Abimbola O. Osoba

Diagnostic value of Brucella ELISA IgG and IgM in bacteremic and non-bacteremic patients with brucellosis.

Summary The diagnostic value of Brucella ELISA IgG and IgM has been evaluated in patients with brucellosis. Serum samples and blood cultures were collected from 83 patients with brucellosis. The sera were tested by Brucella ELISA for Brucella IgM and IgG antibodies. All 44 controls were negative for IgG and IgM. Brucella melitensis was isolated from blood cultures of 30/83 (36.1%) patients. Among the 30 bacteremic patients, 24 (80%) had an increased IgM titer of ≥200. Of the 53 non-bacteremic patients, 41 had IgM titer ≥200, while 22 had IgG titer of ≥1,600. The ELISA IgM and IgG tests achieved a specificity and sensitivity of 100% and 96% respectively, while the positive and negative predictive values were 100% and 94% respectively. The Brucella ELISA is a reliable and sensitive test in the diagnosis of brucellosis. The test is rapid, easy to perform and can be automated.

Tract microflora in Saudi patients with cholelithiasis

OBJECTIVES To identify the microflora in the gallbladder of patients undergoing laparoscopic cholecystectomy for gallstones, and the antibiotic susceptibility pattern of the isolates, as well as the usefulness of Gram staining of bile at the time of operation.

HACEK group endocarditis at the Riyadh Armed Forces Hospital.

INTRODUCTION Fastidious Gram-negative organisms classified as the HACEK group (Haemophilus spp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and Kingella spp.) are rare causes of infective endocarditis. CASE REPORT In this series, we report six cases of endocarditis in Saudi patients occurring between 1990 and 1994 in our hospital, caused by two of the organisms in the HACEK group, i.e. Cardiobacterium hominis and Actinobacillus actinomycetemcomitans. The clinical features, predisposing factors and treatment of the patients are briefly described. The microscopic and cultural characteristics of the organisms are described together with the laboratory methods of diagnosis. MAJOR FINDINGS HACEK endocarditis was frequently associated with prosthetic heart valves or structural heart abnormalities. Dental caries or periodontal disease seems to be a predisposing factor. The prognosis of HACEK endocarditis is very good as clinical and bacteriological cure were achieved with antibiotic therapy in all our cases except one who required mitral valve replacement. Contrary to previous reports we did not find all the organisms sensitive to penicillin and aminoglycosides. However, all our isolates were sensitive to amoxycillin, cefuroxime, ceftriaxone and ciprofloxacin. CONCLUSIONS Laboratory diagnosis of HACEK group of organisms requires a high index of suspicion and should be suspected in cases of endocarditis in which fastidious Gram-negative coccobacilli are isolated which fail to grow on MacConkey agar. Empiric therapy should be started in suspected cases with second generation cephalosporins or with ciprofloxacin, until antibiotic sensitivity results become available. Antibiotic therapy should be continued for 4-6 weeks. Progress and outcome was very good in the series.

Hepatitis C virus genotyping by polymerase chain reaction and DNA enzyme immunoassay among Saudi patients in the Western Province, Saudi Arabia.

BACKGROUND The distribution of hepatitis C virus (HCV) genotypes in the Western Province of Saudi Arabia is unknown. The purpose of our study was to determine the prevalent HCV genotypes among HCV seropositive Saudi patients in the Western Province, and to study the relationship between types/subtypes, clinical status and liver histology. PATIENTS AND METHODS Serum samples were collected from 140 consecutive patients attending the Hepatology Clinic with varying grades of liver diseases, high alanine transferase (ALT) for >6 months, positive HCV, qualitative PCR, and who had had liver biopsy. HCV genotyping was determined on patients who had tested positive by both HCV enzyme immunoassay (EIA) and recombinant immunoblot assay (RIBA). RESULTS Of the 140 patients, 97 (69.2%) had genotype 4, 18 (12.8%) had genotype 1a, and 16 (11.4%) had genotype 1b. Genotypes 2b and 5 were found in two patients (1.4%) each, while 5 patients (3.6%) had mixed infections with genotypes 4 and 5. Of the 97 patients infected with genotype 4, 84 (86.6%) had chronic active hepatitis (CAH), two (2.1%) had CAH with active cirrhosis, 9 (9.3%) had cirrhosis and two (2.1%) had normal liver histology (NLH). CONCLUSION The most prevalent HCV genotype in the Western Province of Saudi Arabia was genotype 4 (69.2%). Genotype 1b was encountered in 16 (11.4%) patients. For the first time, genotype 5 was identified in the Western Province of Saudi Arabia. Genotypes 1b and 4 were associated with different histological grades of liver disease.

The presence of atypical mycobacteria in the mouthwashes of normal subjects: Role of tap water and oral hygiene

BACKGROUND: The nontuberculous mycobacteria (NTM) have been found in different environmental sources. They tend to colonize different body surfaces and secretions. The purpose of this study is to evaluate the presence of NTM in the oral cavity of healthy individuals and its relationship to tap water or oral hygiene. MATERIALS AND METHODS: One hundred sixty-seven healthy subjects were recruited. Three consecutive early morning mouthwashes using tap water were performed and examined for the presence of Mycobacterium tuberculosis (MTB) and NTM. In addition we obtained mouthwashes from 30 control healthy individuals with good oral hygiene using sterile water and examined these for the presence of MTB and NTM. RESULTS: NTM was isolated from the mouthwash of 44 (26.3%) subjects that used tap water. On the other hand, NTM was isolated from the mouthwash of 10 (33%) subjects that used sterile water. Age, gender, social class oral hygiene and the regular use of toothbrush made no statistically significant differences in the isolation rate of NTM. CONCLUSION: The rate of isolation of NTM from mouthwash is high in normal subjects. It is independent of oral hygiene, the use of tap water or teeth brushing. Smear-positive sputum could be NTM rather than M. tuberculosis. Tuberculosis polymerase chain reaction or culture confirmation is essential in developing countries to avoid the unnecessary use of antituberculosis therapy when the clinical suspicion is very low.