Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study.

The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.6% (19/731) in July 2013, 1.7% (19/1100) in August 2013, and 1.69% (21/1238) in September 2013. Male patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.

Clinical management guidelines for pandemic (H1N1) 2009 virus infection in the Eastern Mediterranean Region: technical basis and overview.

During the spring of 2009, a novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in Mexico. After initially spreading in North America, the virus spread globally resulting in the first influenza pandemic since 1968. While the majority of illnesses caused by pandemic (H1N1) 2009 were mild and self-limiting, severe complications, including fatalities, were also reported. In view of the increasing number of laboratory-confirmed cases and deaths from pandemic (H1N1) 2009 in the Eastern Mediterranean Region of the World Health Organization, the Regional Office convened a consultation meeting of experts involved in the clinical management of patients infected with pandemic (H1N1) 2009 virus. The consultation resulted in developing an interim guidance and algorithm for clinical management of pandemic (H1N1) 2009 virus infection in health-care settings. This paper describes the process, the technical basis and the components of this interim guidance.

Clinical management guidelines for pandemic [H1 N1] 2009 virus infection in the Eastern Mediterranean Region: technical basis and overview

During the spring of 2009, a novel influenza a [H1N1] virus of swine origin caused human infection and acute respiratory illness in Mexico. After initially spreading in North America, the virus spread globally resulting in the first influenza pandemic since 1968. While the majority of illnesses caused by pandemic [HINT] 2009 were mild and self-limiting, severe complications, including fatalities, were also reported. In view of the increasing number of laboratory-confirmed cases and deaths from pandemic [HINT] 2009 in the Eastern Mediterranean Region of the World Health Organization, the Regional office convened a consultation meeting of experts involved in the clinical management of patients infected with pandemic [H1N1] 2009 virus. The consultation resulted in developing an interim guidance and algorithm for clinical management of pandemic [HINT] 2009 virus infection in health-care settings. This paper describes the process, the technical basis and the components of this interim guidance

Emergence of influenza A H1N2 reassortant viruses in the human population during 2001.

Influenza A H1N2 viruses, which emerged during 2001, are genetic reassortants between H1N1 and H3N2 subtype viruses which have cocirculated in the human population since 1977. They possess a H1 hemagglutinin antigenically and genetically similar to contemporary A/New Caledonia/20/99 (H1N1)-like viruses and seven genes closely related to those of recent A/Moscow/10/99 (H3N2)-like viruses. The viruses have spread to many regions of the world and have predominated over H1N1 viruses in several countries. Since half of the amino acid changes which accumulated in the HAs of H1N1 viruses since 1995 are in residues implicated in receptor binding, functional changes in the H1 HA may have facilitated its replacement of the H3 HA and may contribute to the future epidemiologic significance of these H1N2 viruses.

Acrophialophora fusispora brain abscess in a child with acute lymphoblastic leukemia: review of cases and taxonomy.

A 12-year-old girl with acute lymphoblastic leukemia was referred to King Faisal Specialist Hospital and Research Center. The diagnosis without central nervous system (CNS) involvement was confirmed on admission, and chemotherapy was initiated according to the Children Cancer Group (CCG) 1882 protocol for high-risk-group leukemia. During neutropenia amphotericin B (AMB) (1 mg/kg of body weight/day) was initiated for presumed fungal infection when a computed tomography (CT) scan of the chest revealed multiple nodular densities. After 3 weeks of AMB therapy, a follow-up chest CT revealed progression of the pulmonary nodules. The patient subsequently suffered a seizure, and a CT scan of the brain was consistent with infarction or hemorrhage. Because of progression of pulmonary lesions while receiving AMB, antifungal therapy was changed to liposomal AMB (LAMB) (6 mg/kg/day). Despite 26 days of LAMB, the patient continued to have intermittent fever, and CT and magnetic resonance imaging of the brain demonstrated findings consistent with a brain abscess. Aspiration of brain abscess was performed and the Gomori methenamine silver stain was positive for hyphal elements. Culture of this material grew Acrophialophora fusispora. Lung biopsy showed necrotizing fungal pneumonia with negative culture. The dosage of LAMB was increased, and itraconazole (ITRA) was added; subsequently LAMB was discontinued and therapy was continued with ITRA alone. The patient demonstrated clinical and radiological improvement. In vitro, the isolate was susceptible to low concentrations of AMB and ITRA. A. fusispora is a thermotolerant, fast-growing fungus with neurotropic potential. We report the first case of human infection involving the CNS. Acrophialophora resembles Paecilomyces but differs in having colonies that become dark and in the development of phialides along the sides or at the tips of echinulate brown conidiophores. Conidia are borne in long chains and are smooth or ornamented with fine-to-coarse echinulations, sometimes in spiral bands. The taxonomy of the genus Acrophialophora is reviewed, and Acrophialophora nainiana and Acrophialophora levis are considered as synonyms of A. fusispora.

Update on diagnosis of congenital infection.

