First case report of chronic pulmonary lung disease caused by Mycobacterium abscessus in two immunocompetent patients in Saudi Arabia

Mycobacterium abscessus is a rapidly growing non-tuberculous mycobacterium that is a common water contaminant, and an exclusive opportunistic pathogen in immunosuppressed patients; however, it occasionally causes lung infections in immunocompetent persons as well. We report two cases of chronic pulmonary infection caused by M abscessus in two young migrant workers; they were nonreactive to HIV antigen, without any history of pulmonary disorders and no evidence of any immunocompromized status. Both were initially suspected as having pulmonary tuberculosis, and antituberculosis drugs were administered. The preliminary culture found the isolate as a rapidly growing nontuberculous mycobacteria and later by advanced molecular genotyping of the isolates revealed it as M abscessus. The patients were treated with multiple drugs including clarithromycin. The symptoms resolved slowly, the smears and culture became negative, and they recovered completely. This is the first case of its type to be reported from Saudi Arabia

Molecular strain typing of Mycobacterium tuberculosis isolates to detect cross-contamination events. Proposed modifications to prevent its recurrence

To investigate possible cross-contamination events of Mycobacterium tuberculosis cultures, and also to shed light on cross-contamination problems in our laboratories. At the TB Research Unit in the Department of Comparative Medicine Research Centre of King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia, we received 22 TB isolates sub-cultured on Lowenstein-Jensen media from a local laboratory in Riyadh on 1st July 2005. We finger printed all 22 isolates in question using a polymerase chain reaction-based spoligotype molecular technique. The epidemiological and clinical data were reviewed. All 22 cases had been proven to be cross-contaminated as a result of processing all specimens using a contaminated buffer. All of these patients had no clinical course consistent with tuberculosis. The discordant clinical pictures, and a deoxyribonucleic acid fingerprint that matches those of other culture-positive specimens processed concurrently, in addition to a lack of an epidemiological link between the patients suggest cross-contamination events. Using molecular techniques has become an absolute necessity to detect cross-contamination events in our laboratory, to prevent the deleterious consequences of cross-contamination in patients

Usefulness of molecular techniques to identify ongoing tuberculosis transmission in Saudi Arabia

This study represents the first time that molecular tracing techniques have been used to identify patterns of tuberculosis TB infection in Saudi Arabia. The 2 strains were isolated from a socio-economically advantaged family who share a number of common facilities including a car and a driver. There are several factors that may play vital roles in on-going transmission of TB in Saudi Arabia including a high number of expatriates, the Hajj pilgrimage, and the social habits of Saudi citizens. Our sibling case series is believed to be a frequent pattern of disease transmission in this country. Control measures such as health education, active case finding, and prompt and supervised medical treatment are needed. More studies using molecular techniques are recommended to find the incidence of cross infection in Saudi Arabia. In addition, molecular techniques have to be established in all reference laboratories to help the detection of ongoing active transmission, molecular epidemiology and detect sources of infection

Role of tuberculosis laboratories in Saudi Arabia. A call to implement standardized procedures

There is no doubt that the laboratory is the backbone for the diagnosis of tuberculosis [TB]. Only through testing in the laboratory can the physician confirm suspicion of TB despite any previous clinical and x-ray findings. Recent visits to several laboratories in the Kingdom of Saudi Arabia showed that some need considerable improvement. Unless there are standardized procedures to diagnose TB, and safety measures are implemented in all laboratories, it will be impossible to diagnose accurately and control TB. The laboratories should be redesigned to conform to international TB Diagnostic Centers, with well trained staff and proper safety procedures