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Primary amebic meningoencephalitis caused by Naegleria fowleri is a rare but nearly always fatal parasitic infection of the brain. Globally, few survivors have been reported, and the disease has no specific treatment. We report a confirmed case in Pakistan in a 22-year-old man who survived after aggressive therapy.

Objective: To discover the frequency of vancomycin resistant enterococci (VRE) fecal colonization and subsequent bacteremia in patients with hematological diseases in a bone marrow transplant center. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), in collaboration with Armed Forces Bone Marrow Transplant Center, Rawalpindi, from Jan 2016 to Dec 2019. Methodology: Stool specimens/anal swabs from all enrolled patients were collected aseptically and transported to the laboratory without delay. Blood cultures were collected aseptically from only those enrolled patients who developed signs and symptoms of bacteremia. Stool and blood cultures were processed as per standard microbiological protocols. Enterococci were identified to species level by colony morphology and biochemical tests. Modified Kirby Bauer disc diffusion method and VITEK-2 system (Version-8.01 bio Merieux, France) were used to perform antimicrobial sensitivity of each isolate. Results: A total number of 246 patients were studied. Among them, 67 (27%) patients had fecal colonization by vancomycin resistant enterococci. We report a statistically significant association of recent hospitalization, prolonged exposure to antimicrobial therapy, chemotherapy exposure and use of indwelling devices during the hospital stay with vancomycin resistant enterococci colonization. Vancomycin resistant enterococci bacteremia was detected in 57 (23%) patients. Among these 57 patients, 53 (93%) were vancomycin resistant enterococci colonizers. Vancomycin resistant enterococci colonization was significantly associated with vancomycin resistant enterococci bacteremia. Conclusion: A considerable burden of vancomycin resistant enterococci fecal colonization exists among patients with hematological diseases. vancomycin resistant enterococci colonization poses a considerable risk of vancomycin........

Objective: To evaluate the cytospin slide microscopy method for detection of acid fast bacilli (AFB) in bronchoalveolar lavage (BAL) fluid comparing it with concentrated smear microscopy. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from Dec 2016 to Sep 2018. Methodology: BAL specimens from suspected tuberculosis patients who were sputum smear negative, submitted to AFIP for diagnosis were included in the study. Smears for microscopy were prepared with the modified cytospin method as well as the standard concentrated technique. The prepared smears from both methods were stained with Ziehl–Neelsen (ZN) staining method and examined under 100 × oil immersion lens. TB culture performed on BACTEC MGIT 960 automated culture system (Becton Dickinson, USA) was taken as gold standard for TB diagnosis. The two methods were compared in terms of sensitivity, specificity, positive predictive value and negative predictive value. Results: Out of the 130 samples tested, 62 (47.7%) were positive on culture using MGIT 960 system. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the modified cytospin method for pulmonary TB diagnosis was found to be 68.3%, 100%, 100%, 77% and 84.6%, respectively. Conclusion: The sensitivity of the modified cytopsin smear method was significantly higher than that of the concentrated method. The study concludes that this is a simpler and more accurate method for BAL fluid microscopy.

Objective: To evaluate the epidemiology of clostridioides difficile infections and colonisation in a tertiary-care setting. Method: The cross-sectional study was conducted at the Combined Military Hospital, Rawalpindi, Pakistan, from June 1, 2017, to October 31, 2019, and comprised adult patients admitted in high-risk units of the hospital for any disease experiencing watery stools after 48 hours of hospital admission and passing more than 3 stools per day with no other recognised aetiology. Stool samples of the participants, diagnosed with antibiotic associated diarrhoea, were submitted forglutamate dehydrogenase antigen assay and clostridioides toxin A/B assay detected by enzyme-linked immunosorbent assay and clostridioides difficile toxin gene detection by polymerase chain reaction. Clostridium difficile-associated diarrhoea was diagnosed by a positive toxin assay or polymerase chain reaction. Data was analysed using SPSS25. Results: Of the 715 subjects, 322(45%) were males and 393(55%) were females. The overall mean age was 56.64±8.57 years, and 488(68.3%) were aged 60 years. The incidence of clostridioides difficile-associated diarrhoea was found in 10(1.4%) patients and was highest in oncology unit 3(4.3%). No positive case was detected from the high dependency unit and the surgical ward. All the10(1.4%) positive cases were on >2 antibiotics with a combination of oral vancomycin and intravenous metronidazole. Mortality rate was significantly higher in the positive cases compared to those with clostridioides difficile colonisation (p

