RESUMEN
Tuberculosis (TB) rates among transplant recipients are 20-74 times higher than in the general population, and have a mortality rate of up to 30%. The majority are potentially preventable. Most cases are reactivated latent infection after immune suppression. Donor-transmitted TB is very rare. We report three cases of TB that were transmitted by organ transplantation from a single donor.
Asunto(s)
Mycobacterium tuberculosis/aislamiento & purificación , Trasplante de Órganos/efectos adversos , Tuberculosis/transmisión , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Donantes de TejidosRESUMEN
OBJECTIVE: To identify the incidence of tuberculosis (TB) in people living with the human immunodeficiency virus (HIV) (PLWH) followed at an HIV referral and care facility. DESIGN: Observational longitudinal cohort. METHODS: Data were collected longitudinally as patients were admitted to the HIV programme and included demographics, TB diagnosis and treatment, CD4+ T lymphocyte count and TB treatment outcomes. The TB-free follow-up period of all patients was used to calculate TB incidence rates. RESULTS: Between 1997 and 2007, 217 new adult patients joined the HIV programme. TB was diagnosed in 16 patients (7.4%), all of whom had acquired immune-deficiency syndrome at the time of TB diagnosis. Seven developed extra-pulmonary disease (44%), six had pulmonary TB (37%), while three had both (19%). The TB incidence rate was 1354 per 100,000 person-years (py) among the HIV-infected cohort. The incidence rate of pulmonary TB was 762/100,000 py and for extra-pulmonary TB it was 592/100,000 py. Seven patients (44%) died despite early diagnosis and treatment for TB. CONCLUSION: Among PLWH in Saudi Arabia, TB incidence is 30 times higher than in the general population, with significant mortality despite early diagnosis, treatment and tertiary care support.
Asunto(s)
Infecciones por VIH/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Recuento de Linfocito CD4 , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Infecciones por VIH/complicaciones , Humanos , Incidencia , Estudios Longitudinales , Masculino , Arabia Saudita/epidemiología , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/patología , Adulto JovenRESUMEN
OBJECTIVE: To study the clinical and pathological patterns of tuberculosis (TB) involving the bone marrow in a tertiary care setting. METHODS: A retrospective study of cases of bone marrow TB diagnosed and treated at King Faisal Specialist Hospital and Research Center from 1990 to 2002. The main criterion for inclusion was the isolation of Mycobacterium tuberculosis from a bone marrow specimen. RESULTS: We identified 22 patients with culture-proven M. tuberculosis infection of the bone marrow. Underlying conditions found in this series include solid organ transplantation in 4 patients (18%), HIV infection in 2 (9%), and diabetes in 3 (14%). No risk factor was identified in 12 patients (55%). Histopathological findings were reported as granuloma in 19 patients (86%) and caseating granuloma in 3 (14%). The outcome was favourable for 11 patients (50%), while 10 (45%) died during hospitalisation and one was lost to follow-up. For patients who completed their regimens, the duration of treatment was 12 months. CONCLUSION: The isolation of M. tuberculosis from a bone marrow specimen is an indication of disseminated disease which carries a high mortality rate and requires prompt initiation of appropriate treatment.
Asunto(s)
Enfermedades de la Médula Ósea , Tuberculosis , Enfermedades de la Médula Ósea/diagnóstico , Enfermedades de la Médula Ósea/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológicoRESUMEN
Clinical presentation, CD4+ T lymphocyte count at diagnosis, and reasons for HIV-1 testing reflect the attitudes towards HIV testing and also the ability of the health-care system to diagnose HIV early. In a cross-sectional study from the HIV database in a large HIV-referral centre in Saudi Arabia, all 410 HIV-infected patients were included, 276 men and 134 women. Women were younger at diagnosis (mean age 25.5 compared with 29 years for men, P < 0.04) and had higher CD4+ T lymphocytes (mean 461 for women and 223 for men, P < 0.001). Out of 276 men, 90 (33%) were identified as HIV infected when they presented with AIDS. Fifty-five percent of the infected women were tested for HIV-1 because of contact with an infected person compared with 8% of the infected men, odds ratio (OR) 13.8 (95% confidence interval [CI]: 7.7-24.9). AIDS remains the main presentation for HIV-infected men. Women are diagnosed earlier and younger than men.
