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Biomedical subjects

M N Chowdhury

Publications and source records attributed to M N Chowdhury.

At least 19 recordsLinked to original sources
PubMed1997

Spectrum of Haemophilus influenzae type b disease in children at a university hospital in Riyadh, Saudi Arabia.

During a period of 5 years, 42 cases of invasive Haemophilus influenzae type b (Hib) disease were studied. An outstanding finding in our patients was occult bacteraemia, which was detected in 13 (31 per cent) patients. Other clinical conditions encountered were nine (21 per cent) patients with pneumonia, nine (21 per cent) with meningitis, six (14 per cent) with cellulitis, three (7 per cent) with arthritis, one (2 per cent) with epiglottitis, and one (2 per cent) with urinary tract infection. The mean age of children was 21 months (range 1-156 months); the majority (62 per cent) belonged to the age group 7-18 months. There were 24 females and 18 males. Eighty-one per cent of these patients were Saudi nationals. Five isolates (12 per cent) of Hib were resistant to ampicillin and similar numbers were resistant to chlorampenicol. Twenty-five children (60 per cent) were treated with ampicillin, nine (21 per cent) with chlorampenicol and eight (19 per cent) with ceftriaxone. All patients made complete recovery.

Adolescent↗
PubMed1997

Non-group A streptococci: are they pathogens in the throat?

A total of 3,184 paediatric patients with sporadic pharyngitis was studied at King Khalid University Hospital in Riyadh, Saudi Arabia. In addition, 478 children without pharyngitis who were matched for age and sex were included as controls. Group A beta-haemolytic streptococci (beta HS) were detected significantly more often among the children with pharyngitis than among the controls (8.4% vs 2.3%; p < 0.0001). In contrast, total non-group A and group C beta HS were isolated at lower frequency from the sick than control children (0.9% vs 2.5% and 0.2% vs 1.2% respectively; p < 0.01) while other non-group A beta HS such as groups B, G and F were each isolated in similar frequency from both the sick and control children. We conclude that non-group A beta HS appear not to be as important as aetiological agents of sporadic pharyngitis in these children.

Adolescent↗
PubMed1995

Diagnostic challenge of tuberculosis of the elderly in hospital: experience at a university hospital in Saudi Arabia.

We studied retrospectively 80 elderly patients who had been admitted to hospital with tuberculosis (TB) between January 1988 and June 1993. There were 64 with pulmonary TB and 16 with miliary tuberculosis (MTB). The mean age was 70+/-7.5 years (range 60-88 years) with 56% over 70 years of age. Underlying disease preceding TB was present in 86.3% patients. In the majority of patients clinical manifestations were subtle. Chest X-ray showed involvement of lower lung fields and miliary shadowing in 71.2% (33/80) and 20% (16/80) patients, respectively. The organism was detected in expectorated sputum specimens in 62.5% (50/80). Of the specimens obtained by flexible fibreoptic bronchoscopy (FOB), 61% were positive for acid-fast bacilli (AFB) by films and culture. Drug-induced adverse effects were observed in 17.6% (6/34). In 18 patients (22.5%), the diagnosis of TB was delayed or missed. The overall mortality of 21% (9/43) included seven patients with MTB and two with pulmonary TB. TB was the direct cause of death in the former and a significant contributory cause in the latter.

Aged↗
PubMed1994

Coagulase-negative staphylococcal bacteraemia with special reference to septic shock: experience in an intensive care unit.

During a period of 4.5 years, 48 patients with bacteraemia due to coagulase-negative staphylococci were studied prospectively in order to evaluate their clinical profile, management and outcome. There were 25 males and 23 females with ages ranging between 13 and 100 years. Over 60% of patients belonged to the age group 30 to 69 years. Shock was recorded in 23 (48%) of the 48 patients. Of the shocked patients, 16 were immunocompromised and also had abnormal coagulation. Their mortality was 44%. By contrast, none of the immunocompromised patients without shock died. Abnormal coagulation was found in 17 patients without septic shock. Their mortality was 5.9%. The commonest underlying disease was respiratory failure especially in shocked patients. The source of infection was identified in the majority of cases. In addition, most patients had an indwelling intravascular catheter especially an arterial one. The overall mortality was 16.7% (8/48). It was significantly higher in patients with shock than in those without shock (30.4% vs. 4.0%, P < 0.05).

Adolescent↗
PubMed1994

Re-evaluation of pneumonia requiring admission to an intensive care unit: a prospective study.

