Category Archives: 2(1) Jan-June 2004

A Twenty Two Year Survey of Mycotic Infections in Peshawar Region

Taj B Uppal* and Raza Muhammad Khan**
* 22, Chinar Road, University Town, Peshawar.
** Department of Dermatology, Khyber Medical College, Peshawar.
Clinically suspected cases of Dermomycoses, deep tissue mycoses and pulmonary mycoses, totalling 2,037, were examined
and subjected to mycological studies over a period of twenty two years. On direct examination, fungal elements were found
in 1,173 specimens, including 114 of Malassezia furfur and one of Pityrosporum. After culture, growth was obtained in 489
specimens, some slide negative specimens were also positive in culture. The commonest clinical type was Tinea capitis, and
Trichophyton violaceum was the most common organism isolated amongst the species isolated. Amongst the Microsporum
species, Micro. ferrugineum was the most common species isolated, and the main clinical disease caused by it was Tinea
capitis. Cases of Chromoblastomycosis were also found.

Mucormycosis of the Gastrointestinal Tract in a Child: A Rare Entity

Anwar-ul-Haq, Nadeem Akhter and Ilyas Bader
Department of Paediatric Surgery, The Children Hospital, Pakistan Institute of Medical Sciences, Islamabad.
Mucormycosis is a rare infection caused by fungi of the order Mucorales. The infection occurs in the rhinocerebral, respiratory, gastrointestinal or cutaneous regions depending upon the port of entry. It is found more in immunocompromised adults. In children the predisposing conditions include prematurity, neutropenia, acidosis and corticosteroid therapy. Mucormycosis of the gut is even a rarer entity, which may be found in neonatal age, mimicking the picture of necrotising enterocolitis. We present a rare pathology of intestinal mucormycosis in an 18 months old child who presented with abdominal mass and fever.

Mitotically Active Leiomyoma: A Word of Caution

Anwar Ul Haque*, Ambreen Moatasim* and Farhan Aslam**
* Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
** Department of Medicine, Geisinger Medical Center Danville, Pennsylvania, USA.
Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively uncommon, the female genital tract leiomyomas are one of the most common benign tumors. It is important to rule out the possibility of leiomyosarcoma whenever examining leiomyomas. At times this may be quite taxing as the nuclear atypia may be minimal. Not only many sections have to be submitted but also each section has to be carefully scrutinized for mitotic counts. Even slightly increased mitotic counts have been associated with malignancy. On the other hand, there are occasionally tumors which despite having very high mitotic counts are benign. These tumors are clinically distinct and if proper attention is given diagnosis of malignancy in such cases can be avoided. We describe here a case of vaginal leiomyoma with high mitotic counts in which correct diagnosis was achieved with patience and proper consultation.
Key words: Leiomyoma; mitotically active leiomyoma; mitotic counts

A Revisit to Foetal “Rhabdomyoma”: An Electronmicroscopic and Immunologic Evaluation

Anwar Ul Haque* and U. M. Chowdhary**
* Head, Department of Pathology, PIMS, Islamabad.
** King Faisal University Dammam Saudi Arabia.
The fetal “rhabdomyoma” is a rare tumor occurring most commonly in the scalp of young chidren1. The tumor closely mimics embryonal rhabdomyosarcoma by light microscopy, however, it lacks frequent mitoses and persues a benign course. We examined a case of classical “Fetal Rhabdomyoma”. In addition to the routine histopathology, immunoperoxidase and electron-microscopic studies were carried out. Our findings negate the origin of this tumor from skeletal muscle and support its origin from fibroblast. The presence of markedly dilated endoplasmic reticulum in fibroblasts gave a false impression of cross striation on light microscopy. We propose that the name of this lesion may be changed from Fetal Rhabdomyoma to Fetal Fibroma.

Chronic Granulomatous Inflammatory Disorders of Skin at a Tertiary Care Hospital in Islamabad

Rubina Qureshi, Riaz A Sheikh and Anwar ul Haque*
Department of Dermatology, Pakistan Institute of Medical Sciences, Islamabad.
* Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
A retrospective study was carried out to evaluate skin diseases associated with Chronic Granulomatous Inflammation at Pakistan Institute of Medical Sciences (PIMS) over a period of six months. There were a total of 249 skin biopsies in this period, among which 14.8 % cases were diagnosed as lesions associated with chronic granulomatous inflammation. Among these cutaneous leishmaniasis constituted 56.7% of cases while cutaneous tuberculosis was diagnosed in 14.9%. Sarcoidosis, Syphilis and Granuloma annulare constituted a small number of cases.
Key words: Chronic granulomatous inflammation, Cutaneous Leishmaniasis, Cutaneous Tuberculosis, Lupus vulgaris, Scrofuloderma, Tuberculosis vericosa cutis, Sarcoidosis, Syphilis, Granuloma annulare

Spectrum of Histopathological Features in Non Infectious Erythematous and Papulosquamous Diseases

Mohammad Younas and Anwar ul Haque
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad
This prospective study consisted of 38 patients clinically diagnosed as having one of the papulosquamous diseases. Appearance and distribution of the lesions were recorded. The histopathological features of the lesions were studied in the weekly clinicopathological conference. The cases were subgrouped into 8 categories. 25 of these patients were males and rest females, showing predominance of males suffering from this skin disease. Maximun number of patients fell in the age group of 21 to 30 years. Clinicopahological correlation was carried out. 29 out of 38 cases (76.30 %) showed compatible clinical as well as histopathological diagnoses. Microscopic features of all the biopsies were scrutinized. It was noted that the majority of the findings of our cases agreed to the literature findings. The additional findings present in our study cases not given in the literature were mentioned separately. The diagnostic microscopic features not present in our cases were also recorded.
Key words: Papulosquamous diseases, Psoriasis, Lichen planus, Pityriasis rosea, Pityriasis rubra pilaris, Prurigo nodularis, Lichen planopilaris, Lichen nitidis.

