Rotavirus and adenovirus in children evaluated for viral gastroenteritis at a single healthcare center in the Eastern Province of Saudi Arabia: A perspective of two decades.

BACKGROUND: The aim of this study was to determine the distribution of rotavirus and adenovirus in pediatric patients evaluated for viral gastroenteritis in a hospital in the Eastern Province of Saudi Arabia for 22 years. MATERIALS AND METHODS: This was a retrospective study based in a secondary healthcare center in Saudi Arabia. Laboratory and demographic data were collected from hospital records for all pediatric patients (up to 14 years old) evaluated for viral gastroenteritis by rotavirus/adenovirus antigen detection kit from January 2000 to December 2022. Data were analyzed utilizing SPSS version 28.0. Categorical data were presented as frequency and percentages, whereas mean and standard deviations were computed for continuous variables. Chi-square test and t-test were used to determine statistical significance. RESULTS: The overall yields of antigen detection were 13.6% for rotavirus and 2.6% for adenovirus. Coinfection with both viruses was documented in 0.5% of the study population. Rotavirus was persistently detected in the past two decades with varying frequency, but the detection of adenovirus showed intervals of at least three consecutive years of zero confirmed cases. Before 2013, when the rotavirus vaccine was introduced in Saudi Arabia, rotavirus was much more prevalent than adenovirus (30% compared to 3.8% in 2010), but they became equally prevalent a decade after the introduction of the vaccine. Rotavirus gastroenteritis showed three different peaks in the year, in March, July, and December. Each peak was followed by a gradual decrease in prevalence before the next peak. Adenovirus, in contrast, was detected consistently around the year at rates between 2% and 5%. CONCLUSION: Rotavirus and adenovirus gastroenteritis have changed in prevalence in the past two decades. We found distinct seasonal patterns associated with rotavirus and adenovirus gastroenteritis. The utilization of virological testing for pediatric gastroenteritis with syndromic testing panels is to be encouraged to improve the knowledge of the true prevalence of enteric viruses.

Susceptibility to Rubella Infection and Incidence of Congenital Rubella Infection: 6 Years Retrospective Study.

Introduction: Rubella is considered one of the most serious and most common congenital infections. Despite global efforts for elimination, rubella cases are still being reported in many parts of the world. The purpose of this study is to determine the level of immunity to rubella in the community and most importantly among women at childbearing age in the eastern province of Saudi Arabia and compare it with the target set by the World Health Organization (WHO) along with the incidence of acute rubella infection and the associated congenital rubella infection and congenital rubella syndrome. Methods: This is a retrospective cross-sectional study over the six years period (Jan 2014-Jun 2020) on all individuals tested for rubella IgM and IgG in a university teaching hospital. Results: Nighty one percent (15,894/17,469) of the population tested showed evidence of rubella immunity with 8.8% (1546/17,469) being susceptible. Among women at childbearing age, susceptibility to rubella was higher with 9.2% (1220/13,278) of women showing no evidence of immunity. In addition, acute rubella infection was reported for 0.17% (29/17,469) of the population tested and 0.15% (20/13,278) in women at childbearing age. No cases of congenital rubella infection were reported in the study period. Discussion: The level of Rubella immunity in the population is 91% and is less than the WHO target for rubella control therefore, risk of resurge of cases is present, indicating the need for continued national surveillance and more efforts to improve vaccination coverage in the kingdom.

Seropositivity of syphilis among individuals screened in a tertiary hospital in the Eastern Province of Saudi Arabia.

