RESUMO
Coronavirus disease 2019 (COVID-19) may present as acute abdomen, although the pathophysiology remains obscure. We report the case of a 45-year-old-man with severe COVID-19 pneumonia with associated pulmonary embolism who presented with acute abdomen. He underwent emergency laparotomy and resection of an ischaemic area of the jejunum. Postoperatively, he had septic shock, acute respiratory distress syndrome and acute kidney injury necessitating continuous renal replacement therapy. We administered antibiotics and therapeutic anticoagulation along with two sessions of haemoadsorption by CytoSorb filter, in conjunction with continuous renal replacement therapy. The patient survived. Bowel ischaemia due to thromboembolic disease should be promptly treated. Extracorporeal blood purification may be useful in managing sepsis in severe COVID-19.
Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Coronavírus da Síndrome Respiratória do Oriente Médio , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Síndrome Respiratória Aguda Grave/diagnóstico , Tomografia Computadorizada por Raios X/métodos , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/epidemiologiaRESUMO
The Méditerranée Infection institute is internationally recognized for its expertise in infectious diseases and tropical medicine, and is one of the most active research centres for infectious diseases in Europe. Surveillance and research addressing infectious diseases in globally mobile populations is one of the strong components of the research conducted at the institute. A significant amount of clinical, microbiologic and epidemiologic works have been conducted in international travellers, pilgrims participating in large international religious gatherings, economic migrants and homeless migrant people over the last decades by our group. Our strong anchoring in several countries around the Mediterranean Sea and beyond, as well as the pivotal role of Marseille in the EuroTravNet and GeoSentinel international networks that monitor travel-associated diseases, reinforce our leading position in the fields of travel and tropical medicine, mass gathering medicine and homeless health.
RESUMO
The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in September 2012 in Saudi Arabia had attracted the attention of the global health community. In 2017 the Saudi Ministry of Health released a visual triage system with scoring to alert healthcare workers in emergency departments (EDs) and haemodialysis units for the possibility of occurrence of MERS-CoV infection. We performed a retrospective analysis of this visual score to determine its sensitivity and specificity. The study included all cases from 2014 to 2017 in a MERS-CoV referral centre in Riyadh, Saudi Arabia. During the study period there were a total of 2435 suspected MERS cases. Of these, 1823 (75%) tested negative and the remaining 25% tested positive for MERS-CoV by PCR assay. The application of the visual triage score found a similar percentage of MERS-CoV and non-MERS-CoV patients, with each score from 0 to 11. The percentage of patients with a cutoff score of ≥4 was 75% in patients with MERS-CoV infection and 85% in patients without MERS-CoV infection (p 0.0001). The sensitivity and specificity of this cutoff score for MERS-CoV infection were 74.1% and 18.6%, respectively. The sensitivity and specificity of the scoring system were low, and further refinement of the score is needed for better prediction of MERS-CoV infection.
RESUMO
During the 2012 Hajj season, the risk of acquisition of Staphylococcus aureus nasal carriage in a cohort of French pilgrims was 22.8%, and was statistically associated with the acquisition of viral respiratory pathogens (p 0.03). The carriage of S. aureus belonging to the emerging clonal complex 398 significantly increased following the pilgrimage (p < 0.05).
Assuntos
Portador Sadio/epidemiologia , Aglomeração , Mucosa Nasal/microbiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Adulto , Idoso , Estudos de Coortes , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Religião , Arábia Saudita , Infecções Estafilocócicas/transmissão , ViagemRESUMO
Antibiotics were once considered the miracle cure for infectious diseases. The tragedy would be the loss of these miracles as we witness increased antibiotic resistance throughout the world. One of the concerns during mass gatherings is the transmission of antibiotic resistance. Hajj is one of the most common recurring mass gatherings, attracting millions of people from around the world. The transmission of drug-resistant organisms during the Hajj is not well described. In the current review, we summarize the available literature on the transmission and acquisition of antibiotic resistance during the Hajj and present possible solutions.