Asunto(s)
Recuento de Linfocito CD4 , Infecciones por VIH/diagnóstico , VIH-1/aislamiento & purificación , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Seropositividad para VIH/epidemiología , Seropositividad para VIH/inmunología , Humanos , Masculino , Arabia Saudita/epidemiologíaRESUMEN
OBJECTIVE: To determine the rate and type of anti-tuberculosis drug resistance at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. DESIGN: Review of microbiology and infection control databases for all patients with culture-positive Mycobacterium tuberculosis between June 1981 and May 2003 at the hospital. BACTEC 460TB radiometry then MGIT 960 were used for both mycobacterial detection and antimicrobial susceptibility testing. RESULTS: A total of 764 M. tuberculosis isolates were obtained from 764 patients. Resistance to first-line agents (isoniazid, rifampicin, ethambutol and streptomycin) was noted in 65 (8.5%). Resistance to isoniazid was the highest, noted in 54 (7.1%); resistance to rifampicin, streptomycin and ethambutol was found in respectively 21 (2.7%), 29 (3.8%) and 12 (1.6%) isolates. Polyresistance was noted in eight (1%) isolates and monoresistance in 38 (5%) isolates. Multidrug-resistant M. tuberculosis was found in 19 (2.5%) isolates. There were 54 primary resistant isolates (7.6%), and 11 (22%) with acquired resistance. The median age of patients with resistant isolates was 38 years compared to 48 years for patients with sensitive isolates (P = 0.002). CONCLUSION: Resistance to first-line anti-tuberculosis agents and multidrug-resistant M. tuberculosis remain relatively low in Saudi Arabia.
Asunto(s)
Antituberculosos/farmacología , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Arabia Saudita/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/prevención & controlRESUMEN
Cutaneous Leishmaniasis is a vector-borne protozoal infection of the skin. Several species of Leishmania cause this disease in the Old World. It is manifested as chronic nodular to ulcerative lesions of the skin, which last for many months and may be disfiguring. They eventually heal leaving a scar. Local care of the lesion and treatment of secondary bacterial infection are essential for healing. Antileishmania therapy is indicated in immunocompromised hosts, patients with progressive, multiple, or critically located lesions. Pentavalent antimony compounds remain the main therapeutic option for all species. They are given intravenously (i.v.), intramuscularly (i.m.), or intralesionally. Cryotherapy, and some systemic antifungal agents have been used successfully. Oral azoles are promising new treatments for lesions caused by L. Major. Several other alternatives and their evidence are also presented.
Asunto(s)
Antiprotozoarios/uso terapéutico , Leishmaniasis Cutánea/tratamiento farmacológico , Antiprotozoarios/administración & dosificación , Humanos , Leishmaniasis Cutánea/microbiologíaRESUMEN
We conducted a retrospective study with the aim of identifying risk factors and clinical characteristics associated with HBV reactivation and clinical flare after allogeneic stem cell transplantation (aSCT). We reviewed the King Faisal Specialist Hospital and Research Center International Bone Marrow Transplant Registry database from January 1998 to June 2000. Complete serological screening for HBV was available in 128 of 131 patients transplanted during that period. Fifty-four (42%) had evidence of prior infection and recovery from HBV before transplant (hepatitis B core antibody positive, B surface antigen negative). Forty-two were evaluable for HBV reactivation and clinical flare. Six (14%) reactivated with clinical flare as documented by seroconversion and/or positive HBV DNA in the serum with biochemical hepatitis at 5.5, 18, 18, 19, 21 and 23 months post-transplant. Five of fifteen patients with chronic graft-versus-host disease (cGVHD) reactivated with clinical flare in contrast to 1/27 without cGVHD (RR: 9.0, 95% CI: 1.2-70.1 P < 0.02). HBV reactivation with clinical flare occurred during immunosuppressive therapy tapering or withdrawal in all patients. In conclusion, hepatitis B core antibody positive allogeneic stem cell recipients with cGVHD are at significant risk of HBV reactivation with clinical flare.