BACKGROUND: Sexually transmitted infections are a serious public health problem. Syphilis, a multistage, curable chronic disease caused by the spirochete Treponema pallidum, remains a major health problem worldwide. The disease re-emerged in the era of HIV in many countries despite the accessibility of curative therapy and continuing public health efforts to eliminate it. OBJECTIVE: Analyse the seropositivity for syphilis. DESIGN: Retrospective cross-sectional. SETTING: Tertiary hospital. PATIENTS AND METHODS: We retrospectively studied individuals who underwent screening tests for syphilis between January 2014 and December 2018. The samples that were positive by both screening and confirmatory tests were considered as confirmed positive for syphilis. MAIN OUTCOME MEASURES: Syphilis positivity identified by chemiluminescence immunoassay, the rapid plasma reagin test, and specific antibodies against Treponema pallidum. SAMPLE SIZE: 11 832. RESULTS: Of the 11 832, 54 (0.45%) were confirmed as seropositive for syphilis. Thirty-three (61.1%) were non-Saudi; 21 (38.9%) were Saudis. Thirty (55.6%) cases were males. Twenty-two (40.74%) were married and 29 (53.70%) were unmarried. Of the 54 diagnosed as syphilis positive, 28 (51.9%) were expatriate workers screened for pre-employment. The percentage of syphilis among Saudis was 0.36%. In an overall chi-square analysis, a P<.0001 indicated a difference among nationalities in the frequency of syphilis. A post-hoc analysis showed that Somalians (P=.004) and Sudanese (P=.005) differed significantly from other nationalities. CONCLUSION: The study showed that syphilis was low among the screened population. More than half of the syphilis positive cases in this study were household employees. Screening for syphilis assists in planning complementary services for target populations and improves syphilis control. LIMITATIONS: Retrospective design. Hospital-based findings may not be representative of the seroprevalence of syphilis in the general population. CONFLICT OF INTEREST: None.

Association between Hepatitis C Virus Viremia and the rs12979860, rs2228145 and rs1800795 SNP (CT/AC/GG) Genotype in Saudi Kidney Transplant Recipients.

BACKGROUND: Hepatitis C virus (HCV) is a major health problem, particularly in high-risk groups such as kidney transplant recipients, where it can adversely affect graft survival and increase the relative risk for mortality. Recently, the role of genetic variation among HCV patients in determining the outcome of infections has been under investigation. OBJECTIVE: To investigate the association of single-nucleotide polymorphisms (SNPs) rs12979860 (located within the interleukin-28B locus), rs2228145 (interleukin-6 receptor) and rs1800795 (interleukin-6 promoter) with HCV viremia in renal transplant patients. MATERIALS AND METHODS: In this analytical cross-sectional study, 149 kidney transplant recipients, 82 males (median age: 41 years) and 67 females (median age: 45 years), were screened for HCV RNA in blood using real-time polymerase chain reaction and genotyped by sequencing (rs12979860) and restriction fragment length polymorphism (rs2228145 and rs1800795). RESULTS: HCV RNA was detected in 17 (11.41%) of the 149 patients. There was no statistically significant association between the studied SNPs and HCV viremia. However, a combination of the CT/AC/GG genotype was significantly associated with HCV viremia (odds ratio: 5.4). The genotype AA of rs2228145 in the IL-6 receptor was associated with viremia levels of >105 copies/ml (odds ratio: 5.96). CONCLUSION: To the best of the authors' knowledge, this is the first study that has shown that the CT/AC/GG genotype has an impact on HCV viremia in kidney transplant patients. Therefore, such SNP genotypes may potentially be used to identify transplant patients at risk of HCV infection.

Lack of MERS coronavirus neutralizing antibodies in humans, eastern province, Saudi Arabia.

We used a lentiviral vector bearing the viral spike protein to detect neutralizing antibodies against Middle East respiratory syndrome coronavirus (MERS-CoV) in persons from the Eastern Province of Saudi Arabia. None of the 268 samples tested displayed neutralizing activity, which suggests that MERS-CoV infections in humans are infrequent in this province.

Detection of extended spectrum beta-lactamases-producing isolates and effect of AmpC overlapping.

