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Alissa DA, Aburas W, Almasuood R, Almudaiheem HY, Al Aseri Z, Alrabiah F, Ezzat H, Moulana AA, Alawi MM, Al-Mutairy E, Alaama T, Alamri MS, Bamousa MS, Alshehri AA, Alosaimi MH, Alali A, Nori R, Devol EB, Mohamed G, Al-Jedai AH. Prevalence and epidemiological trends in mortality due to COVID-19 in Saudi Arabia. Public Health 2023; 215:31-38. [PMID: 36634404 DOI: 10.1016/j.puhe.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This article describes the prevalence and epidemiological trends of COVID-19 mortality in the largest registry in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN A prospective epidemiological cohort study using data from all healthcare facilities in KSA collected between March 23, 2020, and April 30, 2022. Data on the number of daily deaths directly related to COVID-19 were gathered, analyzed, and reported. METHOD Data analysis was carried out using national and regional crude case fatality rate and death per 100,000 population. Descriptive statistics using numbers and proportions were used to describe age, gender, nationality, and comorbidities. The mortality trend was plotted and compared with international figures. In addition, the most common comorbidities associated with mortality and the proportion of patients who received COVID-19 vaccine were reported. RESULTS The total reported number of deaths between March 23, 2020, and April 30, 2022, was 9085. Crude case fatality rate was 1.21%, and death per 100,000 population was 25.38, which compared favorably to figures reported by several developed countries. The highest percentages of deaths were among individuals aged between 60 and 69 years, males (71%), and individuals with diabetes (60%). Only 2.8% of mortalities occur in patients who received COVID-19 vaccine. Diabetes, hypertension, and heart failure had the highest attributable risk of mortality among patients who died due to COVID-19. CONCLUSION Case fatality rate and death per 100,000 population in KSA are among the lowest in the world due to multiple factors. Several comorbidities have been identified, namely, diabetes, hypertension, obesity, and cardiac arrhythmias.
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Affiliation(s)
- D A Alissa
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - W Aburas
- University of Hail, College of Pharmacy, Hail, Saudi Arabia
| | - R Almasuood
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - H Y Almudaiheem
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - Z Al Aseri
- Department of Emergency Medicine and Critical Care, King Saud University, Riyadh, Saudi Arabia; Adult Critical Care, Ministry of Health, Riyadh, Saudi Arabia
| | - F Alrabiah
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - H Ezzat
- Hematology Programs, Ministry of Health, Saudi Arabia; John Hopkins Aramco Healthcare, Dharan, Saudi Arabia; University of British Columbia, Canada
| | - A A Moulana
- Forensic Medicine Center, Makkah Al Mukarramah, Saudi Arabia
| | - M M Alawi
- Infection Control & Environmental Health Unit, Department of Medical Microbiology & Parasitology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - E Al-Mutairy
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - T Alaama
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - M S Alamri
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia
| | - M S Bamousa
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Forensic Medicine General Directorate, Ministry of Health, Riyadh, Saudi Arabia
| | - A A Alshehri
- Forensic Medicine Center, Ministry of Health, Riyadh, Saudi Arabia
| | - M H Alosaimi
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Mortality Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - A Alali
- Internal Medicine and Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - R Nori
- Internal Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - E B Devol
- Department of Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - G Mohamed
- Department of Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - A H Al-Jedai
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia.
