Microbial Profile of Supragingival and Subgingival Plaque of Patients With Glycogen Storage Disease

Abstract Patients with glycogen storage disease (GSD) are either orally fed (ORF) or gastronomy-tube fed (GTF) with cornstarch to maintain normal glucose levels. It is not known whether the use of cornstarch affects the microbiological oral profile of patients with GSD. Thus, the purpose of this study was to compare supragingival and subgingival plaque samples collected from 53 participants with GSD (2-56 years)—29 ORF and 24 GTF. The 16S sequence bacterial profiles of plaque DNA were obtained and a total of 768 probes were detected across the plaque groups. Orally fed patients showed higher means of cariogenic species and periodontal health-associated species, whereas GTF patients showed higher means of periopathogenic species (P < .05). Orally fed patients exhibited high levels of caries pathogens and lower levels of periodontal pathogens possibly due to the acidic environment created by their cornstarch diet, when compared to GTF patients.

Awareness and use of modern contraceptives among physically challenged in-school adolescents in Osun State, Nigeria

This study assessed awareness and use of modern contraceptives among physically challenged in-school adolescents in Osun State, Nigeria. A cross-sectional study was carried out among 215 adolescents in the special schools in the state. A pretested semi-structured questionnaire was administered by trained interviewers. Data analysis was done using SPSS 17 and statistical level of significance was set at p< 0.05. The mean age of the respondents was 15.5years and more than half of them (56%) were males. Only about two fifths of them (38%) had ever heard about modern contraceptives. More males, older adolescents and visually impaired respondents had significantly heard about modern contraceptives compared with females, younger ones and those with other challenges at p-values of 0.026, 0.001 and 0.003 respectively. Only 34% of sexually experienced respondents had used a modern contraceptive method. The male condom was the most commonly used method. Afr J Reprod Health 2014; 18[2]: 87-96)

BK virus infection in a renal transplant Saudi child

BK human polyomavirus BKV causes an asymptomatic primary infection in children, but later, establishes latency mainly in the urinary tract. Virus-host interactions influencing persistence and pathogenicity are not well-understood. We present here a 12-year-old Saudi boy, who had renal transplant in Egypt. Seven months later, he was admitted to our Pediatric Nephrology Unit as a case of renal impairment. He developed BKV infection, diagnosed and successfully managed in our hospital. This case demonstrates the expanding clinical importance of BKV in a post renal transplant patient. This virus can be detected in transitional cells in the urine decoy cells using cytology. Testing for BKV deoxyribonucleic acid in urine and blood is an early detection assay, and can be used as a screening test in the early stages. The early reduction of immunosuppression can improve the prognosis. No specific antiviral treatment has been established yet. This is the first report of detecting BK virus in a Saudi post-transplant child in urine and blood specimens by using polymerase chain reaction

Ecthyma gangrenosum in Saudi Arabia

We report a diagnosis of ecthyma gangrenosum [EG] in 4 females of mean age 54.8 [range 43-64] years, within 10 months. Severe drug reaction treated with high dose systemic corticosteroids in patient one, acute myelocytic leukemia treated with high dose dexamethasone, and multiple broad-spectrum antibiotics in patient 2 preceded the onset of EG. Patients 3 and 4 had vasculitic purpura and hemodialysis. In addition, patient 3 was receiving multiple broad-spectrum antibiotics plus anti-tuberculosis [TB] drugs for gastric TB, while patient 4 was on melphalan and high dose systemic corticosteroids. Pstudomonas aeruginosa was isolated from blood culture of the first 3 patients, and skin culture of patient one. Blister aspirate from patient 4 yielded Candida albicans. Factors enhancing skin invasion by pathogenic organisms in our patients were breached skin integrity, therapy with high dose corticosteroids and multiple broad-spectrum antibiotics, hematologic malignancies and chemotherapy with severe neutropenia

Carriage of staphylococcus aureus among Hajj pilgrims

To evaluate the prevalence of methicillin resistant Staphylococcus aureus [MRSA] carriage among a cohort of pilgrims during 2004 Hajj season. Pilgrims attending the 2004 Hajj season were recruited and screened for carriage of MRSA. Standard microbiological techniques were used to screen for the presence of MRSA. Out of 411 individuals screened, 85 [20.6%] were positive for Staphylococcus aureus [S. aureus] of which only 6 [1.46%] were MRSA. Four individuals [4.6%] had the S. aureus organism in both nasal and axillary swabs, while 7 individuals [8%] had the organism in their axillae only. The other 74 individuals [87.1%] had the organism in their nares only. The 6 MRSA isolates were positive for the mecA gene by polymerase chain reaction method. None of the pilgrims examined had any risk factors for community-acquired methicillin resistant S. aureus [CAMRSA]. Overall, the prevalence of MRSA in the population of pilgrims examined was found to be low [1.46%] in comparison with most community based studies. A low rate of MRSA carriage was noticed among the screened cohort. Physicians treating patients suspected of S. aureus infection during the Hajj pilgrimage should bear in mind the possibility of community acquired - MRSA and should obtain appropriate samples for bacterial cultures and susceptibility testing so that antimicrobial agents could be introduced when necessary at a later stage

