Infectious Diseases Journal of Pakistan

Obituary - Prof Dr Naseem Salahuddin

Editor Office — Sat, 04 Jul 2026 00:00:00 +0000

Clinical and microbiological features of infection with Rhodotorula species; experience from Pakistan

Tue, 30 Jun 2026 00:00:00 +0000

Background: Rhodotorula species is an emerging cause of invasive fungal infection worldwide; however, data from Pakistan is limited. We analysed clinical and microbiological features of Rhodotorula infection identified at a tertiary care hospital laboratory in Pakistan.

Material and Methods: In this retrospective cross-sectional study, clinical samples yielding Rhodotorula species between 1^st January 2010 – 30^th March 2024 were retrieved using Integrated Laboratory Management System. Demographic data and relevant clinical findings were evaluated. Categorical variables are reported as frequencies (%) and continuous variables as mean ± SD or median (IQR).

Results: A total of 64 cases were identified, of which 81.25% (n=52) were from invasive sites; blood being the most common i.e., 54.6% (n=35). Minimum Inhibitory Concentration range of amphotericin (n=27) was 0.12–1 mcg/ml; MIC₅₀ and MIC₉₀ were 0.12 mcg/ml and 0.5mcg/ml respectively. Of the nine patients with detailed clinical findings, all isolates were invasive (5: blood, 1: CSF, 1: EVD, 1: ascitic fluid). Of these, five cases were considered significant, three were contamination/colonization and significance of one case could not be ascertained. Only three patients with fungemia received intravenous amphotericin B deoxycholate. The mean duration of treatment was 14.3± 2.8 days, all nine patients were alive at the time of discharge.

Conclusion: Since Rhodotorula species is ubiquitously present in the environment, careful assessment of clinical findings and underlying risk factors is crucial to determine its significance in clinical specimens.

Keywords: Amphotericin B, Beta D Glucan, Fungemia, Pakistan, Rhodotorula

Reversal of graft dysfunction following treatment of urinary tract infections in renal transplant recipients

Mehak Abro, Ejaz Ahmed, Ranjeet Kumar, Imran Ali, Sidra German, Huda Narejo — Tue, 30 Jun 2026 00:00:00 +0000

Background: UTI is one of the most common complications of the renal transplant recipients. The aim of the study is to assess the reversal of graft malfunction following the management of urinary tract infection in kidney transplant patients.

Material and Methods: This was a prospective observational cohort study done at the Department of Transplant Nephrology, Sindh Institute of Urology and Transplantation. Non-probability consecutive sampling was used to select a total of 70 renal transplant recipients aged between 18 - 65 years with UTI and graft dysfunction. Graft dysfunction reversal was measured at 6 weeks of antibiotic treatment and was divided into complete, partial, and no reversal. The analysis of data was performed by SPSS 22.0 with p<0.05 as significant value.

Results: Graft dysfunction reversal was complete in 38 out of 70 patients (54.3%), partial in 20 out of 70 (28.6%), and absent in 12 out of 70 (17.1%). On multivariable logistic regression analysis, diabetes mellitus (AOR = 0.38, p = 0.041), hypertension (AOR = 0.42, p = 0.048), high baseline creatinine ≥2 mg/dL (AOR = 0.31, p = 0.023), and infection with multidrug-resistant organisms (AOR = 0.56, p = 0.019) were independently associated with decreased odds of complete reversal. The most frequent pathogens were Escherichia coli (32/70, 45.7%) and Klebsiella pneumoniae (18/70, 25.7%).

Conclusions: Graft dysfunction related to UTI is reversible in a high percentage of renal transplant recipients. Comorbidities, impaired baseline renal, and multidrug-resistant infections have a negative impact on recovery.

Keywords: Creatinine; Drug Resistance, Graft Dysfunction, Kidney Transplantation.

Frequency of surgical site infection in patients undergoing lumbar microdiscectomy

Tue, 30 Jun 2026 00:00:00 +0000

Background: Lumbar microdiscectomy is a common minimally invasive procedure for disc herniation, but SSI is a major complication, especially in LMICs where incidence may be higher due to systemic factors.

