hospital acquired outbreak of bacillus cereus gastroenteritis, Oman

To investigate the course of a hospital acquired outbreak of Bacillus cereus gastroenteritis outbreak, and the interventions that were taken to prevent such an outbreak from occurring again. On May 3-5 2008, 58 cases of gastroenteritis were reported among patients and their attendants in a referral hospital in Oman. All affected had eaten meals served by the hospital kitchen the previous day. An outbreak investigation team conducted active surveillance and interviewed people about symptoms and food consumed on the preceding day in the hospital. Food samples from the kitchen and faecal samples from the kitchen staff and those affected were cultured. An environmental audit of the kitchen was conducted. The majority of the 58 persons affected by the outbreak were adult females, predominantly attendants of patients. 90% had diarrhoea and 10% had vomiting, usually mild. All those affected were managed symptomatically except for two patient attendants who required intravenous rehydration. The meal exposure histories implicated at least one meal from the kitchen. Many violations of basic food hygiene standards were observed in the kitchen. Toxin producing B. cereus was isolated from faeces of 3/12 [25%] patients and 19/25 [76%] of food handlers, and 35/61 [57%] of food samples from the kitchen. This is the first report of a nosocomial outbreak of foodborne B. cereus infection from this region. The importance of appropriate epidemiological and microbiological investigation and public relations management is emphasized, in addition to the need for continuing training of food handlers and rigorous enforcement of food hygiene regulations

Leukocytosis as an alarming sign for mortality in patients hospitalized in general wards

There is some evidence that leukocytosis without infection is associated with increased hospital mortality, but data in this regard are very incomplete. This study was designed to investigate the relationship between leukocytosis at the time of admission and mortality among patients hospitalized in general wards. During July to Nov 2004, all deceased patients who had a white blood cell [WBC] count record for the first 24 hours of admission were selected as cases. Among survivors, twice the number of cases was selected as controls. Different levels of WBC counts were compared between cases and controls. Totally 1650 patients, including 550 deceased [cases] and 1100 survivors [controls] were analyzed. Of these, 876 [53%] were males and 774 [47%] females, and 42 [3%] were admitted to ICU, 1426 [86%] to medical and 182 [11%] to surgical wards. There was a significant difference between the mean age of deceased patients [78.0 years] and survivors [53.0 years] [P<0.001]. The median WBC for deceased and surviving patients was 9.4 and 11.4 x 10 [9] /1, respectively. Patients with a WBC > 10x10 [9]/1 accounted for 804, among which 335 [42%] were deceased. Leukocytosis and leucopoenia were more frequent among the deceased patients compared to the survivors. The likelihood ratio for leukocytosis and leucopenia among the cases and controls was 1.4 and 2.3, respectively. Leukocytosis was identified as an alarming sign for mortality among patients admitted to general hospital wards at early stages of admission. A quick medical intervention for amendment of the causes related to leukocytosis should consequently reduce hospital mortality

Cryptosporidiosis in Saudi Arabia and neighboring countries

Cryptosporidium is a coccidian protozoan parasite of the intestinal tract that causes severe and sometimes fatal watery diarrhea in immunocompromised patients, and self-limiting but prolonged diarrheal disease in immunocompetent individuals. It exists naturally in animals and can be zoonotic. Although cryptosporidiosis is a significant cause of diarrheal diseases in both developing and developed countries, it is more prevalent in developing countries and in tropical environments. We examined the epidemiology and disease burden of Cryptosporidium in Saudi Arabia and neighboring countries by reviewing 23 published studies of Cryptosporidium and the etiology of diarrhea between 1986 and 2006. The prevalence of Cryptosporidium infection in humans ranged from 1% to 37% with a median of 4%, while in animals it was different for different species of animals and geographic locations of the studies. Most cases of cryptosporidiosis occurred among children less than 7 years of age, and particularly in the first two years of life. The seasonality of Cryptosporidium varied depending on the geographic locations of the studies, but it was generally most prevalent in the rainy season. The most commonly identified species was Cryptosporidium parvum while C. hominis was detected in only one study from Kuwait. The cumulative experience from Saudi Arabia and four neighboring countries [Kuwait, Oman, Jordan and Iraq] suggest that Cryptosporidium is an important cause of diarrhea in humans and cattle. However, the findings of this review also demonstrate the limitations of the available data regarding Cryptosporidium species and strains in circulation in these countries

Leprosy - a diagnosis that should still be considered in Saudi Arabia

Leprosy is not uncommon in Saudi Arabia, especially in the South West Province. Early detection and treatment can prevent the disfiguring complications of the disease with their associated social stigmata. All physicians concerned with patient care in Saudi Arabia should be familiar with the usual forms of presentation of leprosy in order to effect early diagnosis. Five cases are presented and discussed to illustrate these points