Enterococcus avium-An unusual cause of cerebral abscess

Enterococci are responsible for an increasing number of human infections. They are normally part of the flora of the human gastrointestinal tract, buccal cavity, perineal skin, vagina, urethra and gallbladder, but may occur as pathogens in several sites causing urinary tract infections, intra-abdominal infections, fatal bacteremia, meningitis and endocarditis. Enterococcus avium is a rare cause of infection in humans. Here, we report a 19-year-old Saudi girl diagnosed as a case of astrocytoma grade II arising from the right thalamus. She underwent treatment with radiotherapy followed by 5 chemotherapy sessions. She subsequently developed a cerebral abscess, and we performed mini craniotomy of the left parietal region with drainage of the brain abscess. The pus obtained from the abscess grew Enterococcus avium. We successfully treated her with antibiotics and discharged her home. The rarity of the organism causing cerebral abscess has motivated the documentation of this case and the pathogenesis of Enterococcus avium

Abdominal tuberculosis on-going challenge to gastroenterologists

The aim of this study is to record the observations and experience on the diagnosis and management of abdominal tuberculosis [TB] and to highlight the difficulties in the diagnosis and management of this condition. Two hundred consecutive patients attending the Gastroenterology Department of the King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia between May 1991 and May 2001, suspected with abdominal TB were investigated. A detailed clinical history and physical examination were obtained. Data of 75 confirmed cases of abdominal TB were analyzed. The most common presenting symptoms were anorexia [84%], abdominal pain [84%] and weight loss [72%]. Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass [42%]. The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients [32%]. Computed tomographic [CT] scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculous granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients. The most common presenting symptoms were anorexia [84%], abdominal pain [84%] and weight loss [72%]. Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass [42%]. The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients [32%]. Computed tomographic [CT] scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculous granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients. A high index of clinical suspicion is required to make an early diagnosis of abdominal TB. Suspicion should be aroused, particularly in patients having a combination of anorexia, abdominal pain, weight loss and ascites. Diagnosis requires the utilization of a combination of various diagnostic procedures especially abdominal ultrasound, CT scan and endoscopy, which provides a high diagnostic yield in this disease. A normal chest radiograph does not exclude the presence of abdominal TB. A timely use of laparoscopy are often required to prevent surgical intervention

Comparison of helicobacter pylori stool antigen test with CLO test in the diagnosis of helicobacterpylori associated dyspepsia in a Saudi population

To compare the diagnostic usefulness of Helicobacter pylori [H.pylori] stool antigen test [HpSA] enzyme immunoassay [EIA] with the Campylobacter-like organism [CLO] test in Saudi patients with H.pylori associated dyspepsia. Sixty consecutive adult Saudi patients suspected of H.pylori infection with dyspepsia attending the Gastroenterology Unit of the King Khalid National Guard Hospital, Jeddah, were recruited into the study. The study was carried out between 1st January and 30th June 2003. There were 25 males and 35 females. Their ages ranged from 19-72 years. Mean age was 39.6 years. At endoscopy diagnosis was made by taking gastric antrum mucosal biopsy for histology [Giemsa stain] and the CLO test was performed on a biopsy sample. A stool sample from each patient was sent to the Microbiology Department for HpSA EIA test. Helicobacter pylori status was determined by the positivity of the CLO test, the histology, or both. Both tests were positive in 26 specimens and negative in 21 patients. Discordant results were obtained in 13 specimens. Discordant results were resolved using the histology biopsy results. The sensitivity of the HpSA test was 88.6% and specificity 93.5%. The positive predictive value [PPV] of the HpSA test was 93.9%, while the negative predictive value [NPV] was 87.8%. The sensitivity of the CLO test was 87.8%, and specificity 92.5%, while PPV of the CLO test was 93.5% and NPV was 86.2%. The HpSA test is a useful and reliable test for the diagnosis of H.pylori infection. It is non-invasive, relatively cheap and convenient for the patient. It can be performed in any laboratory performing the enzyme-linked immunoabsorbent assay test. It is particularly suitable for developing countries where facilities for endoscopy are not readily available