Material and Methods: This prospective study of 100 adult patients who underwent lumbar microdiscectomy for lumbar disc herniation at Lady Reading Hospital, Peshawar, Pakistan, from 10 July 2025 to 10 January 2026. Inclusion criteria were patients aged 18–75 years with symptoms >6 weeks; exclusions included prior surgery at the same site, instrumentation, pre-existing infection, severe immunodeficiency, or pregnancy. SSI was defined according to CDC criteria within 30 days postoperatively, with initial clinical assessment performed at 10 days based on wound redness, VAS >4 or cloudy drainage. Data on demographics, comorbidities, and socioeconomic factors were collected. Analysis was performed using frequencies, means/medians, and chi-square or Fisher’s exact test.

Results: 13 (13%) of 100 patients had SSI. The mean age was 46.2 ± 12.8 years; 62% were male. The mean BMI was 28.4 ± 5.1 kg/m2; 38% were obese (BMI > 30). SSI was significantly associated with comorbidities, including Obesity (23.7% vs. 6.5%, p=0.012), diabetes (31.8% vs. 7.7%, p=0.003), smoking (22.9% vs. 7.7%, p=0.028), and rural residence (18.9% vs. 4.8%, p=0.032).

Conclusions: The 13% SSI rate in this LMIC group exceeds high-resource series (1-3%) but aligns with regional posterior spine surgery data. Risk factors are Obesity, diabetes, smoking, and rural residence. Enhance perioperative and infection-control practices to reduce SSI in resource-limited settings.

Keywords: Disc herniation, Lumbar microdiscectomy, Spine surgery, Surgical site infection.

MTB detection frequency using GeneXpert MTB/RIF ultra assay on pleural tissue in the evaluation of exudative lymphocytic effusion

Tue, 30 Jun 2026 00:00:00 +0000

Background: Pleural tuberculosis is a paucibacillary disease, which makes the diagnosis of tuberculous pleural effusion particularly challenging. The study aimed to establish the accuracy of GeneXpert MTB / RIF Ultra in the diagnosis of Mycobacterium tuberculosis in pleural biopsy samples.

Material and Methods: It was a cross-sectional observational study, done at the Department of Pulmonology, Ojha Institute of Chest Disease, Dow University of Health Sciences, Karachi, following institutional ethical approval. Adult patients with exudative lymphocytic pleural effusion were enrolled by consecutive sampling. Biopsy samples of pleura have been collected through medical thoracoscopy or image-guided methods and examined using GeneXpert MTB/RIF Ultra. The data had been analyzed with SPSS version 25, and effect modifiers were stratified; p < 0.05 was regarded as significant.

Results: A total of 130 patients were evaluated. Mean age was 47.3 ± 16.8 years. In 88 (67.7%) patients, histopathological findings were suggestive of tuberculosis. GeneXpert MTB/RIF Ultra assay showed a sensitivity of 36.4%, specificity of 90.5%, PPV of 88.9% and NPV of 40.4%. Stratification analysis revealed significant correlations of GeneXpert positivity with age (p = 0.041), effusion laterality (p = 0.028) and lymphocyte predominance (p = 0.019).

Conclusion: GeneXpert MTB/RIF Ultra has high specificity and low sensitivity in pleural biopsy samples. The high positive predictive value of tuberculous pleura however, justifies its use as a confirmatory test in suspected tuberculous pleural effusion.

Keywords: Biopsy, Molecular diagnostic techniques, Pleural, Pleural effusion, Tuberculosis

Comparative short-term efficacy of 15% potassium hydroxide versus cryotherapy in treatment of viral warts

Tue, 30 Jun 2026 00:00:00 +0000

Background: Viral warts are benign skin lesions, which are ascribed to human papillomavirus. There are several possible treatments options. The objective of this study is to evaluate the short-term effectiveness of 15% potassium hydroxide with cryotherapy in treating viral warts.

Methods: It was quasi-experimental study done in the Department of Dermatology, PNS Shifa Hospital, Karachi after getting ethical approval from September 2025 – April 2026. 260 patients with viral warts aged 10 years and above were enrolled with non-probability sequential sampling into two groups, Group A was treated to topical 15% potassium hydroxide (KOH) applied as a single application per day over four weeks, and Group B underwent a series of four weeks treatment based on the weekly use of cryotherapy. The analysis of data was done in SPSS 23; chi-square test was used and a p-value ≤0.05 was considered statistically significant.