Assuntos
Bactérias/efeitos dos fármacos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/transmissão , Aglomeração , Transmissão de Doença Infecciosa , Farmacorresistência Bacteriana , Religião e Medicina , Infecções Bacterianas/microbiologia , Saúde Global , Humanos , Medição de Risco , Arábia SauditaRESUMO
Every year, more than 10 million pilgrims arrive in the Kingdom of Saudi Arabia for the Hajj or Umrah. Crowding conditions lead to high rates of respiratory infections among the pilgrims, representing a significant cause of morbidity and a major cause of hospitalization. Pre- and post-Hajj nasal specimens were prospectively obtained from a paired cohort (692 pilgrims) and from nonpaired cohorts (514 arriving and 470 departing pilgrims) from 13 countries. The countries of residence included Africa (44.2%), Asia (40.2%), the United States (8.4%) and Europe (7.2%). Nasal specimens were tested for 34 respiratory pathogens using RT-PCR. A total of 80 512 PCRs were performed. The prevalence of viruses and bacteria increased, from 7.4% and 15.4% before the Hajj to 45.4% and 31.0% after the Hajj, respectively, due to the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. We did not identify Middle East respiratory coronavirus carriage. At arrival, the prevalence of several viruses was clearly dependent on the pilgrim's country of origin. After Hajj participation, these viruses were isolated among pilgrims from all countries, with few exceptions. No significant differences were observed between paired and nonpaired cohort results. Our results strongly suggest that, given the particularly crowded conditions during the rituals, an international mass gathering such as the Hajj may contribute to the globalization of respiratory pathogens after the cross-contamination of pilgrims harbouring pathogens that easily spread among participants. Influenza and pneumococcal vaccination, face mask use and hand hygiene should be considered in the context of the Hajj.
Assuntos
Infecções Bacterianas/epidemiologia , Aglomeração , Transmissão de Doença Infecciosa , Mucosa Nasal/microbiologia , Mucosa Nasal/virologia , Infecções Respiratórias/epidemiologia , Viroses/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/microbiologia , Infecções Bacterianas/transmissão , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Portador Sadio/transmissão , Portador Sadio/virologia , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Religião , Infecções Respiratórias/microbiologia , Infecções Respiratórias/transmissão , Infecções Respiratórias/virologia , Arábia Saudita , Viagem , Viroses/transmissão , Viroses/virologia , Adulto JovemRESUMO
Over two million Muslim pilgrims assemble annually in Mecca and Medina, Saudi Arabia, to complete the Hajj. The large number of people in a crowded environment increases the potential for pneumococcal carriage amplification. We evaluated pneumococcal carriage prevalence with four cross-sectional studies conducted at beginning-Hajj (Mecca) and end-Hajj (Mina) during 2011 and 2012. A questionnaire was administered and a nasopharyngeal swab was collected. The swab was tested for pneumococcus, serotype and antibiotic resistance. A total of 3203 subjects (1590 at beginning-Hajj and 1613 at end-Hajj) originating from 18 countries in Africa or Asia were enrolled. The overall pneumococcal carriage prevalence was 6.0%. There was an increase in carriage between beginning-Hajj and end-Hajj cohorts for: overall carriage (4.4% versus 7.5%, prevalence ratio (PR) 1.7, 95% CI 1.3-2.3), and carriage of 23-valent pneumococcal polysaccharide vaccine serotypes (2.3% versus 4.1%, PR 1.8, 95% CI 1.2-2.7), 13-valent pneumococcal conjugate vaccine (PCV) serotypes (1.1% versus 3.6%, PR 3.2, 95% CI 1.9-5.6), 10-valent PCV serotypes (0.6% versus 1.6%, PR 2.6, 95% CI 1.2-5.3), antibiotic non-susceptible isolates (2.5% versus 6.1%, PR 2.5, 95% CI 1.7-3.6) and multiple non-susceptible isolates (0.6% versus 2.2%, PR 3.8, 95% CI 1.8-7.9). Fifty-two different serotypes were identified, most commonly serotypes 3 (17%), 19F (5%) and 34 (5%). These results suggest that the Hajj may increase pneumococcal carriage-particularly conjugate vaccine serotypes and antibiotic non-susceptible strains, although the exact mechanism remains unknown. The Hajj may therefore provide a mechanism for the global distribution of pneumococci.