BACKGROUND: Appropriate treatment of severe community and hospital acquired pneumonias requiring admission to a medical intensive care unit depends on knowledge of the likely aetiological agents in any community. Little is known about the pattern and outcome of patients with such pneumonias in Saudi Arabia. METHODS: In a prospective study 113 patients with pneumonia were investigated in the medical intensive care unit at King Khalid University Hospital, Riyadh, Saudi Arabia between September 1991 and December 1992. The diagnosis was established by microscopy and culture of sputum, blood culture, or serological examination. A standard proforma was used to collect demographic, clinical, and laboratory data. RESULTS: A microbiological diagnosis was made in 80% of the cases with a single pathogen accounting for 69% of the isolates and multiple pathogens for 11%. Pseudomonas aeruginosa was the most common infecting agent (16%), followed by Streptococcus pneumoniae (12%), Staphylococcus aureus (9%), and Mycobacterium tuberculosis (8%). Pneumonia due to Legionella pneumophilia was diagnosed in three patients and infection due to Mycoplasma pneumoniae in two. These five cases were identified by serological examination. Gram negative rods were the predominant pathogens in both community and hospital acquired pneumonia. The aetiology of pneumonia was not identified in 20% of cases. The overall mortality was 37%. Patients with hospital acquired pneumonia had a higher mortality than those with a community acquired pneumonia. Similarly, a high mortality was found in patients who had a serious underlying disease, abnormal mental state, diastolic blood pressure < 60 mm Hg, blood urea > 7 mmol/l, abnormal liver function tests, serum albumin < 30 g/l, those who required mechanical ventilatory support, and those with APACHE II scores > 20. CONCLUSIONS: This study highlights two major findings which differ from previous reports on the aetiology of pneumonia. Firstly, Gram negative rods were the predominant pathogens in community acquired pneumonia and secondly, M tuberculosis was an important cause of pneumonia in these patients, indicating that tuberculous pneumonia should be considered in the differential diagnosis of pneumonia in Saudi Arabia.

Adolescent↗
PubMed1993

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. These relatively good results (by Third World standards) could reflect the rise of the standard of living and wide availability of free treatment for active cases with a lowered risk of infection in the community. This view is supported by the fact that in our survey, only one subject grew Mycobacterium tuberculosis in the sputum. However, there were foci of high prevalence of Mantoux reaction in the urban communities in the Western province (20% +/- 8.7 urban; 1% +/- 1.9 rural). The problem may be caused by the fact that the province receives every year over a million pilgrims, some of whom are known to settle illegally and escape the usual screening for tuberculosis imposed on foreign labourers. In conclusion, even in the absence of an enforceable national programme for the eradication of tuberculosis, the economic standard and wide availability of free treatment for active cases has resulted in relatively low rates of prevalence of tuberculin sensitivity in children. The foci of high prevalence in the Western Province require special screening arrangements.

Adolescent↗
PubMed1992

An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit.

An outbreak of infection due to Staphylococcus aureus phage-type 52, resistant only to penicillin, occurred in children's wards primarily in a neonatal intensive care unit. The outbreak involved 86 infants; the majority presented with conjunctivitis, wound infections, boils, omphalitis and otitis externa. Seven per cent of these infants (six of 86) also had septicaemia. In addition, 6% (five of 86) were colonized by this phage type and the most common site of carriage was the umbilicus. The outbreak was contained by eradication of nasal carriage among the staff members and also by standard infection control measures.

Bacteriophage Typing↗
PubMed1992

Campylobacter gastroenteritis in children in Riyadh, Saudi Arabia.

Campylobacter jejuni/coli (CJC) was isolated from the stools of 82 (1 per cent) of 7369 children with gastrointestinal symptoms during a 2-year period. Among 1130 control children, CJ was isolated from the stool of one (0.09 per cent). The peak incidence of CJC associated gastroenteritis was in the winter. Seventy-six per cent of the patients were 4 years of age and younger with the highest incidence (56 per cent) in children 2 years old and younger. The most common presenting symptoms and signs were diarrhoea (95 per cent), anorexia (71 per cent), abdominal pain (70 per cent), high fever (57 per cent), and frank blood in stools (48 per cent). In five (6 per cent) patients CJC isolates were resistant to erythromycin. In all patients CJC infection was self-limited and the majority of patients required only supportive therapy.

Age Factors↗
PubMed1992

Helicobacter pylori and dyspepsia in an Arab population.

