Adel Alothman

Tuberculous spondylitis: analysis of 69 cases from Saudi Arabia.

Design. Retrospective chart and radiographic review of all cases admitted to the authors’ hospital and diagnosed to have tuberculous spondylitis. Objective. To identify the frequency, presenting features, utility of diagnostic tests, and treatment outcome of spinal tuberculosis in a tertiary care center. Methods. All cases of spinal tuberculosis treated in the authors’ hospital over 14 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous spondylitis therapy were included. Outcome was assessed according to predefined criteria. Results. Between 1985 and 1998, 69 cases of tuberculous spondylitis were found, i.e., 5% of all tuberculous spondylitis cases diagnosed. The mean age was 52.8 years (range, 15–80 years), and 37 (53.6%) were male. Only five patients had a history of tuberculosis. The most frequent symptoms were backache (84%) and fever (32%), and the most frequent sign was spinal tenderness (45%). Nineteen (28%) patients had paraparesis and 12 (17%) had kyphosis. Except for elevated sedimentation rate (94.5%), the laboratory workup was not helpful. Both computed tomography and magnetic resonance imaging were found to be helpful in diagnosis, often with complementary information. Thirty-eight patients (55%) had thoracic spine involvement and 55 patients (80%) had paraspinal abscesses. Tissue aspirates had a yield of 70%, 35%, and 57% for granulomas, acid-fast bacilli smear, and culture, respectively. Medical therapy alone was given in 37 cases (54%), whereas 32 patients (46%) required additional surgical intervention, mainly those with spinal cord compression, spinal deformity, or risk of spinal instability. There was definite improvement in 63 cases (91%). The best outcome was in those patients presenting early before the occurrence of spinal deformity or neurologic symptoms. Conclusion. Tuberculous spondylitis is prevalent in the authors’ hospital. Both computed tomography and magnetic resonance imaging are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. A good outcome is expected if the diagnosis is made in early stages before the appearance of spinal deformity and neurologic symptoms. Surgical intervention can be avoided in these cases regardless of the presence or absence of paraspinal abscesses.

Granulomatous myositis associated with brucellosis: A case report and literature review

Brucellosis, a multisystem infectious disorder, continues to be a serious public health problem in some parts of the world. Neurobrucellosis constitutes about 4% of all brucellosis cases. Brucellosis‐associated myositis is extremely rare, and there is only 1 reported case in the English literature. We report a 16‐year‐old boy with subacute, fluctuating, progressive muscle pain, with tenderness, swelling, and diffuse, asymmetric weakness. He also had significantly elevated serum Brucella titers and a muscle biopsy showed inflammatory granulomatous myositis. We review the literature on myositis associated with brucellosis. Muscle Nerve, 2012

Knowledge and Attitude of Physicians Toward Prescribing Antibiotics and the Risk of Resistance in Two Reference Hospitals.

Introduction Antibiotics are essential and abundantly prescribed in hospitals because of their effectiveness and lifesaving benefits. However, the unnecessary use of antibiotics has been observed in earlier studies, and it has persisted through recent years as a major issue since it is one of the leading causes of antibiotic resistance. The increase in antibiotic resistance nowadays is one of the most critical concerns in global public health around the world. The objective of this study was to evaluate the knowledge and perceptions related to antibiotic prescription among physicians at our medical centers. Method A cross-sectional survey of non-infectious diseases specialized physicians. The study was conducted during 2015 at two tertiary care centers in Riyadh, Saudi Arabia. Result Of the 107 returned questionnaires, 93 were complete and valuable. Most respondents (82%) perceived antibiotic resistance to be a critical problem globally, and 78% also think that it is a very important national problem. These attitudes did not differ across specialty or level of training. Widespread antibiotic use and inappropriate empirical choices were believed by 81% of the participants to be important general causes of resistance. Only half of respondents thought that antibiotic restriction is a useful intervention to decrease the antibiotic resistance. The physicians believed educational interventions are the most useful and effective way to improve prescription patterns and decrease antibiotic resistance. Complications due to infection with resistant organisms were acknowledged by almost all of the participants, with some differences in their estimations of how often it will occur. Conclusion Antimicrobial resistance, globally and nationally, is considered as a serious threat, and physicians in this survey acknowledged that. Among the most significant factors is antimicrobial misuse, either by overprescribing or providing inappropriate drugs with some ambivalence, as well as the importance of hand hygiene and antibiotic restrictions. By adhering to local guidelines, continuous education, and other practical interventions, the burden of resistance can be alleviated, as highlighted in this survey.