Results: A total of 260 patients were enrolled, with 130 patients in each treatment group. After 4 weeks, treatment success (good/excellent response) was achieved in 99 (76.2%) patients receiving 15% potassium hydroxide compared with 73 (56.1%) receiving cryotherapy (p = 0.002). Pain (43.1% vs 13.8%), blistering (31.5% vs 4.6%), and pigmentary changes (20.8% vs 3.8%) were more frequent with cryotherapy (all p < 0.001). Potassium hydroxide independently predicted treatment success (AOR = 2.45, 95% CI: 1.42–4.21; p = 0.001).

Conclusion: Clinical response was better with topical 15% potassium hydroxide than with cryotherapy for viral warts, which was well tolerated.

Keywords: Cryotherapy, Potassium hydroxide, Treatment efficacy, Viral warts

Frequency of healthcare-associated infection and its bacteriological pattern in the pediatric intensive care unit

Tue, 30 Jun 2026 00:00:00 +0000

Background: Healthcare-associated infections (HAIs) are a major cause of morbidity and mortality in pediatric intensive care units (PICUs).

Material and Methods: This descriptive, cross-sectional study was conducted at the Pediatric Intensive Care and High Dependency Unit, Department of Pediatric Medicine, Dr Ruth KM Pfau Civil Hospital, Karachi, from 1^st November 2025 to 30^th April 2026. Children aged 1 month to 12 years admitted to the PICU were enrolled through non probability consecutive sampling. In children with suspected HAIs, site specific samples were collected under strict aseptic technique. Data were analyzed in SPSS version 26.0, and p<0.05 was considered significant.

Results: Among 139 PICU patients, 76 (54.7%) were males and 63 (45.3%) were females. Healthcare-associated infections (HAIs) occurred in 36 (25.9%) patients, while mortality was observed in 26 (18.7%). Most participants were from urban areas (75.5%). The median PICU stay was 5 days (IQR: 3–6). No significant associations were found between HAI occurrence and gender (p=0.368), age group (p=0.437), or residence (p=0.591). Bloodstream infection was the most common HAI (33.3%), followed by ventilator-associated pneumonia (25.0%), and Klebsiella pneumoniae was the most frequently isolated pathogen (25.0% of isolates). Overall, HAIs remained common among critically ill children, highlighting the importance of effective infection prevention strategies.

Conclusion: Healthcare associated infections represented an important burden in the PICU affecting nearly 1/4^th of children. Bloodstream infection with HAI, and Klebsiella pneumoniae was the predominant pathogen isolated.

Keywords: Blood culture, Children, infection, Paediatric intensive care unit, Urinary tract infection

The role of C-Reactive protein as a diagnostic predictor of sepsis in postpartum women

Bushra Ammar , Urooj Naz, Devia Kumari, Marium Usman, Faiza Rana, Misbah Batool — Tue, 30 Jun 2026 00:00:00 +0000

Background: Postpartum sepsis remains a leading cause of maternal mortality worldwide, necessitating the evaluation of C-reactive protein (CRP) as an accessible, rapid diagnostic biomarker to improve early detection and patient outcomes.

Material and Methods: This cross-sectional study was conducted at Civil Hospital Karachi over six months. A total of 471 postpartum women (aged 20–45 years) with suspected sepsis (qSOFA ≥2) within six weeks of delivery were included using non-probability consecutive sampling. Blood samples for quantitative CRP and culture were obtained prior to antibiotic administration. CRP ≥50 mg/L was considered elevated. Diagnostic indices included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and receiver operating characteristic (ROC) analysis.

Results: The mean age was 29.4 ± 5.8 years. Blood culture confirmed sepsis in 370 (78.6%) patients. Elevated CRP (≥50 mg/L) was observed in 356 (75.6%) patients. CRP demonstrated sensitivity of 84.3% (95% CI: 80.2–87.8), specificity of 56.4% (95% CI: 46.2–66.2), PPV of 87.6% (95% CI: 83.7–90.8), NPV of 49.6% (95% CI: 40.2–58.9), and diagnostic accuracy of 78.3% (95% CI: 74.3–81.9). The AUC was 0.71 (95% CI: 0.66–0.76).