Assuntos
Portador Sadio , Islamismo , Infecções Pneumocócicas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Portador Sadio/transmissão , Estudos Transversais , Aglomeração , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/transmissão , Fatores de Risco , Arábia Saudita/epidemiologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Exposure to blood-borne pathogens from needle-stick and sharp injuries continues to pose a significant risk to health care workers. These events are of concern because of the risk to transmit blood-borne diseases such as hepatitis B virus, hepatitis C virus, and the human immunodeficiency virus. OBJECTIVE: To benchmark different risk factors associated with needle-stick incidents among health care workers in the Ministry of Health hospitals in the Kingdom of Saudi Arabia compared to the US hospitals participating in Exposure Prevention Information Network (EPINet™). METHODS: Prospective surveillance of needle-stick and sharp incidents carried out during the year 2012 using EPINet™ ver 1.5 that provides uniform needle stick and sharp injury report form. RESULTS: The annual percutaneous incidents (PIs) rate per 100 occupied beds was 3.2 at the studied MOH hospitals. Nurses were the most affected job category by PIs (59.4%). Most PIs happened in patients' wards in the Ministry of Health hospitals (34.6%). Disposable syringes were the most common cause of PIs (47.20%). Most PIs occurred during use of the syringes (36.4%). CONCLUSION: Among health care workers, nurses and physicians appear especially at risk of exposure to PIs. Important risk factors of injuries include working in patient room, using disposable syringes, devices without safety features. Preventive strategies such as continuous training of health care workers with special emphasis on nurses and physicians, encouragement of reporting of such incidents, observation of sharp handling, their use and implementation of safety devices are warranted.
Assuntos
Benchmarking , Patógenos Transmitidos pelo Sangue , Hospitais , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Exposição Ocupacional , Recursos Humanos em Hospital , Adulto , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Necessidades e Demandas de Serviços de Saúde , Humanos , Serviços de Informação , Masculino , Pessoa de Meia-Idade , Agulhas , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Exposição Ocupacional/prevenção & controle , Estudos Prospectivos , Equipamentos de Proteção , Fatores de Risco , Arábia Saudita/epidemiologia , Seringas , Estados Unidos/epidemiologiaRESUMO
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.
Assuntos
Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/diagnóstico , Coronavírus da Síndrome Respiratória do Oriente Médio/isolamento & purificação , Vigilância da População , Adolescente , Adulto , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/epidemiologia , Família , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento , Coronavírus da Síndrome Respiratória do Oriente Médio/genética , Reação em Cadeia da Polimerase em Tempo Real , Arábia Saudita/epidemiologia , Fatores Sexuais , Adulto JovemAssuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Coronavirus/isolamento & purificação , Aglomeração , Monitoramento Epidemiológico , Coronavirus/classificação , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologiaRESUMO
Since June 2012, 133 Middle East respiratory syndrome coronavirus (MERS-CoV) cases have been identified in nine countries. Two time periods in 2013 were compared to identify changes in the epidemiology. The case-fatality risk (CFR) is 45% and is decreasing. Men have a higher CFR (52%) and are over-represented among cases. Thirteen out of 14 known primary cases died. The sex-ratio is more balanced in the latter period. Nosocomial transmission was implied in 26% of the cases.
Assuntos
Infecções por Coronavirus/epidemiologia , Coronavirus/isolamento & purificação , Epidemias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Busca de Comunicante , Coronavirus/genética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Vigilância da População , Análise de Sequência , Distribuição por Sexo , Adulto JovemRESUMO
The Jordanian Ministry of Health in collaboration with the Eastern Mediterranean Public Health Network (EMPHNET) hosted the Seventh Global Scientific Conference of the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) in Jordan in November 2012. This was the first time this Conference was held in the Eastern Mediterranean region. The Conference theme was "communicable and noncommunicable diseases: public health challenges and successes". Over 400 participants including field epidemiology training program residents, graduates and public health officials from 66 countries attended the Conference as well as 187 people from 57 countries who attended the conference sessions on line. The programme included 121 oral and 130 poster presentations in addition to 5 pre-conference workshops and 9 roundtable discussions. All sessions were recorded and virtually broadcasted and made available on line. The Conference succeeded in creating opportunities for dialogue between residents and graduates of field epidemiology training programmes and public health stakeholders across the region and the globe.
Assuntos
Doença Crônica/epidemiologia , Doenças Transmissíveis/epidemiologia , Saúde Pública , Congressos como Assunto , Educação Profissional em Saúde Pública , Métodos Epidemiológicos , Saúde Global , Humanos , JordâniaRESUMO
The novel coronavirus disease outbreak in Saudi Arabia in 2012 predominately affected males and those living in urban areas. Since September and October 2012, when the first 2 cases were published, a total of 15 confirmed cases have been reported. All but 2 have been linked to conuntries of the Arabian peninsula; Saudi Arabian nationals accounted for a majority, 8 in all, and only 1 case was female. Seven patients had severe pneumonia; 2 survived-1 with mild disease and 1 with significant underlying illness. Although transmission of the virus to health-care workers was suspected in Jordan's April 2012 outbreak, similar clusters have not been found in Saudi Arabia's hospitals, nor have additional cases been indentified through retrospective tracing of exposed health-care workers. Two family clusters have been identified, 1 in Riyadh and 1 in Manchester, England. A second Riyadh family cluster is being investigated.
