Epidemiology of antibody to hepatitis B core antigen screening among blood donors in Estern Saudi Arabia. Need to replace the test by HBV DNA testing

Prevention of the residual risk of transfusion transmitted hepatitis B virus [HBV] infection is mostly relied on serological screening of blood donors for antibody to hepatitis B core antigen [HBc], to detect donors in window period of HBV infection. This study was carried out to determine the prevalence of anti-HBc antibody among blood donors and its impact on rejection of collected blood units. Blood bank records of all the blood donors who donated blood at blood bank of King Fahad Hospital, Al-Hofuf, Kingdom of Saudi Arabia, during the period of 2000 to 2003 were reviewed. All the collected blood units were screened for hepatitis B surface antigen [HBsAg], anti-HBc, hepatitis C virus [HCV], human immunodeficiency virus [HIV] 1 and 2, HIV p24, human T-cell lymphotropic virus [HTLV] I/II, venereal disease research laboratory [VDRL] and malaria. All the HBsAg negative with anti-HBc positive units were checked for anti-HBsAg antibodies. Of 26606 blood donors screened, 514 [1.9%] were HBsAg positive, 853 [3.2%] were isolated anti-HBc positive and 2687 [10.1%] were both anti-HBc and anti-HBsAg positive. The blood units, which were anti-HBc and anti-HBsAg positive, were utilized and the isolated anti-HBc positive blood units were rejected. There was a significant [odds ratio of 1.653, 95% confidence interval 1.298-2.105, p<0.0001] decline in anti-HBc positivity during the study period. Isolated anti-HBc positivity as a marker for window period of HBV infection leads to high rejection rate of collected blood units without completely covering the residual risk of HBV transmission by transfusion. Policy for checking the collected blood unit by 3 tests for anti-HBc, anti-HBsAg and HBsAg should be reconsidered in favor of HBV-DNA testing by polymerase chain reaction, to possibly achieve the zero risk goal of transfusion transmitted HBV infection

Prevalence of methicillin-resistant and methicillin-sensitive staphylococcus aureus nasal colonization among patients at the time of admission to the hospital

Methicillin-resistant Staphylococcus aureus [MRSA] is an important agent of hospital-acquired infection. The mode of entry of MRSA in the hospital might be on admission of patients with MRSA infection or nasal colonization. The present study was undertaken to determine the prevalence of MRSA nasal colonization among patients on admission to hospital. Six hundred patients were screened for nasal colonization of MRSA on admission to hospital. Nasal swabs were cultured on salt mannitol agar and blood agar. Age, sex, previous admission to hospital and antibiotic therapy were recorded. S. aureus was isolated from the nasal swabs of 122 patients [20.2%] on admission to hospital. MRSA was isolated from 7 patients [1.1%] and methicillin-sensitive S. aureus [MSSA] from 115 patients [19.1%]. Nasal colonization of S. aureus was higher in younger and elderly patients and significantly higher colonization was observed among females. The MRSA strains isolated from nasal swabs had a different antibiotic susceptibility pattern than those isolated from patients having hospital-acquired MRSA infection. Previous admissions to hospital, underlying disease antibiotic therapy were not risk factors for MRSA nasal colonization. MRSA nasal colonization of patients on admission to hospital is low in this region. The screening of every new admission would not be cost effective, but patients transferred form other institutions should be screened for MRSA. Standard infection control precautions should be strictly implemented to prevent the spread and control of MRSA infections

Prevalence of human T-lymphotropic virus type I and type II antibody among blood donors in Eastern Saudi Arabia