Conclusion: CRP ≥50 mg/L demonstrates a satisfactory level of sensitivity and good overall test diagnostic accuracy in identifying postpartum sepsis in a high-prevalence tertiary care environment. Serial CRP measurements can also be used to measure therapeutic responses.

Keywords: C-reactive protein, Diagnostic accuracy, Maternal sepsis, Postpartum period, Sensitivity and specificity

Evaluating the frequency of antibiotic consumption in a PICU of a tertiary care hospital in Karachi: A Prospective study

Rubab Naz, Hanif Kamal, Anwar-ul-Haque, Safa Alam, Atika Sher, Muhammad Irfan — Tue, 30 Jun 2026 00:00:00 +0000

Background: Antibiotics have transformed the medical field; however, the increase in antimicrobial resistance (AMR) threatens their effectiveness, particularly in Pediatric Intensive Care Units (PICUs), where critically ill children are highly vulnerable to infections.

Material and Methods: A prospective observational study was conducted in the PICU of a tertiary-care hospital in Karachi, Pakistan, from 1^stJune 2023 to 31^st May 2024. All critically ill children (1 month to 15 years) admitted in the PICU, regardless of the antibiotic exposure were included, excluding immunocompromised children or those who were discharged before 72 hours. Antibiotics were categorized as empirical, therapeutic, or prophylactic. Empirical antibiotics outcomes after 72 hours were classified as "remains unchanged," "discontinued," "changed," or "continued as therapeutics".

Results: Of 265 admissions, 257 (97%) received antibiotics, predominantly Empirical (89.1%). On the first day, 59.1% received monotherapy, primarily Ceftriaxone (57.9%); whereas 39.3% received dual-therapy, most often Meropenem-Vancomycin (37.6%). After 72 hours, empirical therapy remained unchanged in 63% of cases, changed in 15.6%, discontinued in 16.2%, and continued as therapeutic in 5.2%. The median duration of antibiotic therapy was 5 days (IQR: 4-8). The total multidrug-resistance organism (MDRO) rate was 7.6% and mortality rate was 6.6%.

Conclusion: Antibiotics use in the PICU was extensive and predominantly empirical, with limited reassessment after initiation. These findings highlight the importance to strengthen antimicrobial stewardship practices, optimize antibiotic utilization, and mitigate the emergence of AMR in PICU.

Keywords: Antibiotic Stewardship, Empirical Therapy, LMICs, PICU.

Prevalence of methicillin-resistant Staphylococcus aureus in common pyodermas: A cross-sectional study at Fazaia Medical affiliated teaching hospital Islamabad

Nadia Ghazanfar, Sajida Bibi, Muneeza Rizwan , Maryam Rassul, Musafir Ali — Fri, 30 Jun 2023 00:00:00 +0000

Background: Pyodermas are purulent skin infections involving the epidermis, dermis, or hair follicles. Staphylococcus aureus is the predominant causative agent, with methicillin-resistant Staphylococcus aureus (MRSA) becoming an increasing concern in both hospital and community settings. The aim of the study was to determine the prevalence of MRSA in common pyoderma cases.

Material and Methods: This descriptive cross-sectional study was conducted over six months in the Dermatology Department of Fazaia Medical Affiliated Teaching Hospital, Islamabad. A total of 150 patients with pyodermas were enrolled through non-probability consecutive sampling. Clinical data were recorded, and pus specimens were collected using sterile swabs after saline cleansing. Cultures were performed on nutrient agar, Mannitol salt agar, blood agar, and MacConkey agar. MRSA detection was carried out using the Kirby-Bauer disc diffusion method with Mueller-Hinton agar using cefoxitin discs according to CLSI guidelines.

