Salmonella typhi: antibiotic sensitivity pattern in Dubai, United Arab Emirates

Drug resistant typhoid fever is a major clinical problem. The object of this study was to determine the sensitivity pattern of various drugs used for treatment of typhoid fever. This was a hospital based descriptive study, conducted from April 2007- May 2009 at the Infectious Diseases Unit and Medical wards, Rashid hospital Dubai, UAE. Only those patients whose blood culture yielded Salmonella typhi were included in the study. The antibiotic susceptibility testing was performed on pure culture by two available methods; broth dilution by VITEK II automated Microbiology system and Disc Diffusion technique. The results were interpreted using Clinical and Laboratory Standards Institute [CLSI] standards. Sensitivity results were reported as sensitive or resistant based on CLSI criteria. A total of 118 patients fulfilled the inclusion criteria with the mean age + SD 29.2+7.9 years, 86.4% were males and 13.5% females. Most [94.9%] of the patients were expatriates and belong to the developing countries. The history of recent travel [within a month] to endemic areas was positive in 79.6%. The sensitivity pattern showed that the resistance rate was highest for Nalidix acid [71.5%], followed by Chloramphenicol [37.5%], Ampicillin [34.8%], Co-trimaxazole [30.7%], Augmentin [14%] and Ciprofloxacin [6%]. Among the sixty four S.typhi tested for Chloramphenicol sensitivity; 30.2% isolates were found to be multi-drug resistant [i.e. resistant to Chloramphenicol, Ampicillin and Co-trimaxazole]. Whereas, all the S.typhi isolates were sensitive to third generation Cephalosporins, Amikacin, Gentamycin, Tazocin and Meropenem. In this study, we observed that the significant percentage of S. typhi is still resistant to the primary drugs. Whereas, the Quinolones and third generation Cephalosporins are potentially effective drugs against S.typhi, however, the increasing resistance to the Quinolones is a matter of concern

Distribution of Hepatitis C virus genotypes in Dubai, Tnited Arab Emirates

To determine the distribution of HCV genotypes among the patients attending a tertiary care hospital in Dubai, UAE. This was a descriptive study conducted from January 2009 to June 2009 in the Medical and Infectious Diseases clinics at Rashid Hospital Dubai. The study was designed to include patient's demographics, clinical information including the various risk factors for the transmission of HCV and laboratory data. The patients with positive screening test for HCV antibodies referred from the other clinics and peripheral health centers were included in the study. The HBV and HIV positive, as well as patients on haemodialysis and on immunosuppressive drugs were excluded from the study. The blood sample was collected and the confirmation of HCV was done by Western blot. The confirmed cases were subjected for HCV RNA levels and subsequently for HCV genotyping and sub-typing. A total of 223 patients [124 UAE nationals and 99 expatriates] fulfilled the inclusion criteria. The mean age of the patients was 38.3 +/- 11.4 years. Most of the study patients were males [82.2%]. Among the UAE nationals, 49.2% had genotype 1, 34.6% had 3, 14.5% had 4 and only 1.6% patients had genotype 2. High prevalence [68.4%] of genotype 1 was also observed in Iranian patients, while, 96.4% Egyptians had genotype 4 and 77.2% Pakistanis had genotype 3. The patients with genotype 1 had significantly high HCV RNA levels than the patients with genotype 3 and 4, p< .001 and < .009 respectively. In this study high prevalence of genotype 1 followed by 3 and 4 was seen in UAE nationals which is in contrast to the earlier reports of genotypes 4 being most common in Middle East countries. Among expatriates, genotype 1 was common in Iranians, 4 in Egyptians and 3 in Pakistanis

Sero-prevalence of hepatitis C antibodies in the people visiting roadside barbers