Human T-cell leukemia/lymphoma virus type I and type II [HTLV-I/II] infections can be transfusion associated, leading to tropical paraparesis, myelopathy and other neurological disorders. The aim of this study is to circumvent the risk of transmission through blood transfusion and to describe the prevalence of HTLV-I/II antibody among blood donors of Al-Hasa region and the cost effectiveness of screening blood donors. The study was conducted at the Department of Laboratory and Blood Bank, King Fahad Hospital, Al-Hofuf, Al-Hasa, Kingdom of Saudi Arabia during the period of 1997 to 2003. A total of 47426 blood donors were screened for HTLV-I/II antibody by enzyme-linked immunosorbent assay test, during the 7 years of study period. The positive samples were confirmed by western blot analysis. Overall, HTLV-I antibody positivity [confirmed by western blot] was 3/47426 [0.006%]. Out of 3 donors positive for HTLV-I antibody during 1997 to 1998, 2 were expatriates [Indian] and one was native Saudi donor. Human T-cell leukemia/lymphoma virus type I antibody positivity among the native Saudi donors was 1/47426 [0.002%] [2/100000 blood donors]. None of the donor were positive for HTLV-II antibody. During the last 5 consecutive years of the study period [1999-2003], none of the donor was positive for HTLV-I/II antibody. Al-Hasa region is non-endemic for HTLV-I/II virus infections. Screening of native Saudi blood donors for these viruses does not appear to be cost effective

Subcutaneous dirofilariasis caused by Dirofilaria repens

Human dirofilariasis caused by Dirofilaria repens D. repens is a common zoonosis in the Mediterranean countries and parts of South Asia. During the last decade, it has been reported from countries previously considered non-endemic. This is likely due to the increased awareness regarding Dirofilaria infection. In some such cases however, dirofilariasis correlated with the travel of the patient to the endemic areas. We present the case of a Saudi male who had D. repens infection in the subcutaneous tissues of the forearm. The patient had traveled to Iraq, Syria, United Arab Emirates and Kuwait in the last 2 years. However, the known Dirofilaria endemic countries were not visited. Any prior occurrence of the human dirofilariasis in the Kingdom of Saudi Arabia is not documented. Lack of epidemiological studies or incidence reports in the Arabian region precludes any factual evaluation of Dirofilaria prevalence, which requires increased awareness amongst health workers regarding its potential occurrence in the native population

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae hospital acquired bacteremia. Risk factors and clinical outcome

To study the risk factors and clinical outcome in patients having extended-spectrum beta-lactamase producing [ESBL] Klebsiella pneumoniae [K. pneumoniae] hospital acquired bacteremia. The study was conducted at 500 bedded King Fahad Hospital and Tertiary Care Center, Al-Hofuf, Al-Hasa, Eastern Province of Saudi Arabia. Retrospectively infection control and microbiology records of patients having hospital acquired K. pneumoniae bacteremia during July 2001 to July 2003 were reviewed. Data on age, gender, location, onset of bacteremia, hospital stay after onset of bacteremia, prior antibiotic therapy, comorbid conditions and clinical outcome were recorded. During 2 years of study period 26 patients developed hospital acquired K. pneumoniae bacteremia, out of them 10 patients had bacteremia due to ESBL producing strains. Extended-spectrum beta-lactamase producing K. pneumoniae bacteremia was significantly higher among patients of less than 65 years of age [p=0.004]. Klebsiella pneumoniae bacteremia was more common [12/26, 46.1%] among diabetic patients and 8/12 had ESBL K. pneumoniae bacteremia. [p=0.02]. Invasive devices [urinary and vascular catheters] were more commonly observed among patients having ESBL K.pneumoniae bacteremia [p=0.004, 0.001]. Significantly higher number [9/10] of patients with ESBL K.pneumoniae bacteremia received prior third generation cephalosporins [p=0.001]. Extended-spectrum beta-lactamase K. pneumoniae hospital acquired bacteremia had significantly longer hospital stay and higher mortality [p=0.0001]. Elderly age, diabetes, invasive devices and prior third generation cephalosporin therapy are the major risk factors for hospital acquired ESBL K.pneumoniae bacteremia, leading to significantly higher mortality and prolonged hospitalization. Infection control measures should be aggressively followed to prevent such infections among these high risk patients