Congenial infection is one of the greatest diagnostic challenges facing clinicians. The list pathogens related to intrauterine infections continues to grow with the identification of new etiologies and resurgence of others. Identification of a congenital infection as early as possible has both diagnostic and therapeutic advantages. This article will give an overview on common clinical findings in infants with congenital infection and a recommended clinical investigational approach for suspected congenital infection

Influenza viruses in children attending major referral center in Saudi Arabia.

Full text is available as a scanned copy of the original print version.

Influenza viruses in children attending major referral center in Saudi Arabia.

Full text is available as a scanned copy of the original print version.

Respiratory viruses in children attending a major referral centre in Saudi Arabia.

Viral respiratory infections are common causes of illness in infants and children. Examination of clinical specimens submitted for diagnosis during a 3-year period (August 1993-July 1996) at King Faisal Specialist Hospital and Research Center (KFSH & RC) in Riyadh revealed a wide spectrum of diseases associated with the isolation of five respiratory viruses. Severity of disease ranged from mild upper respiratory illness to threatening lower respiratory illnesses including bronchiolitis and pneumonia. Of the 256 isolates, respiratory syncytial virus (RSV) accounted for 73 (28.5%), adenoviruses for 70 (27.3%), influenza viruses for 61 (23.8%), enteroviruses for 39 (15.2%) and para-influenza for 13 (2.3%). Viruses were found more frequently in children attending emergency or paediatric wards than in outpatients. RSV appears in November and the seasonal peak occurs during January and February. Influenza activity begins in September and peaks in November and December. Para-influenza type I emerges in winter and para-influenza type III follows the influenza epidemic and may be detected sporadically in summer. The other viruses (enteroviruses, adenoviruses) were isolated throughout the year.

Enteroviruses at a tertiary care center in Saudi Arabia, 1989-1995.

Enteroviruses (EVs) are among the most common viral pathogens affecting humans. Enterovirus (EV) infections occur worldwide in temperate climates with a marked summer/fall season and have a high year-round incidence in tropical and subtropical areas. In Saudi Arabia, the epidemiology of enteroviruses is unknown. Of the clinical specimens submitted for diagnosis during a six-year period (1989-1995) at King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh, a wide variety of diseases were associated with the isolation of enteroviruses. Among the diseases were herpangina, sepsis-like illness, hand-foot-and-mouth syndrome, laryngotracheitis (croup), aseptic meningitis, pneumonia, and gastrointestinal illness. During the six-year study, a variety of enteroviruses were isolated. Although epidemics were seen in mid-winter and early spring, EV which may cause sporadic diseases were isolated in each of the 12 months. Health care providers must become aware of the epidemic potential not only in mid-winter and early spring, but also throughout the year, as this will aid in the diagnosis and management of this illness.

High proportion of multi-drug resistant Mycobacterium tuberculosis in Saudi Arabia.

289 patients with TB, presented to a single tertiary care unit in Saudi Arabia between 1989 and 1994. The isolate from each patient was tested for in vitro susceptibility to rifampicin, isoniazid, ethambutol, pyrazinamide and streptomycin. 25 patients (8.7%) had isolates resistant to at least 1 anti-tuberculous drug. Single drug resistance (SDR)-mainly isoniazid-occurred in 14, and resistance to at least 2 drugs (multi-drug resistance-MDR) in 11, of which 8 were due to both isoniazid and rifampicin. Previous drug treatment occurred significantly more often in patients with MDR (8/11), than SDR (1/14) (p = 0.0021). A literature review of another 5571 patients from Saudi Arabia with TB revealed an incidence of resistance of M. tuberculosis isolates to at least 1 anti-tuberculous drug tested, of between 5.9% and 44%. The overall percentage of patients with resistant tuberculosis (including our own patients) was 14.9%. Resistance to streptomycin (8.9%), isoniazid (6.6%), and rifampicin (6.1%) were the commonest reported. There were as many patients with MDR as there were SDR. A history of previous anti-tuberculous treatment was found in over 40%. The high rate of anti-tuberculous resistance in Saudi Arabia may be due to poor supervision of anti-TB treatment, the embryonic healthcare system, over-the-counter antibiotic availability, treatment of endemic diseases such as brucella with rifampicin etc., a large migrant work force, and possibly increased toxicity of anti-tuberculous drugs secondary to the high incidence of chronic liver disease in the country.

Viral contamination of environmental surfaces on a general paediatric ward and playroom in a major referral centre in Riyadh.

In order to determine the incidence of viral contamination of environmental surfaces in a hospital in Saudi Arabia. A 6-month prospective study was carried out on a general paediatric ward in which both enteric and respiratory viruses were screened. Weekly samples were taken between August 1993-February 1994. A total of 155 samples were taken in which 11 (7%) tested positive for rotavirus. No other viruses were detected. Internal and external temperatures were monitored and an increase in rotavirus incidence was noted with decrease in temperature. Rotavirus was detected on surfaces involving human activity (toilet handles, televisions, toys and vital signs chart). One patient had rotavirus on his hands but no staff were found to carry rotavirus. Further contamination of environmental surfaces (9%) was detected during an increased incidence of rotavirus infection. A proper programme of disinfection and handwashing is essential in order to eliminate this mode of transmission.