Mycobacterium tuberculosis in a Saudi Arabian hospital.
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Antitubercular Agents↗
Biomedical subjects
Abdulrahman A Alrajhi
Publications and source records attributed to Abdulrahman A Alrajhi.
Mode of transmission of HIV-1 in Saudi Arabia.
The mode of HIV-1 transmission was determined for 410 Saudi patients. Heterosexual transmission occurred in 189 patients (46%), blood product transfusion in 107 (26%), and perinatal transmission in 47 (12%). Men who have sex with men and injection drug users represented 5% and 2%,respectively. Sixty-three of 65 heterosexually infected women acquired HIV-1 from their spouses, whereas 111 of 124 heterosexually infected men acquired the virus from commercial sex workers. Heterosexual transmission is the main mode in Saudi patients.
Adult↗
Fatal transplacental infection with non-typhoidal Salmonella.
We report a case of transplacentally acquired neonatal sepsis with non-typhoid Salmonella. The infant's mother, a 36-y-old woman, presented with fever and malaise in the 25th week of gestation. Because of a pathological cardiotocogram, Caesarean section was performed a few h following admission. The premature infant had clinical signs of sepsis with multiorgan failure and died 4 d later despite intensive medical care. Maternal blood cultures and swab cultures taken from within the uterine cavity and from cutaneous and mucosal surfaces of the infant grew Salmonella virchow. This case and the few sporadic reports in the literature indicate that septicaemia due to non-typhoidal Salmonella spp. during pregnancy is highly lethal to the foetus or newborn, whereas prognosis for the mother apparently is excellent.
Adult↗
Extrapulmonary tuberculosis, clinical presentation and outcome.
OBJECTIVE: To identify patterns, features, and outcome of extrapulmonary tuberculosis in a tertiary care setting. METHODS: A retrospective case-series was carried out of all cases diagnosed and treated as extrapulmonary tuberculosis during 1991 through to 2000 at King Faisal Specialist Hospital and Research Centre (KFSH and RC), Riyadh, Kingdom of Saudi Arabia. Demographic, clinical, laboratory, and outcome data were abstracted from medical records. RESULTS: Over a 10-year period, 394 cases of extrapulmonary tuberculosis were diagnosed and treated at KFSH and RC. Isolated extrapulmonary tuberculosis was identified in 339 (86%) patients, 55 cases (14%) had both pulmonary and extrapulmonary tuberculosis. Mean age was 45-years, and 188 patients (47%) had co-morbidities, most commonly diabetes mellitus in 14.2% of patients. Laboratory confirmation of extrapulmonary tuberculosis was available on 386 patients. The most frequent site involvement was lymphadenopathy in 41% of the time. Chest x-ray was normal in 75% of patients. Among 298 patients with follow up data, 10 (3.4%) had documented relapse and 50 (16%) died. Death was related to tuberculosis in 24 (48%) patients. CONCLUSION: A high level of clinical suspicion is essential for early diagnosis and treatment of extrapulmonary tuberculosis to reduce the significant morbidity and mortality.
Adult↗
Human immunodeficiency virus in Saudi Arabia.
The human immunodeficiency virus HIV type 1 has evolved as one of the most important global infectious pathogens. Although the virus had initially emerged among certain high risk groups in developed countries, it quickly gained momentum in developing countries threatening most population groups. The first case of acquired immunodeficiency syndrome from the Kingdom of Saudi Arabia was diagnosed in 1984. Twenty years later, by the end of 2003, 1509 patients have been reported to have acquired HIV 1. The majority of the early infected patients have acquired HIV 1 from blood product transfusion. Subsequently, the most prevalent mode of transmission became heterosexual. In this review, the distribution of HIV infected persons, prevalence data, and future outlook are presented. Communities considered conservative are not immune from a sexually transmissible virus that has infected 60,000,000 people globally.
Disease Outbreaks↗
Fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major.
