brucellosis a common infectious cause of Pyrexia of unknown origin in Kuwait?

To investigate the prevalence of brucellosis and to compare it with other causes of pyrexia of unknown origin [PUO] in Kuwait Retrospective study Infectious Disease Hospital, Kuwait All patients admitted to Infectious Disease Hospital with a diagnosis of PUO between January 2001 and December 2004 were included in this study. Age, gender, nationality, occupation, residence and laboratory investigations One hundred thirty six patients were admitted with PUO to the hospital. Their mean age was 36.7 +/- 11.69 years [range: 14-80 years]. The mean duration of hospitalization was 8.7 +/- 7.8 days. Infectious diseases were the most common causes of PUO. Brucellosis was diagnosed in 80 [58.8%] patients, respiratory tract infection in 10 [7.4%], gastrointestinal diseases in 14 [10.3%] and HIV was diagnosed in three patients. Other diseases such as thyroiditis and glaucomatous hepatitis were diagnosed in 15 [11%] patients. Brucellosis patients had high alanine amino transferase [ALT] level and lower white blood cell [WBC] count than other PUO patients [56.9 +/- 40.6 Vs. 38 +/- 31.4, p < 0.003 and 7.1 +/- 3.9 Vs. 8.5 +/- 4.04, p < 0.01 respectively]. Brucellosis was common among Asian population [58.8% compared to Gulf residents 31.3% and other nationals 10%, p = 0.022]. Brucellosis is common among patients in high-risk occupations [62.5% compared to non-high risk occupations 37.5%, p < 0.0001]. Brucellosis is the common infectious cause of PUO among Asian and patients in high-risk occupations in Kuwait

Bacterial spectrum of perm-cath related infection among hemodialysis patients

Dual-lumen cuffed central venous catheter [perm-cath] is an alternative vascular access in maintenance hemodialysis Infection however is a major problem associated with long-term central venous catheters. This study assesses the spectrum of catheter related bacterial infectkin among hemodialysis patients. Charts of 174 patients were reviewed during The period between January 2005 and December 2006. Quantitative blood culture was obtained simultaneously from the catheter and from a peripheral vein when catheter related infection is suspected. Episodes of catheter related infection were registered including the causative bacteria. 76perm-cath double-lumen catheters rooted in 76 [43.7%] hemodialysis patients. Seventy nine episodes of catheter related bacteria in 45 [59%] patients were analyzed Six [13.33%] patients had more than one episode of catheter related infection. The rate of infection is equal to 3.3 per hundred patient-month treatment The causative bacteria included Gram-positive organisms in 51 [64.6%]. Staphylococcus aureus in 33 [41.8%] episodes. Methicillin resistant staphylococcus aureus [MRSA] was detected in 25 [31.6%] episodes. Coagulase negative staphylococcus species in 9[11.4%] episodes, and enterococci in 6[7.5%] episodes. Gram-negative bacteria were the cause of infection in 28 [35.4%] episodes. Pseudomonas was isolated in 6[7.5%] episodes, acinetobacter in 5[6.3%] episodes, and E-coli in 5[6.3%] episodes. Other bacteria were the cause of infection in 15[18.9%] episodes. Bacteremia was reported in 47[59.5%] episodes. Isolated exit site infection was reported in 26[32.9%] episodes. Concomitant exit site infection and septicemia was reported in 6 [7.5%] episodes. Seventy five [95%] episodes were cured with proper antibiotics without catheter removal and 4 episodes [5%] required catheter removal. This study dearly demonstrated that MRSA is most common cause of perm-cath infection in hemodialysis patient. Early treatment and or catheter removal reduces patients' morbidity. Exit site infection should be treated punctually

Does parathyroid hormone affect erythropoietin therapy in dialysis patients?

The objective of this study was to assess the response to recombinant human erythropoietin [rHuEPO] during treatment of anemia in dialysis patients with hyperparathyroidism. A total of 118 patients with stage 5 renal failure on dialysis therapy were selected for this study. Anemia was treated with rHuEPO. Laboratory data for each patient included intact parathyroid hormone [iPTH], hemoglobin [Hb], hematocrit [Hct], blood urea nitrogen, serum creatinine, calcium, phosphate, and alkaline phosphatase. Patients with iPTH >32 pmol/l were considered hyperparathyroid. Erythropoietin resistance index [ERI] was expressed as the ratio of weekly rHuEPO dose/Hct level. Of the 118 patients, 83 [70.3%] were on hemodialysis [HD] and 35 [29.7%] were on continuous ambulatory peritoneal dialysis [CAPD]. Sixty-three patients [64.3%] with iPTH >32 pmol/l had Hb <11 g/dl, while 34 [54.8%] with iPTH <32 had Hb >11 g/dl [p = 04]. Thirty-three [56%] patients with iPTH >32 pmol/l had hemocrit <33%, while 38 [61.3%] with iPTH <32 had hemocrit <33% [p = 0.4]. The median value of weekly rHuEPO dose in HD patients [12,000 units] was significantly higher in comparison with CAPD patients [6,000 units; p < 0.0001]. ERI was significantly higher in HD than CAPD patients with iPTH <16 pmol/l [p = 0002] as well as with patients with 16-32 pmol/l [p = 0.012]. CAPD patients showed a reduced requirement for rHuEPO and better control of anemia compared with HD patients. ERI was also lower in CAPD than in HD patients. Hyperparathyroidism is a parameter predictive of rHuEPO hyporesponsiveness in dialysis patients