Objective: To determine cut off value of Interferon Gamma Release Assay (IGRA) among Tuberculosis (TB) suspected patients and to compare median Interferon Gamma Release Assay value for Tuberculosis culture positive and culture negative patients. Study Design: Cross sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, from Oct 2015 to Apr 2016. Methodology: The study was conducted on patients with suspected tuberculosis. Quantiferon Tuberculosis Gold that has an important role in the immune response to Tuberculosis was performed by Enzyme Linked Immunosorbent Assay method and specimens were cultured on Mycobacterium Growth Indicator Tube 960 System (MGIT 960 system). Quantiferon Tuberculosis Gold values obtained by Enzyme Linked Immunosorbent Assay method were used to determine the sensitivity and specificity of this test. Results: A total of 240 suspected isolates of tuberculosis during the study period were subjected to culture using MGIT 960 system, as per recommended protocol for the method. These samples were also subjected to Quantiferon TB Gold (QTBG) to measure Interferon Gamma Release Assay release. Sensitivity and specificity of IGRA was determined keeping tuberculosis culture as gold standard for this study. Conclusion: Sensitivity and specificity values showed a significant p-value

Objective: To compare the in vitro disk diffusion method and agar dilution method for sensitivity of Polymyxin B against multi drug resistant Acinetobacter baumannii. Study Design: Comparative cross sectional. Place and Duration of Study: The study was carried out in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st Dec 2016 to 30th Dec 2017. Methodology: Total 253 clinical specimens received from intensive care units with yielded growth of multidrug resistant Acinetobacter baumannii were evaluated for Polymyxin B susceptibility. Both Kirby bauer disk diffusion and agar dilution methods were compared with a reference method, broth microdilution. Results: Among 253 multidrug resistant isolates, 180 (71%) were extensively drug resistant and 221 (87%) were carbapenem resistant. Comparison of the disk diffusion and the MIC method by Agar dilution showed 100% correlation. 251 isolates were sensitive and 2 were resistant to Polymyxin B with MICs and disk zone diameters within the range recommended by the CLSI (2014-17). MIC 50 and MIC 90 of Polymyxin B were found to be 0.5 and 1μg/ml with 99.2% susceptibility. Conclusion: Both disk diffusion and agar dilution can be used together as initial screening methods in low income countries for susceptibility reporting of polymyxins. They are simple, reliable and economical. Also hetero resistance shown by some Acinetobacter baumanii strains can easily be picked up by agar dilution method.

Objective: To evaluate Gene Xpert MTB/RIF and Multiplex PCRfor detection of Mycobacterium tuberculosis and Rifampicin resistance comparing with gold standard MGIT 960. It was cross sectional validation study. Methods: This study had been carried out at Department of Microbiology Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan from March 2018 to October 2018.MGIT 960 culture system MTB positive Rifampicin (RIF) resistant and RIF susceptible (negative control) samples were taken. Gene Xpert MTB / RIF assay and Multiplex PCR were applied simultaneously and compared with gold standard MGIT 960. Results: Out of 192 samples evaluated, 84(44%) were culture positive RIF resistant and 108(56%) were culture positive RIF susceptible as negative control. Out of total culture positive RIF resistant, all 84 were found positive for MTB by Gene Xpert MTB /RIF assay and Multiplex PCR method. Gene Xpert MTB/RIF assay detected all 84 RIF culture resistant samples for Rif resistance. Multiplex PCR detected only 44 RIF culture resistant, while remaining 40 did not showed resistance to rpoB gene codon 531 region. Sensitivity, Specificity, PPV and NPV of Gene Xpert MTB/RIF were 100% each respectively. Sensitivity, Specificity, PPV and NPV of Multiplex PCR for detection of RIF resistance were 52%, 100%, 100%, 72% respectively. Conclusion: Molecular detection of MTB and RIF resistant by Gene Xpert MTB/ RIF and Multiplex PCR simultaneously is rapid and cost effective method. Both methods can help clinician to initiate early empirical therapy to patient in resource limited region. Keywords: RIF, Gene Xpert MTB/ RIF, Multiplex PCR.

