PubMed Health⌕ Search

Biomedical subjects

S Al-Kandari

Publications and source records attributed to S Al-Kandari.

13 recordsLinked to original sources

Hepatitis delta virus infection in acute hepatitis in Kuwait.

Over a period of 1 year, 254 patients presenting with acute hepatitis at the Infectious Disease Hospital, Kuwait were positive for hepatitis B surface antigen (HBsAg). Of these, 23 (9%) patients were found to have antibodies to hepatitis D virus (HDV) (anti-HDV). Eight of these anti-HDV positive patients were shown to have a coinfection with acute hepatitis B and 8 had a superinfection of HDV on a chronic HBsAg infection. The remaining 7 had had a previous HDV infection and were also chronic carriers of HBsAg. The cause of the acute hepatitis in this group was probably non-A, non-B virus(es). The prevalence of anti-HDV was 4% among patients with acute hepatitis B and 31% among carriers of HBsAg. In the coinfection group, 5/8 patients recovered completely, 1 developed chronic active hepatitis and 1 died due to fulminant hepatitis, while 1 patient was lost to follow up. 5/8 patients with superinfection developed chronic hepatitis on follow-up, 2 died while only 1 patient recovered completely. In the group of patients with previous delta infection, 5/7 recovered from the acute bout of hepatitis while 1 patient developed chronic active hepatitis and 1 was lost to follow-up.

Acute Disease↗

Induced malaria and antibody titres in acute infections and in blood donors in Kuwait.

Concurrent with the increase in the number of imported cases of malaria into non-endemic Kuwait during the past 5 years, induced infections have been identified for the first time. We report 10 such cases over a 4-year-period. Of 8 transfusion-induced infections, 4 were due to Plasmodium falciparum and 4 to P. vivax. The mean incubation period for P. falciparum patients was 13 d and for P. vivax, 17 d. An accidental syringe-needle transmission and a congenital infection were due to P. falciparum and P. vivax respectively. Malarial antibody levels were assayed on commercially-available cultured P. falciparum schizonts by the indirect fluorescent antibody (IFA) test. To establish a base line, the sera of patients with blood film-confirmed P. falciparum and P. vivax were assayed. 96% of the P. falciparum sera were positive, the geometric mean titre (GMT) being 10,280. However, all sera from P. vivax patients were reactive but the GMT was lower at 505. 28% of sera from Kuwaitis and 45% of sera of a consecutive group of blood donors were also reactive, the respective GMTs being 38 and 51. The risk of transfusion malaria was calculated as 79 per million units drawn, an unacceptably high figure for a non-endemic country. We suggest a revised blood donor policy.

Adolescent↗

Viral hepatitis and pregnancy in Kuwait.

The frequency and severity of viral hepatitis among pregnant and non-pregnant women in Kuwait was studied from 1980 to 1984. 542 female hepatitis patients were investigated, of whom 52 (9.6%) were pregnant. 35 of the 52 (67.3%) cases of viral hepatitis in pregnancy were due to hepatitis B virus while 11 of 52 (21.2%) and 6 of 52 (11.5%) had acute hepatitis non-A, non-B (NANB) and hepatitis A virus infections, respectively. The frequency and severity of viral hepatitis among the pregnant women was similar to that among non-pregnant women. Hepatitis did not have a deleterious effect on pregnancy and no death was recorded. Fulminant acute NANB hepatitis was seen in only one patient, who recovered completely.

Adult↗

Acute non-A, non-B hepatitis in Kuwait.

