Q fever: a neglected zoonosis in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Infection due to Coxiella burnetii (C burnetii), the causative agent of Q fever is rarely sought for in clinical practice. This study was performed to detect C burnetii infection in patients with pyrexia of undetermined cause (PUC). DESIGN AND SETTINGS: This is a prospective study conducted at King Khalid University Hospital, Riyadh be.tween March 2011 and January 2013. PATIENTS AND METHODS: A total of 3 mL venous blood was collected from 51 patients with PUC at King Khalid University Hospital, Riyadh. This group of patients included 30 males and 21 females (mean age 33.9 [21.3] years) with the history of febrile illness ranging between 4 and 8 weeks. A control group of 50 healthy individuals comprising 39 males and 11 females (mean age 27 [9] years) was also included in the study. Detection of phase II C burnetii-specific IgG antibodies was performed by immunofluorescence assay, and a titer of > 1:64 was considered positive. RESULTS: Phase II C burnetii-specific IgG antibodies were detected in 18 (35.2%) patients out of the total 51 tested. Two (4%) individuals out of 50 in the control group tested positive for anti-C burnetii IgG antibodies. The proportion of positive results among the patients was significantly higher than the controls (P < .0002, 95% CI, 15.09-46.25). The antibody titer range was between 1:128 and 1:1024 where 6 patients had titers of 1:256, 5 had 1:512, 4 had 1024, and 3 had 1:128. CONCLUSION: The evidence of C burnetii infection in a sizable number of patients emphasizes the need for inclusion of serologic investigations for Q fever in patients with PUC.

Modifications influencing Widal test reactivity in a novel microplate assay.

Reliability of the Widal tube agglutination test has been the subject of many controversies over the years. This study was performed to assess the effect of certain modifications on the performance of Widal test in a novel microplate assay. Sera from 37 patients (21 males; 16 females) (mean age 28 +/- 7 years) were tested in the Immunology Unit at King Khalid University Hospital, Riyadh. Among them were 26 patients with suspected typhoid fever and 11 had bacteriologically confirmed diagnosis of Salmonella infection. The modifications included either the use of 0.5% bovine serum albumin (BSA), absorption of sera with sheep red blood cells (SRBC) or heat inactivation of sera. Compared with Widal tube agglutination test, microplate assay with SRBC absorption of the sera from patients with suspected typhoid fever was not only associated with enhancement of detection titers for both H (p < or = 0.001) and O (p < or = 0.005) Salmonella agglutinins but also the percentage of reactivity. The presence of BSA augmented detection titers for Salmonella H agglutinins (p < or = 0.02) only. Heat inactivation of sera however was found to be associated with reduction in the detectable titers for both H (p < or = 0.03) and O (p < or = 0.01) agglutinins. Increased titers of Salmonella agglutinins were also evident in 11 patients with confirmed diagnosis of Salmonella infection. The novel microplate agglutination assay using the SRBC absorption was associated with enhancement in Widal test reactivity and appears to be a useful alternative for the diagnosis of Salmonella infection.

Pattern of patch test reactivity among patients with clinical diagnosis of contact dermatitis: a hospital-based study.

BACKGROUND AND OBJECTIVES: Contact allergy is associated with a significant morbidity all over the world. This study was performed to investigate the pattern of sensitization by contact allergens in the local population. DESIGN AND SETTING: Retrospective study to investigate patch test reactivity among patients with clinical diagnosis of contact dermatitis who were referred to the allergy clinic at the King Khalid University Hospital, Riyadh, between April 2008 and March 2010. PATIENTS AND METHODS: Of the 196 patients referred to the allergy clinic over the 2-year period, 91 (46.4%) patients reacted to one or more patch test allergens, and these patients were included in this study. The study group included 82 (91.1%) of Saudi nationality and 9 (8.9%) patients of other nationalities. The patch test was performed using the T.R.U.E TEST, containing 24 allergens/allergen mixes. RESULTS: Of the 91 cases who reacted positively to one or more allergens, 67 (73.6%) were females with a mean age of 37 (8.3 years) and 24 (26.4%) were males with a mean age of 34 (11.6 years). Thirty-three (36.2%) patients reacted to nickel sulfate, 14 (15.3%) to p-phenylenediamine, 13 (14.2%) to p-tert-butylphenol-formaldehyde resin, 13 (14.2%) to thimerosal, and 9 (9.8%) to colophony. Reactivity against the rest of the allergens was not remarkable. A significantly higher percentage of females reacted to nickel sulfate (84.8% vs 15.2% in males;P=.0001), p-tert-butylphenol-formaldehyde resin (92.3% vs 7.7%; P=.0001), and thimerosal (76.9% vs 23.1%;P=.03). CONCLUSIONS: Patch test reactivity to nickel sulfate was high. The pattern of contact allergy observed in this study indicates the need for large-scale investigations to identify local allergens responsible for contact allergy and for formulation of policies directed towards avoidance of exposure.