Epidemiological and clinical features of salmonella typhi infection among adult patients in qatar: a hospital-based study

Objectives: We sought to describe the epidemiological and clinical features of typhoid fever in Qatar

Methods: We conducted a retrospective study of adult patients treated for typhoid fever at Hamad General Hospital and Alkhor Hospital between 2005 and 2012

Results: The mean age of the 354 patients enrolled in the study was 28.4+/-9.3 years; 296 [83.6%] were males. There were 42, 48, 39, 44, 46, 47, 52, and 36 cases of adults with typhoid fever in 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012, respectively. Overall, 343 [96.9%] patients had a history of travel to endemic areas. Among them, 93.0% acquired typhoid fever in the Indian subcontinent. Fever was observed in all cases, and the other predominant symptoms were abdominal pain [38.1%], diarrhea [35.6%], and headache [33.1%]. Salmonella typhi, showed high resistance to ciprofloxacin [n = 163; 46.0%], and low resistance to ceftriaxone [n = 2; 0.6%]. Four patients developed intestinal perforation, which was surgically repaired in two cases. Two patients [0.6%] died

Conclusions: Typhoid fever was frequent among immigrants to endemic areas. Travelers returning from endemic areas with suspected typhoid fever should be treated empirically with third-generation cephalosporin after obtaining appropriate cultures. Moreover, preventive measurements such as education on food and water hygiene, and effective vaccination of travelers should be practiced widely among travelers to endemic areas to reduce morbidity and mortality

Nosocomial pseudomonas putida meningitis: a case report and literature review

We report a case of Pseudomonas putida meningitis in a 26-year-old Nepalese man who was admitted to Hamad General Hospital with epidermoid cyst for drainage. Ommaya reservoir was placed into the cyst for drainage and externalventricular drainage [EVD] was performed. After four days, the patient was transferred to the ward in stable condition. His weakness resolved partially and headache severity decreased. After three days, the patient developed fever and headache severity increased with deterioration of consciousness level. Cerebrospinal fluid [CSF] through EVD showed 2 200 leucocytes/µL, protein level of 295 mg/dL, and glucose level of < 1.8 mg/dL. Meropenem was started on the patient. Aspirate from Ommaya reservoir and CSF showed gram-negative rods and cultures yielded P. putida sensitive to cefepime, gentamycin, ciprofloxacin, and amikacin, but resistant to meropenem and piperacillin-tazobactam. EVD was replaced and the patient received cefepime and ciprofloxacin for 21 days after which he improved and was discharged with right sided residual weakness

Adult Klebsiella pneumoniae meningitis in Qatar: Clinical pattern of ten cases

Objective: To describe the clinical presentation, underlying diseases, antimicrobial susceptibility, treatment and outcome of Klebsiella pneumoniae meningitis patients. Methods: This retrospective study involved all patients with 15 years of age or older who admitted to Hamad General Hospital with culture proven Klebsiella pneumoniae meningitis from January 1, 2007 to December 31, 2012. Results: A total of ten cases were identified (nine males and one female). Their mean age was (43.3±12.8) years. Eight patients (80%) had nosocomial meningitis with neurosurgery being the most frequent associated condition. Fever and altered consciousness were the most frequent symptom. Cerebrospinal fluid showed elevated protein and glucose levels. Gram stain showed Gram-negative rods in 50% of cases, while positive cerebrospinal fluid culture results were found in all patients. Multidrug resistance was observed in two cases, and all patients had received appropriate empirical and definitive antibiotic treatments. The mean duration of intravenous antimicrobial treatment was (19.3±7.0) d and all patients with external ventricular drains underwent removal of the device, while in-hospital mortality was 50%. Conclusions: The number of cases was too small to come up with therapeutic and prognostic conclusions. Further large-scale prospective study is needed.

Clostridium difficile infection: A review of the literature

Clostridium difficile is a Gram-positive, strictly anaerobic, spore-forming bacterium. It is the most common cause of antibiotic-associated diarrhea in hospitals and other healthcare facilities and is of significant concern because of the increasing morbidity and mortality rates as well as increased health care costs. Spectrum of presentation of Clostridium difficile infection ranges from mild, self-limiting diarrhea, to serious diarrhea, pseudomembranous colitis and life-threatening fulminant colitis, which may result in death. Prompt identification of patients with symptomatic Clostridium difficile infection is essential as the majority of patients respond quickly to antimicrobial therapy. Prevention is best accomplished by implementation of infection-control measures and by judicious use of antimicrobial agents.