Candidemia and the susceptibility pattern of Candida isolates in blood

C and ida species has become one of the most common blood isolates as well as one of the leading causes of nosocomial bloodstream infections. The purpose of our study was to determine the prevalence of C and ida species among our bloodstream infecting organisms and the susceptibility pattern of the C and ida isolates to antifungal agents. A prospective study was carried out in the Division of Microbiology, King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia of all positive blood cultures for C and ida species. The study took place from 1st January 1998 to March 2002. Identification and susceptibility pattern of isolates were determined by the C and ifast technique to amphotericin B, fluconazole, nystatin, Flucytosine, econazole, ketoconazole and miconazole. Over a 2-year period, 17,916 blood cultures were performed in our hospital. There were 2,972 positive cultures, of which 83 [2.8%] patients had C and ida species isolated from their bloodstream. Of these, 38 [46%] were C and ida albicans [C.albicans]. The remaining 45 strains were made up of C and ida tropicalis 9 [10.8%]; C and ida parapsilosis 9 [10.8%]; C and ida species 9 [10.8%]; C and ida guilliermondi 6 [7.2%]; C and ida krusei 5 [6%]; C and ida glabrata 4 [4.8%] C and ida pseudotropicalis 2 [2.4%] and Trichosporon species 1 [1.2%]. All C and ida species were susceptible to amphotericin B. However, only 18 [47%] out of 38 C.albicans were susceptible to fluconazole, while only 8 [17.7%] of 45 non-C. albicans strains were susceptible to this drug. The susceptibility of C.albicans to fluconazole in our hospital using the C and ifast method is very low [47%]. These results need to be confirmed by carrying out the Etest or the NCCLS M27-A method to confirm the true susceptibilities of C and ida strains in our locality

MRSA prevalence in a teaching hospital in Western Saudi Arabia

To determine the prevalence of Methicillin Resistant Staphylococcus aureus [MRSA] colonization in our institution. A 5-day period prevalence study of all adult and pediatric patients. Excluded areas were the adult intensive care unit [screened on admission and weekly thereafter], the outpatient hemodialysis population [screened monthly], and newborns. Our facility is a referral/teaching hospital for the National Guard population and their dependants in Western Saudi Arabia. A total of 240 patients were screened. Nasal sampling was carried out and isolation/identification of MRSA was performed using standard microbiological methods. The total number of patients sampled was 240 and of those 10 [4%] were colonized. The 10 positives were found in 4 patient care areas; adult male medicine 5, adult male oncology 3, adult female medicine one, adult high dependency unit one. These patients care areas had 69 patients [42 males and 27 females]. Ten [14%] were colonized by MRSA; 9 males [21%] and one female [3%]. Statistical analysis Chi Square for discontinuous variables, "F" test for continuous variables found that one], male gender [p=0.04], 2] the presence of a long term invasive device [p=0.04], 3], length of stay [p=0.004] were predictive of MRSA colonization. The overall prevalence of MRSA colonization in our hospital was low, however a sub-segment of the population identified as male, having long term invasive devices, and hospitalized more than 2 weeks, were frequently colonized. Any strategy, in our hospital, to control the spread of MRSA should include the testing of this population

Hepatitis C Virus Genotypes in the Kingdom of Saudi Arabia

Hepatitis C virus genotypes have been associated with specific geographical areas and in many cases with specific mode of transmission. In developed countries, genotype determination has formed a part of the management of patients with hepatitis C virus seropositivity and liver diseases due to hepatitis C virus. The epidemiology of hepatitis C virus has been shown to be changing rapidly in many countries due to population movement and different life-styles; hence the distribution of the genotypes is being monitored closely in many countries. In the Kingdom of Saudi Arabia, there are only a handful of publications recording the hepatitis C virus genotypes in various population groups. These studies have been carried out mainly in Riyadh [Central province] and Jeddah [Western province]. There are no studies emanating from the Eastern or Northern provinces. According to these studies, the most prevalent genotype in the Western Province and probably in the whole Kingdom of Saudi Arabia was genotype 4, followed by genotypes 1a and 1b. Genotypes 1, 2a,/2b, 3 and 6 are very rare in the Kingdom of Saudi Arabia. Genotype 5 was identified exclusively in the Western province and nowhere else. Genotypes 1b and 4 were associated with different histological grades of liver disease. Mixed infections with more than one genotype were observed in some studies. More detailed epidemiological studies of hepatitis C virus infections are needed in the Kingdom of Saudi Arabia to gain more insight into a possible type/subtype-specific pathogenesis of hepatitis C virus in the different regions of the Kingdom of Saudi Arabia as well as the distribution of the genotypes in the various localities

Antimicrobial susceptibility pattern of gram-negative aerobic isolates from intensive care units in Saudi Arabia; a multicenter study