INTRODUCTION: Few reports about the prevalence and genetic basis of extended spectrum beta-lactamases (ESBLs) are available from Saudi Arabia. We sought to determine the prevalence of ESBL-producing Enterobacteriaceae in a university hospital in eastern Saudi Arabia and to characterize the ESBLs produced by these isolates at the molecular level. METHODOLOGY: All clinical isolates of Escherichia coli, Klebsiella spp., and Proteus spp. collected over two years were evaluated for susceptibility to a panel of antimicrobials and were analyzed for the ESBL phenotype using screening and confirmatory tests. ESBL-positive isolates were then screened for the presence of genes encoding CTX-M, SHV, and TEM beta-lactamases by PCR. RESULTS AND CONCLUSIONS: The overall prevalence of ESBL-producing isolates was 4.8% (253/5256). Most isolates (80%) were from the inpatient department. The ESBL phenotype was more frequently detected in K. pneumonia. CTX-M genes were the most prevalent ESBL genes, detected in 82% of the studied isolates. The ESBL producers demonstrated a high multidrug resistance rate (96.6%). In transconjugation assay, the same ESBL gene pattern was transmitted from 29.7% of K. pneumoniae donors to the recipient strain, and the latter exhibited concomitant decreased aminoglycosides and co-trimoxazole susceptibility. We observed the presence of ESBL screen-positive but confirmatory-negative isolates (8.9%). Phenotypic tests for the production of AmpC ß-lactamase tested positive in 52% of these isolates. Further studies are needed for appropriate detection of concomitant ESBL and AmpC enzyme production among such isolates. Continued surveillance and judicious antibiotic usage together with the implementation of efficient infection control measures are absolutely required.

Molecular and serological assessment of parvovirus B19 infections among sickle cell anemia patients.

INTRODUCTION: Parvovirus B19 is a cause of hemolysis and red blood cell aplasia in patients with sickle cell anemia. The present study aimed to assess parvovirus B19 infection among sickle cell anemia patients. METHODOLOGY: All patients (n = 138) included in the study were sickle cell anemia patients. Blood donors were used as a control group. Assessment of parvovirus B19 antibodies and viral DNA was performed using established methods of detection and B19 recomBlot assay. RESULTS: Detectable levels of parvovirus B19 IgG were found in 52 samples (37.6%) whereas anti-parvovirus B19 IgM antibodies were detected in four (2.89 %) patients of the sickle-cell anemia group. Anti-B19 IgM-positive samples contained B19-viral DNA.  These four patients presented with fever, malaise, pallor and no cutaneous rash. Anti-parvovirus B19 antibodies were detected in 22 (39.3%) of the control blood donors group. Anti-parvovirus B19 IgM antibodies were not detected in the control group. Using the recomBlot assay, 58 test samples (42%) were found to contain detectable levels of Parvovirus B19 antibodies. All the samples that were positive for parvovirus B19 IgG by the ELISA were also positive by the recomBlot assay. Six samples were only positive by the recomBlot assay and not by the ELISA. Two of these six samples were positive for B19 viral DNA. CONCLUSIONS: Establishing the extent of parvovirus B19 infection in sickle cell anemia patients will help in proper management of aplastic crisis in such patients. The B19 recomBlot assay may be suitable as a confirmatory assay.

Characterization of human rotavirus subgroups and serotypes in children under five with acute gastroenteritis in a Saudi Hospital.

