Tuberculosis infection during hajj pilgrimage. The risk to pilgrims and their communities

Millions of Muslims travel to Makkah every year to perform Hajj. Many pilgrims come from countries with a high incidence of tuberculosis [TB]. Over-crowding, physical exhaustion, heat, and co-morbid condition of mostly middle-aged and elderly pilgrims make them susceptible to infection, or reactivation of latent TB. Evidence from previous reports indicated a significant risk of acquiring infection during Hajj. Pilgrims infected in Makkah may spread the infection to contacts in their countries. Spread of multi-drug resistant TB is of real concern. Control efforts are required to reduce the risk of infection and transmission. Screening of pilgrims from high burden countries before travel with chest x-ray will help to detect and treat active TB, and prevent infection of others. Low incidence countries may consider carrying out tuberculin skin test or Quanti-FERON TB assay for pilgrims before and after Hajj, to identify and treat recent converters. National and international coordinated efforts are essential for successful implementation of control measures to prevent the spread of the disease

Visceral leishmaniasis in Gizan, Saudi Arabia

Visceral leishmaniasis is endemic in southern Saudi Arabia. We prospectively evaluated 121 patients with visceral leishmaniasis at King Fahad Hospital in Gizan. All patients were infants and children. Seasonal variation was observed with more cases presenting in late spring and summer and few in winter. The predominant clinical features in these patients were chronic fever, abdominal distention, weight loss and hepatosplenomegaly. Lymphadenopathy was rare in contrast to African kala-azar. Common laboratory abnormalities included anemia, leukopenia, thrombocytopenia, hypoalbuminemia and hypergammaglobulinemia. Liver function tests were deranged in one-third of patients. Leishmania hemagglutination test was positive in all patients and all of them had positive bone marrow smear or culture for Leishmania donovani. Patients responded well to stibogluconate [Pentostam] therapy with a cure rate of 96.7%. Four patients died in the first few days of therapy. Jaundice and grossly deranged liver function tests were found to be bad prognostic signs

Sensitivity of brucella melitensis to chemotherapeutic agents

The sensitivity of 106 strains of Brucella melitensis to tetracycline, streptomycin, netilmicin, rifampicin, co-trimoxazole and ciprofloxacin was determined. Ninety percent of the strains were inhibited by tetracycline, netilmicin and ciprofloxacin at 1 microg/ml and by streptomycin and rifampicin at 4 microg/ml and by co-trimoxazole at 16 microg/ml. Three strains were resistant to tetracycline and one resistant to rifampicin. No resistance was found to other drugs

Pneumococcal bacteraemia, clinical presentation and factors influencing prognosis

Fifty-one patients [31 males and 20 females] with pneumococcal bacteraemia were seen at King Khalid University Hospital over 5 1/2-year period. Their ages ranged from 1 day to 80 years. Of these 51% had pneumonia, 17% had peritonitis and 6% had meningitis. No focus of infection was found in 15.7% of patients. Underlying diseases were present in 74% of patients. The overall mortality rate was 27.5% and most of the deaths occurred within 48 h of infection. The mortality was significantly high among older patients, and those with underlying diseases or shock. Patients with extrapulmonary focus of infection, afebrile bacteraemia, or inappropriate therapy had a higher mortality than others, but the difference was not significant. Recognition of these problems and the factors associated with high mortality may help in improving the prognosis

Community-acquired bacteremia in a teaching hospital in Saudi Arabia

During one year, 153 episodes of community-acquired bactermia were documented at King Khalid University Hospital in Riyadh, with an incidence of 6.7 cases/1000 admissions. Over 70% of the isolates were gram-negative organisms. Brucella sp. accounted for 42% of all isolates. The other common isolated were Escherichia coli and streptococci. The origin of infection could be identified in 79% of patients with non-Brucella bacteremia, with the urinary and respiratory tracts the most common sources of bacteremia. The mortality of bacteremia in this series was 5.2%. Streptococcus pneumoniae bacteremia was associated with the highest mortality

Medical manpower in Saudi health services

In 1985 there were 14, 057 physicians in all health services in Saudi Arabia. Of these, 8, 239 worked in Ministry of Health facilities, and the overall physician: population ratio was 1: 750. The ministry of health has had a moderate shortage of physicians as evidenced by a low physician: population ratio and a high number of patient visits annually to each doctor. The shortage has been greater in the northern and southern regions of the Kingdom. The targeted physician: population ratio in the fourth development plan [1: 550] calls for an increase in the number of physicians in 1990 to 22, 000. With the same target ratio for 1995, the number o physicians needed is estimated to be over 25, 000. The shortage of Saudi physicians is severe. Their present proportion is 10% of all physicians in the Kingdom. To achieve the goal of the fourth development plant, the proportion of Saudi physicians in the Kingdom will need to increase to about 23% by 1995. this would imply a real need for expansion in medical education facilities to achieve adequate medical manpower in a reasonable time