Results: The mean patient age was 30.58 ± 17.44 years, with 91 (60.67%) males and 59 (39.33%) females. Furuncle (32.67%) and folliculitis (28.67%) were the most common diagnoses. MRSA was isolated in 53 (35.33%) patients. MRSA prevalence was significantly higher in secondary pyodermas (66.7%) versus primary pyodermas (21.9%) (p<0.001), in patients with symptoms >10 weeks (66.7%) versus ≤10 weeks (29.4%) (p<0.001), and in those with fewer lesions (41.7%) compared to those with more lesions (10%) (p=0.001).

Conclusion: The 35.33% MRSA prevalence aligns with other regional studies. The higher detection in secondary and chronic pyodermas highlights its clinical importance.

Keywords: Antimicrobial resistance, Community-acquired infections, Methicillin-resistant Staphylococcus aureus, Pyoderma, Skin infections

Survey of endoscopes reprocessing and evaluation of outcomes using bacteriologic cultures for optimization of strategies

Tue, 30 Jun 2026 00:00:00 +0000

Background: Flexible endoscopes are complex equipment that are expensive and reuse deems necessary thorough reprocessing composed of several important steps. This study aims to look into the practices used for endoscope reprocessing at a tertiary care unit and help evaluate outcomes using bacteriologic cultures at the end of High-level disinfection (HLD).

Material and Methods: The study was conducted at the endoscopy suite of Indus Hospital & Healthcare Network Karachi which is a tertiary care unit from November 2025 till February 2026. It was a hospital based cross sectional study with an embedded clinical audit component of the current endoscopic reprocessing practices using CDC Audit tool. Sixty-two endoscopes including bronchoscopes, endoscopes, colonoscopes and duodenoscopes were cultured for bacteriologic and Acid-fast bacillus (AFB) growth after HLD to serve as a measure of efficacy of disinfection.

Results: We found bacterial growth in 14 out of 62 endoscopes rendering a culture positivity rate of 23%. The highest proportion of contamination was found in colonoscopes amongst all endoscopes. Total 17 bacterial pathogens were isolated, 8 were identified as Pseudomonas species. About 74% samples were collected 12-18hrs after disinfection The mean time duration between sample collection and sample processing was 2.85 hrs.

Conclusion: Current practices displayed suboptimal adherence to recommended protocols for disinfection of endoscopes translating into positive cultures. Strategic steps were taken for formal training of the personnel, provision of recommended infrastructure and proposition of an appropriately bioengineered endoscopy suite to optimize care.

Keywords: Centers for Disease Control and Prevention, U.S., Disinfection, Endoscopes.

Role of oral antifungal in treatment of malignant otitis externa in diabetic patients

Tue, 30 Jun 2026 00:00:00 +0000

Background: To assess specific oral antifungal therapy effectiveness in diabetic patients with fungal malignant otitis externa (FMOE) not responding to early intravenous antibacterial treatment.

Material and Methods: This cross-sectional study was conducted at Nishtar Hospital Multan (September 2025–February 2026) on 78 diabetic patients with confirmed FMOE. Inclusion criteria included persistent otorrhea despite ≥7 days of IV ceftazidime, positive fungal culture, and HRCT evidence of temporal bone osteitis. After failed ceftazidime therapy, patients received oral voriconazole or itraconazole based on susceptibility testing. Response was assessed clinically and with Technetium-99m and Gallium-67 scans at 6 and 10 weeks.

Results: Out of 78 patients, 67 (85.9 percent) had clinical improvement using oral antifungals by week 6. Mean days to symptom improvement were 9.3 ±2.7 days. Radiological resolution of Technetium and Gallium scans correlated strongly with clinical response (p < 0.001). No major significant difference existed in results of diabetes types (p = 0.42) or genders (p = 0.61). Side effects were not severe, notably showing increased LFTs in 6 patients managed with regular dose adjustment.

Conclusion: Oral antifungal therapy is overall effective in diabetic patients with fungal malignant otitis externa unresponsive to traditional antibacterial treatment. Technetium-99m and Gallium-67 scans remain further useful when measuring response to therapeutic use in an outpatient clinical environment.