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Bosaeed M, Alharbi A, Mahmoud E, Alrehily S, Bahlaq M, Gaifer Z, Alturkistani H, Alhagan K, Alshahrani S, Tolbah A, Musattat A, Alanazi M, Jaha R, Sultana K, Alqahtani H, Al Aamer K, Jaser S, Alsaedy A, Ahmad A, Abalkhail M, AlJohani S, Al Jeraisy M, Almaziad S, Albaalharith N, Alabdulkareem K, Alshowair A, Alharbi NK, Alrabiah F, Alshamrani M, Aldibasi O, Alaskar A. Efficacy of favipiravir in adults with mild COVID-19: a randomized, double-blind, multicenter, placebo-controlled trial clinical trial. Clin Microbiol Infect 2022; 28:602-608. [PMID: 35026375 PMCID: PMC8747778 DOI: 10.1016/j.cmi.2021.12.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022]
Abstract
Objective To evaluate whether favipiravir reduces the time to viral clearance as documented by negative RT-PCR results for severe acute respiratory syndrome coronavirus 2 in mild cases of coronavirus disease 2019 (COVID-19) compared to placebo. Methods In this randomized, double-blinded, multicentre, and placebo-controlled trial, adults with PCR-confirmed mild COVID-19 were recruited in an outpatient setting at seven medical facilities across Saudi Arabia. Participants were randomized in a 1:1 ratio to receive either favipiravir 1800 mg by mouth twice daily on day 1 followed by 800 mg twice daily (n = 112) or a matching placebo (n = 119) for a total of 5 to 7 days. The primary outcome was the effect of favipiravir on reducing the time to viral clearance (by PCR test) within 15 days of starting the treatment compared to the placebo group. The trial included the following secondary outcomes: symptom resolution, hospitalization, intensive care unit admissions, adverse events, and 28-day mortality. Results Two hundred thirty-one patients were randomized and began the study (median age, 37 years; interquartile range (IQR): 32–44 years; 155 [67%] male), and 112 (48.5%) were assigned to the treatment group and 119 (51.5%) into the placebo group. The data and safety monitoring board recommended stopping enrolment because of futility at the interim analysis. The median time to viral clearance was 10 days (IQR: 6–12 days) in the favipiravir group and 8 days (IQR: 6–12 days) in the placebo group, with a hazard ratio of 0.87 for the favipiravir group (95% CI 0.571–1.326; p = 0.51). The median time to clinical recovery was 7 days (IQR: 4–11 days) in the favipiravir group and 7 days (IQR: 5–10 days) in the placebo group. There was no difference between the two groups in the secondary outcome of hospital admission. There were no drug-related severe adverse events. Conclusion In this clinical trial, favipiravir therapy in mild COVID-19 patients did not reduce the time to viral clearance within 15 days of starting the treatment.
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Affiliation(s)
- Mohammad Bosaeed
- Department of Medicine, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Ahmad Alharbi
- Department of Medicine, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ebrahim Mahmoud
- Department of Medicine, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sanaa Alrehily
- King Fahad Hospital - Almadinah, Ministry of Health, Saudi Arabia
| | - Mohannad Bahlaq
- Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Zied Gaifer
- Department of Medicine, Prince Mohammed Bin Abdul Aziz Hospital - Almadinah, Ministry of National Guard Health Affairs, Saudi Arabia
| | | | - Khaled Alhagan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saad Alshahrani
- Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Ali Tolbah
- Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Abrar Musattat
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Alanazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Raniah Jaha
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khizra Sultana
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hajar Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Kholoud Al Aamer
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saud Jaser
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alsaedy
- Department of Medicine, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ayoub Ahmad
- Department of Medicine, King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Abalkhail
- Infection Prevention and Control Program, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sameera AlJohani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Majed Al Jeraisy
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sultan Almaziad
- Infection Prevention and Control Program, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nahlah Albaalharith
- Department of Nursing, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | | | - Naif Khalaf Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fahad Alrabiah
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Infection Prevention and Control Program, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Omar Aldibasi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Alshammari K, Al Hothaly B, Alrabiah F. Case of Nocardia Cyriacigeorgica Infection of the Eye in a Granulomatosis With Polyangiitis Patient. Cureus 2020; 12:e11178. [PMID: 33133800 PMCID: PMC7593125 DOI: 10.7759/cureus.11178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Nocardiosis is an infectious disease caused by a group of organisms that are often found in soil and has a very rare incidence of infecting immunocompromised patients. Granulomatosis with polyangiitis patients are often susceptible to being infected with many atypical organisms such as Nocardia cyriacigeorgica. We present a case of a 35-year-old male who is a known case of granulomatosis with polyangiitis and has a repeated history of farm visits. The patient presented with progressive early morning right eye secretions followed by dryness throughout the day with no history of trauma or allergy of seven months duration. An eye swab for culture and sensitivity showed an isolated Nocardia cyriacigeorgica and was treated by trimethoprim/sulfamethoxazole (Bactrim) for one year but was lost to follow-up. Early detection of Nocardia cyriacigeorgica is crucial in those groups of patients, as it can prevent further complicated outcomes while proper hygiene education is important.