OBJECTIVES: Rotavirus is the most common cause of severe diarrhea in children. Currently, there is no published data on the prevalence of subgroups and serotypes of rotavirus in the Eastern province of Saudi Arabia. The objectives of the present study were to assess the rotavirus infection in children with acute gastroenteritis and to assess the subgroups and serotypes of rotavirus in the Children and Maternity Hospital in Dammam, Eastern Saudi Arabia. MATERIALS AND METHODS: Children under 5 years of age with gastroenteritis attending the emergency rooms, or hospitalized in the pediatric wards of in the Children and Maternity Hospital in Dammam were included in the study (N=156). Laboratory diagnosis of rotavirus shedding was established using the novel rotavirus STAT-PAK immunochromatographical test. Subgroup and G-serotype of the positive stool specimens were analyzed by the ELISA method. RESULTS AND CONCLUSIONS: Using the novel immmunochromatographic assay, 37 samples were shown to be positive for rotavirus (23.7%). Subgroup I (serotype 2) was found to constitute 5.4% of the isolates and subgroup II (serotypes 1, 3 and 4) was found to constitute 56.7% of the isolates, whereas 37.8% were non-typeable. A survey of serotypes of rotavirus in the whole region as well as in the whole of Saudi Arabia will provide important information about the subgroups and groups of rotavirus in the community and may help in assessing the success of the rotavirus vaccine in the future.

Analysis of chemokines and soluble adhesion molecules in cytomegalovirus-positive renal transplant recipients.

BACKGROUND: The relationship among cytomegalovirus (CMV) infection and the serum level of chemokines and soluble adhesion molecules is not well studied. This study aimed to assess chemokines and soluble adhesion molecules in CMV-positive Saudi renal transplant recipients. METHODOLOGY: The study was conducted in a tertiary hospital in Eastern Saudi Arabia over a 12-month period. All kidney transplant recipients who regularly attended the nephrology clinics were included (n = 150). Randomly selected age- and sex-matched individuals served as a control group (n = 158). CMV antibodies (IgG and IgM), chemokines and soluble adhesion molecules were measured using standard enzyme-linked immunosorbent assay (ELISA). CMV viral DNA was detected using real time polymerase chain reaction (PCR). RESULTS: Of the 150 patients studied, 149 (n = 150) had detectable levels of Anti-CMV IgG antibodies (99.3%). In the control group, 113 (n = 158), blood donors had anti-CMV IgG antibodies (71.5%). Forty-one (n = 150) kidney transplant recipients were positive for anti-CMV IgM antibodies (27.3%), whereas only one (n = 158) blood donor had detectable anti-CMV IgM antibodies. All IgM positive samples contained CMV viral DNA. MCP-1, IL-8, ICAM-1, and VCAM-1 levels were measured using ELISA. Of those, only MCP-1 and IL-8 were detectable. Eighteen kidney transplant recipients were positive for MCP-1 (12%). All MCP-1 patients were also anti-CMV IgM positive, while 5 patients had detectable levels of IL-8 (3.3%). All these patients were CMV IgM-positive. CONCLUSIONS: The increase in chemokine levels during CMV infection may reflect a possible role for these molecules in the immunopathogenesis of CMV infection in this study population.

Screening of pregnant women attending the antenatal care clinic of a tertiary hospital in eastern Saudi Arabia for Chlamydia trachomatis and Neisseria gonorrhoeae infections.

INRODUCTION: Of the "top ten" sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrhoeae are ranked second and fifth, respectively, worldwide. AIM: The aim of this study was to screen the pregnant women for C. trachomatis and N. gonorrhoeae infections and to detect antimicrobial resistance pattern of N. gonorrhoeae. MATERIALS AND METHODS: This study was a prospective, hospital-based analysis of a random sample of pregnant women visiting the antenatal clinic of a tertiary hospital in eastern Saudi Arabia. Endocervical and high vaginal swabs were collected both from pregnant women and female patients attending gynecology clinic with lower genital tract infection (control group). C. trachomatis antigen was detected using enzyme-linked immunosorbent assay (ELISA). N. gonorrhoeae was detected by culture and identification of isolates, and antimicrobial susceptibility testing was performed. Statistical Package for Social Sciences (SPSS) version 13.0 and Chi-square test were used for statistical analysis. RESULTS: C. trachomatis antigen was detected in 10.5% (10/95) and 34.4% (35/102) of pregnant women and control group, respectively (P < 0.001). The isolation rate of N. gonorrhoeae among pregnant women was 0.0% compared to 7.8% (8/102) among the control group (P < 0.01). N. gonorrhoeae were resistant to penicillin (62.5%), tetracycline (50%), ampicillin (25%), amoxycillin-clavulinic acid (25%) and ciprofloxacin (37.5%), while they were susceptible to cefepime, ceftriaxone, ceftazidime, spectinomycin, and cefuroxime. CONCLUSION: Screening of pregnant women for C. trachomatis infection should be included in the antenatal care in this area. The detection rate of both organisms among the control group highlights the importance of preventive strategies. Certain antibiotics previously used in treating gonorrhea are no longer effective.

