Polymerase chain reaction for diagnosis and identification of distinct variants of Crimean-Congo hemorrhagic fever virus in the United Arab Emirates.

Viral hemorrhagic fever has re-emerged in the United Arab Emirates (UAE) since November 1993. Genomic RNA of Crimean-Congo hemorrhagic virus (C-CHFV) was detected by a newly developed, nested reverse transcriptase polymerase chain reaction (RT-PCR) in the sera of four (25.0%) of 16 suspected cases of viral hemorrhagic fever. The RT-PCR was based on oligonucleotide primers deducted from the small RNA segment encoding the nucleoprotein of the virus. By comparison with a nucleotide sequence of a C-CHFV isolate from a Chinese sheep, a divergence of 10.0-11.8% was detected in the C-CHFV variants causing the UAE outbreak. In the four positive sera, three phylogenetically distinct C-CHFV variants were amplified and confirmed by direct sequencing of the PCR fragments. These C-CHFV sequences were obtained directly from sera of infected humans without prior propagation in cell culture. The RT-PCR allows rapid detection of genomic C-CHFV RNA in clinical specimens and study of the molecular epidemiology of this infection.

Laboratory diagnosis of Haemophilus ducreyi: sensitivity of culture media.

Laboratory confirmation of the clinical diagnosis of chancroid requires the isolation of Haemophilus ducreyi. Enriched gonococcal (GcHbS) and Mueller-Hinton agar (MHHb) both support the growth of most strains of H. ducreyi. In this study we compared the isolation rate of H. ducreyi on GcHbs and MHHb media in 111 men with genital ulcer disease. A second culture was obtained in 84 men at 48 hr in order to determine the reproducibility of H. ducreyi culture. The sensitivity of a single and a sequential pair of cultures on GcHbS was 67% and 74%, respectively, on men with presumed chancroid. The sensitivity of the MHHb as a single culture was 53%. Using both media for the initial culture of genital ulcers, and repeating the culture on GcHbs at 48 hr, increased the sensitivity of the isolation of H. ducreyi to 92% in men who had no prior antimicrobial use and who had no laboratory evidence of primary syphilis.

Isolation and identification of Haemophilus ducreyi in a clinical laboratory.

Routine procedures used to isolate Haemophilus ducreyi in a busy laboratory are reported. Identification was based on colony morphology and nutritional and biochemical properties of 120 fresh isolates of H. ducreyi. These isolates grew very well on Gonococcal Agar and Mueller-Hinton Agar incubated at 34 degrees C in candle extinction jars containing moistened filter paper. Colonies varied in size, giving a polymorphic appearance. They were smooth, dome-shaped, and buff-yellow to grey in colour, and measured 2 mm in diameter. They could be pushed intact across the agar surface. By microscopic examination of gram-stained smears the isolates were gram-negative coccobacilli arranged in short chains, clumps or whorls and occasionally in typical "rail track" arrangements. Individual bacteria showed bipolar staining. Colonies autoagglutinated in saline. All strains were catalase-negative and did not produce indole or H2S. They were oxidase- and beta-lactamase positive and required X but not V factor for growth. Now that reliable techniques have been developed and characteristics established it is possible for most clinical laboratories to isolate and identify this organism from most patients with chancroid.

Systemic antibiotic prophylaxis in elective cesarean delivery.

OBJECTIVE: To test the value of using prophylactic antibiotics at elective cesarean delivery. METHOD: One-hundred and twenty women delivered by elective cesarean in the absence of labor and before the rupture of membranes were randomized to receive either 1.5 g of cefuroxime intravenously at cord clamping (n = 59) or no prophylaxis (control group, n = 61). RESULTS: Twelve women developed febrile morbidity (six study, six control, P = 0.09). Of these, five had endometritis (two study, three control, P = 0.09) and two had wound infection (one study, one control, P = 0.09). Ten more women had microbiological evidence of endometritis and wound infection (six study, four control, P = 0.08). There was no significant difference in the hospital stay (6.5 days study, 6.8 days control, P = 0.06). Staphylococcus aureus was the commonest pathogen accounting for 14 infection episodes. Amniotic fluid culture could not predict the development of infection. CONCLUSION: Administration of prophylactic antibiotics at elective cesarean deliveries was not associated with decreased postoperative morbidity.

In vitro antibacterial activity of Omani and African honey.