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Affiliation(s)
| | - Bushra Al Hothaly
- Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Fahad Alrabiah
- Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Mohana A, Sulaiman T, Mahmoud N, Hassanein M, Alfaifi A, Alenazi E, Radwan N, AlKhalifah N, Elkady E, Almohaizeie A, AboGazalah F, AlabdulKareem K, AlGhofaili F, Jokdar H, Alrabiah F. Hydroxychloroquine Safety Outcome within Approved Therapeutic Protocol for COVID-19 Outpatients in Saudi Arabia. Int J Infect Dis 2020; 102:110-114. [PMID: 33075525 PMCID: PMC7567693 DOI: 10.1016/j.ijid.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background Global healthcare is challenged following the COVID-19 pandemic, since late 2019. Multiple approaches have been performed to relieve the pressure and support existing healthcare. The Saudi Arabian Ministry of Health (MOH) launched an initiative to support the National Healthcare System. Since the 5th of June 2020, 238 outpatient fever clinics were established nationwide. This study aimed to assess the safety outcome and reported adverse events from hydroxychloroquine use among suspected COVID-19 patients. Method A cross-sectional study included 2,733 patients subjected to MOH treatment protocol (hydroxychloroquine) and followed-up within 3-7 days after initiation. Data was collected through an electronic link and cross-checked with the national database (Health Electronic Surveillance Network, HESN) and reports from the MOH Morbidity and Mortality (M&M) Committee. Results 240 patients (8.8%) discontinued treatment because of side effects (4.1%) and for non-clinical reasons in the remaining (4.7%). Adverse effects were reported among (6.7%) of all studied participants, including mainly cardiovascular (2.5%, 0.15% with QTc prolongation), and gastrointestinal (2.4%). No Intensive Care Unit admission or death were reported among these patients. Conclusion Our results show that hydroxychloroquine for COVID-19 patients in mild to moderate cases in an outpatient setting, within the protocol recommendation and inclusion/exclusion criteria, is safe, highly tolerable, and with minimum side effects.
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Affiliation(s)
- Abdulrhman Mohana
- Saudi Centre for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh, 13354, Saudi Arabia.
| | - Tarek Sulaiman
- King Fahad Medical City, 59046, Riyadh, 11525, Saudi Arabia.
| | - Nagla Mahmoud
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Mustafa Hassanein
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Amel Alfaifi
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Eissa Alenazi
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Nashwa Radwan
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | | | - Ehab Elkady
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Abdullah Almohaizeie
- King Faisal Specialist Hospital and Research Centre, Zahrawi St., Al Maather، Al Maazer, Riyadh, 12713, Saudi Arabia.
| | - Fouad AboGazalah
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Khaled AlabdulKareem
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | | | - Hani Jokdar
- Deputyship of Public Health, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Fahad Alrabiah
- King Faisal Specialist Hospital and Research Centre, Zahrawi St., Al Maather، Al Maazer, Riyadh, 12713, Saudi Arabia.
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Edathodu J, Varghese B, Alrajhi AA, Shoukri M, Nazmi A, Elgamal H, Aleid H, Alrabiah F, Ashraff A, Mahmoud I, Al-Hajoj S. Diagnostic potential of interferon-gamma release assay to detect latent tuberculosis infection in kidney transplant recipients. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/31/2016] [Accepted: 10/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jameela Edathodu
- Department of Medicine; King Faisal Specialist Hospital and Research Centre (KFSHRC); Riyadh Saudi Arabia
| | - Bright Varghese
- Department of Infection and Immunity; KFSHRC; Riyadh Saudi Arabia
| | - Abdulrahman A Alrajhi
- Department of Medicine; King Faisal Specialist Hospital and Research Centre (KFSHRC); Riyadh Saudi Arabia
| | | | - Ahmad Nazmi
- Department of Medicine; King Faisal Specialist Hospital and Research Centre (KFSHRC); Riyadh Saudi Arabia
| | | | - Hassan Aleid
- Department of Surgery; KFSHRC; Riyadh Saudi Arabia
| | - Fahad Alrabiah
- Department of Medicine; King Faisal Specialist Hospital and Research Centre (KFSHRC); Riyadh Saudi Arabia
| | | | - Ihab Mahmoud
- Department of Surgery; KFSHRC; Riyadh Saudi Arabia
| | - Sahal Al-Hajoj
- Department of Infection and Immunity; KFSHRC; Riyadh Saudi Arabia
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Varghese B, Shoukri M, Memish Z, Abuljadayel N, Alhakeem R, Alrabiah F, Al-Hajoj S. Occurrence of diverse mutations in isoniazid- and rifampicin-resistant Mycobacterium tuberculosis isolates from autochthonous and immigrant populations of Saudi Arabia. Microb Drug Resist 2015; 20:623-31. [PMID: 25014484 DOI: 10.1089/mdr.2014.0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
For the first time in Saudi Arabia, the impact of a patient's ethnic background on mutations conferring resistance to rifampicin (RIF) and isoniazid (INH) in Mycobacterium tuberculosis isolates was analyzed on a nationwide sample collection. Four hundred fifteen isolates were subjected to drug susceptibility testing, mutation analysis, spoligotyping, and 24 loci-based Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeat typing, respectively. Phenotypically, 41 (9.9%) isolates were resistant to RIF, 239 (57.6%) to INH, and 135 (32.5%) to both RIF and INH, respectively. Forty (9.6%), 236 (56.8%), and 133 (32%) isolates were determined as resistant to RIF, INH, and to both by molecular assay. Codon 531 (S531L) mutations (69.4%) in the rpoB gene and codon 315 (S315T) mutations (67.2%) in the katG gene were the most prominent among RIF- and INH-resistant isolates, respectively. The autochthonous population showed a predominance of rpoB codon 516 and 526 mutations, while the inhA promoter position -15 and -8 mutations were prominent among immigrants. A strain cluster ratio of 32% (30 clusters) was observed and 24 clusters displayed identical mutations. Overall, Euro-American lineages were predominant. However, Beijing (56.7%) and EAI (42.7%) were noticed with the highest cluster rate. In Saudi Arabia, the occurrence of mutations responsible for INH and RIF resistance was significantly associated with the ethnic origin of the patient.
