Tuberculosis incidence trends in Saudi Arabia over 20 years: 1991-2010.

Objective: To evaluate tuberculosis (TB) incidence rates and trends over a period of 20 years (1991-2010) and assess the impact of the National TB Control Program (NTP) on incidence trends.

Methods: This is a retrospective study of TB surveillance data reported by the Ministry of Health. We evaluated TB incidence data by nationality, age, and region of the country and assessed incidence trends over 20 years of study.

Tuberculosis infection during Hajj pilgrimage. The risk to pilgrims and their communities.

Millions of Muslims travel to Makkah every year to perform Hajj. Many pilgrims come from countries with a high incidence of tuberculosis (TB). Over-crowding, physical exhaustion, heat, and co-morbid conditions of mostly middle-aged and elderly pilgrims make them susceptible to infection, or reactivation of latent TB.

Diagnosis of latent tuberculosis: Can we do better?

Latent tuberculosis infection (LTBI) is often diagnosed by the tuberculin skin test (TST). The latter has several limitations with regard to its sensitivity and specificity. It may be positive in people with prior bacille Calmette-Guérin (BCG) vaccination or exposure to nontuberculous mycobacteria.

Improved sensitivity for detection of tuberculosis cases by a modified Anda-TB ELISA test.

Tuberculosis is still a major health problem in most developing countries and its incidence is rising in many industrial countries. The diagnosis of tuberculosis depends primarily on identification of mycobacteria and on clinicoradiological evidence of the disease. Compared to other diagnostic methods, serological tests are faster and do not necessarily require samples that contain the tubercle bacilli.

Does the protective effect of neonatal BCG correlate with vaccine-induced tuberculin reaction?

A case-control study was conducted in Saudi Arabia, where the same strain of BCG has been used and surveys had shown that up to 88% of vaccinated children remain tuberculin negative. Active cases were obtained by surveying the seven tuberculosis centers in 1 yr. Control subjects were obtained from a nationwide survey of normal individuals.

Visceral leishmaniasis in Gizan, Saudi Arabia.

Visceral leishmaniasis is endemic in southern Saudi Arabia. We prospectively evaluated 121 patients with visceral leishmaniasis at King Fahad Hospital in Gizan. All patients were infants and children.

Nationwide community survey of tuberculosis epidemiology in Saudi Arabia.

In the first nationwide community-based survey of the epidemiology of tuberculosis in Saudi Arabia, 7721 subjects were screened in the 5 provinces (using an equal proportional allocation formula) for 2 parameters: (1) prevalence of positive Mantoux test in non BCG vaccinated subjects; (2) prevalence of bacillary cases on sputum culture. The prevalence of positive Mantoux reaction in children aged 5-14 years was 6% +/- 1.8; higher in urban areas (10%), and lower in rural areas (2%), thus classifying Saudi Arabia among the middle prevalence countries.

Detection of mycobacterial antigens in sputum by an enzyme immunoassay.

An enzyme immunoassay (EIA) for the detection of mycobacterial antigens in sputum was evaluated. The system utilises commercially available anti-BCG immunoglobulin. BCG protein standard was used as positive control.

The significance of positive Mantoux reactions in BCG-vaccinated children.

As the interpretation of tuberculin skin tests is controversial in subjects who have received BCG vaccine, we administered Mantoux tests to 2588 randomly selected Saudi children aged 5-13, 1945 of whom had been vaccinated with BCG at birth and 643 were unvaccinated. Only 7.8% of the BCG-vaccinated children were Mantoux positive (greater than or equal to 10 mm induration) at the age of 5 years, which was not significantly different from the unvaccinated children.

Mantoux reaction survey conducted in the northern region of Saudi Arabia.

A nationwide epidemiological survey is under way to assess the prevalence of tuberculosis infection in the inhabitants of Saudi Arabia. The assessment tools include the Mantoux test and culturing of sputum samples obtained from inhabitants of the five regions of the Kingdom. The study population has been selected using a proportional-to-population-size method with cluster sampling and urban/rural stratification.

Tuberculin survey in the Eastern Province of Saudi Arabia.