In a prospective study of acute hepatitis in Kuwait covering the period February 1983 to January 1984, a total of 1781 cases were diagnosed as having an acute viral hepatitis. 1,384 (77.7%) were found to be due to hepatitis A virus (HAV), 206 (11.5%) hepatitis B virus (HBV), 8 (0.4%) coinfection with HBV and delta virus (HDV), 8 (0.4%) superinfection of HDV on chronic HBsAg carriers and 157 (9%) non-A, non-B virus (NANB). 13 cases of CMV and 5 of EBV infections were also diagnosed. NANB viral hepatitis was a disease of young adults (mean age 29 years) with a male-female ratio of 3:1. A high incidence was noted among males from the Indian subcontinent (29.1/100,000 of population, compared to 5.4/100,000 among local Arabs), the majority of whom gave a history of recent visit to the Indian subcontinent. The clinical features and biochemical findings of acute NANB infection were found to be less severe than those of acute HBV infection and similar to acute HAV infection. Three patients (2.3%) with acute NANB virus infection developed chronic hepatitis (all women), and another 3 patients died because of fulminant hepatitis.

Acute Disease↗

Hepatitis A and B virus infections in children in Kuwait.

In a 1-year prospective study of 1788 cases of acute viral hepatitis, 26 (1.5%) presented with evidence of simultaneous hepatitis A (HAV) and hepatitis B (HBV) virus infection. Twenty-three of 26 (88.5%) of these cases had serological evidence of a recent HAV infection in a chronic HBV carrier. The remaining 3 (11.5%) showed serological evidence of a recent concomitant HAV/HBV infection. Twenty-four of the 26 (92.3%) patients with simultaneous infection were children with a mean age of 4.6 years. Clinical and laboratory data indicated that the disease in patients with a recent concomitant HAV/HBV infection was not different from that in patients who had HAV infection superimposed on a chronic HBV carrier or that in age and sex matched patients presenting with an acute viral hepatitis A infection alone. Furthermore, the outcome of the disease was not affected by the HBeAg/anti-HBe status of the hepatitis B positive patient. All patients recovered completely and on follow-up none showed any signs of chronic liver disease. Simultaneous HAV/HBV infection, therefore, does not result in a more severe disease.

Adolescent↗

Hepatitis B virus perinatal transmission among Arab women.

One thousand five hundred and fifty-four Arab women were screened at delivery for the presence of hepatitis B virus (HBV) antigenaemia in their sera. Forty-five or 2.9% were found to be positive. Only three of 41 (7.3%) of these hepatitis B surface antigen-positive (HbsAg) mothers were found to be positive for the presence of hepatitis B e antigen (HBeAg), 27 (65.8%) had anti-HBe and the remaining 11 (26.8%) had neither HBeAg nor its corresponding antibody. These results, therefore, predicted a low rate of transmission of virus from mother to newborn. Follow-up for 4-13 months after delivery on 14 of these HBsAG-positive mothers and their infants indicated that in only one infant born to an HBeAg-positive mother did HBV antigenaemia develop. Another infant died from undetermined causes. Therefore, HBV perinatal transmission among Arabs, unlike that among populations in Southeast Asia, does not appear to contribute in an important way to the pool of carriers in this population.

Female↗

Imported malaria in Kuwait.

The number of imported malaria cases in Kuwait rose from 87 in 1980 to 504 in 1983, an increase of 579%. The continued resurgence of malaria in endemic zones, improved diagnostic techniques and a heightened awareness of imported malaria have contributed to the increase in the number of microscopically proved cases. Thick blood films fixed in acetone and stained in Giemsa proved a rapid method of diagnosis; species identification on the basis of a thin film on the same slide was performed with ease. Malaria was acquired in 38 countries. Most patients were young male adults. Most of the cases were due to Plasmodium vivax originating from India, although an increasing number of P. falciparum cases are also now being diagnosed from there. P. falciparum infections were evenly distributed throughout the year and most cases presented within 14 days of their arrival in the country. The highest number of P. vivax cases were diagnosed between May and October, when heat stress might have been a factor in precipitating a clinical attack of an infection previously acquired in the endemic zone. Attention is drawn to the importance of delayed attacks of P. vivax and, in semi-immunes, of P. falciparum. The time interval involved in establishing a history of "recent" travel in clinically suspected cases of malaria needs to be more clearly defined in each geographical area. Cases of induced malaria due to transfusion, accidental and congenital infections were identified. The fatality rate due to P. falciparum infections was low. In terms of the risk of renewed transmission, Kuwait may be considered a vulnerable area.