To determine the pattern and prevalence of recognized categories of resistance to broad-spectrum antibiotics in seven Intensive Care Units [ICUs] in the Kingdom. A multicenter study was established to carry out susceptibility tests on at least 100 isolates from patients admitted into ICUs of seven hospitals in various areas in the Kingdom. Tests were performed using the Microscan MIC Plus type MIC panel. Setting: Microbiology laboratories and ICUs of seven hospitals in the Kingdom. Four hundred and seventy eight patients admitted into the study provided 703 isolates, which were examined for beta-lactamase production. The dominant species isolated were Ps. aeruginosa [148], E.coli [117] and Kleb. pneumoniae [11]. In all but one center, most isolates resistant to 3rd generation cephalosporins were E. coli and Klebsiella spp. with multi-resistance pattern consistent with extended spectrum B-lactamase [ESBL]. Inducible Enterobacteriaceae [IE], with chromosomal type-1 cephalosporinases were next in importance, followed by Ps.aeruginosa. Amikacin was the most effective aminoglycoside least affected by IE, while amoxil/clavulanate had a low impact on conferring sensitivity on the isolates. Blood culture isolates showed a strong contribution of resistance from inducible Enterobacteriaceae, principally nosocomial Serratia spp. and Enterobcater spp. with linked resistance to the aminoglycosides. The superiority of imipenem and ciprofloxacin over other antibiotics for empiric therapy of bacteremia in ICU patients was evident from the susceptibility data of all isolates

Septicemia due to vancomycin resistant enterococcus: a case report

Enterococci commonly found in the intestinal flora have emerged as common nosocomial pathogens. Up till 1988, all enterococcal strains were sensitive to vancomycin. However, there are now reports of vancomycin resistant Ecterococcus [VRE] from Europe and USA. In this communication we report the case of a patient with acute myeloid leukaemia who was colonized with VRE and subsequently developed septicaemia. The enterococci were resistant to both vancomycin and teicoplanin but sensitive to tetracycline and trimethoprim. The patient made a favourable response to tetracycline therapy. It is suggested that all enterococcal isolates should be routinely screened for vancomycin resistance, especially in immunocompromised patients on prophylactic antibiotics

Determination of insecticide susceptibility in Culex quinquefasciatus Say adults by rapid enzyme microassays.

Rapid enzyme microassays for the detection of resistance due to organophosphate and carbamate in individual field-collected strains of Culex quinquefasciatus adults were conducted. These tests allowed accurate differentiation by eye, on the basis of color changes of susceptible and resistant individuals. Two separate tests were conducted for the biochemical assays. In the insensitive acetylcholinesterase (AChE) test, acetylthiocholine iodide (ACTH) and 5,5-dithiobis-(2-nitrobenzoic acid) (DTNB) were used as substrate and coupling agent respectively. The resulting yellow chromophore indicated AChE activity. Test results showed that the color intensity decreased as increasing concentrations of propoxur were added, thereby confirming the susceptibility of the enzyme to inhibitor. Assay of non-specific esterase however, indicated elevated levels which were correlated with degree of malathion resistance. Electrophoretic data revealed the presence of 2 esterase bands in all strains. It was concluded that such a pattern was not contributory to malathion resistance in adults.

Maternal transmission of human immunodeficiency virus [HIV]

It has now been shown clearly that materno-fetal transmission of HIV does occur and this can happen as early as the 15th week of gestation. The great majority of HIV infections in children have occurred through the transplacental route. A family is presented, where the mother acquired HIV from blood transfusion at delivery of the first baby. The first baby was HIV antibody positive with early signs of HIV infection. The second baby asymptomatic and HIV seronegative. The third child was seropositive and has developed AIDS-related complex [ARC]. The father of the children is well and seronegative. The mother of the family although asymptomatic herself, remains seropositive and possibly still infective. The first child appears to have been infected through breast milk or close maternal contact while the third child was infected transplacentally. It is suggested that pregnant women who fall into HIV risk groups should be offered the opportunity of being screened for HIV as well as women who have been transfused with untested blood in the Kingdom in the last 5 years. Some suggestions are offered for the prevention of HIV in children in the Kingdom of Saudi Arabia

Susceptibility of common bacterial isolates to ceftriaxone

The in vitro antibacterial activity of ceftriaxone has been determined among 1060 strains of organisms isolated from patients attending our hospital. All sensitive strains showed wide zones of inhibition by disc susceptibility testing. No strains were encountered which were resistant to ceftriaxone but sensitive to either cefuroxime or cefotaxime. The broad spectrum of activity of the antibiotic has been confirmed for our locality. This finding together with its exceptionally long half-life and ease of administration [single daily dosage] warrants clinical studies to confirm its efficacy in serious infections and surgical prophylaxis