Background: Effective control of tuberculosis is achieved by early diagnosis and drug susceptibility testing for initiation of appropriate treatment. The performance of crystal violet decolorization assay (CVDA) for susceptibility testing of Mycobacterium tuberculosis to isoniazid (INH) and rifampicin (RIF) was compared in a multicenter study. Methods: Seventy-two M. tuberculosis isolates were tested in two phases by CVDA. Results: In Phase I, the specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and agreement for INH were 100%, respectively. Specificity, sensitivity, PPV, NPV, and agreement for RIF were 98.2%, 100%, 94.1%, 100%, and 98.6%, respectively. In Phase II, specificity, sensitivity, PPV, NPV, and agreement were 98%, 100%, 95.4%, 100%, and 98.6% for INH, respectively. Specificity, sensitivity, PPV, NPV, and agreement for RIF were 96.3%, 88.2%, 88.2%, 96.3%, and 94.4%, respectively. Results in the study were obtained on average 10.9 ± 3.1 days in Phase I and 9.8 ± 2.2 days in Phase II. Conclusion: CVDA can be performed for drug susceptibility testing in developed and developing countries. In addition, further studies with larger sample size are needed for evaluation of this method.

Invasive salmonellosis caused by Salmonella typhi and Salmonella paratyphi is a serious life-threatening complication in immunocompromised patients. Since blood cultures have only 40-80% sensitivity, very limited diagnostic modalities are left. Here, authors present a case of a 24-year-old pregnant lady who develops a unilateral breast abscess harbouring Salmonella typhi. The isolate was Extremely Drug Resistant (XDR), that is resistant to first line drugs, ciprofloxacin and ceftriaxone. She was successfully treated with combination of injection meropenem and tablet azithromycin and continued for 14 days. To the best of authors knowledge, this was the first reported case of Salmonella enterica serovar Typhi in a pregnant lady from Pakistan.

Background: Urinary tract infections are one of the most common infections especially in young adults. Due to increase in fluoroquinolones use, empirical therapy in uncomplicated urinary tract infections with this group is now controversial. This study was aimed to see the efficacy of nitrofurantoin, ciprofloxacin and cotimoxazole (trimethoprim-sulphamethaxazol); the three most common drugs which can be used orally. Materials & Methods: This descriptive study was carried out at the Department of Microbiology, Combined Military Hospital, Quetta, Pakistan from Januery 2014 to June 2014. A total of 270 urinary isolates (Outdoor 132, indoor 138) were cultured from urine specimens during the study period. Identification of isolates were performed by conventional methods and by using API 10S (Biomerieux, France). All the isolates were tested against nitrofurantoin, ciprofloxacin and cotimoxazole (trimethoprim-sulphamethaxazol) along with other routine antibiotics used for urinary pathogens. Results: Out of total 270 urinary isolates, Escherichia coli was the dominant isolate cultured in 158 (58.51%) cases, followed by Klebsiella pneumonia in 48 (17.77%) and enterococcus spp. In 16 (5.92%) cases. Out of total 132 outdoor isolates, percentages of sensitivities of nitrofurantoin, ciprofloxacin and cotimoxazole were 92.4, 47.1 and 62.1 respectively. In case of total 138 indoor isolates, percentages of sensitivities for these three drugs were 84.0, 34.7 and 28.9 respectively. Conclusion: Nitrofurantoin is very effective against both outdoor and indoor urinary isolates and can be used empirically for uncomplicated urinary tract infections.