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Affiliation(s)
- Bright Varghese
- 1 Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
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Varghese B, Memish Z, Abuljadayel N, Al-Hakeem R, Alrabiah F, Al-Hajoj SA. Emergence of clinically relevant Non-Tuberculous Mycobacterial infections in Saudi Arabia. PLoS Negl Trop Dis 2013; 7:e2234. [PMID: 23738024 PMCID: PMC3667756 DOI: 10.1371/journal.pntd.0002234] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 04/13/2013] [Indexed: 01/15/2023] Open
Abstract
Background Non-Tuberculous Mycobacteria (NTM) are emerging around the world due to a higher prevalence of immunosuppressive illness and therapy. Saudi Arabia is not an exception as there have been novel mycobacterial species also identified. In addition, several published case reports from different parts of the country suggest a growing pathogenic potential of NTM. As the first nationwide study, we sought to gain an insight into the species diversity of NTM clinical isolates. Methodology/Principal findings During June 2009–July 2010, 95 clinical isolates were collected from tuberculosis reference laboratories in major provinces within Saudi Arabia and subjected to standard line probe assay techniques to identify their species. Diagnostic guidelines of the American Thoracic Society were applied to determine the clinical relevance of respiratory isolates. Species diversity (13 species) was very high and dominated (61.0%) by rapid growing NTM. The major species obtained were Mycobacterium abscessus, M. fortuitum, M. intracellulare followed by M. kansassi, M. gordanae and M. avium. Interestingly this study reports for the first time the clinical relevance of M. celatum, M. xenopi, M. scrofulceum, M. lentiflavum, M. asiaticum and M. simiae in Saudi Arabia. Of the total, 67.1% were clinically relevant respiratory cases, 23.2% were non-respiratory cases and 9.7% were respiratory colonizers. Coexisting illness was reported in 53.7% of the studied cases. The major risk factors observed among the patients were previous history of tuberculosis, chronic obstructive pulmonary disorder and human immunodeficiency virus infection. Conclusion/Significance The high rates of clinically confirmed respiratory cases suggest that NTM infections are indeed a new challenge to health authorities. The current findings show an opposite picture of the Western world where M. avium complex and particularly slow growing NTM are the most predominant respiratory pathogens. The complexity of species demands an immediate strengthening of the current diagnostic facilities. Non-Tuberculous Mycobacteria (NTM) are opportunistic human pathogens. Global reports show an emergence of various NTM diseases among immuno-suppressed as well as immuno-competent individuals. In Saudi Arabia, data are scarce on the prevalence of NTM and their genetic diversity. Currently, NTM infections are neglected in the country and the real magnitude of problems is still masked. As the first study of its type to be conducted in Saudi Arabia, we sought to explore the species spectrum of NTM by utilizing a nationwide collection of clinical isolates. The NTM species diversity is large and shows a different trend compared to Western countries as rapidly growing mycobacterial species are the most prevalent to cause diseases in the country. A large number of clinically relevant pulmonary cases show high pathogenic potential of NTM. Indeed, timely identification of mycobacterial species will lead to adapting an appropriate therapy and supports the implementation of control policies which is urgently needed in the country.