Hepatitis C Virus Seropositivity in Repeatedly Transfused Thalassemia Major Patients

Muhammad Younus, Khalid Hassan, Nadeem Ikram*, Lubna Naseem, Hassan Abbas Zaheer and Muhammad Farooq Khan**
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad
* Department of Pathology, DHQ Hospital, Rawalpindi
** Divisional Blood Transfusion Center, Holy Family Hospital, Rawalpindi
Multiple transfusions in patients of thalassemia major who are conventionally treated by a regular transfusion regimen, are at a risk of developing Transfusion Transmitted Infections (TTIs), including HCV-hepatitis. Strict criteria of safe donor selection have to be adopted in order to minimize the risk of TTIs. The present study was conducted to evaluate the seropositivity of anti-HCV antibodies in multiply transfused thalassemia major patients. A total of 75 patients of thalassemia major who had received at least 10 transfusions were tested for anti-HCV antibodies, using third generation ELISA kits. Amongst these patients, 42% were seropositive for anti-HCV antibodies. This is a high prevalence rate and calls for a critical look into the prevailing transfusion practices and adoption of stricter donor selection criteria.
Key words: Anti-HCV antibodies; Thalassemia major; Safe blood transfusion.

Red Cell Alloimmunization in Repeatedly Transfused Thalassemia Major Patients

Khalid Hassan, Muhammad Younus, Nadeem Ikram*, Lubna Naseem and Hassan Abbas Zaheer
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad
* Department of Pathology, Rawalpindi Medical College, Rawalpindi
Thalassemia major patients managed by regular transfusion regimen may develop anti-red cell alloimmunization. If the alloantibodies are hemolyzing in nature, transfusion reaction may occur, and provision of blood thereafter requires matching of the relevant blood group in addition to ‘ABO” and Rh ‘D’ matching. We investigated 75 cases of multiply transfused thalassemia major patients for development of alloantibodies against red cells by indirect antiglobulin test, using 3-red cell panel, and when required 11-red cell panel. Anti-red cell alloantibodies were detected in 17 (22.7%) patients. Anti-Kpa antibodies were the commonest, followed by Anti-e, anti-E and anti-K antibodies, respectively. Anti-k, -CW, -Fyb, -Kpb, -Rh ‘D’ and –c were detected in one patient each. It is concluded that in multiply transfused patients, alloantibodies develop in a significant number of patients. The hemolyzing nature of antibodies should be determined in patients who develop these antibodies, and transfusion should be arranged accordingly
Key words: Red Cell Alloimmunization; Alloantibodies; Thalassemia Major; Multiple Transfusions.

Prevalence and Antimicrobial Susceptibility of Methicillin Resistant Staphylococcus Aureus (MRSA)

Rubeena Hafeez*, A.S. Chughtai and M. Aslam
* Consultant Microbiologist, Chughtai’s Lahore Lab, Jail Road, Lahore.
The isolation rate of MRSA from different specimens was determined. Between January 1999 and June 2002, 448 out of 1322 (35.67%) isolates were found to be MRSA. A detailed study of these isolates showed a high prevalence of MRSA in patients in ICU’s and special care wards. The yield of MRSA was highest from endotracheal secretions (100%), bronchial washings (70%), and catheter tips (51.85%) followed by sputum (40.54%), ear swabs (40%), fluids (37.25%), pus/wound swabs (34.83%) and blood cultures (28.07%). Vancomycin remains the drug of choice with no resistance detected. The resistance to ciprofloxacin was 86.61%, to erythromycin 85.5% and to gentamicin 81.03%. After vancomycin, fusidic acid was the most sensitive drug with only 21.21% of the isolates exhibiting resistance. In view of the high prevalence of MRSA in our community, authorities must introduce more effective measures to control its spread, otherwise it may seriously disrupt the efficient delivery of the health system in the country.
Key words: Methicillin Resistant Staphylococcus Aureus; MRSA; Antimicrobial Susceptibility.

Pathology of Chorionic Villi in Spontaneous Abortions

Anwar Ul Haque, Saadia Siddique, Mahera Mustafa Jafari, Imjaad Hussain and Saad Siddiqui
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
Spontaneous abortions are quite common. While in a normal multiparous woman, one or two spontaneous abortions are not unusual, recurrent spontaneous abortions may pose serious problems for some couples. Many such abortions may have a background of genetic anomaly that is reflected in abnormalities of chorionic villi. It is therefore, important to study placenta for various pathological lesions in order to understand the etiology & pathogenesis of the abortion. The chorionic villi are the main fetal part and functional unit of placenta. In this study we examined various pathological changes in chorionic villi in 64 cases of spontaneous abortion specimens. These included hydropic change, numbers of vessels, patency of vessels, stromal fibrosis, fibrinoid degeneration and Hofbauer macrophages. We observed that the villi were reduced in 97% of cases, 83% of villi had stromal fibrosis, 75% displayed fibrinoid degeneration, 75% contained reduced numbers of blood vessels while the patency of vessels was seriously affected in 66% of cases, and 67% cases had prominent Hofbauer macrophages. We conclude that vast majority of spontaneous abortions have abnormal chorionic villi and the most common abnormalities are marked fibrosis and severely compromised vasculature incompatible with fetal development and viability.
Keywords: Chorionic villi; Products of conception; Spontaneous abortions.