Adolescent↗

Malaria in non-endemic Kuwait: resident status of patients with imported infections and the need for prophylaxis.

Kuwait is non-endemic for malaria but, with a large expatriate population, the number of imported infections has escalated from 87 in 1980 to 534 in 1984, an increase of over 613%. During a period of 1 year at the Infectious Diseases Hospital, where most of the cases were diagnosed each year, 16.7% of blood samples sent for microscopy were positive for malaria; 95.47% of these patients were hospitalized for an average of 4 days. In a 2-year period, only three (0.52%) Kuwaiti nationals imported the infection out of a total of 577 patients with malaria. About equal numbers of expatriate 'residents' and 'new arrivals' were responsible for the remainder, but over 80% of patients with Plasmodium falciparum were 'residents'. The proportion of residents among the patients is increasing and will be more pronounced with the downturn in the economy. To curtail the tide of imported malaria, the current data suggests the viability of an active campaign to offer chemoprophylaxis to travellers at risk who are essentially 'semi-immune visitors of a non-malarious area visiting a malarious area'. The benefits of simple prophylactic measures need to be emphasized. The disinfection of aircraft arriving from endemic zones should be mandatory.

Antimalarials↗

Measles and age of vaccination.

Measles is responsible for high morbidity and mortality in children particularly in developing countries. Infants, found by analytical studies to constitute a high risk group, are usually not covered by current vaccination programmes. In Kuwait in the epidemic years during the period 1976-1982, the incidence of measles in infants under one year was found to be more than five times that in the population over one year of age, ranging between 758 and 992 per 100000 live births. During this period as many as one fifth of the total cases (13.3-21.7%) and about one-third of the total deaths (35%) occurred in infants. The mean fatality rate for infants under one year was 3.3 while for the population one year and above it was 1.4. As the immunity derived from the mother declines markedly a large majority of children over six months of age become susceptible to measles. There is a strong case for lowering the age of vaccination against measles to protect the infants, at least in the developing countries, and to control and eventually eradicate the disease.

Adolescent↗

A randomised controlled study of intravenous acyclovir (Zovirax) against placebo in adults with chickenpox.

In a double-blind, randomised, placebo-controlled trial of intravenous acyclovir (ACV) in normal adults with chickenpox, the drug was shown to have a significant effect on the duration of vesicles, on virus counts after one day's treatment and in lowering the body temperature on the third, fourth and sixth days of treatment. There were no significant effects on the duration of symptoms or on the evolution of the rash. No adverse effects of acyclovir were seen.

Acyclovir↗

Frequency of delta agent infections in Kuwait.

Antibodies to delta antigen have been found among all populations in the world studied so far. The prevalence is high (40%-47%) in chronic HBsAg carriers in southern Italy. In other parts of the world, the prevalence is low (less than 5%); however, 30%-75% of polytransfused hemophiliacs and drug addicts in Europe and the United States have antibodies to delta antigen [2]. Most Arab nationalities are well represented in the population of Kuwait. Among 144 HBsAg-positive sera studied, 58 (40%) were positive for antibodies to delta antigen. Data regarding diagnosis, age, sex, and nationality were available for 80 of the patients investigated. Among these, 32 (40%) were antibody-positive. The highest number of positive patients was among those with chronic liver disease; all except two of the positive patients were Gulf or Mediterranean Arabs. Thus, infection with delta agent is an important cofactor in the pathogenesis of chronic liver disease in this region, because delta agent is known to become chronic [2]. The patients who had chronic liver disease and those who had illnesses other than liver disease or acute hepatitis are probably all chronic HBsAg carriers; however, it was not possible to differentiate between chronic and transient carrier states. Some of the patients with acute hepatitis also probably carried HBsAg with a superimposed delta infection. The carriage rate of HBsAg in the normal population in Kuwait is 2.8%-4% [3]. The only fatal case of acute hepatitis in this study occurred among the patients who were positive for delta antibody.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