Clinical pattern of tuberculosis among Saudi nationals in the western region of Saudi Arabia

Tuberculosis is a major health problem in Saudi Arabia and developing countries. Understanding the epidemiology of the disease helps in its early identification and prevention. This study was conducted to evaluate the pattern and clinical presentation of Mycobacterium tuberculosis [MTB] among Saudi nationals. We reviewed the clinical and laboratory records of 147 patients with proven cultural diagnosis of MTB attending King Khalid National Guard Hospital [KKNGH], Jeddah, Saudi Arabia between June 1993 and June 1999 and also studied the symptoms and clinical pattern of the disease. Our study demonstrated that MTB affected mainly young adults in their second and third decades. There was no significant difference in the prevalence of the disease between the genders, though slightly more males [75/147, 51%] were affected compared to females [72/147, 49%]. There was a high incidence of extra-pulmonary TB [36.6%], with lymph node involvement being the most common extra-pulmonary site [27%]. Although the most common symptoms were chronic cough [51.7%], fever [46.3%] and weight loss [41.5%], these symptoms seem to occur less frequently in patients with TB than previously reported. There was an alarming high prevalence of drug resistant MTB [15% for isoniazid, 9.5% for rifampicin, 8.2% for pyrazinamide, 15.6% for ethambutol, and 9.5% for multi-drug resistant]. The presence of classical symptoms of MTB [cough, fever, weight loss] was less frequent than expected suggesting atypical presentation of the disease may be more common than what was previously held. There was a high incidence of extra pulmonary TB in our study, lymph node involvement being the most common. Physicians working in Saudi Arabia should be aware of the unusual presentation of the disease. The high prevalence of drug resistant MTB emphasizes the importance of performing culture and sensitivity tests for MTB in all new cases

Leuconostoc Bacteremia in a child with short - gut syndrome

In the last decade Leuconostoc species have been reported with increasing frequency as human pathogens, causing bacteremia, meningitis and peritonitis. We report here a child with short-bowel syndrome who developed bacteremia following multiple surgeries for necrotizing enterocolitis. Leuconostoc species was isolated from the blood cultures. The child was successfully treated with ampicillin and gentamycin. He however remained total parenteral nutrition dependent due to his multiple abnormalities. We call the attention of microbiologists and pediatricians to this emerging pathogen, which is intrinsically resistant to vancomycin and can be misidentified in the microbiology laboratory as Viridans streptococci or Enterococci. Increased awareness by clinicians of this organism is called for, if it is to be recognized and appropriately treated

Unusual cause of hepatosplenomegaly

Tuberculosis [TB] and its complications are increasing public health problems in many parts of the world, especially in immunocompromised patients. The disease has wide spectrum oi presentations which necessitate its consideration in differential diagnosis of unresolved clinical problems particularly in developing countries. It is infrequently encountered in developed countries, hence a high index of suspicion is required. However, in developing countries where TB is endemic, the facilities for accurate and timely diagnosis of extrapulmonary TB are lacking and not readily available. Here we report an unusual case of hepatosplenomegaly due to TB with an insidious presentation