Keywords: Diabetes mellitus, fungal malignant otitis externa, Gallium scan, HRCT temporal bone, Itraconazole, otorrhea, Oral antifungal, Voriconazole, Technetium scan, Treatment failure

Frequency of new-onset various autoimmune diseases in patients recovered from COVID-19 pneumonia

Namrah Fatima, Khurram Saleem, Samrah Fatima — Tue, 30 Jun 2026 00:00:00 +0000

Background: Coronavirus disease 2019 (COVID-19) has been associated with long-term immune dysregulation and may predispose recovered patients to development of autoimmune diseases. This study aimed to determine the frequency of new-onset autoimmune diseases in patients recovered from COVID-19 pneumonia. The aim of this is to determine the frequency of new-onset various autoimmune diseases in patients recovered from COVID-19 pneumonia.

Material and Methods: This Descriptive cross-sectional study was conducted at the Department of General Medicine, Lahore General Hospital, Lahore, from 02 December 2025 to 02 April 2026. A total of 191 patients aged 18–70 years with documented recovery from COVID-19 pneumonia for at least six months were enrolled through non-probability consecutive sampling. Patients presenting with symptoms suggestive of autoimmune disease underwent targeted evaluation under specialist guidance.

Results: Mean age was 44.2 ± 13.6 years, while 108 (56.5%) were males. New-onset autoimmune diseases were identified in 49 (25.7%) patients. Autoimmune thyroiditis was the most frequent disorder in 14 (7.3%) patients, followed by alopecia areata in 11 (5.8%), rheumatoid arthritis in 10 (5.2%), psoriasis in 6 (3.1%), systemic lupus erythematosus in 3 (1.6%), and ANCA-associated vasculitis in 1 (0.5%) patient. Autoimmune diseases were significantly more common in females (p=0.048) and in patients with comorbidities (p=0.041).

Conclusion: It is concluded that a considerable proportion of patients with a history of COVID-19 pneumonia were later diagnosed with new-onset autoimmune diseases, likely related to persistent immune dysregulation.

Keywords: COVID-19 pneumonia, Autoimmune diseases, Immune dysregulation, Post-COVID complications

Comparative efficacy of oral and topical antifungals in recurrent vulvo-vaginal candidiasis

Sat, 04 Jul 2026 00:00:00 +0000

Background: Vulvovaginal candidiasis (VVC) is a common gynaecological infection that significantly affects women's quality of life. Both oral and topical antifungal therapies are widely used; however, their comparative efficacy remains a subject of clinical interest.

Material and Methods: This quasi-experimental study was conducted in the Department of Gynaecology, Continental Medical College, Lahore (1^st June to 30^th November 2025). A total of 120 women with recurrent vulvovaginal candidiasis were included, who were divided into Group-A (oral fluconazole) and Group-B (topical clotrimazole). Both groups were treated for three months. After completion of therapy, patients were assessed for efficacy. Intergroup comparison of parameters was performed with Mann Whitney U-test and Fisher exact or chi-square test using SPSS v22.

Results: In this study, 120 patients were included and were divided into two groups. Median age was 29.00 (15.00) years. Median duration of discharge was 9.00 (6.00) days. There were 43 (35.80%) primiparous and 77 (64.20%) multiparous women. Among all women, 94 (78.30%) were premenopausal and 26 (21.70%) were menopausal. There were 71 (59.20%) women who were diabetic. In Group-A, efficacy/complete cure was achieved in 52 (86.67%) while in Group-B, it was achieved in 35 (58.33%) of the women, (p = 0.001).

Conclusion: In this study population, oral fluconazole demonstrated significantly better efficacy than topical clotrimazole for treating recurrent vulvovaginal candidiasis. However, given the study limitations, these findings should be considered preliminary and require confirmation through larger randomized controlled trials.

Keywords: Candidiasis, Clotrimazole, Fluconazole, Recurrent Vulvovaginal Candidiasis, Vulvovaginal.

Diagnostic accuracy of MRI contrast enhanced FLAIR and T1-weighted images in diagnosis of infectious meningitis taking CSF analysis as reference standard

Ammara Akram, Saman Chaudhry, Sana Arbab, Noor ul Ain Lali — Tue, 30 Jun 2026 00:00:00 +0000

Background: Early diagnosis of infectious meningitis is critical to reduce morbidity and mortality, particularly in paediatric patients where delayed diagnosis may lead to severe neurological complications.