Asunto(s)
Enfermedad Injerto contra Huésped/complicaciones , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Hepatitis B/etiología , Adolescente , Adulto , Enfermedad Crónica , ADN Viral/sangre , Femenino , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/crecimiento & desarrollo , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Trasplante Homólogo/efectos adversos , Activación ViralRESUMEN
Our study determined the rate of screening tuberculosis patients for HIV co-infection and the HIV seroprevalence among them. We retrospectively reviewed medical charts of 437 patients diagnosed with tuberculosis from 1995-2000 in Riyadh, Saudi Arabia. Screening was done for 178 (41%) patients: 2 (1.1%) of these were found to be HIV positive. Prior to screening, 4 patients were already known to be HIV positive. Males were screened more often than females (45% and 36% respectively). All HIV positive patients were males. Screening was not affected by origin of the patient, history of prior tuberculosis or treatment, type of tuberculosis involvement or resistance to first line anti-tuberculosis agents. In Saudi Arabia, screening for HIV in tuberculosis patients remains underutilized. Among screened patients, seropositivity was low.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Tamizaje Masivo/organización & administración , Tuberculosis/epidemiología , Serodiagnóstico del SIDA , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Academias e Institutos , Femenino , Seroprevalencia de VIH , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Hospitales Especializados , Humanos , Masculino , Evaluación de Necesidades , Selección de Paciente , Vigilancia de la Población , Derivación y Consulta , Características de la Residencia/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Arabia Saudita/epidemiología , Distribución por Sexo , Tuberculosis/diagnóstico , Población Urbana/estadística & datos numéricosRESUMEN
Our study determined the rate of screening tuberculosis patients for HIV co-infection and the HIV seroprevalence among them. We retrospectively reviewed medical charts of 437 patients diagnosed with tuberculosis from 1995-2000 in Riyadh, Saudi Arabia. Screening was done for 178 [41%] patients: 2 [1.1%] of these were found to be HIV positive. Prior to screening, 4 patients were already known to be HIV positive. Males were screened more often than females [45% and 36% respectively]. All HIV positive patients were males. Screening was not affected by origin of the patient, history of prior tuberculosis or treatment, type of tuberculosis involvement or resistance to first line anti-tuberculosis agents. In Saudi Arabia, screening for HIV in tuberculosis patients remains underutilized. Among screened patients, seropositivity was low
Asunto(s)
Serodiagnóstico del SIDA , Academias e Institutos , Seroprevalencia de VIH , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Hospitales Especializados , Tamizaje Masivo , Evaluación de Necesidades , Selección de Paciente , Características de la Residencia , Distribución por Sexo , Tuberculosis , Infecciones Oportunistas Relacionadas con el SIDARESUMEN
In immunocompetent patients, paranasal invasive aspergillosis is rare and has a high recurrence rate. Twenty-three cases of paranasal invasive aspergillosis, involving 14 male and nine female immunocompetent patients were reviewed. All patients were cancer-free, HIV-negative, with normal WBC, and none of the patients had received immunosuppressive therapy or corticosteroids. Mean duration of symptoms before diagnosis was 18 months. Aspergillus flavus was the species most frequently isolated. Surgical debridement was performed in all patients followed by antifungal therapy in 18 patients. Mean follow-up duration was 30 months. Fourteen patients relapsed after a mean of 13 months and required an average of 4.3 admissions for repeat surgical evacuation. In a logistic regression model, relapse was not associated with age, duration of symptoms, clinical findings, extent of disease, or mode of therapy. However, patients who were relapse-free tended to have had complete surgical evacuation followed by antifungal therapy.
Asunto(s)
Aspergilosis/cirugía , Aspergillus flavus/crecimiento & desarrollo , Enfermedades de los Senos Paranasales/microbiología , Adolescente , Adulto , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Niño , Desbridamiento , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/tratamiento farmacológico , Enfermedades de los Senos Paranasales/cirugía , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Arabia SauditaRESUMEN
Chloroquine-resistant Plasmodium falciparum is endemic in many areas. Saudi Arabia was considered to have chloroquine-susceptible P. falciparum. During the 1997-1998 season, an outbreak of malaria occurred in the southwestern region. Over a 4-month period, 32 cases (6.2%) of 520 malaria admissions met the World Health Organization criteria for cerebral malaria. The mean patient age was 28 years. Thirteen male and 19 female patients were admitted in coma. The mean duration of coma was 4.3 days; the case fatality rate was 41%. Compared with those who recovered, patients who died had a lower mean admission diastolic blood pressure and hemoglobin level, higher mean blood urea nitrogen and blood glucose levels, and thrombocytopenia. Logistic regression analysis identified treatment with quinine rather than chloroquine to be associated with survival. These findings show the potential of P. falciparum to emerge as chloroquine resistant in previously susceptible areas, resulting in significant morbidity and mortality in spite of sophisticated medical care.