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Affiliation(s)
- Bright Varghese
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- * E-mail: (BV); (SAH)
| | | | | | | | - Fahad Alrabiah
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sahal Abdulaziz Al-Hajoj
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- * E-mail: (BV); (SAH)
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AlSemari A, Baz S, Alrabiah F, Al-Khairallah T, Qadi N, Kareem A, Alrajhi AA. Natural course of epilepsy concomitant with CNS tuberculomas. Epilepsy Res 2011; 99:107-11. [PMID: 22119105 DOI: 10.1016/j.eplepsyres.2011.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 10/25/2011] [Accepted: 10/30/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Epilepsy is relatively common in CNS tuberculomas, but its natural course is unclear. AIM To determine the prevalence and prognosis of epilepsy in patients with seizures related to CNS tuberculomas. METHODS We retrospectively reviewed the charts of patients with CNS tuberculomas who presented at our institution between 1983 and 2001. RESULTS Seizures occurred in 22 of 93 (23.6%) of the patients with CNS tuberculomas. These patients were treated with standard antituberculous therapy for a period varying between 6 and 20 months. Sixty-three out of 93 patients were cured of tuberculosis, and 21 of the 63 (33%) who had concomitant epilepsy became seizure-free. TB recurred in 3 patients, and 1 out of 22 who had concomitant epilepsy continued to have seizures; 3 died and 24 were lost to follow-up. Anti-epileptic medications were discontinued after completion of the anti-TB course. CONCLUSION Seizures are commonly associated with CNS tuberculomas and most often resolve after successful treatment of the underlying CNS tuberculosis.
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Affiliation(s)
- Abdulaziz AlSemari
- Neurology Section, Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, MBC 76, P.O. Box 3354, Riyadh 11211, Saudi Arabia.
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Memish ZA, McNabb SJN, Mahoney F, Alrabiah F, Marano N, Ahmed QA, Mahjour J, Hajjeh RA, Formenty P, Harmanci FH, El Bushra H, Uyeki TM, Nunn M, Isla N, Barbeschi M. Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1. Lancet 2009; 374:1786-91. [PMID: 19914707 DOI: 10.1016/s0140-6736(09)61927-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mass gatherings of people challenge public health capacities at host locations and the visitors' places of origin. Hajj--the yearly pilgrimage by Muslims to Saudi Arabia--is one of the largest, most culturally and geographically diverse mass gatherings in the world. With the 2009 pandemic influenza A H1N1 and upcoming Hajj, the Saudi Arabian Ministry of Health (MoH) convened a preparedness consultation in June, 2009. Consultants from global public health agencies met in their official capacities with their Saudi Arabian counterparts. The MoH aimed to pool and share public health knowledge about mass gatherings, and review the country's preparedness plans, focusing on the prevention and control of pandemic influenza. This process resulted in several practical recommendations, many to be put into practice before the start of Hajj and the rest during Hajj. These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings.
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Affiliation(s)
- Z A Memish
- Ministry of Health, Riyadh, Saudi Arabia.
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Kadry R, Hamadah I, Al-Issa A, Field L, Alrabiah F. Multifocal scalp abscess with subcutaneous fat necrosis and scarring alopecia as a complication of scalp mesotherapy. J Drugs Dermatol 2008; 7:72-73. [PMID: 18246702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Over the past several years, there has been a growing interest in the treatment method termed mesotherapy. Marketed for nonsurgical fat melting, skin rejuvenation, and hair regrowth, this technique has become increasingly popular and, in the public's view, it is considered to be a relatively benign intervention method. Mesotherapy was introduced over 50 years ago by M. Pistor, a French physician who utilized this technique initially as a novel analgesic therapeutic method for a variety of rheumatologic disorders. Since its introduction, the basic principal of locally injecting subcutaneous doses of varying chemicals has been expanded and is now utilized for the aforementioned cosmetic concerns. With its increased popularity, there has been an increase in the number of reported side effects resulting from mesotherapeutic intervention. We report multifocal scalp abscesses with subcutaneous fat necrosis as a direct result of mesotherapy; therefore, requiring extensive surgical repair.
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Affiliation(s)
- Razan Kadry
- Affiliated Dermatologists, Morristown, NJ, USA.
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Sabeel A, Alrabiah F, Alfurayh O, Hassounah M. Nocardial brain abscess in a renal transplant recipient successfully treated with triple antimicrobials. Clin Nephrol 1998; 50:128-30. [PMID: 9725786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Nocardia is a serious opportunistic infection in renal transplant recipients and nocardial brain abscess in these patients has a high mortality. In addition to antimicrobial therapy, treatment usually involves craniotomy and excision of the abscess. We describe a renal transplant recipient maintained on cyclosporine and prednisone developing Nocardia Asteroides brain abscess. After stereotactic aspiration of the abscess, successful treatment was achieved by triple therapy with trimethoprim sulfamethoxazole (TMP/SMX), ceftriaxone and amikacin. The allograft function remained stable. Long-term prophylaxis with TMP/SMX is necessary to prevent the relapse of nocardia.
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Affiliation(s)
- A Sabeel
- Department of Medicine, King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia
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Abstract
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.
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Affiliation(s)
- A A Alrajhi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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