Material and Methods: This Cross-sectional study was conducted at Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore, from 3^rd January 2026 to 10^th April 2026. A total of 154 children aged ≤15 years with clinical suspicion of infectious meningitis were enrolled through non-probability consecutive sampling. All participants underwent contrast-enhanced FLAIR and post-contrast T1-weighted brain MRI. CSF analysis, including cytological, biochemical, and microbiological assessment, was used as the reference standard as CSF findings consistent or not consistent with infectious meningitis.

Results: The mean age was 8.17 ± 4.4 years, and 90 (58.4%) participants were male. CSF findings were consistent with infectious meningitis in 104 (67.5%) cases. Contrast-enhanced FLAIR MRI showed leptomeningeal enhancement suggestive of infectious meningitis in 100 (64.9%) patients, whereas post-contrast T1-weighted MRI was positive in 93 (60.4%) patients. CE-FLAIR showed a sensitivity, specificity, PPV, NPV, and overall accuracy of 92.3%, 92.0%, 96.0%, 85.2%, and 92.2%, respectively. Corresponding values for post-contrast T1-weighted MRI were 81.7%, 84.0%, 91.4%, 68.9%, and 82.5%, respectively.

Conclusion: Contrast-enhanced FLAIR MRI showed higher sensitivity, specificity, predictive values, and overall diagnostic accuracy than post-contrast T1-weighted MRI for detecting infectious meningitis.

Keywords: Cerebrospinal fluid, Child, Magnetic resonance imaging, Meningitis, Sensitivity and specificity

Determining the frequency of pulmonary tuberculosis in patients presenting with bronchogenic carcinoma at tertiary care hospital, Karachi

Tue, 30 Jun 2026 00:00:00 +0000

Background: Pulmonary tuberculosis (PTB) may accompany bronchogenic carcinoma, making it very difficult to diagnose and treat.

Material and Methods: A descriptive cross-sectional study was carried out at Outpatient Department of Pulmonology, Ojha Institute of Chest Diseases, Karachi, 1^st November 2025 – 30^th April 2026. Consecutive enrolment of adult patients with histopathologically or radiologically confirmed bronchogenic carcinoma was done (n = 97). The diagnosis of PTB was done by acid-fast bacilli (AFB) smear, Lowenstein-Jensen media culture, or Xpert MTB/RIF assay. Chi-square or Fisher exact tests were used to analyze the association between PTB and patient characteristics and multivariate logistic regression was used to determine independent predictors. P value of less than or equal to 0.05 was considered to be significant.

Results: The study involved 97 patients who were diagnosed with bronchogenic carcinoma. The mean age was 58.4 ± 11.7 years, and 62.9% were males. The diagnosis of pulmonary tuberculosis (PTB) was made in 38 patients (39.2%). In the multivariate logistic regression analysis, male sex (AOR = 3.18, p = 0.048), rurality (AOR = 6.85, p < 0.001), low education (AOR = 4.72, p = 0.015), and low income (AOR = 5.90, p = 0.014) were independently associated with an increased likelihood of pulmonary tuberculosis (PTB) among patients with bronchogenic carcinoma.

Conclusion: PTB was prevalent among bronchogenic carcinoma patients. Male gender, rural residence, low education, and low income were significantly associated with a higher likelihood of PTB, whereas age showed no significant association.

Keywords: Bronchogenic Carcinoma, Comorbidity, Cross-Sectional studies, Pulmonary tuberculosis.

In Memoriam: Dr. Naseem Salahuddin (1944–2026) – Founding Editor, Visionary Leader, and the Mother of Infectious Diseases in Pakistan

Asma Nasim — Tue, 30 Jun 2026 00:00:00 +0000

Dr. Naseem Salahuddin—our beloved mentor and a fierce, unwavering defender of human dignity—is no more. Her sudden departure on May 22, 2026, leaves the entire medical community in profound mourning.

Dr. Naseem laid the very foundation of the Infectious Diseases Society of Pakistan (IDSP) in 1993, and later spearheaded and launched the Infectious Diseases Journal of Pakistan (IDJP). To understand the genesis of this monumental legacy, one has to look back to the quiet, determined beginnings of a specialty that did not yet exist in our country.

