Trends in outcome and hospitalization charges of adult patients admitted with botulism in the United States.

BACKGROUND: To assess the impact of new therapeutic strategies on outcomes and hospitalization charges among adult patients with botulism in the United States. METHODS: We determined in-hospital outcomes and charges for patients with botulism hospitalized in 1993-1994 and compared them with those observed among patients hospitalized in 2006-2007. Mortality, length of stay, and hospitalization charges were calculated. Age, sex, race, ethnicity, and discharge status were also reported. RESULTS: There were 66 and 132 admissions of adult patients with botulism in 1993-1994 and 2006-2007, respectively. Men predominance was observed in 2006-2007 compared to women predominance during the 1993-1994 time period. There was no significant difference in the average length of stay and in-hospital mortality rate between the two groups studied. However, in the 2006-2007 group, there was a significant increase in the mean hospitalization charges (USD 126,092 ± 120,535 vs. USD 83,623 ± 82,084; p = 0.0107) and in the proportion of patients requiring mechanical ventilation when compared to 1993-1994 (34 vs. 13.6%; p < 0.0001). CONCLUSION: Botulism continues to be an infrequent cause of hospitalization, with a significant increase in the average hospitalization charges in 2006-2007 when compared to 1993-1994, despite a nonsignificant change in the mortality rate and average length of hospitalization.

HTLV-1 antibody testing in a Saudi Arabian blood donor population.

Human-T lymphotrophic virus Type 1 may be transmitted by cellular blood products. A low but definite risk exists that recipients of HTLV-1 infected products may develop severe even fatal disease. After one year of screening for HTLV-1 antibodies in 12,851 units of blood collected from a multinational volunteer donor population of which 42.6% were Saudi nationals, we found two units of blood which reacted repeatedly positive in the screen test. In both cases, the Western Blot confirmatory test was indeterminate in that not all bands required for a positive reaction were present. Both donors were expatriates from North America either living in an endemic area or with Caribbean ancestors. Although more than 5,000 Saudi national donors were tested and found negative for HTLV-1 antibodies, a statistical estimate of the maximal risk of finding a positive donor in this donor population subgroup is in the order of 0.055%. Based on these results it is recommended that blood banks in this region screen for HTLV-1.

Hepatitis C antibody prevalence in Saudi Arabian blood donor population.

Based on the screening of 10,646 units of blood by a recombinant hepatitis C antibody enzyme-linked immunosorbent assay (ELISA), the prevalence of hepatitis C (HCV) antibody-reactive donors was established in a Saudi Arabian donor population. The overall prevalence of HCV antibody was found to be 1.01%. By nationality, the antibody frequency was 1.00% (Saudi males), 2.30% (other Middle Easterners), 0.71% (Far East nationals), and 0.39% (Europeans/North Americans). The ELISA HCV antibody reactive units were further tested by a recombinant immunoblot assay (RIBA) in which 47.2% of the initially reactive samples were found to contain specific antibodies to two recombinant antigens. HCV antibody seroprevalence defined by reactiveness in both tests was 0.48% for the entire population, 0.33% (Saudis), 1.42% (Middle Easterners), 0.27% (Far East nationals and Europeans/North Americans). The surrogate markers alanine aminotransferase (ALT) and hepatitis B core (HBc) antibody identified 7.7 to 40% and 20 to 56.4%, respectively, of donors of different nationalities testing repeatedly reactive in the HCV ELISA. Likewise, ALT and HBc antibody identified 20 to 57.1% and 0 to 66.75%, respectively, of HCV ELISA and RIBA reactive donor samples, depending on nationality. It was concluded that the present anti-HCV testing, althought useful in screening blood for HCV carriers, must be supplemented by surrogate tests until additional specific tests are available.