Background: Tinea pedis is the most common fungal infection especially prevalent in certain groups. The objective of this study was to determine the frequency of tinea pedis and its predisposing factors in the military recruits. Material & Methods: This cross-sectional study was conducted at Combined Military Hospital, D.I.Khan, from March 2012 to September 2012. A random sample of 350 individuals was selected out of individuals who were undergoing initial military training. Clinical examination, microscopic examination of scrapings from suspected lesions to see fungal hyphae and subsequent culture was done for species identification. Findings were recorded on a performa. Data was analyzed using SPSS version 10.0. Results: The mean age of subjects was 18.57±1.02 (16-23) years. On clinical examination tinea pedis was suspected in 34 (9.71%) out of 350 subjects. A total of 10 (2.8%) individuals were found to have positive fungal hyphae while 14 (4%) were culture positive for trichophyton. Out of 14 positive cultures, 8 yielded growth of Trichophyton mentagrophytes, 5 Trichophyton interdigitale and one yielded Trichophyton rubrum. Predisposing factors were occlusive footwear for >8 hours/ day in (96%), history of excessive sweating in (7.7%), history of fungal infection of feet during last 6 months in (3.4%) and fungal infection of nails during the last 6 months in (2.8%). Conclusion: The prevalence of tinea pedis in Pakistani military recruits is low. Occlusive footwear for more than 8 hours a day is the major risk factor. Excessive sweating and history of previous fungal infection are also risk factors.

Background: Urinary tract infections are one of the most common infections especially in young adults and pregnant women. Due to increase in fluoroquinolones use, empirical therapy in uncomplicated urinary tract infections with this group is now controversial. In recent years, fosfomycin has emerged as an economical and effective single dose agent in uncomplicated urinary tract infections. Materials and Methods: This descriptive laboratory based study was carried out at the Department of Pathology, Combined Military Hospital, Dera Ismail Khan. A total of 120 clinical isolates cultured from urine specimens were processed from July 2012 through February 2013. All the isolates were checked for their susceptibility testing against fosfomycin and other routine antibiotics used for urinary pathogens. Results: Out of total 120 urinary isolates, percentages of sensitivities of fosfomycin against Escherichia coli, Klebsiella pneumoniae, Pseudomonas spp, Proteus spp, Enterobacter spp, Enterococcus spp, and Staphylococcus aureus were 97.2, 63.6, 80, 87.5, 71.4, 83.3, and 80% respectively. Conclusion: Our study suggests that fosfomycin has reasonably good in-vitro activity against common urinary isolates. Therefore it can reliably be used in uncomplicated urinary tract infections as empirical therapy. However, further studies are needed on larger specimen size to support our evidence.

Klebsiella pneumoniae has played an important role as a cause of infection in the neonatal high risk units around the globe. The widespread use of broad-spectrum antibacterial agents has led to an increase in the emergence of resistance to broad-spectrum cephalosporins and carbapenems. We report an outbreak caused by a strain of Klebsiella pneumoniae that was susceptible only to ciprofloxacin and tigecycline and that affected neonates hospitalized in neonatal intensive care unit of Combined Military Hospital Rawalpindi during October 2010. Outbreak investigation was carried to find out the possible source of infection which turned out to be suction tubing of resuscitation table, emergency tray and scissors. The outbreak was resolved by temporarily closing down the nursery and using remedial measures such as disinfection, reinforcing the use of antiseptic techniques and timely treatment of neonates with ciprofloxacin.

Background: To determine the frequency and resistance pattern of Mycobacterium tuberculosis in our settings. Methods: This study was carried out in Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from January 2007 through December 2009. A total of 4159 specimens were received during the three years study period. All specimens were cultured on conventional LJ medium, BACTEC 460 system and fully automated MGIT 960 system. Sensitivity testing was performed on BACTEC 460 and MGIT 960 system. Results: Most of the specimens were received from hospitalized patients. Out of total 4159 specimens, 693 were culture positive and out of them 262 were multi drug resistant (MDR). Percentage of MDR isolates in 2007 till 2009 were 33, 42.1 and 40.4% respectively in AFIP. Maximum number of MDR isolates was recovered in 2008. Conclusion: The rising pattern of MDR tuberculosis is of great concern. There is an urgent need for the early diagnosis, drug susceptibility testing and isolation of patients with MDR tuberculosis.

