Fatal strongyloidiasis in three kidney recipients in Kuwait

It was the aim of this study to report 3 rare fatal cases of strongyloidiasis in Kuwait renal transplant patients. All 3 cases received allografts from cadaveric donors of Asian origin, the first 2 from an Indian [transplanted on the same day] and the third from a Bangladeshi. In all 3 cases, Strongyloides stercoralis larvae were first isolated from bronchoalveolar lavage. All 3 patients were on immunosuppressive therapy which included prednisolone, thereby leading to the hyperinfection syndrome. All patients presented with gastrointestinal symptoms [abdominal pain, vomiting, diarrhea, constipation and paralytic ileus], as well as pulmonary symptoms [cough, dyspnea and blood-stained sputum]. Albendazole 800 mg twice daily orally was started. Cyclosporine A was started after discontinuing prograf. The patients continued to deteriorate with a fall in blood pressure and platelets. All 3 patients died from adult respiratory distress syndrome following hyperinfection with S. stercoralis. Hyperinfection with S. stercoralis is a rare but preventable complication of immunosuppressive therapy. A high index of suspicion is required for the diagnosis of this infection. Persistent examination of sputum, bronchial washings and upper intestinal aspirates should be done as part of surveillance following cadaveric renal transplantation. Adult respiratory distress syndrome is indeed a red flag in patients who are on steroids, not on cyclosporine and receiving a kidney from donors in endemic countries of S. stercoralis

Risk of introduction of drug-resistant malaria in a non-endemic country, Kuwait: AReal threat?

This study investigates the prevalence of drug-resistant malaria infection in Kuwait in patients with malaria infection to the two most important and primary antimalarial drugs, chloroquine and mefloquine. Study Subjects and In vitro screening of malarial parasites to chloroquine and mefloquine was done during 1994-1996 in all those cases who presented with malaria-like symptoms and had a parasite density of >/= 1,000 asexual pure Plasmodium falciparum parasites per microlitre of blood and had not taken any antimalarial drugs during the last 3 weeks. During 1987-1997 the total number of malaria cases detected ranged between 650 and 1,350 each year. More than 75% of the cases had Plasmodium vivax infection. The majority of these cases [>98%] were detected in individuals coming from various malaria-endemic areas to reside or work in Kuwait. Of the 575 cases tested for drug resistance 42 isolates [7.3%] were resistant to chloroquine [MIC >8 pmol] and 6 isolates [1.04%] were resistant to mefloquine [MIC >64 pmol]. The 50% inhibitory concentrations were 2.7 and 4.8 pmol for chloroquine and mefloquine, respectively. All the 6 isolates that were resistant to mefloquine were also resistant to chloroquine. Chloroquine resistance was seen in patients from various malaria-endemic countries. To date no indigenous case of malaria has been detected in Kuwait, however, recent environmental and demographic changes in and around the State of Kuwait may threaten the present status of zero endemicity. In this study we show that 7.3% of the malaria isolates tested were resistant to chloroquine and 1.04% isolates were resistant to mefloquine

Malaria in non-endemic Kuwait: detection of very low level plasmodium falciparum infections using polymerase chain reaction

Imported malaria continues to be a problem in Kuwait since most patients present with very low levels of parasitaemia. The diagnosis is often delayed or missed because of the low sensitivity of the standard stained blood smear test used for the identification of malarial parasites. In this study, we standardized a highly sensitive polymerase chain reaction [PCR] to detect malarial parasites. A total of 100 individuals presenting with various forms of infection were screened with the standard Giemsa-stained smears and were compared with the PCR for diagnosis and the sensitivity of the two methods. Our results show that PCR is a highly sensitive and specific technique to detect low levels of Plasmodium falciparum parasites in clinical samples, and at least 6 cases [12%] who were microscopically negative had PCR-detectable parasitaemia. The PCR is a highly sensitive assay which can detect very low levels of malarial parasites and thus is of great value to obtain accurate detection of chronic, residual and sub-patent infections in Kuwait