Extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the neonatal intensive care unit: does vancomycin play a role?

Background: Extended-spectrum β-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU.

Methods: A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008.

Brucella spp isolated from respiratory sample and grown in Mycobacterium growth indicator tube (MGIT).

Brucellosis remains endemic in many countries including Saudi Arabia. The disinfection of objects and surfaces contaminated with Brucella spp is not difficult, but we encountered a situation in which the organism survived the decontamination and liquefaction procedure adopted for AFB culture. A sputum specimen from a patient was sent for TB culture and the BACTEC MGIT 960 system isolated an organism identified as Brucella spp.

Antimicrobial susceptibility patterns of multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii against carbapenems, colistin, and tigecycline.

Objective: To examine susceptibility of Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii ) against carbapenems along with colistin and tigecycline as alternative therapeutic options.

CD4+ T-lymphopenia in HIV negative tuberculous patients at King Khalid University Hospital in Riyadh, Saudi Arabia.

Tuberculosis (Tb) is a chronic infectious disease in which the cellular immunity (specifically CD4+ and CD8 lymphocytes) provides the most important defense in controlling infection. CD4 lymphopenia is a well-defined risk factor for the development of active tuberculosis in patients infected with Human Immunodeficiency Virus. In HIV - negative patients, CD4 and CD8 cell count suppression has been associated with Tb infection.

Mycobacterium chelonae complex bacteremia from a post-renal transplant patient: case report and literature review.

In this report we present a case of a young lady with abdominal abscesses and septicemia caused by Mycobacterium chelonae complex. Identification of the organism and initiation of the appropriate antimicrobial therapy was delayed, resulting in significant morbidity and multiple hospital admissions. Gram staining of these organisms from blood culture can be easily overlooked or confused with either debris or diptheroids.

Frequency of isolated positive sputum cultures among pulmonary tuberculosis patients.

Objective: The occurrence of isolated positive sputum cultures among pulmonary tuberculosis (PTB) patients during treatment is not widely reported. This study describes the frequency of isolated positive sputum cultures among PTB patients after initiation of chemotherapy.

Methods: Fifty sputum culture positive PTB patients, consisting of 38 (76%) males and 12 (24%) females with a mean age of 34.

A review of gastrointestinal manifestations of Brucellosis.

Brucellosis is hyperendemic in the Kingdom of Saudi Arabia (KSA) with more than 8,000 cases reported each year to the public health authorities. The disease can affect almost any organ system in the body including the gastrointestinal system. In some instances, gastrointestinal manifestations may be the only presenting features of the disease.

Is hepatitis C virus genotype 4 predominant in Saudi Arabia?

Hepatitis C virus (HCV) genotype 4 is believed to be predominant in the Middle East including Saudi Arabia (SA). We attempted to genotype 80 HCV isolates from different parts of SA by direct sequencing of a variable 222bp fragment from the NS5B region. The phylogenetic analysis of the NS5B sequences was complemented by direct sequence analysis of the conserved 5'-NCR region for HCV type-specific polymorphism.

Tuberculous peritonitis in chronic liver disease: Clinical features and response to treatment.

To find out the clinical presentation, laboratory results, and treatment response of tuberculous peritonitis in patients with chronic liver disease, we retrospectively reviewed the medical records of all patients with tuberculous peritonitis diagnosed by laparoscopy at King Khalid University Hospital over a period of seven years. A total of 17 patients (Group 1, consisting of 11 males and six females with a mean age of 539 +/- 17.5 years) had both chronic liver disease and tuberculous peritonitis, while 27 patients (Group 2, consisting of 17 males and 10 females with a mean age of 39.

Seasonal variation of culture positive brucellosis at a major teaching hospital.

Brucellosis is one of the main zoonoses in the world. In Saudi Arabia, it was recognized as a major health problem in 1983G and since then many measures have been implemented to control the disease. We conducted a study to determine the yearly incidence and seasonal variation of blood culture positive brucellosis (Brucella cases) diagnosed at King Khalid University Hospital (KKUH) in Riyadh between 1985G and 1991G.

Laparoscopy in tuberculous peritonitis.

Intra-abdominal tuberculosis remains a significant health hazard in the developing countries. In countries where sophisticated medical facilities are not easily available, laparoscopic examination of intra-abdominal organs is helpful. In this study, 22 patients were found to have peritoneal tuberculosis out of 82 laparoscopic examinations.

Hepatitis C in chronic renal failure patients.