Detection of Hepatitis C virus and Human immunodeficiency virus in expatriates in Saudi Arabia by antigen-antibody combination assays.

BACKGROUND: The simultaneous detection of antigen and antibody was originally described for the early detection of the human immunodeficiency virus (HIV). The same approach was applied to detect the hepatitis C virus (HCV). The aim of this work was to use the antigen and antibody combination assay for the detection of HCV and HIV infections in expatriates in Eastern Saudi Arabia. METHODOLOGY: The study group (N = 875) included expatriate workers of both sexes who were undergoing mandatory pre-employment testing. Detection of anti-HCV antibodies, HCV core antigen, HCV viral RNA, HIV antigens and antibodies was conducted using commercially available kits. RESULTS: Of the 875 samples that were screened for HCV-specific antibodies, four (0.46%) tested positive (two from Pakistan, one from India, and one from the Philippines) and two (0.23%) were equivocal (one from Egypt and one from Nepal). All four samples that were positive for HCV-specific antibodies also tested positive using HCV RNA assay and the HCV antigen-antibody combination assay. The two samples that were equivocal tested positive using the HCV RNA assay and the HCV antigen-antibody combination assay. Of the 875 samples that were tested for HIV antibodies, only one (0.11%) sample gave repeatedly positive results. The same sample also tested repeatedly positive using the HIV combination assay. These results were subsequently confirmed by HIV western blot assay. CONCLUSIONS: Our study indicates that the addition of antigen detection to the screening of HCV and HIV may lower the risk of transmission of these viruses in the host country and contribute to the overall control of HCV and HIV in Saudi Arabia.

Molecular detection of hepatitis B, hepatitis C, and torque teno viruses in drug users in Saudi Arabia.

Injecting drug users are at increased risk of infection with hepatitis viruses and blood-borne pathogens. The aim of this study was to examine HBV, HCV, HDV, and TTV infections in Saudi drug users (N = 344). Extraction of nucleic acid from serum, reverse-transcription, amplification of viral nucleic acids, and HBV and HCV genotyping were done using established techniques. Of the analyzed samples, 41 (12%) contained detectable HBV DNA, 131 (38%) contained detectable HCV RNA, and 174 (51%) had detectable TTV DNA. The predominant HBV genotype was found to be genotype D and the predominant HCV genotype was found to be genotype 1b. All the samples were negative for HDV. Twelve samples (3.5%) were found to contain mixed HBV and HCV genomes, 24 samples (7%) were found to contain mixed HBV and TTV genomes, 82 samples (24%) were found to contain mixed HCV and TTV genomes, and 9 samples (2.6%) were found to contain mixed HBV, HCV, and TTV genomes. Identification of various infections in drug users will help the control of these infections in this group as well as in the community.

Prevalence of herpes simplex virus types 1 and 2 and associated sociodemographic variables in pregnant women attending king fahd hospital of the university.

