Background Staphylococcus aureus (S. aureus) is a major pathogen implicated in skin and soft tissue infections, abscess in deep organs, toxin mediated diseases, respiratory tract infections, urinary tract infections, post-surgical wound infections, meningitis and many other diseases. Irresponsible and over use of antibiotics has led to an increased presence of multidrug resistant organisms and especially methicillin resistant Staphylococcus aureus (MRSA) as a major public health concern in Afghanistan. As a result, there are many infections with many of them undiagnosed or improperly diagnosed. We aimed to establish a baseline of knowledge regarding the prevalence of MRSA in Kabul, Afghanistan, as well as S. aureus antimicrobial susceptibility to current available antimicrobials, while also determining those most effective to treat S. aureus infections.MethodsSamples were collected from patients at two main Health facilities in Kabul between September 2016 and February 2017. Antibiotic susceptibility profiles were determined by the disc diffusion method and studied using standard CLSI protocols.ResultsOut of 105 strains of S. aureus isolated from pus, urine, tracheal secretions, and blood, almost half (46; 43.8%) were methicillin-sensitive Staphylococcus aureus (MSSA) while 59 (56.2%) were Methicillin-resistant Staphylococcus aureus (MRSA). All strains were susceptible to vancomycin. In total, 100 (95.2%) strains were susceptible to rifampicin, 96 (91.4%) susceptible to clindamycin, 94 (89.5%) susceptible to imipenem, 83 (79.0%) susceptible to gentamicin, 81(77.1%) susceptible to doxycycline, 77 (77.1%) susceptible to amoxicillin + clavulanic acid, 78 (74.3%) susceptible to cefazolin, 71 (67.6%) susceptible to tobramycin, 68 (64.8%) susceptible to chloramphenicol, 60 (57.1%) were susceptible to trimethoprim-sulfamethoxazole, 47 (44.8%) susceptible to ciprofloxacin, 38 (36.2%) susceptible to azithromycin and erythromycin, 37 (35.2%) susceptible to ceftriaxone and 11 (10.5%) were susceptible to cefixim. Almost all (104; 99.05%) were resistant to penicillin G and only 1 (0.95%) was intermediate to penicillin G. Interestingly, 74.6% of MRSA strains were azithromycin resistant with 8.5% of them clindamycin resistant. Ninety-six (91.4%) of the isolates were multi-drug resistant.ConclusionsThere was a high rate of Methicillin resistance (56.2%) among S. aureus strains in the samples collected and most (91.4%) were multidrug resistant. The most effective antibiotics to treat Staph infections were vancomycin, rifampicin, imipenem, clindamycin, amoxicillin-clavulanic acid, cefazolin, gentamicin and doxycycline. The least effective were azithromycin, ceftriaxone, cefixim and penicillin. We recommend that, where possible, in every case of S. aureus infection in Kabul, Afghanistan, Antibiotic susceptibility testing (AST) should be performed and responsible use of antibiotics should be considered.

Nasal carriage of Staphylococcus aureus/Methicillin-resistant Staphylococcus aureus (S. aureus/MRSA) poses a major risk for the transmission and infection of this pathogen especially in hospital setting. The main objective of this study was to investigate the colonization of S. aureus/MRSA among healthy individuals and determine their susceptibility patterns to common antibiotics in Kabul. A total of 150 healthy participants have been included and nasal swabs were collected from all. Samples were cultured on appropriate and selective media for proper identification of S. aureus. Antibiotic susceptibility profiles were determined by the disc diffusion method and interpreted according to the Clinical & Laboratory Standards Institute (CLSI) protocols. The prevalence of S. aureus nasal colonization was 33.3% with 12.7% MRSA nasal carriage. The prevalence of S. aureus/MRSA colonization was not statistically significant according to gender (p=0.84) and age (0.18). All MRSA isolates were sensitive to rifampicin, linezolid and acid fusidic. Thirty-two percent of the S. aureus isolates were multi-drug resistant. Multi-drug resistance varied from resistance to at least three classes of antibiotics (14%) to maximum six classes of antibiotics (4%). This study revealed a high prevalence of S. aureus/MRSA nasal carriage among healthy individuals when compared to similar studies conducted elsewhere and is a reason of concern. Identifying and treating MRSA carriers, as well as responsible use of antibiotics is recommended.

