Potential Zoonotic Trematodes Recovered in Stray Cats from Kuwait Municipality, Kuwait

Stray cats are a common feature roaming the streets and alleys of Kuwait; they could be a source of parasites, including trematodes, that affect humans. A survey was conducted to identify feline trematodes and throw the light on their public health significance in Kuwait. Out of 240 stray cats trapped from different localities of Kuwait from June 2011 to May 2012, 59 (24.6%) were found to be infected with 14 species of trematodes. The most common were trematodes of the genus Heterophyes, particularly H. heterophyes and H. dispar that were found in respectively 15.8% and 10.8% of the cats examined. Other trematodes recorded, with lower prevalences, were Heterophyes nocens (2.9%), Haplorchis taichui (3.8%), Stictodora sawakinensis (2.1%), Stellantchasmus falcatus (1.6%), Echinochasmus japonicus (1.6%), and Mesostephanus dottrensi (1.3%). Centrocestus cuspidatus, Galactosomum fregatae, Ascocotyle sp., Mesostephanus appendiculatus, Haplorchis yokogawai, and Pygidiopsis genata showed the lowest prevalence (0.4%) and intensity. The majority of the trematodes are recorded for the first time in Kuwait and even in the Gulf region. The study reveals that stray cats are good indicators of fish-borne trematodes in the environment. As all trematodes recovered are zoonotic, their significance to public health should be considred.

An outbreak of CTX-M-15-producing Klebsiella pneumoniae isolates in an intensive care unit of a teaching hospital in Kuwait.

Objective: This study reports an outbreak of Klebsiella pneumoniae infections in 14 patients during a 2-month period (August-September, 2008) in the intensive care unit (ICU) of a teaching hospital in Kuwait. Materials and Methods: The clinical sources were blood (9), urine (3) and respiratory secretions (2) identified by the automated VITEK-2 ID System. Susceptibility testing was performed by the E-test method. Extended-spectrum β-lactamase (ESBL) production was assessed using the ESBL E-test and confirmed by PCR. Carriage of bla genes was determined by PCR and sequence analysis. The transferability of resistance phenotypes was demonstrated by conjugation experiments and clonal relatedness was determined by PFGE. Results: The isolates were susceptible to imipenem, meropenem, and tigecycline and produced ESBL. All isolates yielded an amplicon of 499 bp with universal consensus primers (MA primers). DNA sequence analysis showed that they all harboured blaCTX-M-15 and blaTEM-1 genes. The environmental isolate obtained from a suction machine was also CTX-M-15/TEM-1 producer. The resistance phenotypes were transferrable to the Escherichia coli J53 r strain. PFGE, revealed two clones, A and B, related with a Dice coefficient of >94.1%. A mortality rate of 21.4% was recorded. Conclusion: The outbreak was contained by robust and aggressive infection control measures. This study highlights the first outbreak of CTX-M-15-producing K. pneumoniae associated with high mortality in an adult medical ICU in Kuwait.

Results of screening for retinopathy of prematurity in a large nursery in Kuwait: Incidence and risk factors.

Aims: The aim of the study was to report the incidence of retinopathy of prematurity (ROP) and severe ROP and identify the risk factors for their development in a large nursery in Kuwait. Materials and Methods: This was a retrospective, interventional, non-comparative, hospital-based study. Retrospective review of ROP records of premature babies having either birth weight of less than 1501 g or gestational age at birth of 34 weeks or less and born between January 2001 and August 2003. Statistical Analysis: By univariate and multivariate logistic regression analysis. Results: Out of the 599 babies studied, 38.9% developed ROP and 7.8% needed treatment for severe ROP. Multivariate analysis showed low birth weight (OR 13.753, 95% CI 3.66-51.54; (P < 0.001), gestational age (OR 13.75, 95% CI 3.66-51.54; P < 0.001), surfactant (OR 1.72, 95% CI 1.04-2.83; P = 0.032) and stay in the intensive care unit for longer than 15 days (OR 2.25, 95% CI 1.05-4.85; P = 0.033) to be significant for the development of any ROP. Low birth weight (OR 22.86, 95% CI 3.86-134.82; P = 0.001), bacterial sepsis (OR 3.27, 95% CI 1.51-7.05; P = 0.002) and need for surfactant (OR 4.41, 95% CI 0.94 -20.56; P = 0.059) were found to be the risk factors for severe ROP needing laser treatment. Conclusion: The incidence of both any ROP and ROP needing treatment are comparable to other studies. Low birth weight is the most important risk factor for both any ROP and severe ROP.

Racial variation in risk factors and occurrence of acute myocardial infarction: comparison between Arab and South Asian men in Kuwait.