BACKGROUND: Whereas certain oral antifungal azoles are well documented to have activity against leishmania, data on the efficacy of fluconazole for leishmaniasis are limited. We conducted a controlled trial in Saudi Arabia of fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major. METHODS: This randomized, double-blind, placebo-controlled trial assessed the efficacy of oral fluconazole, in a dose of 200 mg daily for six weeks, in the treatment of parasitologically confirmed cutaneous leishmaniasis. The primary outcome measure was the time to the complete healing of all lesions. RESULTS: A total of 106 patients were assigned to receive fluconazole, and 103 patients were assigned to receive placebo. Follow-up data were available for 80 and 65 patients, respectively. At the three-month follow-up, healing of lesions was complete for 63 of the 80 patients in the fluconazole group (79 percent) and 22 of the 65 patients in the placebo group (34 percent; relative risk of complete healing, 2.33 [95 percent confidence interval, 1.63 to 3.33]). According to an intention-to-treat analysis, the rates of healing were 59 percent and 22 percent, respectively (relative risk, 2.76 [95 percent confidence interval, 1.84 to 4.12]). Sodium stibogluconate was offered to 11 patients in the fluconazole group who returned for follow-up (14 percent) and 33 of those in the placebo group (51 percent) in whom oral treatment was judged to have failed. According to a Kaplan-Meier analysis, the time to healing was shorter for the fluconazole group (median, 8.5 weeks, as compared with 11.2 weeks in the placebo group; P<0.001 by the log-rank test). Side effects were mild and similar in both groups. CONCLUSIONS: A six-week course of oral fluconazole is a safe and useful treatment for cutaneous leishmaniasis caused by L. major.
Adult↗
Meningococcal disease.
Meningococcal disease occurs as both endemic and epidemic disease in most parts of the world with significant morbidity and mortality. Among the different serogroups of Neisseria meningitidis, serogroups A, B, C account for 90% of the disease. In the last few years there has been a change in the epidemiology of the disease with an increase in the prevalence of serogroup C in Europe and North America, serogroup Y in the United States of America and Sweden, and W135 in the Kingdom of Saudi Arabia. The emergence of Neisseria meningitidis serogroup W135 in the Kingdom of Saudi Arabia has lead to 2 major outbreaks mainly among Pilgrims during the Hajj season of 2000 and 2001. This has lead the health officials in the Kingdom of Saudi Arabia to change their vaccine requirements for the Umra and Hajj to include the quadrivalent meningococcal vaccine (A, C, Y, W135) instead of the bivalent one (A, C). Despite all the advances in prevention, diagnosis and treatment, the disease continues to have high mortality (5-10%). Prompt empirical treatment for suspected cases should include penicillin or a 3rd generation cephalosporin. A new conjugate vaccine against Neisseria meningitidis serogroup C has been recently licensed, while quadrivalent conjugate vaccine against serogroup A, C, Y and W135 is in early development. Meanwhile targeted vaccination with the available vaccines according to the epidemiology of the disease and rapid chemoprophylaxis for the close contacts of active cases are the most effective preventive strategies.
Adult↗
Risk factors for drug-resistant Mycobacterium tuberculosis in Saudi Arabia.
OBJECTIVE: To identify rates of primary and secondary drug-resistant Mycobacterium tuberculosis and their risk factors from a tertiary-care center in the Kingdom of Saudi Arabia. METHODS: Review of microbiological and clinical data of all patients with positive isolates of Mycobacterium tuberculosis between 1995 and 2000 at King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. RESULTS: Susceptibility to antituberculosis agents was tested in 320 isolates from 320 patients. The median age was 50 years. Pulmonary tuberculosis was diagnosed in 106 (33%) patients, extrapulmonary in 183 (57%), and both in 31 (10%) patients. Two hundred forty-six isolates were sensitive to all 5 first line agents. Resistance to at least one of the first line agents was documented in 36 (11.3%) isolates. For the year 2000, resistance rates increased to 17.6%. Monoresistance was noted in 20 isolates (6.3%) and polyresistance in 16 isolates (5.0%) including 9 multidrug-resistant Mycobacterium tuberculosis isolates (2.8%). Resistance rates for antituberculosis agents are: Isoniazid, 9.1%; Rifampin, 2.8%; Ethambutol, 1.6%; Streptomycin, 5%; Pyrazinamide, 3.6%. Seventy-eight percent of the resistant isolates are considered primary resistance. History of antituberculosis therapy was the only risk factor associated with drug resistant Mycobacterium tuberculosis, odds ratio 19.9 (P< 0.00001). The mean age of patients with resistant isolates was 42 years compared to 49 years in patients with susceptible isolates (P= 0.047). CONCLUSION: In a population of mostly Saudi patients, primary and secondary drug-resistant Mycobacterium tuberculosis is relatively low but has increased lately. Previous history of antituberculosis chemotherapy and young age are risk factors identified.