Streptococcus pyogenes (S. pyogenes) is the main agent of acute pharyngitis and skin infections that may result in the late complications of glomerulonephritis and rheumatic fever. Infection with streptococcus group A is a global health problem, which is most common in children and adults. This study was conducted to investigate the rate of S. pyogenes throat carriers and its main risk factors among healthy students of Kabul university. In the present study pharyngeal swabs of 260, [155 (59.6%) were male and 105 (40.4%) were female] asymptomatic university students aged between 19-30 years, were collected and immediately transported to the laboratory for detection of S. pyogenes following standard microbiological procedures. Production of beta hemolytic colonies on blood agar, sensitivity to bacitracin antibiotic, gram stain positivity, catalase negativity test and streptococcal grouping latex kit (ProlexTM) tests were used to identify and differentiate S. pyogenes from other streptococcus spp. Statistical analysis of data was performed using SPSS 21, Chi-square and Logistic regression tests were applied for the categorical data analysis. A P value equal to or less than 0.05 was considered statistically significant. Totally 61 (23.5%) beta hemolytic streptococci were isolated from 260 samples. Among 61 beta hemolytic isolates, 44 (16.9%) were identified as S. pyogenes. The colonization rate of S. pyogenes was higher in male 25 (56.8%) than female 19 (43.2%), which was not statistically significant (p=0.678). Age, residence of the students at hostel and shared utensil use were not statistically significant (p=0.088, p= 0.449, p=0.241 respectively), but the number of children in the family was an important risk factor. People with 1-3 children had a 23-fold higher risk (p˂0.05), and people with 4-6 children had a 27-fold higher risk of carrying S. pyogenes, than those who did not had any children (p˂0.05). In the present study the asymptomatic throat carriage rate of S. pyogenes among Kabul University students, was high. Among all risk factors the number of children in the family was significantly associated with S. pyogenes throat carriage.

Background: SARS-CoV-2 is a novel member of human coronavirus that is newly identified in Wuhan, Hubei, China. The COVID-19 pandemic has spread to over 213 countries and affected more than 33 million individuals and caused 999000 deaths worldwide.Methods: This cross-sectional study conducted on 124 symptomatic COVID-19 patients in Kabul, Afghanistan. Demographic and clinical data collected using a standard form.  Nasopharyngeal/oropharyngeal swab sample collected for viral detection. Data were analyzed using IBM SPSS statistics (version 21) software.Results: Out of 124 patients, 88 (71%) were male and 36 (29%) were female. The mean age of patients was 41.2±17.07 years and the majority of patients 32 (25.8%) were in the age group of 20 – 29 and minority 3 (2.4) was over 79 years. On clinical presentation, most patients had ageusia (71.3%), fever (69.4%), headache (69.4%), sore throat (66.1%), myalgia (66.1%), cough (64.5%), weakness (63.7%), dyspnea (38.7%), and the fewer symptom was diarrhea (31.5%). 19 (15.3%) patients had Hypertension, 16 (12.9%) had cardiovascular disease, 8 (6.5%) had diabetes, 5 (4.0%) had cancer, 4 (3.2%) had chronic pulmonary disease, and 3 (2.4%) had liver disease. The mean duration for the presence of symptoms was 13.3±6.3 days. The fatality rate was 4%.Conclusion: Our study reveals that males are more affected by COVID-19 than females and the young generation is more affected than elders.  The most common symptoms are ageusia, fever, headache, sore throat, and myalgia, and the less common symptom is diarrhea.

Background: Hepatitis B virus (HBV) infections are one of the world's health problems that annually kill about 500,000 to 1,200,000 people. Investigation of HBV DNA in the person infected with HBV is a definitive indicator of activation and replication of HBV.Objectives: The aim of this study is to investigate the DNA of HBV in HBsAg positive patients and to study the risk factors for virus activation. Methods: This study was conducted on 106 HBsAg positive patients from January 2020 to July 2020 in Kabul. After informed consent, 3 to 5 milliliters of blood was collected for the HBV-DNA testing using the Real-time PCR method.Result: Out of 106 HbsAg positive patients, 74 (69.8%) were males and 32 (30.2%) females. The patients were aged between 11 and 65 years. Hepatitis B virus DNA was positive in 58 (54.7%) of the samples, 41 (70.7%) were male and 17 (29.3%) were female. The viral DNA load was in the range of 9.85 x 102 to 9.3 x 108 copies/ ml. Most of the patients were aged between 20 and 30 years. Conclusion: From 106 HbsAg positive patients, 23(39.7%) were in the age group of 20 – 30 years, and males were more infected than females. The majority of the patients were married and had an informal job with education below grade 12. No specific differences were found in the availability of HBV DNA between patients who received hepatitis B treatment before and those who did not.