Seroprevalence of community-acquired atypical bacterial pneumonia among adult COVID-19 patients from a single center in Al Madinah Al Munawarah, Saudi Arabia: A retrospective cohort study

OBJECTIVES

To investigate the seroprevalence of the community-acquired bacterial that causes atypical pneumonia among confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) patients.

METHODS

In this cohort study, we retrospectively investigated the seroprevalence of Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila among randomly selected 189 confirmed COVID-19 patients at their time of hospital presentation via commercial immunoglobulin M (IgM) antibodies against these bacteria. We also carried out quantitative measurements of procalcitonin in patients' serum.

RESULTS

The seropositivity for L. pneumophila was 12.6%, with significant distribution among patientsolder than 50 years (χ2 test, p=0.009), while those of M. pneumoniae was 6.3% and C. pneumoniae was 2.1%, indicating an overall co-infection rate of 21% among COVID-19 patients. No significant difference (χ2 test, p=0.628) in the distribution of bacterial co-infections existed between male and female patients. Procalcitonin positivity was confirmed amongst 5% of co-infected patients.

CONCLUSION

Our study documented the seroprevalence of community-acquired bacteria co-infection among COVID-19 patients. In this study, procalcitonin was an inconclusive biomarker for non-severe bacterial co-infections among COVID-19 patients. Consideration and proper detection of community-acquired bacterial co-infection may minimize misdiagnosis during the current pandemic and positively reflect disease management and prognosis.

COVID-19 with underdiagnosed influenza B and parainfluenza-2 co-infections in Saudi Arabia: Two case reports

The emerging of the COVID-19 pandemic is currently challenging for the public health system globally. Beyond SARS-CoV-2 pathogenicity, co-infections with recycling respiratory pathogens, whether bacterial, viral, or fungal, might increase disease symptoms, morbidity, and mortality.

In this study, we reported two COVID-19 cases in the early phase of the virus spread in Saudi Arabia with underdiagnosed respiratory viruses’ co-infections, influenza B and Parainfluenza-2, detected retrospectively. Fortunately, both patients recovered and were discharged home.

Underestimation of co-infection among COVID19 patients might lead to hospital stay prolongation and increases morbidity and mortality. Therefore, it is crucial to consider and screen for co-infecting pathogens among COVID-19 patients and those with risk factors.

Respiratory tract samples, viral load, and genome fraction yield in patients with Middle East respiratory syndrome

BACKGROUND

Analysis of clinical samples from patients with new viral infections is critical to confirm the diagnosis, to specify the viral load, and to sequence data necessary for characterizing the viral kinetics, transmission, and evolution. We analyzed samples from 112 patients infected with the recently discovered Middle East respiratory syndrome coronavirus (MERS-CoV).

METHODS

Respiratory tract samples from cases of MERS-CoV infection confirmed by polymerase chain reaction (PCR) were investigated to determine the MERS-CoV load and fraction of the MERS-CoV genome. These values were analyzed to determine associations with clinical sample type.

RESULTS

Samples from 112 individuals in which MERS-CoV was detected by PCR were analyzed, of which 13 were sputum samples, 64 were nasopharyngeal swab specimens, 30 were tracheal aspirates, and 3 were bronchoalveolar lavage specimens; 2 samples were of unknown origin. Tracheal aspirates yielded significantly higher MERS-CoV loads, compared with nasopharyngeal swab specimens (P = .005) and sputum specimens (P = .0001). Tracheal aspirates had viral loads similar to those in bronchoalveolar lavage samples (P = .3079). Bronchoalveolar lavage samples and tracheal aspirates had significantly higher genome fraction than nasopharyngeal swab specimens (P = .0095 and P = .0002, respectively) and sputum samples (P = .0009 and P = .0001, respectively). The genome yield from tracheal aspirates and bronchoalveolar lavage samples were similar (P = .1174).

CONCLUSIONS

Lower respiratory tract samples yield significantly higher MERS-CoV loads and genome fractions than upper respiratory tract samples.

Detection of coronaviruses in children with acute gastroenteritis in Maddina, Saudi Arabia

BACKGROUND

The role of coronaviruses in paediatric gastro-enteritis is not well defined. We investigated the detection rate and epidemiological features of infection with coronavirus in children receiving hospital care for acute gastro-enteritis in Maddina, Saudi Arabia.

METHODS

Stool specimens were collected from children less than 5 years of age who were either hospitalised in Maddina or given oral rehydration therapy as outpatients between April 2004 and April 2005. Coronaviruses were detected by electron microscopy.