The study aims to investigate the antibacterial activity of honey obtained from different parts of Oman and compare it with that of honey obtained from elsewhere in Africa. A total of 24 honey samples (16 from different parts of Oman and eight from elsewhere in Africa) were investigated for their antibacterial activity against Staphylococcus aureus (NCTC 6571), Escherichia coli (NCTC 10418) and Pseudomonas aeruginosa (NCTC 10662) using standard antimicrobial assays. Marked variations in the antibacterial activity of the different honey samples were observed. Fourteen of the 16 Omani samples and five of the eight African samples showed antibacterial activity ranked as either fair, good or excellent to at least one of the three bacterial strains tested. Both Omani and African honeys possess in vitro antibacterial activity against the three bacterial strains tested, with 25% of the samples showing excellent antibacterial activity.

Gonococcal drug resistance and treatment of gonorrhoea in Nairobi.

PIP: The in vitro antibiotic sensitivities of 108 isolates of Neisseria gonorrhoeae from a Nairobi clinic were determined by the agar dilution method. The results indicate that the majority of gonococci were relatively resistant to penicillin (86%) and to tetracycline (85%). By using the relationship between the in vitro antibiotic sensitivity of gonococci and treatment failure of gonorrhea in US patients, we predict that the minimum treatment failure rate for the gonorrhea treatment schemes used in the US would be 5.6% for aqueous procaine penicillin G, 4.8 megaunits intramuscularly together with 1.0 g probenecid by mouth; 6.9% for oral tetracycline HC1, given 500 mg 4 times daily for 5 days; 10.4% for a single oral dose of ampicillin, 3.5 g together with 1.0 g of oral probenecid; and 6.2% for a single dose of spectinomycin, 2.0 g intramuscularly. Gonococcal drug resistance and morbidity will likely continue to increase in Kenya in the absence of a gonorrhea control program.^ieng

Problems and approaches in the surveillance and control of sexually transmitted agents associated with pelvic inflammatory disease in Africa.

The problems in surveillance of sexually transmitted disease (STD) in Africa are numerous and are based mainly on socioeconomic barriers. Policies for controlling STD are either inadequate or nonexistent in many African countries. Gonococci are becoming increasingly insusceptible to penicillin and other drugs because of widespread use of inadequate therapy. Gonorrhea is recognized as the major pathogen of pelvic inflammatory disease in Africa. The magnitude of the PID problem is so great that current efforts are directed at case treatment rather than surveillance and control. The formation of the African Union Against Venereal Diseases and Treponematoses is an important step, and its suggestions and resolutions form a sound basis for improved STD control in Africa.

AUVDT recommendations for management of gonorrhoea and genital ulcers in Africa.

PIP: The African Union Against Venereal Diseases and Treponematoses (AUVDT), inaugurated in 1979, held its 3rd biannual conference in Nairobi in March 1983 with local participants and participants from 15 English and French speaking countries as well as from Europe, USA and Canada. The conference was devoted to high level training and discussion, workshops on genital ulcer diseases (GUD) and scientific sessions during which many papers were read and discussed. Resolutions and recommendations were made concerning STD in Africa and later passed on to relevant health authorities for necessary action. It was agreed that all African governments who have not already done so should set their own STD control committees as soon as possible. The establishment of microbiological laboratories was strongly urged as well as specific training of health workers. It was felt that gonorrhea and genital ulcer disease were the most frequent sexually transmitted diseases and so management recommendations were made. The efficacy of current regimens using penicillin is increasingly dropping and trimethoprim sulfametrole should be substituted. Failure rates of over 10% would indicate the need to review the accepted regimen. The ideal drug should be effective, orally administered as a single dose, whithout harmful side-effects and preferably not masking syphilis. National programs can purchase drugs through WHO's and UNICEF's purchasing channels at very low prices and governments should utilize these channels. Monitoring of antimicrobial sensitivities should be encouraged and assistance should be sought from university departments of microbiology whenever possible. Genital Ulcer Disease (GUD) is an important public health problem in Africa. Chancroid is the most frequently diagnosed and etiologically proven GUD in eastern, central and southern Africa, accounting for 3-60% of GUD cases. Syphilis, herpetic ulceration, lymphogranuloma venereum and donovanosis are other GUDs found in Africa. Consideration of efficacy, availability, and compliance should be given to treatment. Recent studies have shown that single doses or short-term therapy regimens are as efficient for both ulcers and bubos. Syphilis may be treated with benzathine penicillin im or aqueous procaine penicillin G. No current curative therapy is available for herpes. Local management includes keeping lesions clean and dry; symptomatic treatment involves giving analgesics.^ieng

Gonococcal scalp abscess in a neonate delivered by caesarean section.