Sharing of blades and shaving kits, especially unsterilized ones are known risk factors for the transmission of Hepatitis C. The objective of this study was to determine the prevalence of Hepatitis C antibodies reactivity among the patients admitted due to any medical condition and who have been visiting roadside barbers. This was a descriptive study conducted from July 2007 to June 2008 in the Medical Unit-111, Jinnah Postgraduate Medical Center, Karachi. The study was designed to include patient's demographics [age, occupation, marital status and education], clinical information and duration of the visits to roadside barbers with an approximate frequency of shavings per month. The patients with history of>3 visits to a roadside barber during the last six months were included in the study. Whereas, the patients with history of liver disease, blood transfusion, surgery, dental treatment, tattoo marks, intravenous drug use, on regular injectable medicine [like insulin, etc], multiple sexual partners and on haemodialysis were excluded from the study. A blood sample was collected at the time of admission and the screening for HCV-antibodies was done by Enzyme Linked Immuno-Sorbant Assay [ELISA]. A total of 184 male patients were included in the study. The mean age+ SD of the patients under the study was 33.8+13.2 years. The majority of study patients were uneducated and belonged to low socioeconomic group. Out of 184 patients, 70 [38%] were found to be HCV-antibodies reactive. In comparison to younger patients [age<40 years], the older patients as well as those with history of longer duration of visits to roadside barbers had high prevalence of HCV-antibodies reactivity, P.015 and P.02 respectively. There was no statistical significant difference for the prevalence of HCV-antibodies reactivity among the different socioeconomic groups, educational level and marital status. In the present study, it is concluded that the sharing of unsterilized shaving kits and used blades by roadside barbers are the main sources for the transmission of HCV. The transmission rate of HCV infection increases with the duration and multiple exposures for shaving

Behcet's disease associated with hyperthyroidism: case report and review of literature

Behcet's Disease is a multi-system, chronic inflammatory disorder characterized by chronic relapsing course. Its principal manifestations are oral and genital ulcers as well as inflammation of the eyes, skin and joints, while vascular and neurological complications may results in death. The etiology and pathogenesis of the disease are still obscure and specific treatment is not available. We report the case history of a patient with Behcet's Disease. He presented with fever, arthritis and weight loss of 3-week duration. He was also found to have hyperthyroidism, extra-pulmonary tuberculosis, and strongyloidiasis. Although, the association between thyroid diseases and auto-immune connective tissue disorders as well as tuberculosis is well recognized, there had been, to the best of our knowledge, no reports of Behcet's Disease associated with thyroid dysfunction. However, further studies are required to investigate any association between Behcet's Disease and thyroid dysfunction

Jaundice with hepatic dysfunction in P.faldparum malaria

To evaluate the frequency and severity of jaundice with hepatic dysfunction in Plasmodium [P.] falciparum malaria in adult patients admitted in the hospital. Descriptive study. The Infectious Diseases Unit and Medical Wards at Rashid Hospital, Dubai, United Arab Emirates, from January 2005 to December 2007. This study included 105 adult patients who fulfilled the inclusion criteria. The diagnosis of P.falciparum malaria was confirmed by examination of thin and thick film stained with Leishman's stain. Other laboratory investigations included full blood count, liver function tests, blood urea, electrolytes, serum creatinine, reticulocyte count, blood sugar, viral hepatitis serology and coagulation profile. Patient with significant clinical/biochemical hepatic dysfunction were also subjected to ultrasonic examination of abdomen. On clinical examination, 23% patients were found to be jaundiced. Serum alanine amino transferase [ALT] level was above the reference range in 67.6%, but in only 11.4%, ALT was more than 3 times of normal level. Serum bilirubin was found to be higher than normal level in 81%, however, only in 23% of the patients, Serum bilirubin was >3mg/dl. Predominantly conjugated hyperbilirubinemia was observed in patients with high ALT. There was no significant change in serum albumin and prothrombin time. In comparison to normal bilirubin level, the patient with bilirubin >3mg/dl had high frequency of raised ALT 87.5% vs. 45% [p <.0001], thrombocytopenia 91.6% vs. 65% [p <.01], anemia 70.8% vs. 25% [p <.05] and renal impairment 50% vs. 20% [p >.05]. Overall, 5 [4.7%] patients died and mortality rate was high among the patients with bilirubin level >3mg/dl than with normal bilirubin level 4 [16.6%] vs 1 [5%]. Hepatic dysfunction in acute P.falciparum malaria ranged from mild elevation of liver enzymes to acute hepatitis [ALT >/= 10 times of normal level]. It indicates severe illness with high frequency of complication and mortality rates