Asunto(s)
Antimaláricos/farmacología , Cloroquina/farmacología , Malaria Cerebral/epidemiología , Malaria Cerebral/parasitología , Plasmodium falciparum/efectos de los fármacos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Resistencia a Medicamentos , Femenino , Humanos , Lactante , Malaria Cerebral/patología , Masculino , Persona de Mediana Edad , Arabia Saudita/epidemiologíaRESUMEN
Bone marrow transplant (BMT) recipients are prone to bacterial, viral and fungal infections. Mycobacterium tuberculosis infection can occur in these patients, but the incidence is lower than that of other infections. This report describes four patients with Mycobacterium tuberculosis infection identified from 641 adult patients who received a BMT over a 12-year period (prevalence 0.6%). The pre-transplant diagnosis was AML in two patients and CML in the other two. Pre-transplant conditioning consisted of BU/CY in three patients and CY/TBI in one. Graft-versus-host disease (GVHD) prophylaxis was MTX/CsA in three patients and T cell depletion of the graft in one patient. Sites of infection were lung (two), spine (one) and central nervous system (one). Onset of infection ranged from 120 days to 20 months post BMT. Two patients had co-existing CMV infection. One patient had graft failure. The two patients who received anti-tuberculous (TB) therapy recovered from the infection. Although the incidence of tuberculosis in BMT patients is not as high as in patients with solid organ transplants, late diagnosis due to the slow growth of the bacterium can lead to delay in instituting anti-TB therapy. A high index of suspicion should be maintained, particularly in endemic areas.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Huésped Inmunocomprometido , Leucemia Monocítica Aguda/terapia , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Leucemia Mieloide de Fase Crónica/terapia , Leucemia Mielomonocítica Aguda/terapia , Trasplante Homólogo/efectos adversos , Tuberculosis/etiología , Absceso/diagnóstico , Absceso/tratamiento farmacológico , Absceso/etiología , Adulto , Antituberculosos/uso terapéutico , Encefalitis/etiología , Resultado Fatal , Femenino , Rechazo de Injerto , Enfermedad Veno-Oclusiva Hepática/etiología , Humanos , Leucemia Monocítica Aguda/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucemia Mieloide de Fase Crónica/complicaciones , Leucemia Mielomonocítica Aguda/complicaciones , Masculino , Insuficiencia Multiorgánica/etiología , Prevalencia , Sepsis/etiología , Acondicionamiento Pretrasplante/efectos adversos , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/etiología , Tuberculosis de la Columna Vertebral/diagnóstico , Tuberculosis de la Columna Vertebral/tratamiento farmacológico , Tuberculosis de la Columna Vertebral/etiologíaRESUMEN
Full text is available as a scanned copy of the original print version.
Asunto(s)
Trasplante de Riñón/efectos adversos , Leishmania donovani/aislamiento & purificación , Leishmaniasis Mucocutánea/parasitología , Enfermedades de la Lengua/parasitología , Lengua/parasitología , Anfotericina B/uso terapéutico , Animales , Antiprotozoarios/uso terapéutico , Humanos , Huésped Inmunocomprometido , Itraconazol/uso terapéutico , Leishmaniasis Mucocutánea/tratamiento farmacológico , Liposomas , Masculino , Persona de Mediana Edad , Lengua/patología , Enfermedades de la Lengua/tratamiento farmacológico , Enfermedades de la Lengua/patología , Resultado del TratamientoRESUMEN
Corticosteroids are beneficial as treatment of certain tuberculosis syndromes. We reviewed all cases of peritoneal tuberculosis diagnosed at our institution over 10 years to evaluate the role of corticosteroid administration combined with antituberculous therapy. Nine patients were treated with steroids plus antituberculosis agents (cases), and 26 received antituberculosis treatment only (controls). The two groups were not significantly different in terms of their basic demographics or disease. Nineteen controls compared with one case had recurrent abdominal pain. Seven controls had 17 emergency department visits because of abdominal pain. Intestinal obstruction was diagnosed for five of these patients, four of whom underwent laparotomy revealing extensive adhesions. Three controls died, and no case died. No case required laparotomy, had a diagnosis of intestinal obstruction, or visited the emergency department because of abdominal pain. These findings suggest that corticosteroid administration combined with antituberculosis treatment reduces the frequency of morbidity and complications in patients with peritoneal tuberculosis.