Background: Chronic suppurative otitis media is a common infectious disease. The micro-organisms commonly associated with it and their antibiotic sensitivity pattern is important for its treatment. This study was conducted to identify the common microorganisms involved and their antibiotic sensitivity pattern in patients with chronic suppurative otitis media. Material & Methods: This descriptive study was carried out from January 2011 to August 2011 at Department of ENT, DHQ Teaching Hospital and Microbiology Department, CMH, D.I.Khan. A total of 190 patients with unilateral or bilateral active chronic suppurative otitis media attending the out patient clinic were included in the study. Pus samples were collected from the discharging ears and sent for microbiology. Results: From 190 specimens, 174(91.6%) were positive, and 16(8.4%) culture negative. There were 167(87.9%) bacterial isolates and 7(3.7%) fungi. Pseudomonas aeruginosa 80(45.9%) was the dominant isolate, followed by Staphylococcus aureus 46(26.4%) including 10 isolates of Methicillin resistant Staphylococcus aureus (MRSA). Antibiotic sensitivity pattern of Pseudomonas aeruginosa showed that piperacillin/tazobactum was active against 100% isolates of Pseudomonas aeruginosa and all Staphylococcus aureus except MRSA. Conclusion: Pseudomonas aeruginosa is the most common isolate followed by Staphylococcus aureus from the culture specimens of chronic otitis media. Both of these are sensitive to tazocin except MRSA. Pseudomonas aeruginosa is increasingly becoming more resistant to the commonly used antibiotics like quinolones.

We report a case manual exchange blood transfusion in a young patient having falciparum malaria along with its severe complications. Parasite load reduced to 2% from over 20% with significant improvement in neurological status but unfortunately, the patient succumbed to death due to acute renal failure.

Objective: To investigate and document the clinical course of typhoid fever and the sensitivity pattern of Salmonella typhi to antibiotics among patients admitted to Pakistan Naval Ship Shifa Hospital. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, from Jul to Dec 2021. Methodology: The patients admitted with typhoid fever to the hospital during the study period were included using consecutive sampling. After getting informed consent, the patients’ demographic characteristics, course of the disease, blood culture sensitivity, the treatment administered, the complications that emerged, and the length of their hospital stay were noted. Results: There were 77 patients with culture-proven typhoid fever admitted during the study period. The mean age was 18.6±11.84 years (range 1-55 years). The most frequent presenting complaints were fever, abdominal pain, and vomiting. Additional symptoms included a rash, bodily aches, and weariness. Out of the 77 patients, 76(99%) were extensively drugresistant (sensitive to Meropenem and Azithromycin only). The complications noted were hepatitis, myocarditis, ascites, pleural effusion, and shock. The mean length of stay in the hospital was 16.56+3.87 days. The typical time gap between commencing culture-specific antibiotics and fever defervescence was 4.03±2.84 days. Conclusion: Almost all (99%) patients admitted with typhoid fever in PNS Shifa are extensively drug-resistant and require a relatively longer hospital stay for management.

Objective: to determine the frequency of the possible side effects of the COVID -19 inactivated vaccine. Study Design: Cross-sectional survey. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi Pakistan from Jan to Apr 2021. Methodology: A total of 305 recipients of inactivated COVID-19 vaccine were asked to fill out a questionnaire themselves or by the health care worker via telephonic conversation. The questionnaire comprised queries regarding general and local side effects that the participants experienced after getting vaccinated for COVID-19. Results: Out of 305 recipients, 270(88.5%) were men, and 35(11.5%) were women. Participants' age ranged from 18-60 years.After the first dose, 83(27.2%) cases [male 63(23.3%) vs. female 20(57.1%)], were reported with side effects, while 75(24.5%)recipients, [male: 54(19.9%) vs. female: 21(58.8%)], had side effects after the second dose. Generalized symptoms were fever,headache, dizziness, and body aches, while local side effects were pain, itching, swelling and rash at the injection site.259(84.9%) recipients reported spontaneous recovery after the first dose. After the second dose, 286(93.8%) recipients recovered spontaneously. The remaining 44(13%) of the recipients' required symptomatic treatment. After the second dose,only 19(6%) recipients needed symptomatic treatment. Conclusion: It is important to document the possible side effects of COVID vaccine so that public awareness and education can be made to minimize public fear of vaccine side effects. Inactivated vaccine for COVID-19 has minimal reported side effects and hence has a good safety profile.