Varicella induced thrombocytopenia in adults

To describe the frequency and severity of thrombocytopenia associated with adult chickenpox patients admitted in the hospital. This was a hospital based descriptive study conducted from January 2005 to March 2008 at the Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates. The study was designed to record demographics, clinical information, hematological and biochemical changes observed in each patient. The data was entered into a structured proforma separately. Patients with history of chronic liver disease, immunocompromized status [HIV/Drugs], history of blood disorder, recent intake of drugs/conditions which can cause thrombocytopenia and active alcohol consumers were excluded from the study. Full blood count including platelet count was performed by an automated Beckman Coulter machine. To verify the hematological finding, the cases with low platelet count [thrombocytopenia] were subjected to peripheral smear examination. A total of 110 patients were recruited into the study. The mean age +/- SD of the patients under the study was 32.9 +/- 9.7 years and males outnumbred the females, 83.6%vs 16.3%. Forty six [41.8%] patients developed thrombocytopenia and their mean platelet count was 111.8 +/ -30.59x10[3] /ul [24-149x10[3] /ul]. High frequency of thrombocytopenia was observed in patients who also had associated varicella pneumonia, hepatic dysfunction and renal impairment. None of the patients with thrombocytopenia developed bleeding manifestations during the course of the disease. Platelet count returned to the reference range within 1-2 weeks of the treatment of varicella without platelet transfusion. Thrombocytopenia is frequently associated with chickenpox. The incidence of thrombocytopenia was observed higher in patients with the evidence of disseminated disease. Furthermore, low platelet count usually does not cause bleeding tendency and count improves with the treatment of varicelta

Hematological and biochemical changes in typhoid fever

The hematological and biochemical changes due to multi-organ involvement in typhoid fever are not uncommon. The aim of this study was to determine the frequency and severity of the above changes in adult patients admitted to the hospital because of typhoid fever. This was a hospital based descriptive study conducted at the Infectious Diseases unit and medical wards at Rashid Hospital Dubai, United Arab Emirates, from March 2005 to February 2008. The study was designed to include demographics, clinical information, hematotogical and biochemical changes observed in each patient. Only patients whose blood culture yielded Salmonella typhi were included in the study. Full blood count, liver function tests, blood culture, urea, electrolytes, malaria parasite and coagulation profile were performed for all the patients, whereas viral hepatitis serology and ultrasound abdomen were limited to those with disturbed liver function tests. The patients with ALT> 3 times of normal were screened for viral hepatitis [A, B, and C] serology, whereas the patients' with significant hematologicat changes were subjected to bone marrow examination. A total of 75 patients were enrolled into the study. The mean age +/- SD of the patients under the study were 28.4 +/- 8.7 years and males outnumbered the females, 81.3% vs. 18.6%. The most common hematological changes observed were; anemia [61.3%], thrombocytopenia [40%], leucocytosis [10.6%] and leucopenia [4%]. Whereas, the biochemical changes included; raised alanine aminotransferase [73.3%], aspartate aminotransferase [62.7%], bilirubin [30.6%], alkaline phosphatase [44%], prothrombin time [57.3] and blood urea [12%], but the serum albumin was found to be low in 40%. The patients with raised ALT had high frequency of thrombocytopenia [p <0.04], raised serum bilirubin [p <0.02], alkaline phosphatase [p <0.01] and prothrombin time [p 10-fold of normal levels in 8%, serum bilirubin was >3mg/dI in 10.3% and prothrombin time was 3 sec above the control in 8% patients. All the patients were discharged in good health once hematotogical and biochemical changes returned to reference range. Typhoid fever causes significant hematological changes as well as hepatic dysfunction. The involvement of liver was associated with high frequency of extrahepatic complications. Despite the high incidence and serious nature of the hematological changes and liver involvement, these changes are transient and respond favorably to the appropriate antimicrobial therapy