Adolescent↗
Extrapulmonary tuberculosis, epidemiology and patterns in Saudi Arabia.
Annual incidence rates of extrapulmonary tuberculosis have been increasing over the last few years in the Kingdom of Saudi Arabia. True rates may even be higher due to incomplete reporting. Diagnosis of this condition requires high clinical suspicion, special diagnostic procedures, special staining, and culture media for acid fast bacilli. Delayed diagnosis results in increasing morbidity, mortality, and cost to the health care system. Particularly in areas of high endemicity of Mycobacterium tuberculosis, clinicians should be aware of the various forms of extrapulmonary tuberculosis. The available epidemiology and patterns of various forms of extrapulmonary tuberculosis in the Kingdom of Saudi Arabia are presented in this review.
Adult↗
Mycobacterium tuberculosis susceptibility in Saudi Arabia.
OBJECTIVE: To present the available susceptibility data of Mycobacterium tuberculosis (M. tuberculosis) isolates from the Kingdom of Saudi Arabia (KSA) published in peer-reviewed journals. METHODS: In a meta-analysis, studies published between 1966 and 2001 were included. Publication sites include Medline-indexed and non-indexed. Numbers of grown and resistant isolates were tabulated for first-line anti-tuberculosis agents. RESULTS: Twelve studies met the pre-set criteria. Data on 6,316 isolates between 1979 and 2000 were available. Resistance to at least one agent of the first-line anti-tuberculosis agents was 18.4%. Monoresistance to a single first-line agent was found in 10.9%, while polyresistance was noted in 7.6%. Multidrug-resistant M. tuberculosis was noted in 5.7% of all isolates. Resistance to isoniazid was most common noted in 11% of isolates. Resistance rates to other agents were: rifampin 9.7%, streptomycin 9.1%, pyrazinamide 3.1%, and ethambutol 2.5%. The overall resistance rate to at least one agent was not statistically different in isolates grown between 1979-1991 (18.5%) and 1989-2000 (18.3%). There were large regional variations and higher resistance rates in the Western and Southern regions. CONCLUSION: Mycobacterium tuberculosis resistance rates to first-line antituberculosis agents and multidrug-resistant M. tuberculosis are high in KSA. A survey and monitoring program for drug-resistant tuberculosis will determine resistance rates at the community level.
Drug Resistance, Bacterial↗
Extra pulmonary tuberculosis in Saudi Arabia.
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Adult↗
Drug-resistant Mycobacterium tuberculosis in Saudi Arabia: how little we know.
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Comment↗
Documentation and coding of medical records in a tertiary care center: a pilot study.
BACKGROUND: Since the medical record is the major source of health information, it is necessary to maintain accurate, comprehensive and properly coded patient data. We reviewed 300 medical records from patients at King Faisal Specialist Hospital and Research Center, representing four departments (medicine, surgery, pediatrics and obstetrics and gynecology). METHODS: The records were audited following the guidelines of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for accuracy and completeness of documentation and coding of primary and secondary diagnoses and procedures performed. RESULTS: Of 1051 items abstracted, 876 (83.3%) were accurately documented, 41 (3.9%) were inaccurately documented, and 134 (12.7%) were not documented. Of the items abstracted, 736 (70%) were assigned a correct code, 110 (10.5%) were assigned an incorrect code, and 205 (19.5%) were not coded. More items classified as accurately documented were coded correctly (71.1%) than items inaccurately documented (49.7%) (P < 0.0001). The difference in comprehensiveness of documentation, which reflects physician performance, was not statistically significant among the four departments (P value < 0.234). The difference in the accuracy of coding, which reflects coder performance, was statistically significant (P value < 0.036). CONCLUSIONS: Only 60% of the audited records met the benchmark for good quality medical records with regards to documentation and coding. A positive correlation between the accurate documentation and correct coding was noted, which supports the conclusion that high quality documentation enhances coding accuracy. These data, although encouraging, suggest room for improvement, which can be achieved through the collaboration of clinicians, who have extensive clinical experience, and coding professionals, who have comprehensive classification system expertise.
Documentation↗
Tuberculous aortitis.
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Antitubercular Agents↗