Objective: To see the efficacy of rapid color test for the sensitivity of ceftriaxone against clinical isolates of Salmonella Typhi. Methods: This descriptive cross sectional study was carried out at the department of Microbiology, Pakistan Navy Ship (PNS) Shifa Hospital, Karachi from Nov 2018 through April 2019.We tested 97 clinical isolates of Salmonella Typhi by this rapid color test. All the isolates were also test by conventional disc diffusion method and MICs by Vitek-2 system. Results: Out of these isolates, 83 were ceftriaxone resistant while 14 isolates were ceftriaxone sensitive. Sensitivity and specificity of rapid color test were 100% when compared with results of disc diffusion, E-test and Vitek 2 system. All the results were readable within 2 hours on color test. Conclusion: This color test is rapid, accurate and inexpensive and can be used as a screening test for ceftriaxone resistance in typhoid endemic areas. Keywords: Ceftriaxone; drug resistance; meropenem Continuous...

Objective: To evaluate the performance of CHROMagar and API 20C AUX for the documentation of different Candida species. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in the Department of Microbiology at AFIP (Armed Forces Institute of Pathology), CMH Rawalpindi and Army Medical College Rawalpindi in collaboration with Departments of Pathology (Microbiology) at Pakistan Railways Teaching Hospital (PRH), Islamic International edical College Rawalpindi from 01 April 2017 to 30 September 2017. Materials and Methods: Collectively 100 isolates of candida yielded from HVS clinical samples. Phenotypic tests including growth on CHROMagar Candida and API 20C AUX were used for reporting different Candida species. Clinical Candida isolates along with reference institutional control strains of Candida species were used in the study. Data was analyzed using simple descriptive statistics (frequencies, percentages) for each categorical variable. Results: Among 100 candida isolates 92 (92%) isolates of Candida were identified correctly to level of species by CHROMagar Candida, in comparison to 100% identification of candida species using API 20C AUX. Results of present study revealed that CHROMagar Candida can be used to report three species of Candida considering the morphology and colour of colonies of these particular species, and to distinguish them as C. albicans, C.tropicalis, and C. glabrata. Conclusion: Both phenotypic tests CHROMagar plates and API 20 C AUX are effective in the documentation of Candida species. However API 20 C Aux is found to be more accurate than CHROMagar because less commonly isolated Candida species cannot be documented using CHROMagar. Moreover being less costly; use of CHROMagar Candida is helpful in rapid identification and constructing suitable therapeutic plan for patient's management in laboratories with limited resources.

Objectives: To determine the antimicrobial activity of silver nano-particles(AgNPs) with tetracycline and ampicillin against multi-drug resistance (MDR) and extensively-drug resistance (XDR) Salmonella typhi ., Methods: Cross sectional non-probability purposive study was conducted from September, 2021 to May, 2022 at Microbiology department PNS Shifa, Hospital Karachi. Blood cultures of patients suspicious of typhoid fever were collected and incubated in automated Bact/Alert system. Positive cultures were identified on blood and MacConkey and processed by API-10S, confirmed by serotyping (O9 antisera) (SSI Diagnostica's Salmonella) . Antibiotic resistance was done by Kirby-Bauer disk diffusion (Sigma and Rich). MDR and XDR isolates were preserved in Brain Heart Infusion in a volume of 2ml in screw capped bottles at -70°C. Antimicrobial powders (ampicillin and tetracycline (Alfa Aesar) weighed by an electrical weighing balance (OHAUS) to take 1mg of antimicrobial drug. Absorbance spectra of serial concentrations of antibiotics (UV-Vis spectrophotometer (Mole-Qule-) AgNPs (10nm) (nanocomposix) + Antibiotic in (1:1 volume ratio). Conjugation of silver nanoparticles with tetracycline and ampicillin was done by FTIR (thermos scientificThermos ScientificNicolet 50)., Results: Out of 77 isolates, 54 were resistant to ceftriaxone (XDR) and 23 sensitive to ceftriaxone (MDR). All isolates were susceptible to azithromycin and meropenem. Comparison of zone of inhibitions of ampicillin and Amp-AgNPsas and tetracycline with Tet-AgNPs was done. Minimal inhibitory concentration was also done to determine antimicrobial activity., Conclusion: Significant synergistic inhibitory effects against Salmonella Typhi isolates were obtained by combination of tetracycline with silver nano-particles even at low concentration., (Copyright: © Pakistan Journal of Medical Sciences.)