8%] females) was 7.93 ± 3.0. The most common chief complaints were cough and pain. Number of cysts was higher in females (2.00 ± 2.8 vs. 1.52 ±  1.0). The most common locations of cysts are lung and liver (52 patients); however, other organs had been also affected.Conclusions: Lung hydatidosis is more common than hepatic hydatidosisin children than adults and it is more frequent in males. Hydatid disease should be considered in differential diagnoses of liver and lung cystic lesions in children.Key words: Echinococcus granulosus, hydatid cyst, liver, lung mas

nim-Gen-unabhängige Metronidazolresistenz von Bacteroides fragilis in Surgical Site Infections

Background: Bacteroides fragilis is the most common anaerobic pathogen isolated from surgical site infections (SSIs). Metronidazole resistance is increasing and the mechanisms of resistance are not clear in some isolates. The aim of the present study was to investigate the metronidazole susceptibility prevalence, and detect nim genes in B. fragilis isolates from SSIs. Methods: This study included 100 surgery patients with signs and symptoms indicative of SSIs. Syringe aspiration of the infected site was used to collect specimens. All specimens were cultured on BBA (Brucella blood agar), KVLB (kanamycin-vancomycin laked blood), and BBE (Bacteroides bile esculin) agar. The MIC (minimum inhibitory concentration) of metronidazole was determined by the agar dilution method according to the Clinical and Laboratory Standard Institute (CLSI). Then the PCR method was used to determine the presence of the nim gene.Results: In the present study, 26 B. fragilis were isolated from 100 SSIs specimens. Eight isolates were metronidazole resistant; the metronidazole MIC was 32 µg/mL for 7 isolates and 64 µg/mL for one isolate. All isolates were nim gene negative. Conclusion: The emergence of metronidazole-resistant B. fragilis limits the application of this drug for treatment and prophylaxis of SSIs. Thus, rapid identification of metronidazole-resistant B. fragilis is essential to restrict inappropriate, superfluous administration. In spite of various metronidazole resistance mechanisms other than that depending on the nim gene, detection of nim by PCR is unsuitable for identifying resistant isolates. Therefore, phenotypic methods are better to screen for and identify metronidazole-resistant B. fragilis .Hintergrund: Bacteroides fragilis ist der häufigste bei Surgical Site Infections (SSI) isolierte Anaerobier. Da die Resistenz gegen Metronidazol im Anstieg begriffen ist und die Resistenzmechanismen bei einigen Isolaten unklar sind, sollten die Prävalenz Metronidazol-sensibler Erreger und das Vorkommen von nim -Genen bei B. fragilis -Isolaten von SSIs untersucht werden.Methode: Es wurden 100 Patienten mit diagnostizierter SSI untersucht. Die mikrobiologischen Proben wurden mittels Nadelaspiration aus dem Infektionsherd gewonnen. Die Kultivierung erfolgte auf Brucella-Blutagar, Kanamycin-Vancomycin-Laked Blutagar und Bacteroides-Galle-Esculin-Agar. Die minimale Hemmkonzentration (MHK) von Metronidazol wurde im Agarverdünnungstest gemäß Clinical and Laboratory Standard Institute (CLSI) bestimmt. Der Nachweis des nim -Gens erfolgte mittels PCR.Ergebnisse: In 26 Fällen wurde B. fragilis isoliert. Acht Isolate waren gegen Metronidazol resistent (MHK 32 µg/mL bei 7, 64 µg/mL bei einem Isolat). In keinem Isolat war das nim -Gen nachweisbar.Schlussfolgerung: Das Vorkommen Metronidazol-resistenter B. fragilis -Stämme kann den Erfolg der perioperativen Antibiotikaprophylaxe und ebenso der Therapie infrage stellen. Daher ist die rasche Identifikation Metronidazol-resistenter B. fragilis -Stämme wichtig, um eine ungeeignete Verabreichung zu verhindern. In Anbetracht verschiedener nim -Gen-unabhängiger Resistenzmechanismen ist der Nachweis des nim -Gens mittels PCR zur Identifikation resistenter Isolate ungeeignet. Stattdessen eignen sich phänotypische Methoden zum Screening Metronidazol-resistenter B. fragilis -Stämme