Meningococcal immunization among emergency room health care workers in Almadinah Almunawwarah, Saudi Arabia

Meningococcal diseases are recognized worldwide, and regionally, Almadinah Almunawwarah experiences a substantial number of suspected cases of meningococcal diseases. This study reports the prevalence of meningococcal vaccination uptake in ER health care workers [HCWs] in Almadinah Almunawwarah, Kingdom of Saudi Arabia [KSA]. In this cross-sectional study conducted in December 2012, HCWs serving four hospitals under the ministry of health [MOH] were asked about their meningococcal vaccination status. Data were collected using a self-administered questionnaire that asked participants about their demographic characteristics and meningococcal vaccination status. Among the 321 respondents, 32.1% were physicians, and 45.8% were nurses. Fifty-seven percent of the respondents were Saudi, and the other respondents were of other nationalities. Among all participants, 84.7% had received the vaccine, 37.1% did not receive it regularly and 15.3% had never been vaccinated. Among all vaccinated participants, 60.7% received the vaccine to protect themselves from illness, 2%-4.1% received it to obtain a Hajj certificate and 13% received it as part of a preemployment procedure. The barriers to vaccination declared by the 15.3% of participants who did not receive the vaccine were unavailability of the vaccine, difficultly accessing the vaccine and poor scheduling, and these barriers were declared by 33.3%, 20.4% and 18.4% of the unvaccinated participants, respectively. Although KSA has witnessed a number of outbreaks of meningococcal diseases, the majority of the vaccinated respondents in this study had not received the vaccine according to the recommendations of the Saudi MOH

Tuberculosis treatment outcome in a tertiary care setting

The outcome of chemotherapy for pulmonary, extrapulmonary, and disseminated tuberculosis is not well documented, especially in developing countries. This study assessed tuberculosis treatment outcome, cure-to-treatment ratio and mortality among all types of tuberculosis patients in a tertiary care setting in Saudi Arabia. All cases diagnosed and treated for active Mycobacterium tuberculosis infection between 1991 and 2000 were included retrospectively. Data collected included type of tuberculosis involvement, treatment outcome, relapse, and co-morbidities. Over a ten-year period, 535 cases of tuberculosis were diagnosed and treated. Isolated pulmonary tuberculosis was identified in 141 cases [26.4%], extrapulmonary tuberculosis in 339 cases [63.3%], and combined pulmonary and extrapulmonary disseminated involvements in 55 cases [10.3%]. Co-morbidities were noted in 277 [52%] patients. Immunosuppression was found in 181 [34%] patients. The cure rate was 82%. The cure-to-treatment ratio was 86% in extrapulmonary tuberculosis and 78% in pulmonary tuberculosis, and 65% in disseminated tuberculosis. Overall mortality was 18%. Disseminated tuberculosis had the highest mortality [34.9%], followed by pulmonary [21.8%], then extrapulmonary tuberculosis [13.6%]. Forty-seven percent of all mortalities were directly related to tuberculosis. Relapse was documented in 14 out of 349 patients [4%] who had 24 months of follow up. Despite tertiary care support, complicated tuberculosis carries a high mortality. Earlier diagnosis and complete appropriate chemotherapy are essential for improved outcome

Tuberculous aortitis

Tuberculous aortitis [TA] is a rare entity that is invariably indicative of disseminated tuberculosis. TA is associated with aneurysm formation in about half of cases. Another possible complication is perforation of adjacent structures [1-7]. Both abdominal and thoracic aorta are involved with equal frequency.[7-9] Fatal outcomes are frequently reported even after antituberculosis chemotherapy and surgical intervention. We present a case of tuberculous aortic aneurysm [TBAA] that underwent surgical resection and graft replacement in the bed of the infected aorta. Following an apparently successful chemotherapy, the patient died suddenly. We postulate that reactivation of the un-eradicated bacilli precipitated graft failure. Similar cases in the literature are reviewed. We propose lifelong suppressive therapy with antituberculosis agents to prevent such a catastrophic event

Extrapulmonary tuberculosis, clinical presentation and outcome

To identify patterns, features, and outcome of extrapulmonary tuberculosis in a tertiary care setting. A retrospective case-series was carried out of all cases diagnosed and treated as extrapulmonary tuberculosis during 1991 through to 2000 at King Faisal Specialist Hospital and Research Centre [KFSH and RC], Riyadh, Kingdom of Saudi Arabia. Demographic, clinical, laboratory, and outcome data were abstracted from medical records. Over a 10-year period, 394 cases of extrapulmonary tuberculosis were diagnosed and treated at KFSH and RC. Isolated extrapulmonary tuberculosis was identified in 339 [86%] patients, 55 cases [14%] had both pulmonary and extrapulmonary tuberculosis. Mean age was 45-years, and 188 patients [47%] had co-morbidities, most commonly diabetes mellitus in 14.2% of patients. Laboratory confirmation of extrapulmonary tuberculosis was available on 386 patients. The most frequent site involvement was lymphadenopathy in 41% of the time. Chest x-ray was normal in 75% of patients. Among 298 patients with follow up data, 10 [3.4%] had documented relapse and 50 [16%] died. Death was related to tuberculosis in 24 [48%] patients. A high level of clinical suspicion is essential for early diagnosis and treatment of extrapulmonary tuberculosis to reduce the significant morbidity and mortality