The occurrence of hepatitis C virus (HCV) infection amongst chronic renal failure (CRF) patients in our Nephrology Unit was investigated over a period of 1 year. A total of 71 patients was studied comprising 26 chronic haemodialysis (CHD) patients, 6 acute haemodialysis patients, 4 peritoneal dialysis patients and 35 CRF patients not on dialysis. Patients were screened before and after haemodialysis, and their baseline and postdialysis values of liver enzymes were determined.

Depression of phagocytic activity of the immune system following traditional cautery in experimental animals.

Traditional cautery, which is practiced widely in Saudi Arabia and some other countries, has not been exposed to detailed scientific investigation. In an attempt to elucidate some of its physiological aspects, we assessed the effect of cautery on a normal animal's nonspecific immune system. Male Wistar rats and guinea pigs were cauterized to simulate traditional cautery in size and percentage of cauterized area.

An outbreak of acute hepatitis A infection in rural Saudi Arabia.

In areas of hyperendemicity of hepatitis A virus (HAV) infection, acquisition of immunity occurs relatively early in life. In such populations epidemic outbreaks are rare. A recent HAV infection outbreak occurred in the Al-Dahnah district in Saudi Arabia.

Hepatitis B virus vs schistosomiasis and hepatocellular carcinoma in Saudi Arabia.

Fifty patients with histopathological diagnosis of hepatocellular carcinoma were studied with special reference to infection with hepatitis B virus and schistosomal infestation. The possible correlation of these two risk factors and liver malignancy is discussed.

Gastrointestinal manifestations of brucellosis in Saudi Arabian patients.

Gastrointestinal manifestations of brucellosis in 340 Saudi Arabian patients are reported. Sixty seven per cent of patients presented with gastrointestinal disturbances. The most frequent symptoms were anorexia (40%), abdominal pain (16%), vomiting (11%), and diarrhoea (6%).

Experimental treatment of Brucella melitensis infection in sheep with oxytetracycline alone or combined with streptomycin.

The efficacy of oxytetracycline (OTC) alone or combined with streptomycin in the treatment of 118 Najdi ewes believed to have been naturally infected with Brucella melitensis, was evaluated by culture of selected tissues and organs at slaughter. Groups of sheep were given 250, 500 or 1,000 mg of OTC intraperitoneally (i/p) daily for six weeks and in the respective groups at necropsy 52, 69 and 100% of sheep were found to be Brucella-free. Treatment with 250 mg OTC (daily for six weeks i/p) combined with 1,000 mg streptomycin (daily for three weeks intramuscularly) increased the percentage of Brucella-free sheep to 82%.

Laboratory-acquired brucellosis.

Brucellosis is endemic in Saudi Arabia and hospital laboratories are handling increasing numbers of specimens for diagnosis. We report four cases of laboratory-acquired brucellosis.

Neurological syndromes of brucellosis.

Eleven patients with brucellosis presented with neurological features closely simulating transient ischaemic attacks, cerebral infarction, acute confusional state, motor neuron disease, progressive multisystem degeneration, polyradiculoneuropathy, neuralgic amyotrophy, sciatica and cauda equina syndrome. Most patients improved quickly after adequate antibiotic treatment but chronic cases responded poorly. These protean neurological manifestations of brucellosis indicate that the underlying pathological mechanisms are diverse.

Unusual presentation of culture positive brucellosis.

We have reviewed the clinical presentation of 100 consecutive culture positive cases of brucellosis which came under our care during the last two years. Of these, six had atypical presentations and but for the routine practice of sending blood for brucella culture, the diagnosis would have been missed. The unusual presentations included a 19 year old boy presenting as an acute abdomen ending in laparotomy, a 52 year old man presenting with a psoas abscess, a 29 year old woman presenting with a transient perinephric mass, a 75 year old man with an acute flare up of his osteoarthritis, a 65 year old diabetic man presenting in an insulin-resistant diabetic state and a 35 year old man presenting with a cauda equina syndrome.

The chest radiograph in brucellosis.

A retrospective study of chest radiographs in patients with brucellosis was undertaken at King Khalid University Hospital, Riyadh. The commonest presenting symptoms were fever, back and joint pains, excessive sweating, headache, and cough. Different chest radiographic abnormalities were detected, including soft miliary mottling, parenchymal nodules, consolidation, chronic diffuse changes, hilar or paratracheal lymphadenopathy and pneumothorax.

Upper gastrointestinal endoscopy in Saudi Arabia: analysis of 6386 procedures.

Fibreoptic endoscopy is now established in the investigation of upper gastrointestinal disease. We report our findings in a large series of endoscopic procedures (6386) mostly in Middle Eastern Arabs, and compare the results obtained in Western patients. We find fibreoptic endoscopy to be feasible, safe, acceptable and effective.