When reflecting on those early days, Dr. Altaf Ahmed—Head of Infection Control and Clinical Microbiology at the Pakistan Kidney and Liver Institute & Research Center, Lahore, her dear colleague, and one of the fellow founding pioneers of Infectious Diseases in Pakistan—shared this deeply heartfelt remembrance:

“I first met her in 1993 at Liaquat National Hospital — a slim, elegant, soft-spoken, middle-aged physician. Most of her conversation was in English rather than Urdu. She introduced me to “KIDS” — the Karachi Infectious Diseases Society — and invited me to its meetings. There were only 10-12 of us, sitting in a room, discussing infectious diseases. Two years later, we decided KIDS should grow into IDSP and expand its reach.

At that time, there was no journal dedicated to infectious diseases in Pakistan. She was a gifted writer with a strong command of English and frequently contributed articles to newspapers, especially DAWN. One day she said, “Let’s start an infectious diseases journal focused on our national issues.” Back then, JPMA was the only reputed medical journal, but it did not focus on ID. In 1994 she started with the “Karachi Infectious Diseases Newsletter” which in 1995 became IDJ — the Infectious Diseases Journal. She solicited articles from colleagues, reviewed manuscripts, raised funds for printing, and distributed copies herself. A one-woman army.”

Indeed, Dr. Naseem raised an army of dedicated specialists in Infectious Diseases in Pakistan by her sheer grit, dedication, and boundless love for her country. For those of us who grew up under her wings, the most beautiful reward was her maternal pride; she constantly expressed how deeply proud she was to see us all growing, thriving, and taking the field of Infectious Diseases to new, unprecedented heights

In her honor, we stand together today to pledge to uphold the exact values she demanded of us every single day. We promise to keep the pages of this journal a sanctuary for rigorous, data-driven truth, ensuring that local data is always met with international standards of excellence. We commit to keeping this platform a vibrant, welcoming voice for young, emerging researchers, lifting them up just as she lifted us. We will continue to publish the science that matters to our people—focusing on diseases specific to our region—and we will ensure that our voice is heard clearly in the international community. We will guard the independence and ethical boundaries of this journal with the same fierce, unyielding discipline that Dr. Naseem modeled for decades.

With profound grief and the heaviest of hearts, the Editorial Board of the Infectious Diseases Journal of Pakistan (IDJP) is officially transitioning the name of our beloved founding member and guiding light, Dr. Naseem Salahuddin, from our active editorial roster.

While her name moves from the operational masthead, her spirit is permanently, indelibly etched into the very DNA of this journal and into the heart of every physician who carries her torch.

Rest in eternal peace, Dr. Naseem. We miss you profoundly, but we promise to march on.

Isolation of Salmonella enterica Serovar Typhi from Breast Abscess : A Rare Extra-Intestinal Presentation

Sidra Naveed , Luqman Satti , Warda Furqan, Afnan Naeem, Inam Ullah Khan — Sat, 04 Jul 2026 00:00:00 +0000

Extra-intestinal manifestations of Salmonella enterica serovar Typhi are uncommon and usually occur in individuals with compromised immunity. Breast abscess caused by Salmonella Typhi is a rare clinical entity, particularly in non-lactating pregnant females. Here, we report the case of a 28 year old pregnant female (G4P3) who presented with a unilateral breast abscess. The patient had no significant past medical history or prior similar episodes. Surgical incision and drainage was performed, and pus aspirated from the breast was sent for microbiological evaluation. Culture yielded non-lactose fermenting colonies, which were biochemically suggestive of Salmonella species. Final identification was confirmed as Salmonella enterica serovar Typhi using API 10S and VITEK 2 automated identification system with excellent confidence. The patient responded well to surgical and medical management and was discharged in stable condition. This case highlights a rare extra-intestinal presentation of typhoid fever and emphasizes the importance of considering Salmonella Typhi as a potential etiological agent of breast abscess in pregnant patients residing in typhoid-endemic regions.

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Editor Office — Sat, 04 Jul 2026 00:00:00 +0000