Gonococcal infection in caesarean delivered babies is very rare and is usually limited to ophthalmia neonatorum. The mother had rupture of membranes 14 hours before the caesarean section. The infection was most likely introduced by the fetal scalp electrode probes applied 2 hours before delivery. This is the first reported of a neonatal gonococcal abscess in a caesarean delivered infant.

Gonorrhea and female infertility in rural Uganda.

We studied sociocultural and medical factors in the Teso District in eastern Uganda and the Ankole District in western Uganda to discover the cause of the low and high fertility rates in these respective districts. The findings related to gonorrhea in women are presented in this article. Gonococcal cervicitis and clinical evidence of salpingitis occurred significantly more frequently in Teso (18.3% and 19%, respectively) than in Ankole (2.4% and 5.9%) women. Significantly more of the husbands of the gonococcal-negative infertile women compared to gonococcal-negative fertile women were found to have active gonorrhea, a past history of urethral discharge, and bilaterally thickened epididymides.

PIP: Teso District in eastern Uganda with low fertility (crude birth rate in 1969 was 37/1000), and Ankole District in western Uganda with high fertility (55/1000), were selected to study malaria, nutrition, gonorrhea, and syphilis. The gonorrhea methodology for women included genital examination and endocervical smears and cultures. Husbands of gonococcal-negative fertile and infertile women also were examined for the presence of gonorrhea and evidence of infection in the past. Three hundred and forty-three women in Teso and 250 in Ankole underwent medical examination. In the Teso District, 84 (25%) of the women, as compared with 22 (8.9%) in Ankole, complained of lower abdominal pain (p 0.001). Seven women in Teso but none in Ankole had signs of bartholinitis. Mucopurulent discharge in the vagina was found in 56 (19%) of the Teso women as compared with 17 (10%) of the Ankole women (p 0.02). 90 (30.5%) of the women in Teso but only 21 (12.5%) women in Ankole had an eroded and/or infected cervix (p 0.001). Evidence of salpingitis was obtained in 56 (19%) of the Teso women as compared with 10 (5.9%) Ankole women (p 0.001). A tender adnexal mass was felt in 23 (7.8%) of the Teso sample but in only one (0.6%) in Ankole. Among the women in Teso, 54 (18.3%) had a positive cervical smear or culture for gonorrhea, but only four (2.4%) in Ankole had similar positive tests (p 0.001). Evidence of pelvic inflammatory disease was present in 17% of the infected Teso women. None of the infected Ankole women, however, had PID. Cervical secretions showed gonococci in only 10% of the infertile women as compared with 23% of the fertile women. However, 24.5% of husbands of the gonococcal-negative infertile women, as compared with 6.7% of husbands of the gonococcal-negative fertile women, were found to have active gonorrhea (p 0.01). In this group 75.5%, and 57.7% of husbands, respectively, had a past history of urethral discharge (p 0.05), while 18.4% and 5.8%, respectively, had bilaterally thickened epididymides (p 0.05).

Clinical features of Crimean-Congo haemorrhagic fever in the United Arab Emirates.

Crimean-Congo haemorrhagic fever (C-CHF) re-emerged recently in the United Arab Emirates. The clinical outcome of 11 cases of viral haemorrhagic fever patients admitted to hospital between June 1994 and January 1995 is described. Four cases were laboratory confirmed retrospectively as C-CHF, the other patients were diagnosed likely to have the same disease on epidemiological and clinical grounds. In 72.7% of the patients, infection was fatal. Symptoms started 3.5 days before hospitalization. On admission, 81.8% of patients had high fever, 45.5% were vomiting, 63.6% had diarrhoea, 45.5% had haemorrhagic signs, and 18.2% had throat pain. Fatalities occurred 6.8 days after admission. Survivors were hospitalized for 9.3 days. Nosocomial transmission was not observed.

Group A streptococcal throat colonization is a dynamic phenomenon.