Assuntos
Infecções por Coronavirus/epidemiologia , Coronavirus/isolamento & purificação , Surtos de Doenças/estatística & dados numéricos , Adulto , Idoso , Animais , Feminino , Humanos , Internacionalidade , Jordânia/epidemiologia , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologia , Distribuição por Sexo , População Urbana/estatística & dados numéricosRESUMO
Mass gatherings are attended by an increasingly global audience and thus raise the concern of possible acute public health risks not normally encountered by the host population. The potential acute risks to individual and population health include communicable diseases. The communicable disease risks include emerging and re-emerging diseases in host and visiting populations. In this review, we provide an overview ofthe literature on respiratory infections at mass gatherings, then describe the impact of novel coronavirus 2012 (nCoV), an emerging respiratory disease virus, on the preparations for mass gathering. Although, nCoV emerged prior to the 2012 Hajj pilgrimage season, Muslims completed their religious duty without acquiring infections by nCoV. Clearly, the global nature of mass gatherings and their potential risks to international health make it imperative that research on such events and guidelines produced for their management are relevant to diverse contexts and are a collaborative effort between global experts.
Assuntos
Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/transmissão , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/transmissão , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/transmissão , Surtos de Doenças , Humanos , Internacionalidade , Oriente Médio/epidemiologia , Saúde Pública/métodos , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/transmissãoRESUMO
The emergence of a novel strain of coronavirus in the Arabian Peninsula raised a global health concern in 2012, partly because the majority of human infections were fatal and partly due to its presumed animal origin. An urgent meeting of scientific and public health experts was convened by WHO in January 2013 in view of the limited knowledge available on the epidemiological and natural history of infection with this novel virus. The meeting reviewed current evidence and identified critical knowledge gaps to improve better understanding of the public health risk associated with the virus so as to improve preparedness and to safeguard and protect global health.
Assuntos
Infecções por Coronavirus/epidemiologia , Coronavirus/isolamento & purificação , Saúde Pública/métodos , Encaminhamento e Consulta , Animais , Egito , Humanos , Internacionalidade , Oriente Médio/epidemiologia , Fatores de RiscoRESUMO
A cohort of 154 French Hajj pilgrims participating in the 2012 Hajj were systematically sampled with nasal swabs prior to returning to France, and screened for the novel HCoV-EMC coronavirus by two real-time RT-PCR assays. Despite a high rate of respiratory symptoms (83.4%), including 41.0% influenza-like illness, no case of HCoV-EMC infection was detected. Despite the fact that zoonotic transmission was suspected in the first few cases, a recent family cluster in the Kingdom of Saudi Arabia suggests that the virus might show at least limited spread from person to person, which justifies continuing epidemiological surveillance.
Assuntos
Portador Sadio/virologia , Infecções por Coronavirus/virologia , Coronavirus/isolamento & purificação , Aglomeração , Cavidade Nasal/virologia , Infecções Respiratórias/virologia , Viagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos de Coortes , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/epidemiologia , Arábia Saudita , Adulto JovemRESUMO
Expatriate workers must be medically examined in their country of origin at accredited centres prior to their arrival in any Gulf Cooperation Council (GCC) country and are reexamined when they enter the country. This review investigated the epidemiological profile of registered expatriate workers in Saudi Arabia who were found medically unfit to work. A descriptive analysis was performed on 4,272,480 records of a Ministry of Health database from 1997 to 2010. The greatest proportion of workers was from Indonesia (34.3%). The total proportion of unfit expatriate workers was low (0.71%). The highest rate of unfitness was among workers from Ethiopia (4.06%), followed by Somalia (2.41%). Hepatitis B infection was the most common cause (57.5%), followed by noncommunicable diseases (21.2%) and hepatitis C infection (17.4%). This review suggests that the total number of workers registered in the Saudi Ministry of Health was underestimated, and the rate of unfit workers was lower than for other GCC countries, suggesting that standards and quality assurance in Saudi laboratories require revision.