To determine the incidence and significance of the detection of Helicobacter pylori in an Arab population, 116 patients with dyspepsia were studied. 89 percent of these patients had H. pylori detected by culture or/and histological definition of Campylobacter-like organisms. By the modified rapid urease test (RUT) 80% of the patients had H. pylori (sensitivity of 91%, specificity of 75%). Irrespective of the endoscopic diagnosis, the presence of H. pylori was associated with histologic evidence of gastritis. A heavy growth of H. pylori on culture was associated with active gastritis. There was no difference in the incidence rates of H. pylori with regard to various diagnoses by endoscopy. It is suggested that H. pylori may be hyperendemic among Arab patients with dyspepsia. Its presence is associated with varying severity of gastritis with or without additional endoscopically recognised findings.

Chronic Disease↗
PubMed1992

Empiric therapy of common bacterial infections in Saudi Arabia; a review.

The common infective conditions encountered at King Khalid Teaching Hospital, Riyadh, Saudi Arabia were described. These data were collected mostly during a period of 8 years between 1981 to 1988. These infections included brucellosis, cholecystitis, conjunctivitis, enteric fever, gastroenteritis, infective endocarditis, meningitis, otitis media, pneumonia, septicaemia, sorethroat, treponemal infections, urethritis, urinary tract infections, and vaginitis. A scheme for empiric chemotherapy has been suggested for these infections based on the sensitivity results obtained mostly from the microbiology laboratory at Teaching Hospital, Riyadh. This scheme of empiric therapy is offered as a guide only. It does not cover all possibilities and is not intended as a rigid dogma. Empiric therapy has also been suggested for some other infective conditions where sufficient data were not available from the Teaching Hospital. Empiric therapy should be started after relevant specimens are collected. Culture and sensitivity tests are invaluable in the management of patients with infectious diseases. As soon as sensitivities of the infecting organisms' are known, treatment should be adjusted accordingly. In some cases, Gram-staining is valuable to guide the initial therapy (eg. meningitis, pneumonia, and urethritis). Finally, close liaison between physicians and clinical microbiologists is mandatory for successful therapy.

Anti-Bacterial Agents↗
PubMed1991

Antibiotic sensitivity pattern; experience at University Hospital, Riyadh, Saudi Arabia.

Results of sensitivity testing were discussed based on examination of 5192 isolates of the various bacteria isolated from clinical specimens from King Khalid University Hospital in Riyadh, Saudi Arabia. Streptococcus pyogenes and Streptococcus pneumoniae were sensitive to penicillin and erythromycin. The sensitivity pattern of Staphylococcus aureus was also predictable as they were fairly sensitive to both methicillin (98%) and erythromycin (96%). Neisseria gonorrhoeae (27%) showed a high level of resistance to penicillin. The resistance of Haemophilus influenzae to ampicillin and chloramphenicol was low. Brucella species was sensitive to tetracycline and rifampicin; resistance to streptomycin and cotrimoxazole was minimal being 1% and 6% respectively. The resistance of E. coli, Klebsiella species and Proteus species to second and third generation cephalosporins and amikacin was fairly low ranging from 1.3% to 3%. The gentamicin resistance for these organisms was also within the acceptable range (3%-10%). Gentamicin and amikacin resistance for Pseudomonas aeruginosa was low (2-8%). Salmonella typhi was sensitive to ampicillin, cotrimoxazole, and chloramphenicol. Salmonella enteritidis, Shigella species, and enteropathogenic E. coli were highly resistant to various antibiotics. Campylobacter jejuni was sensitive to gentamicin but 6% of isolates were resistant to erythromycin. Ninety six percent of Gram-negative rods except P. aeruginosa isolated from urine of patients having urinary tract infections were sensitive to amoxycillin-clavulanic acid. In addition, P. aeruginosa showed fairly low resistance to norfloxacin which is given orally to treat cystitis caused by this organism.

Bacteria↗
PubMed1991

Seroepidemiology of enteric fever and brucellosis in a developing country.

The seroepidemiology of infection due to S. typhi and Brucella spp. in a sub-tropical, developing country of the Middle East was investigated in 130 children of age less than 1 to 15 years, 117 young adults (16-30 years) and in a further 40 adults (greater than 30 years) using an agglutination test to detect antibodies to of S. typhi, B. abortus and B. melitensis. Only 4.5% of the children's and adult's sera respectively showed the presence of antibodies to both O and H antigens of S. typhi with reciprocal titers greater than or equal to 80. Prevalence rates of 11.6%, 11.3% respectively in children and adults of antibodies to B. abortus with reciprocal titers greater than or equal to 80 and similarly 13.1%, 12.4% to B. melitensis were found. The usefulness of a single Widal test to diagnose enteric fever in a non-endemic area and the agglutination test in the diagnosis of brucellosis in an endemic area was investigated. Of 244 patients with suspected enteric fever, the sera of 100 showed reciprocal antibody titers 80 to both O and H antigens and included in these were 8 patients with concurrent culture positivity. Among 138 children and adults with suspected brucellosis, 29 culture proven cases where serologically confirmed and a further 90 were detected serologically. The sera of all the culture proven cases exhibited antibody reciprocal titer greater than or equal to 640. A similar antibody response was noted in seventy-two of the culture negative cases diagnosed serologically for brucellosis. In culture proven, cases B. melitensis was the isolate. Comparative evaluation indicated the potential usefulness of the Rose Bengal Antigen Slide Agglutination Test (Brucelloside Test) as a screening test in the serodiagnosis of human brucellosis.