In order to gain knowledge about the nature of group A streptococcal throat colonization of asymptomatic children, we studied a cohort of healthy children selected at random. Those with throat cultures positive for group A Streptococci (GAS) were followed for 5 weeks. Repeat throat swabs were obtained at weekly intervals for antigen detection and culture. GAS obtained were serotyped for T antigen. Twenty-two children were identified as having GAS and 50% had a positive antigen test and culture at least five times in 6 weeks. There was no consistent pattern in the typeable organisms. Most individuals had more than one T-type alternating with non-T-typeable organisms. We conclude that colonization may be a dynamic process involving numerous organism serotypes, which wax and wane.

Aetiology of onychomycosis in Al Ain, United Arab Emirates.

A 1-year study was conducted on 151 patients with finger- or toenail disease attending a dermatology clinic in Al Ain, United Arab Emirates. Nail scrapings and or clippings were collected and investigated with a KOH preparation for direct microscopy and cultured for fungi. Eighty-nine (59%) patients were females. Most females (62%) presented with fingernail disease while in men the toenails were involved in 76%. Fungi were isolated in 78 (52%) of all cases and the fingernails were more commonly positive than toenails. Of the 78 isolates, 49 (63%) were yeasts, including eight Candida species, dermatophytes accounted for 22 (28%) and seven (9%) were other moulds. Non-dermatophyte moulds constituted 20% of male isolates but only 4% of female isolates. Eighty-one per cent of Candida species were from fingernails, while 87% of all the dermatophytes were from toenails.

Single-dose therapy with trimethoprim-sulfametrole for chancroid in females.

Women with genital ulcer disease who were culture-positive for Haemophilus ducreyi were treated with a single dose of the drug combination trimethoprim-sulfametrole; the dosage was 640 mg of trimethoprim and 3,200 mg of sulfametrole. All 27 women who were treated with this regimen and adequately followed were cured. Thus a single dose of trimethoprim-sulfametrole appears to be an effective treatment regimen for women with chancroid in Kenya.

The prevalence of group A streptococcal throat carriage in Al Ain, United Arab Emirates.

The aim of this study was to establish the carrier rate of group A beta haemolytic streptococci in school children in Al Ain, United Arab Emirates. One thousand and two randomly selected school children aged 5-7 years had their throats swabbed twice for both culture and direct antigen detection of group A streptococci. One hundred and fourteen children (11.3%) had both a positive antigen and culture test, while 216 (21.6%) had antigen-positive tests only and 16 (1.5%) had a positive culture only. Thus, the combination of culture and antigen detection revealed a carrier rate of 35.4% in the children examined. We conclude that in an affluent but isolated desert area on the Tropic of Cancer, group A streptococcal carriage rate is high. Antigen detection is superior to culture techniques in asymptomatic carrier studies.

Ophthalmia neonatorum in the United Arab Emirates.

Ophthalmia neonatorum in small babies is a common problem in neonatal units in Al Ain, but is infrequently associated with sexually transmitted disease agents. A study of 81 babies with ophthalmia neonatorum showed that 81.5% had bacterial or fungal infections. Staphylococcus aureus was the commonest causative organism followed by Escherichia coli and Pseudomonas aeruginosa while Chlamydia trachomatis and Neisseria gonorrhoeae were responsible for less than 5% of all cases. The disease was predominantly mild to moderately severe and easily treated with topical broad-spectrum antibiotic agents which are effective against Gram-positive and Gram-negative bacteria, including hospital-associated strains. The most effective antimicrobial agents were gentamicin topically or ceftriaxone systemically.

PIP: Neonatal conjunctivitis is common in many developing countries, often due to a sexually transmitted disease (STD) such as Chlamydia trachomatis and Neisseria gonorrhoea. The prevention of ophthalmia neonatorum (ON) depends considerably upon knowledge of the type and incidence of the causative organisms, just as the recommended treatment protocols for ON vary according to the local causative microorganisms and their sensitivity to available antimicrobial agents. ON is a common problem in the neonatal units of Al Ain, but infrequently associated with STD agents. A study found 81.5% of 81 babies with ON to have either bacterial or fungal infections. Staphylococcus aureus was the most common causative organism followed by Escherichia coli and Pseudomonas aeruginosa. Chlamydia trachomatis and Neisseria gonorrhoea were responsible for less than 5% of all cases. The disease was mainly mild to moderately severe and easily treated with topical broad-spectrum antibiotic agents effective against Gram-positive and Gram-negative bacteria, including hospital-associated strains. The most effective antimicrobial agents were gentamicin topically and ceftriaxone systemically.