VIM-4 carbapenemase-producing Enterobacter cloacae in the United Arab Emirates.

Screening 34 carbapenem non-susceptible Enterobacteriaceae recovered in Abu Dhabi hospitals identified an Enterobacter cloacae strain carrying bla(VIM-4) , bla(CMY-4) and bla(CTX-M-15) . It was isolated from the urine of an Egyptian patient repeatedly hospitalized and treated with broad-spectrum antibiotics, including carbapenems, in the United Arab Emirates. The bla(VIM-4) coding class I integron, highly similar to In416, was carried on a 175-kilobase non-conjugative incA/C type plasmid also hybridizing with the bla(CMY-4) probe. This is the first detailed report on the isolation of a Verona integron-encoded metallo-ß-lactamase (VIM) -producing enteric bacterium in the Arabian Peninsula with characteristics suggestive of spreading from the Mediterranean region.

NDM-2 carbapenemase-producing Acinetobacter baumannii in the United Arab Emirates.

Screening 155 carbapenem non-susceptible Acinetobacter baumannii strains recovered in Abu Dhabi hospitals identified two metallo-ß-lactamase bla(NDM) gene-carrying isolates. They were isolated 4 months apart from the urine of a cancer patient previously treated in Egypt, Lebanon and in the United Arab Emirates. They were clonally related and carried the bla(NDM-2) gene recently identified in A. baumannii in Egypt and Israel. Sequences surrounding the bla(NDM-2) gene showed significant similarities with those associated with bla(NDM-1) in Enterobacteriaceae and A. baumannii. Repeated isolation of bla(NDM-2)-positive A. baumannii in the Middle East raises the possibility of the local emergence and spread of a unique clone.

Hepatic amebiasis among patients in a public teaching hospital.

The increase in immigration to the United States is associated with diseases, such as amebiasis, that are endemic to developing countries. We retrospectively reviewed 49 public-hospital patients with hepatic amebiasis occurring between 1985 and 1995. Most patients were immigrants (47) from Latin America (43), male (43), and young (mean age, 39.8 years). Symptoms noted by more than half were abdominal pain and fever. Ultrasonography showed single lesions in 70% and right-sided involvement in 85%. Serologies against Entamoeba histolytica were noted in 86%. After treatment, the median interval from admission to defervescence was 2 days, to normalization of white cell count 3 days, and to resolution of abdominal pain 4 days. Morbidity (one case of pericarditis) and mortality (one death in a cirrhotic man) were low. Hepatic amebiasis continues to be diagnosed in the United States, primarily among Hispanic and Asian immigrants. When appropriately considered, current diagnostic and therapeutic modalities result in rapid improvement and excellent outcome.

Cryptosporidiosis in Houston, Texas. A report of 95 cases.

Cryptosporidiosis is an important cause of diarrhea. We identified 95 patients with cryptosporidiosis over a 6-year period in our county hospital system, including 9 children and 86 adults infected with the human immunodeficiency virus (HIV). Risk factors included male-to-male sexual practices and Hispanic race. Diarrhea, weight loss, and gastrointestinal complaints were the most common symptoms at presentation. Among the HIV-infected adults, 20 (23%) developed biliary tract disease. Biliary involvement was associated with low CD4 counts. Treatment with paromomycin and antimotility agents was effective in reducing diarrheal symptoms in 54 of 70 (77%) patients with the acquired immunodeficiency syndrome (AIDS), although there was a high rate of relapse. Paromomycin did not prevent the development of biliary disease. Biliary disease responded to cholecystectomy or sphincterotomy with stent placement. Though often a cause of morbidity, cryptosporidiosis was only rarely the cause of death, even among patients with HIV. Cryptosporidiosis continues to be an important medical problem even in developed-countries. Current methods of prevention and treatment are suboptimal.

Parasites and Diarrhea. I: Protozoans and Diarrhea.

Intestinal parasitism is extremely common, with approximately 70% of all people harboring one or more intestinal parasite. Parasitism and diarrhea are both hyperendemic in areas where sanitation is suboptimal. Many clinicians assume that the identification of intestinal parasites in patients with diarrhea implies that the parasites are the cause. This approach is frequently misguided. Some intestinal parasites such as Giardia lamblia and Entamoeba histolytica certainly do cause diarrhea. Others, for example Entamoeba coli and Ascaris lumbricoides, almost certainly do not. In addition, there are a number of other organisms that have been associated with diarrheal illness in some cases, which may or may not be important pathogens. In this article, we will review the role of protozoans as definite and possible causes of diarrhea. In Part II, we review the role of helminths in diarrhea.