RESULTS

Coronaviruses were detected in 63 (6%) of 984 children with acute gastro-enteritis and were more commonly detected in outpatients (47/423, 11%) than in inpatients (16/561, 3%). The median age (range) of children with coronavirus infection was 42 months (10-60). Coronaviruses were detected throughout the year with the highest detection rate at the end of the winter season.

CONCLUSIONS

Coronaviruses were commonly identified in children with diarrhoea in Saudi Arabia. Their role in paediatric gastro-enteritis warrants further evaluation.

Rotavirus gastroenteritis and strain diversity in Saudi Arabia. Current status and future prospects

OBJECTIVE

To determine the epidemiological profile and strain diversity in the light of recent published studies to provide an updated comprehensive picture of the significance of the effect of this virus in Saudi Arabia.

METHODS

The epidemiology, disease burden, and strain diversity of rotavirus in Saudi Arabia were reviewed using 22 studies of rotavirus and the etiology of diarrhea. We reviewed the studies conducted between 1982 and 2005 as well as the 2 recently published studies in 2008. This study took place in King Fahd Hospital, Maddina, Kingdom of Saudi Arabia.

RESULTS

In Saudi Arabia, a review published in 2006 showed that rotavirus prevalence ranged from 10-46%, with a median prevalence of 30% of cases of gastroenteritis. Recent studies in the country however showed a lower detection rates (18% and 12%). These 2 studies described the distribution of G and P types of rotavirus circulating in Saudi Arabia and demonstrated the presence of serotype G1-G4, G9, G12, P[4], P[6], and P[8].

CONCLUSION

These results have importance regarding a future rotavirus immunization strategies in Saudi Arabia, and underscore the need for a countrywide monitoring a rotavirus G- and P-types before the introduction of a rotavirus vaccine.

Characterization of rotavirus strains detected among children and adults with acute gastroenteritis in Gizan, Saudi Arabia

OBJECTIVE

To assess the circulating rotavirus strains among hospitalized children and adults in Gizan City.

METHODS

This cross-sectional study was based in 5 hospitals in the Gizan area. Stool samples were collected between November 2004 and March 2005, from sequential patients with acute, dehydrating diarrhea. Rotavirus antigen was detected in stool by enzyme-linked immunosorbent assay. The diversity of rotavirus strains was investigated using electropherotying and reverse transcription-polymerase chain reaction amplification of the VP7 and VP4 genes (G and P genotyping).

RESULTS

Rotavirus was detected in 54 of 454 (12%) subjects. The ages of those infected with rotavirus ranged from 15 days to 20 years, with a median age of 36 months. The highest rotavirus detection rate (24%) occurred in children aged 48-59 months. Overall, 50 (93%) of strains could be assigned both a G- and P-type; G1P[8] was the most frequently detected strain type (n=48, 89%) with one rotavirus each of G2P[4] and G9P[8].

CONCLUSION

Rotavirus strains circulating in Gizan would be well covered by current rotavirus vaccines. Rotavirus serotype G9 has been detected in Saudi Arabia for the first time. Continued surveillance of rotavirus strains is required.

Rotavirus infection in Saudi Arabia

BACKGROUND

Human rotavirus, an important causative agent of severe gastroenteritis in infants and young children worldwide, leads to high morbidity in both developing and developed countries, including Saudi Arabia, and high mortality in developing countries. Effective control depends upon an accurate understanding of disease burden and the relative importance of circulating serotypes.

METHODS

We examined the epidemiology and disease burden of rotavirus in Saudi Arabia through a review of 22 published studies of rotavirus and the aetiology of diarrhoea carried out from 1982 to 2003.

RESULTS

The prevalence of rotavirus infection ranged between 10% to 46% with a median of 30%. Most cases were among children less than 2 years of age, and particularly in the first year of life. There were significant differences in seasonality within Saudi Arabia, with increased infection during winter in some cities and during summer in others. G1 was the predominant serotype followed by G4, G3 and G2, in 4 studies where strains had been G-typed. The prevalence of nontypeable strains ranged from 11.0% to 31.3%. No data were available on P types. Results of electropherotyping in 4 studies revealed that the long electropherotype was predominant.

CONCLUSION

Rotavirus is an important cause of severe diarrhoea in Saudi children. However, the available data on rotavirus strains in circulation are limited and there is an urgent need for up-to-date and comprehensive studies to evaluate rotavirus strains in circulation and identify unusual types that could be incorporated into future vaccines.