We present the results of the Mantoux test (5 units tuberculin) survey in the Eastern Province of Saudi Arabia, which was conducted as part of a nationwide epidemiological survey of tuberculosis. A total of 1105 subjects were screened out of whom 630 gave a history of BCG vaccination in the past and 363 were BCG-negative. Among BCG-negative children aged 5-14 years, only 5% had a positive Mantoux, a rate lower than most Third World countries but higher than developed countries were under 2% of children are tuberculin reactors.

Effect of initial isoniazid resistance on response to chemotherapy of tuberculosis: A review of clinical trials.

This study evaluated seventeen clinical trials of short-course chemotherapy of tuberculosis and assessed the influence of initial resistance to isoniazed on the response to therapy. High failure rates were observed for the non-rifampicin-containing regimens. When rifampicin was included, there was a very good response among patients suffering from sensitive and resistant strains.

Failure of ciprofloxacin to eradicate brucellosis in experimental animals.

Ciprofloxacin is a quinolone that penetrates well intracellularly. It was shown to be active against Brucella melitensis in vitro. In this study, ciprofloxacin and tetracycline were used to treat B.

Drug resistance in tuberculosis.

Resistance to antituberculosis drugs is due to the occurrence of resistant mutants in the bacterial population even before exposure to these drugs. These mutations are chromosomal in origin. Resistance occurs when the bacterial population is large or when drugs are used alone.

Nosocomial bacteraemia in a teaching hospital in Saudi Arabia.

During a period of one year, 117 episodes of nosocomial bacteraemia were documented at King Khalid University Hospital, an incidence of 5 per 1000 admissions. Sixty-two percent were gram-negative organisms with Escherichia coli, Klebsiella spp., Serratia spp.

Resistance to antituberculosis drugs in Riyadh, Saudi Arabia.

The prevalence of resistance to antituberculosis drugs in Riyadh was found to be 21.3%, while the rate of primary drug resistance was 11.5%.

The pattern of infection of the nervous system in Riyadh: a review of 121 cases.

Analysis of 121 consecutive cases with infection of the nervous system showed that the majority were the granulomatous infections, tuberculosis and brucellosis (53 cases (44 per cent)). Thirty-nine patients had tuberculosis and 14 had brucellosis. The clinical and microbiological pattern of infection differs from that frequently reported from Western countries.

Joint mobility and mitral valve prolapse in an Arab population.

The association of joint laxity and mitral valve prolapse (MVP) has been disputed. In this study of an Arab population, the joint mobility scores of 29 subjects with MVP, 10 of whom were asymptomatic, were compared to 60 normal controls. It was found that the joint mobility score was significantly higher in both the asymptomatic and the symptomatic subjects with MVP when compared to the controls.

A genetic marker for rheumatic heart disease.

The frequency of antigen types (A, B, C, and DR) in an unselected group of 25 patients with chronic rheumatic heart disease and an unselected group of 15 patients with acute rheumatic fever was compared with that in a group of 100 healthy volunteers. All patients and controls were Arabs of Saudi origin. Only the frequency of HLA-DR4 was significantly different in the controls and the patient groups--controls 12%, chronic rheumatic heart disease 72%, acute rheumatic fever 53%, both patient groups together 65% (relative risk 13.

Brucella meningitis.

Infection with Brucella melitensis is endemic in Saudi Arabia but involvement of the central nervous system (CNS) is rare. We report on three patients with acute brucella meningitis, all of whom had a history of exposure to a possible source of infection. Diagnosis was confirmed by isolation of Brucella species from blood cultures.

Spinal brucellosis.

The findings in 44 patients with back pain and brucellosis are described. Radiological changes tended to occur in older patients with a longer duration of disease. The younger patients more often experienced an acute arthritis with sacroiliitis resembling a reactive disease.

Heat stroke at the Mekkah pilgrimage: clinical characteristics and course of 30 patients.

The clinical picture and the final outcome of 30 patients with heat stroke during the Mekkah pilgrimage 1404 (September 1984) were analysed. Rapid cooling by the 'evaporative method' was achieved in a mean time of 59 min (range 15-135). An initial temperature above 42 degrees C and a cooling time of more than 1 h indicated a poor prognosis.