Clostridium difficile infection: a review of the literature

Clostridium difficile is a Gram-positive, strictly anaerobic, spore-forming bacterium. It is the most common cause of antibiotic-associated diarrhea in hospitals and other healthcare facilities and is of significant concern because of the increasing morbidity and mortality rates as well as increased health care costs. Spectrum of presentation of Clostridium difficile infection ranges from mild, self-limiting diarrhea, to serious diarrhea, pseudomembranous colitis and life-threatening fulminant colitis, which may result in death. Prompt identification of patients with symptomatic Clostridium difficile infection is essential as the majority of patients respond quickly to antimicrobial therapy. Prevention is best accomplished by implementation of infection-control measures and by judicious use of antimicrobial agents.

Epidemiology, clinical features and outcome of liver abscess: a single reference center experience in Qatar

To describe the etiology, clinical presentation, management and outcome of liver abscess in adult patients admitted at Hamad general hospital, Qatar. A cross sectional study was conducted to involve all adult patients who sequentially encountered episodes of liver abscess during the period from January 1, 2009, to December 31, 2010. Blood cultures were drawn from all patients in the first 24 hours after admission. In addition, all patients had stool examinations and indirect Hemagglutination test for Entameba histolytica. Aspiration of abscess was done under CT guidance and aspirated pus was sent for gram stain and culture. In total, 67 patients were admitted with liver abscess; 56 patients with pyogenic liver abscess and 11 with amebic liver abscess. There were 61 [91%] males and six [9%] females and their mean age was 47.4 +/- 18.5 years. Fever, abdominal pain and vomiting were the commonest presenting features. Of the 56 pyogenic liver abscess patients, four discharged against medical advice and seven refused all invasive procedures and were treated with antibiotics for six weeks. The remaining 44 [79%] patients were treated with antibiotics and one or more invasive procedures, while one patient was treated surgically. The commonest organism isolated was Klebseilla pneumonia found in 21 patients [38%]. The mean duration of hospitalization was 13.6 +/- 8.1 days; the mean duration of antibiotic therapy was 34.7 +/- 40.6 days, and one patient died. In contrast, all amebic liver abscess patients underwent ultrasound guided aspiration and showed good response to metronidazole treatment. Their mean duration of hospitalization was 7.7 +/- 4.1 days, mean duration of therapy was 11.8 +/- 2.1 days, and all patients were cured. Pyogenic liver abscess was more common than amebic liver abscess with Klebseilla pneumonia being the commonest organism. With good medical measures and early drainage of liver abscess, surgical intervention was unnecessary in almost all the case

Adult Klebsiella pneumoniae meningitis in Qatar: clinical pattern of ten cases

<p><b>OBJECTIVE</b>To describe the clinical presentation, underlying diseases, antimicrobial susceptibility, treatment and outcome of Klebsiella pneumoniae meningitis patients.</p><p><b>METHODS</b>This retrospective study involved all patients with 15 years of age or older who admitted to Hamad General Hospital with culture proven Klebsiella pneumoniae meningitis from January 1, 2007 to December 31, 2012.</p><p><b>RESULTS</b>A total of ten cases were identified (nine males and one female). Their mean age was (43.3±12.8) years. Eight patients (80%) had nosocomial meningitis with neurosurgery being the most frequent associated condition. Fever and altered consciousness were the most frequent symptom. Cerebrospinal fluid showed elevated protein and glucose levels. Gram stain showed Gram-negative rods in 50% of cases, while positive cerebrospinal fluid culture results were found in all patients. Multidrug resistance was observed in two cases, and all patients had received appropriate empirical and definitive antibiotic treatments. The mean duration of intravenous antimicrobial treatment was (19.3±7.0) d and all patients with external ventricular drains underwent removal of the device, while in-hospital mortality was 50%.</p><p><b>CONCLUSIONS</b>The number of cases was too small to come up with therapeutic and prognostic conclusions. Further large-scale prospective study is needed.</p>