Tetanus: presentation and outcome in adults

Tetanus is still a common clinical entity, especially in developing countries. The purpose of this study was to evaluate the presenting features as well as the outcome of tetanus in adult patients admitted to the hospital. This was a hospital based descriptive study conducted at the Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates from Jan. 2003 to Dec. 2008. The study was designed to include demographics, clinical information and outcome observed in the patients admitted with clinical diagnosis of tetanus. Patients with malignancy, immunosuppression [AIDS/Drugs], significant cardiac dysfunction and renal impairment were excluded. The patients were treated as per the standard protocol for the management of tetanus. A total of 44 patients were enrolled into the study. The mean age+SD of the patients were 26.3+5.8 years and all of the study patients were males. Thirty six [81.81%] patients gave the history of injury prior to onset of the symptoms, whereas eight [18.18%] patients were unable to recall any history of injury. All the study patients were laborers working in construction companies except for four who were gardeners. Body stiffness/spasm, difficulty in opening the mouth, difficulty in swallowing, body pain, neck pain and backache were the main presenting complaints. The patients with upper limb injuries had shorter incubation period and more severe disease with high frequency of autonomous nervous system insufficiency. Overall, hospital stay was 46.6+11.4 days. Forty [90.9%] patients required mechanical ventilation. The mean+SD ICU stay was 26.4+5.8 days and on weaning all the ventilated patients required tracheostomy. Eight [18.18%] patients died as a result of ventilator associated complications [Pneumonia] and autonomic nervous system dysfunction. Tetanus still carries high morbidity and mortality rate despite the available advanced management facilities including ICU care. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients

Malaria and hematological changes

The hematological changes associated with acute malaria are well recognized. This study was conducted to assess and compare the incidence and severity of hematological changes in various types of malaria in adult population. This observational study included 133 acute malaria patients admitted in the Infectious Diseases Unit of Rashid Hospital Dubai [JCI accredited] UAE, during January 2005 to December 2007. The diagnosis of malaria was confirmed by thick and thin film stained with Leishman,s staining for malarial parasite. Slides were reviewed by hematologist and FBC were performed using an automated Beckman Coulter machine. Overall 83% of the patient had thrombocytopenia, 64% anemia, 24% lymphopenia and 10% monocytosis. The incidence of thrombocytopenia was slightly more in P. Falciparum [87%] than P. Vivax [81%] cases, p value > 0.05, where as there was no significant difference in the incidence of anemia in two groups [67% vs 63%]-p value > 0.05. However, lymphopenia was observed in 36% in P. Vivax as compared to 15% in P.Falciparum cases, p value < 0.04. Eosinophil and basophil count was normal in both groups. P.Falciparum as well as P.Vivax can cause significant hematological changes with high frequency of thromboctopenia, anemia lymphopenia and monocytosis

Hepatic dysfunction is frequent in varicella infection

To determine frequency and severity of hepatic dysfunction in adult chickenpox patients admitted in our hospital. This was a hospital based descriptive study conducted from January 2005 to December 2007 at the Infectious Diseases Unit, Rashid hospital Dubai, UAE. The demographics, clinical information, radiological and biochemical changes observed in each patient were entered in a proforma. Full blood count, liver function tests, blood sugar, urea and electrolytes were done for all the patients, whereas, patients with clinical and/or biochemical evidence of hepatic dysfunction were subjected to viral hepatitis serology, coagulation profile, blood culture and ultrasound abdomen. Management was done as per standard guidelines for the management of chickenpox and its complications. A total of 105 patients were entered into the study. Serum alanine transaminases [ALT] levels were above the reference range in 50.9%. Among the 52 patients with raised serum ALT levels, 16 [30.7%] had levels > 3 times, 4 [7.6%] had > 5 times and 5 [9.6%] had > 10 times of normal levels. Serum bilirubin was increased above the normal value in 20% and was greater than 3-folds in 4.9%. High frequency of thrombocytopenia [p < 0.009], pneumonia [p0.004], impaired renal function [p < 0.01] and disturbed coagulation profile [p < 0.01] were observed in patients with hepatic dysfunction. Overall, five [4.9%] patients expired and two [1.9%] of them had acute fulminant hepatic failure. We observed that liver is frequently involved in adult chickenpox patients and the severity of hepatic dysfunction ranges from mild elevation of transaminases levels to acute fulminant hepatic failure

Typhoid fever with hepatic and extrahepatic manifestations

Hepatic involvement is not uncommon in typhoid fever. We report a case of typhoid fever complicated by acute hepatitis, acute choliangitis, acute acalculous cholecystitis, anaemia and severe thrombocytopenia [platelets 1x10[3]/ul]. He received antibiotics, steroids, immunoglobulin, multiple platelet and packed RBC transfusion. Fever responded and blood parameters started improving after 16th day of the treatment and patient was discharged healthy on 21st day of the admission. In conclusion, hepatic dysfunction with jaundice is a serious development in typhoid fever and patient may take longer time to respond to treatment