Serum Levels of Interferon Gamma in Patients with Brucellosis in a Saudi Hospital.

Background: Brucellosis is a major zoonotic disease that is endemic in Saudi Arabia and it remains a major health problem that has not been eradicated in the country yet. Place and Duration of Study: This retrospective study was conducted in a Saudi Hospital at Al Madinah city during the period of 1 November, 2010 to 31 October, 2011. Methodology: All sera of patients suspected to have brucellosis (n= 65) and 18 healthy subjects were tested for brucella antibody using slide latex agglutination (SAT) and ELISA. Quantitation of IFN-ɣ was also done using ELISA. Results: Brucellosis was detected in all age groups but the incidence was higher and reached 33.3% in age group (40- <50) years with average of 43.9±2.53 years. Male to female ratio in infected patients was 2:1 by using SAT. The incidence of seropositive cases was high (80.1%) in the three months (April, May and June), with the highest peak in May (46.7%). Drinking raw milk was the most encountered risk factor with a prevalence of 66.1% followed by consumption of milk products (11.9%). The most prevalent species among the examined cases was B. melitensis (93.3%). Among the studied cases, 60 cases (92.3%) were serologically positive for brucellosis by SAT. Among the 60 cases yielding significant titers against brucella, 14 sera (23.3%) had agglutinin levels of 1:80, 34 sera (56.7%) had titers of 1:160 and 12 sera (20%) had titers of 1:320. By estimating IgM and IgG levels in the sera of examined cases using ELISA, 52 cases (80%) had brucellaIgM while 42 cases (64.6%) had brucella IgG. Sensitivities of SAT, IgM ELISA and IgG ELISA were 91.5%, 88.1% and 71.2%, respectively compared with combined ELISA. Mean IFN-ɣ levels ± SD in the subacute phase was 136.7±70.07pg/ml, 120.2±54.25pg/ml in the acute phase, and 121.3±51.09 pg/ml in the chronic phase of brucellosis. Conclusion: The sensitivity and specificity of ELISA to diagnose human brucellosis was higher when combined ELISA (IgM/IgG or both) was used. Mean IFN-ɣ levels were lower, but not significantly, in the chronic phase of the disease than in the sub acute phase and healthy subjects.

Clinical, Endoscopic, Pathological and Serological Findings of Helicobacter pylori Infection in Saudi Patients with Upper Gastrointestinal Diseases.

Background: The prevalence of Helicobacter pylori is typically higher in developing countries like Saudi Arabia. Aims: To estimate the prevalence of H. pylori among patients suffering from upper gastrointestinal (GI) symptoms, know the main risk factors leading to infection, and detect the clinical, endoscopic and pathological changes of the gastric mucosa of patients infected with H. pylori. Place and Duration of Study: This is a five-months prospective study conducted in King Fahd Hospital, Al-Madinah, Saudi Arabia. Methodology: H. pylori status in patients was determined by two biopsy based tests (histology and rapid urease test) as invasive tests and by a serological testing (ELISA IgG) as non-invasive test. Results: The age of the selected 68 patients ranged from 18-70 years with a mean age of 37.9 ± 14.15 years. H. pylori was more prevalent among males than females (70.5% vs 29.5%, p=0.020) and among age group (18-< 30) years. No significant difference was estimated between positive and negative HP cases in residency, work status, marital status, smoking, socioeconomic level and aspirin intake. The most common complaints in the selected patients having endoscopy were: epigastric pain, heart burn, and dyspepsia. A significant correlation was detected between H. pylori and each of age, sex and Diabetes Mellitus. The most prevalent endoscopic findings of the positive H. pylori cases were mild gastritis (84.1%). There was a significant difference in gastritis (p=0.003) and duodenitis (p=0.031) between positive and negative cases for H. pylori histopathology. The prevalence of H. pylori was 60.29% by rapid urease test, 64.7% by histopathological examination and 67.6% by serology among the studied cases. Conclusion: H. pylori-infected patients with upper GI symptoms were found to have more abnormal endoscopic and pathological findings than those without H. pylori infection.

Antimicrobial Resistance in Pathogens Causing Pediatrics Bloodstream Infections in a Saudi Hospital.

Background: Bloodstream infection (BSI) is one of the most common life-threatening conditions in hospitalized pediatrics especially if associated with resistant microbes. Aims: To determine the incidence, predisposing factors, microbiological and antimicrobial resistance patterns in suspected BSI pediatric patients in a Saudi hospital. Place and Duration of Study: Different wards of Madinah Maternity and Children's Hospital, Saudi Arabia, during one year period from July 1, 2009 to June 30, 2010. Methodology: Blood cultures were performed to all cases (n= 11968) using Bactec 9240 instrument Blood Culture Systems. Microorganisms were identified by colony morphology, Gram stain and biochemical profiles. BD Phoenix™ was used in confirmation of identification of all BSI Gram-negative isolates. Antibiotic susceptibility pattern of isolates was further done by using disk diffusion method. Results: 728 cases (6.1%) were diagnosed with BSI after having a one positive blood culture. The overall mortality rate was 11%. Gram-positive, Gram-negative and yeast accounted for 63.8%, 31.6% and 4.6% of the total isolates, respectively. Coagulasenegative staphylococci were the most prevalent Gram-positive isolates (44%); while Serratia marcescens and Klebsiella pneumoniae were the most common Gram-negatives. Gram-positive bacteria were mostly sensitive to cephalothin (82.3%) and vancomycin (72.2%), while Gram-negative bacteria were mostly sensitive to ciprofloxacin (93%), piperacillin/tazobactam (92.9%), and meropenem (89.8%). Conclusion: The incidence rate of BSI is highest in ICU neonates. Therefore, special attention should be given to the quality of care provided for them to improve safety. There was appreciable resistance to commonly used antibiotics; and continued monitoring of antibiotic resistance is of great importance to ensure the proper use of antibiotics and to detect any increasing trends in resistance.