Another hazard to laboratory workers

Needle-stick injuries, unfortunately, are a common occurrence during blood extraction and handling of specimens in the laboratory, which often lead to the contraction of blood-borne viral diseases. Mycobacterium tuberculosis infection also poses a threat to healthcare workers, especially laboratory workers in areas with endemic levels of tuberculosis infections. We present in this report, a case of primary inoculation of tuberculosis of the skin transmitted following a needle-stick injury, which was successfully treated. Reports of such an occurrence are few, and our report further underlines the need to take greater precautions against these accidents. In addition, our case draws attention to the possibility of prophylactic anti-tuberculous treatment in high-risk patients to prevent the progression of an overt illness

review of community-acquired methicillin-resistant Staphylococcus aureus for primary care physicians

Community-acquired methicillin-resistant Staphylococcus aureus [CA-MRSA] infections among young people without healthcare-associated risk factors have emerged during the past decade. Reported prevalence rates of CA-MRSA vary widely among studies, largely because of the different definitions employed and different settings in which the studies have been performed. Although the majority of CA-MRSA infections are mild skin and soft tissue infections, severe life-threatening cases have been reported. CA-MRSA infections have mostly been associated with staphylococcal strains bearing the staphylococcal cassette chromosome mec type IV element and Panton-Valentine leukocidin genes. These strains are more frequently susceptible to a variety of non-beta-lactam antibiotics. Clinicians must be aware of the wide spectrum of disease caused by CA-MRSA. Continued emergence of MRSA in the community is a public health problem, and therefore warrants increased vigilance in the diagnosis and management of suspected and confirmed staphylococcal infections

Characteristics of pulmonary tuberculosis and extrapulmonary tuberculosis in immunocompetent adults

Objective: While tuberculosis is primarily considered a pulmonary disease, it has the potential to infect almost every organ via lymphohematogenous dissemination during the initial pulmonary infection. The aim of this study was to explore the importance of demographics, clinical characteristics and the various patterns of extrapulmonary tuberculosis among Saudi and non Saudi patients presenting to King Fahd Hospital of the University, Alkhobar, in the Eastern Province of Saudi Arabia. <br>Methods: Prospective study of all adult patients (13 years of age and above) with tuberculosis over a period of 9 years between 1997 and 2005. <br>Results: A total of 390 cases of tuberculosis were diagnosed during the 9-year period. There were 221 Saudis (57%), and 169 non-Saudis (43%). Pulmonary tuberculosis (PTB) was diagnosed in 132 cases (33 %), extrapulmonary tuberculosis (EPTB) in 244 cases (63%), and both pulmonary and extrapulmonary in 14 cases (4%). The proportion of EPTB was similar among Saudi and non Saudi patients. Constitutional symptoms were more common among PTB than EPTB patients. Lymphadenopathy was the most frequent site of involvement. Of the 244 EPTB patients, 113 (45%) had lymphadenopathy and more than half were located in the cervical region. Osteoarticular tuberculosis noted in 41 patients (17%) was the second most frequent involvement. Pleural, peritoneal, miliary, genitourinary, and central nervous system tuberculosis, each accounted for 2%10% of the total number of cases of EPTB. Co-morbidities were found in 56 patients, 12% from EPTB, and 16% from PTB. Human immunodeficiency virus test results were available for 234 patients; all were found to be seronegative. <br>Conclusion: Extrapulmonary tuberculosis remains frequent even in patients lacking risk factors. Dealing with EPTB has been hampered by the absence of a quick and accurate diagnostic tool. Because the clinical presentation of EPTB is extremely variable, a high level of suspicion is required to diagnose and treat EPTB in a timely and health-preserving manner.

Breast infections in non-lactating women

Breast infection in lactating mothers is a common entity which in the majority of cases can be explained by ascending infections. However, it has been noticed that the number of non- lactating women presenting with breast abscesses is rising. This study attempts to explore the sensitivity pattern of organisms and underlying cause of breast infections in non-lactating women. Materials and Methods: This review was undertaken at King Fahd of the University, Alkhobar, Saudi Arabia between 1991-2003. All patients presenting with breast infections were included. Medical records, operative notes, cultures, histopathology reports and outcome were reviewed. Results: The number of patients presenting with breast infections accounted for 179[3.5%] out of the total number of patients 6314 with variable breast complaints. Infection occurred in 136[76%] lactating women [Group I] ,while Non lactating [Group II] breast infections accounted for 43[24%]. Age ranged from 24 years to 52 years. Underlying clinical conditions were found in 26 patients[60%] in Group II namely granulomatous mastitis13[50%], duct ectasia4 [15.3%], pregnancy3[11.5%], fat necrosis1[3.8%], diabetes3 [11.5%] and breast cancer 2[7.6%]. The pattern of culture results was different in the two groups, from differing causative organisms namely staphylococcus aureus as the commonest organism in both groups, in comparison to such uncommon organisms as Klebsiella pneumonae, Peptococcus magnus, Streptococcus group B, Entro-bacter cloacae, Methicillin resistant staphylococcus aureus [MRSA] and Mycobacterium tuberculosis occurring in group II only. Fortunately, all organisms were sensitive to antimicrobial therapy. Breast infection in non-lactating women is an infrequent but recognized clinical entity that deserves special attention. An underlying clinical condition should always be sought and treated. Indeed, in addition to cultures, radiological modalities such as ultrasonographic imaging may provide specific diagnosis and aid the management

Gastroesophageal reflux in bronchial asthma patients. A clinical note

The objective is to correlate the symptoms of gastroesophageal reflux with the results of esophageal reflux with the results of esophageal pH metry in asthmatic patients. A prospective study was carried out in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia [KSA], during the period January 2000 through to February 2001, whereby 50 patients [34 females and 16 females] with primary diagnosis of bronchial asthma were consecutively enrolled, their mean age + SD was 38.01 + 9.8 years. Twenty-two subjects who were not suffering from asthma or gastroesophageal reflux [GER] [13 females and 9 males] constituted the control group. A questionnaire was administered to all participants and demographic data; asthma and GER symptoms were obtained. Esophageal manometry was performed, whereby the location, length and resting pressure of the lower esophageal sphincter [LES] were determined, pH catheter was inserted nasogastrically, and ambulatory pH data over 24 hours were collected. Pulmonary function tests were also performed. Twenty-two [44%] patients with asthma had a Demeester score greater than 14.7 and were therefore diagnosed as having pathological GER. Accordingly, the asthma patients were divided into 2 groups, asthma patients with GER [n=22] and those without GER [n=28]. Multiple logistic regression analysis revealed that age did not significantly influence occurrence of GER, but it indicated that hoarseness of voice and nocturnal symptoms were significant predictors for the presence of GER in asthmatic patients, hence, the probability of having GER in an asthma patient is nearly 8 times if he/she has nocturnal symptoms and about 7 times if they have hoarseness of voice. However 36.4% of asthmatic patients diagnosed by esophageal ph metry as having GER did not complain of heartburn and hoarseness of voice; such as the reflux was silent. The frequency of GER among 50 patients with asthma reporting to KFHU, Al-Khobar, KSA is 44%. The presence of nocturnal symptoms and hoarseness of voice are significant clinical predictors of GER in asthmatic patients. Patients with difficult to treat asthma should be subjected to esophageal pH metry since a substantial proportion of them may have silent reflux