BACKGROUND: There are little data available on the rates of occurrence, risk factors and mortality due to acute myocardial infarction among the various ethnic groups living in Middle-East countries. Therefore, we did a study to compare Arabs and South Asians living in Kuwait. METHODS AND RESULTS: The data for this retrospective study were collected from the computerized database of the Coronary Care Unit at the Mubarak Al-Kabeer Hospital (a 476-bed teaching hospital) and the 1997-2000 Census data for the State of Kuwait. Arab and South Asian men above 25 years admitted between September 1997 and August 2000 with a diagnosis of acute myocardial infarction were included in the study A total of 866 Arabs and 277 South Asian men were admitted. The rate of admission for the entire patient population was two-fold higher among Arabs as compared with South Asians (6.7/1000 population and 3.3/1,000, respectively). Diabetes mellitus was present in 453 Arabs (52.3%) and 109 South Asians (39.4%) (p< or = 0.001) of those >25 years of age. Hypertension was recorded in 247 Arabs (28.5%) and 57 South Asians (20.6%) (p < or = 0.01). Among patients <55 years of age (454 Arabs and 226 South Asians); the rate of admission was 4.0/1,000 in Arabs and 3.5/1,000 in South Asians (not significant). Hypertension was present in 97 Arabs (21.3%) and 43 South Asians (19%) (not significant). Diabetes mellitus was present in 202 Arabs (44.5%) and 80 South Asians (35.4%) (p < or = 0.05). Smoking was recorded in 353 Arabs (77.8%) and 160 South Asians (70.8%) (notsignificant). Hypercholesterolemia was presentin 182 (40.1%) and 88 (39%), respectively (not significant). While in hospital, 11 Arabs and 9 South Asians died (not significant). CONCLUSIONS: Among men >55 and <75 years of age, Arabs had a higher rate of admission with acute myocardial infarction compared with men of South Asian origin. The incidence of diabetes and hypertension was significantly higher among Arabs in this age group. In younger patients (<55 years), the rate of acute myocardial infarction was not different between the two groups; however, diabetes was present more often among Arabs. The smoking rate is very high in both groups and is an important risk factor for both Arab and South Asian men living in the Middle East.

Invasive fungal infections in Kuwait: A retrospective study.

A retrospective review of a five year period (1994-1998) revealed that opportunistic mycoses caused by ubiquitous fungal pathogens are a serious problem in the immunocompromised patient population of Kuwait. Patients with renal transplantation and diabetes mellitus were most susceptible to aspergillosis, cryptococcosis, and zygomycosis, whereas patients with candidemia/hematogenous candidiasis had multiple risk factors. Basidiobolomycosis of the rectum in a Bangladeshi male, cryptococcosis due to Cryptococcus neoformans var. gatti in an AIDS patient,fungal peritonitis due to Absidia corymbifera in a patient on peritoneal dialysis, and endocarditis due to Aspergillus terreus detected by direct microscopic examination and culture of the blood clot are some of the notable cases diagnosed during the period under review. The predominance of Candida species other than C. albicans as bloodstream pathogens is another noteworthy observation. Although outbreaks of C. parapsilosis candidemia in neonatal intensive care units contributed significantly to this shift in favour of non-albicans Candida species, a surveillance strategy comprising of molecular, epidemiologic and antifungal susceptibility studies is warranted. With the proposed expansion of organ and bone marrow transplantation facilities in Kuwait, the incidence of opportunistic fungal infections is likely to increase.

Prevalence of HIV/AIDS in Kuwait among male patients with sexually transmitted diseases

To determine HIV/AIDS prevalence among the non-Kuwaiti male patients with sexually transmitted disease [STD] attending the Jleeb Al-Shuyoukh Special Health Care Clinic and to suggest relevant preventive programs. A sentinel surveillance was carried among all non-Kuwaiti male STD patients attending the Special Health Care Clinic in Jleeb Al-Shuyoukh during the period of June to November 1997. The data was recorded on a pre-coded questionnaire. No HIV/AIDS case was found among the 599 screened STD patients. The 599 patients were predominantly Asians [51.8%] and Arabs [44.6%]. The majority of the subjects [70%] were in the 15-34 age group, were married [66%], had a primary/junior level of education [62%], were laborers [52.3%], had a low socio-economic status [91%], and lived in the Farwaniya Govemorate [97%]. The most common STDs were Gonorrhea [37%] and a combination of STDs [31%]. A large majority [88%] reported sexual contact with female prostitutes inside Kuwait. The absence of any HIV positive case was probably due to the mandatory screening required before the granting of a residency permit in Kuwait which, in turn, facilitates early detection of virus carriers among expatriates. This screening makes the possibility of the circulation of HIV within Kuwait remote. The data on sexual practices shows female prostitutes to be the reported sexual partners [88%], despite the fact that prostitution is illegal in Kuwait. The study found most STDs were associated with low socio-economic groups comprised of laborers with a low level of education who were probably unaware of the means of protection against the virus. Close monitoring and surveillance is necessary to prevent groups with risky behaviors from contracting the virus through sexual transmission. There is a distinct need to develop public education and awareness programs to serve as measures of prevention and protection

Vitamin D deficiency rickets at birth in Kuwait.

In the present study vitamin D deficiency rickets has been diagnosed within 24 hrs. of birth. Seventy five full term, otherwise healthy newborns, weighing more than 2.5 kg were born with rachitic rosary. 25-Hydroxyvitamin D was lower than normal in 56 newborns and 15 mothers. Alkaline phosphatase was higher than normal in 26 and radiological changes suggestive of rickets were seen in the wrist X ray of only 14 newborns. Hyperphosphataemia was present in all the newborns. 1,25 dihydroxyvitamin D was markedly increased in six out of ten newborns.