Adolescent↗
PubMed1989

Screening for toxoplasmosis in pregnancy.

Randomly collected sera from 386 pregnant women attending obstetric and gynecology clinics at Kind Khalid University Hospital, Riyadh, Saudi Arabia, were examined for toxoplasma antibodies by five serological methods, i.e. latex agglutination test (LAT), two indirect hemagglutination tests (IHAT) (Carter-Wallace, USA and Ismunit, Italy), enzyme immunoassay (EIA) and indirect fluorescent antibody test (IFAT). The percentage of sensitivity, specificity and coincidence value of these tests were compared with IFAT which was used as a reference test. For routine screening of toxoplasmosis, LAT has proved in this study to be the most suitable test. The LAT is cost effective and easy to perform. In this study of the three tests (IFAT, EIA, immunosorbent agglutination assay) to demonstrate specific IgM for toxoplasmosis, the EIA test proved to be the most satisfactory because of its 99% specificity. If EIA equipment is available, it can be used for routine screening (IgG) as well as IgM determination. The incidence of toxoplasmosis in pregnant women varied between 25.4% and 36.3% depending on the method used.

Female↗
PubMed1989

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. and Pseudomonas spp. being the most frequent. Staphylococcus aureus was the most common gram-positive organism isolated. The source of infection was identified in 75% of patients. Intravenous lines accounted for a high proportion of cases (22%). Most deaths occurred in infants and patients with serious underlying disease.

Adolescent↗
PubMed1989

Indirect haemagglutination (IHA) test in the serodiagnosis of amoebiasis.

Among 72 patients clinically suspected of Entamoeba histolytica (E. histolytica) infections, 39 positive cases (54%) were detected serologically by the indirect hemagglutination (IHA) test. Parasitologically, microscopic examination of three consecutive stool specimens from all these patients indicated positivity for E. histolytica cysts and or trophozoites in 10 of the patients with IHA antibody titers greater than or equal to 1:128, which is of clinical significance. Another 2 patients were parasitologically positive but showed low IHA antibody titres (1:32-1:64); follow up indicated response to treatment with metronidazole. The highest serological positivity (100%) were detected in patients with liver abscess, all were clinically proven cases of extra-intestinal amoebiasis. IHA antibody levels of clinical significance were seen in all four patients with chronic dysentery with parasitological evidence of E. histolytica in their stools. In a group of patients with abdominal pain nine positives were detected serologically, four of which were positively diagnosed concurrently by parasitology; the remaining five patient's sera showed high IHA antibody titres with absence of cysts or trophozoites in stools, indicative possibly of persistence of antibodies from past infection. The serologic determination of E. histolytica IHA antibodies in a control group consisting of normal healthy school children and adults of both sexes without any clinical evidence of amoebiasis showed the absence of any positive titres of clinical significance; low titres (1:32-1:64) were detected in 5.2% of 232 sera tested. Parasitological examination of three consecutive stool specimens from all individuals in the control group showed the presence of cysts of E. histolytica in just two among 232 tested (0.9%).

Adolescent↗
PubMed1987

Meningitis and septicaemia due to a multiply resistant strain of Haemophilus influenzae type b.

A case of meningitis and septicaemia caused by a multiply resistant strain of Haemophilus influenzae in a Saudi infant aged 7 months is reported. Haemophilus influenzae, resistant to ampicillin and chloramphenicol, was isolated from the cerebrospinal fluid, the blood and throat. The minimum inhibitory concentrations (MIC) for ampicillin and chloramphenicol were 64 mg/l and 16 mg/l respectively. After failure of initial therapy with high doses of ampicillin and chloramphenicol, the child made a full and uneventful recovery when treated with cefotaxime. The implications of isolating such a strain on the policy for treating meningitis in our situation are discussed.

Ampicillin↗