OBJECTIVES: The risk factors associated with herpes simplex virus (HSV) seropositivity in pregnant women in Saudi Arabia are not known. This study was aimed at identifying the sociodemographic variables associated with seroprevalence of HSV-1 and HSV-2 in pregnant women in a Saudi hospital. MATERIALS AND METHODS: This is a hospital-based cross-sectional study that included all pregnant mothers who delivered at King Fahd Hospital of the University (KFHU) over a period of two years (November 2002 to October 2004). Anti-HSV-1 and anti-HSV-2 IgG and IgM antibodies were determined using type-specific ELISA. Each subject completed a structured questionnaire. Relevant sociodemographic variables were analyzed. RESULTS: A higher prevalence of HSV-1 IgG antibodies (93.2%) was found in those mothers who were not educated (illiterate or read and write only) in comparison with pregnant women with formal school education (p = 0.021). This was confirmed by using multiple regression analysis (p = 0.027). The prevalence of HSV-2 IgG was higher among civil servants and teachers (40.0 % and 14.7 % respectively) than in unskilled labourers, professionals, or housewives (p = 0.0001). Using multiple regression analysis, the prevalence of HSV-2 IgG was found to increase in older mothers (p = 0.037). No statistically significant association was found between HSV seroprevalence and other socio demographic variables. CONCLUSIONS: Identifying the sociodemographic factors associated with HSV infection will help in understanding the epidemiology of HSV infection in Saudi women and may help in designing preventive measures.

Increased seroprevalence of human herpes virus-8 in renal transplant recipients in Saudi Arabia.

BACKGROUND: Human herpes virus-8 (HHV-8) is a herpes virus that is always associated with Kaposi's sarcoma. Previous studies suggested a high rate of Kaposi's sarcoma in renal transplant patients in Saudi Arabia. The aim of this study was to investigate the prevalence of HHV-8 in Saudi renal transplant recipients and healthy controls. METHODS: An immunofluorescence technique was used to detect antibodies to the latent nuclear antigen (LANA) of HHV-8 in renal transplant patients, members of a family affected with Kaposi sarcoma, as well as healthy controls. RESULTS: A significantly higher HHV-8 seroprevalence was detected in renal transplant recipients from Saudi Arabia (27 out of 150; 18%) and in members of a family affected with Kaposi sarcoma (seven out of 10; 70%) relative to the seroprevalence in healthy controls (10 out of 577; 1.7%). Seropositivity for HHV-8 in these transplant patients was not significantly influenced by: the existence of relatives with kidney failure, the donors' country of origin, the recipients' home region within Saudi Arabia, the haemodialysis centre, the time that elapsed since the renal transplantation operation and the immunosuppressive regimen used. CONCLUSION: The present results provide some explanation for the previously noted high incidence of Kaposi's sarcoma in Saudi transplant patients.

Detection of hepatitis C virus core antigen in blood donors using a new enzyme immunoassay.

OBJECTIVES: The purpose of the study was to evaluate the presence of hepatitis C virus [HCV] core antigen (HCV core Ag) in blood donors at King Fahd Hospital of the University, Al-Khobar, using the new HCV core Ag assay, and to correlate this finding with anti-HCV antibodies detected in the same samples using the standard Abbott MEIA(microparticle enzyme immunoassay). MATERIALS AND METHODS: A total of 898 samples from blood donors were analyzed using the new assay prototype designed to detect and quantify total HCV core Ag in serum (Ortho-Clinical Diagnostics). Positive results were confirmed by the neutralization assay. The results of the HCV core Ag assay were compared with the results of the standard Abbott MIEA which measures anti-HCV antibody. RESULTS AND CONCLUSIONS: Out of the 898 samples tested, 18 samples were found to be positive by the HCV core Ag assay (2%). Out of these, 3 samples were confirmed positive by the neutralization protocol (0.33%). All the HCV core Ag positive samples were negative for anti-HCV antibodies (using MEIA by Abbott). These 3 donors may have been in the window period of HCV infection, or may be low responders for the HCV antigens, and are thus unable to mount detectable antibody level. The HCV core Ag assay is a potentially useful assay for screening blood donors, which will minimize the risk of using HCV positive blood from a patient in the window period of HCV infection.