Epidemiology of meningitis in Al-Ain, United Arab Emirates, 2000-2005.

OBJECTIVE: To describe the epidemiologic features of meningitis in Al-Ain Medical District, United Arab Emirates from January 2000 through June 2005. METHODS: A retrospective review of clinical records and notification forms for cases of meningitis reported to the Department of Preventive Medicine, Al-Ain. Data collected and compiled included demographic features, causative microbiologic agents, and annual incidence rates of meningitis, by etiology. RESULTS: Ninety-two cases of meningitis were reported during the study period; 53% were bacterial and 37% were viral in origin. Neisseria meningitidis was the leading bacterial pathogen (35%) followed by Streptococcus pneumoniae (16%). Ten percent of clinically diagnosed cases of meningitis had no causative microorganism recovered, and in 33% of patients with presumed pyogenic meningitis no specific bacterial pathogen could be identified. The peak occurrence of meningitis was in young children less than one year old. Most cases of meningococcal meningitis were seen among prison inmates and laborers, while viral meningitis occurred mainly in children and young adults attending school. The incidence rate of meningitis in Al-Ain ranged between 2.2/100,000 population in 2000 and 1/100,000 in 2005, with an overall downward trend by year. The incidence of Haemophilus influenzae type b decreased significantly after implementation of the national immunization program in 1999. CONCLUSIONS: Improved methods of bacterial detection including isolate serotyping must be made available in order to further reduce mortality and morbidity from meningitis.

Helicobacter pylori profile in asymptomatic farmers and non-farmers.

There is a positive correlation between Helicobacter pylori infection and chronic active gastritis, peptic ulcer and gastric cancer and maltoma. There is little information on H. pylori profiles in farmers and non-farmers in the literature. Our main objective was to study the H. pylori profiles in farmers and non-formers in the United Arab Emirates. A prospective study of 151 subjects - 76 farmers and 75 non-farmers - was undertaken by determining their IgG and IgA H. pylori antibody profiles in their serum samples. Data on lifestyle were obtained from them. Eligible subjects were those who had engaged in farming for at least five years and who had not received an anti-H. pylori treatment during the six months prior to admission into the study. Most of the farmers lived in less modern accommodation, were less educated, ate their vegetable products unwashed, did not have drinking water facilities, when compared to non-farmers. Helicobacter pylori serology by IgG and IgA was positive in 112 and 77 subjects respectively (p < 0.0001). The sensitivity values for IgG and IgA serology tests were 74.2 and 51.0% respectively (p < 0.001). There were 59 and 42 H. pylori-positive farmers by IgG and IgA H. pylori serology tests respectively (p < 0.001). Among the non-farmers, the corresponding figures were 53 and 25 (p < 0.01), and neither IgG nor IgA (p = 0.4), respectively. The H. pylori serology test was able to differentiate between farmers and non-farmers. When the discordant values between IgG and IgA tests were computed for each group of subjects, the difference was significant for both farmers and non-farmers (p < 0.001 in each case). There was no difference between the farmers and non-farmers in respect of their H. pylori profiles. The farmers have a lower standard of living than non-farmers.

Serodiagnosis of tuberculosis and leprosy by enzyme immunoassay.

OBJECTIVE: To evaluate the use of serodiagnosis for tuberculosis and leprosy using mycobacterial antigen 38 kDa, with kits from Omega laboratories, to detect IgG by enzyme immunoassay (EIA). METHODS: The study population consisted of 58 patients with evidence of tuberculous infection (culture of Mycobacterium tuberculosis complex or microscopic evidence), of whom 23 had pulmonary and 35 had extrapulmonary disease. There were six subjects who had recently been treated for tuberculosis, 11 patients on treatment for leprosy and 137 patients suspected of having tuberculosis on clinical or radiologic grounds (without laboratory evidence). A control group comprised 35 healthy individuals or patients suffering from diseases other than tuberculosis. RESULTS: The tests showed that there was a significant difference in antibody levels between the patients with active pulmonary disease, extrapulmonary tuberculosis and leprosy in comparison with the control group (p<0.001). The sensitivities of the two tests together for proven pulmonary tuberculosis were 100% and 95.7% at 1.0--1.5 and >1.6 EIA cut-off points respectively, while the specificities were 88.5% and 100% at the same cut-off points. The sensitivities for extrapulmonary tuberculosis were 71.4% and only 51.4% at 1.0--1.5 and >1.6 EIA cut-off points. The test was positive in 30 (21.9%) of the 137 suspected patients, while 43 (31.4%) had an equivocal result and the remaining 64 (47.7%) suspects were definitely negative. There was again a significant difference in positivity rates between suspects and the control group. CONCLUSIONS: Omega IgG test is useful in the serodiagnosis of active pulmonary tuberculosis and leprosy, but less sensitive in extrapulmonary disease, particularly in children. Equivocal results may only add to the evidence of tuberculosis in early or minimal disease.