Ischaemic hepatitis precipitated by recurrent episodes of atrial fibrillation

We report a case of ischaemic hepatitis associated with recurrent fast atrial fibrillation [AF] episodes in a 59-year-old male who presented with shortness of breath, nausea and vomiting. The patient had a history of ischaemic cardiomyopathy. An emergency electrocardiogram showed fast AF with a ventricular rate of 190 min[-1]. The aspartate aminotransferase [AST] level was 2222 U l[-1], alanine aminotransferase [ALT] was 1255 U l[-1], lactate dehydrogenase [LDH] was 1842 U l[-1] and serum creatinine was 150 micromol l[-1]. An ultrasound of the abdomen showed an enlarged liver with hypoechoic lesions. The patient received digoxin. In the next few days, while liver enzymes and serum creatinine started to return to normal levels, the patient had two attacks of fast AF, each associated with elevated liver enzymes and a concomitant rise in serum creatinine. The patient was transferred to the intensive care unit to improve control of his AF, after which his liver enzymes and renal function gradually returned to normal

Three different presentation of same pathophysiology

We report three male patients of younger age group presented with acute vein thrombosis of different sites, right lower limb, cortical venous sinuses thrombosis with cerebral vascular accident and third case is mesenteric vein thrombosis. All patients were Vegetarian, had low level of cobalamin with marked hyper homocysteinemia with normal serum and red cell folic acid. The low Cobalamin level was not suspected secondary to pernicious anemia, based on the fact that there was no evidence of atrophic gastritis and an absence of antiparietal cell antibodies. There were no evident of immobilization, recent surgery, malignancy, antiphospholipid antibody, myeloproliferative disorder, and hormone replacement therapy. No deficiencies in protein C, protein S, or antithrombin III, normal factor V Leiden, no prothrombin gene mutation 20210A and no clone for paroxysmal nocturnal hemoglobinurea were detected, no cause was found for the thrombosis apart from their secondary hyperhomocysteinemia

Lung gangrene in a mechanically ventilated woman due to streptococcus pneumoniae

A 51-year-old woman with long-standing type II diabetes, presented to the accident and emergency department with 5 day history of fever, cough, with minor greenish sputum and right pleuritic pain. Pulmonary auscultation revealed right rales. Arterial blood gas analysis [ABG] showed, pH 7.41; PaCO2 30 mmHg; PaO2 55 mmHg [while patient breathing oxygen at 3 L/minute]. Chest radiograph showed a consolidated area in the right middle lobe. The patient was admitted in the intensive care unit for further management. Because of persistent hypoxia the patient was intubated and placed on mechanical ventilator. Multiple sputum smears revealed Gram-positive cocci while sputum cultures revealed Streptococcus pneumoniae. Two blood cultures obtained on admission yielded Streptococcus pneumoniae. A CT scan of the chest revealed a crescent-shaped lucency [air crescent sign] within the area of consolidation in the right middle lobe. Based on these radiographic findings the patient was diagnosed with lung gangrene and she was treated with antibiotic. There was no time to intervene surgically because she died six days after admission

One year-study of patients with acute organophosphate insecticide poisoning admitted to the intensive care unit of Hamad General hospital, Doha, State of Qatar

Organophosphate poisoning continues to be one of the important problems of poisoning presenting to the intensive care unit. To describe the clinical course, diagnosis, out come of acute organophosphate [OP] insecticide poisoning and to review the management measures taken in intensive care unit [ICU]. Descriptive prospective observational study. Intensive Care Unit of Hamad General Hospital, State of Qatar. Patients with acute OP poisoning admitted to the ICU from 1st January to 31st December 2005. Eight patients were admitted to the ICU; six males and two females. Seven had accidental exposure, while one was attempted suicide. The majority of patients exhibited the classic clinical features of patasympathetic overactivity. No patient had features of intermediate syndrome or Organophosphate Induced Delayed Neuropathy [OPIDN]. All patients received atropine, while pralidoxime was given to only 6 patients. Mechanical ventilation was required in 3 patients for respiratory failure, with mean ventilation duration of 2.3 +/- 1.5 days. No mortalities were recorded. The widespread use of organophosphates as a household and agricultural pesticide, in the absence of adequate regulations and education in their use is probably the most important reason for OP poisoning in a non-agricultural country like Qatar. Despite severe toxicity in most of our cases, there were nofatalities. This reflects the necessity of early diagnosis, treatment and the implementation of advanced supportive care in ICU

Doxycycline-induced esophagitis

Esophageal ulceration occasionally occurs in patients taking doxycycline capsules or tablets. We report two patients who develop acute esophageal ulceration after ingestion of doxycycline capsules for Acne vulgaris. Despite extensive investigation, no evidence of other causes was found. The ulcers are postulated to result from close contact between the capsules and the esophageal mucosa. We show the endoscopic image of the lesion, symptomatology, diagnosis, treatment, and prevention of doxycycline-induced esophageal lesions