Management of Pleural Brucellosis: Case Report:

Background Brucellosis is a zoonotic disease, with low incidence rate in developed countries, however the incidence rate in Middle Eastern countries remains high. Chest symptoms in brucellosis cases account for about 15% of the cases, but dealing with respiratory system involvement is rare particularly pleural involvement. Case Report We report a case of a 60-year-old Saudi woman who was admitted with two months history of fever, productive cough anorexia and weight loss, contact with sheep. She was ill looking, underweight and febrile while she was on treatment. Examination of the chest showed signs of pleural effusion on the right side with right infrascapular crepitations. Chest X-ray: showed pleural effusion and right LL infiltrates. CT chest: showed right loculated, pleural effusion. Pleural fluid examination showed exudative changes, on culture of pleural fluid, Brucella species grew. AFB in pleural fluid was negative. She was treated with Streptomycin, Doxycyclin and Ciprofloxacin. She improved within one week of treatment and was discharged, after 14 days on antibrucella therapy. Discussion Pulmonary brucellosis is reported in medical literature occasionally but only few reports are available about pleural brucellosis. The challenge with pleural brucellosis and the association of loculated abscesses lies in therapy. Due to lack of previous information with such cases, we suggest that a period of more than six weeks is needed to treat this condition. We recommend that pleural brucellosis needs to be treated with at least two therapeutic agents for nine weeks.

Neurobrucellosis: Challenges for Therapy

Background Brucellosis is a common zoonotic infection throughout the world, and is endemic in Saudi Arabia. Neurobrucellosis is a rare, severe form of systemic brucella infection. Treatment of neurobrucellosis continues to be variable, depending on the location of diagnosis. Methods A retrospective patient chart review was undertaken from 1995 to 2010 at King Abdulaziz Medical City, Riyadh, to identify cases of neurobrucellosis following a proposed case definition. Follow-up visits were evaluated to determine response to treatment. Results A total of 22 cases of neurobrucellosis were identified from a total of 517 cases of brucellosis. The mean patient age was 42.5 years with a male to female ratio of 1:1. Most antibiotic combinations included doxycycline, rifampin, and cotrimoxazole (36%). Three patients received ciprofloxacin in combination with other antibiotics and showed a satisfactory response. Conclusion Combination of antibrucella antibiotics is recommended, but there are no clear guidelines regarding antibiotic selection and duration of therapy. The use of ciprofloxacin in cases of neurobrucellosis should be evaluated.

Experience with ceftazidime–avibactam treatment in a tertiary care center in Saudi Arabia

INTRODUCTION Carbapenem-resistant organisms have become major healthcare-associated pathogens and are responsible for significant morbidity and mortality worldwide. CASES AND MANAGEMENTS This case-series describes our experience with ceftazidime-avibactam in the treatment of six cases with carbapenem-resistant organisms in King Abdulaziz Medical City in Riyadh, Saudi Arabia. After trying various combinations of antibiotic therapies without improvement, cases were treated with ceftazidime-avibactam. OUTCOMES Five of the six achieved complete cure, both clinically and microbiologically.

Successful treatment of multi-focal XDR tuberculous osteomyelitis

We herein describe the nosocomial transmission of a pre-XDR or MDR case of pulmonary tuberculosis in a HIV-negative health care worker in an area endemic for MDR and XDR tuberculosis. Following inadequate therapy and non-compliance, he presented with extra-pulmonary XDR tuberculosis in the form of multi-focal osteomyelitis and encysted pleural effusion. He was cured after two years of treatment with various anti-tuberculous drugs in addition to interferon gamma.

Knowledge and Attitude of Physicians towards Human ImmunodeficiencyVirus Infection in a Tertiary Care Center

Introduction: Human immunodeficiency virus infection is a serious health issue. In 2014, around 36.9 million people were living with the human immunodeficiency virus worldwide. Saudis perceive AIDS as a moral disease. The gap between the proper attitude and knowledge of physicians and dentists about AIDS has adversely influenced the quality of HIV-related health care. Our target for this study is to evaluate the knowledge and attitude of physicians and dentists toward the human immunodeficiency virus infection in our society. Method: A cross-sectional study was designed to collect data using a self-administered, structured questionnaire from physicians and dentists. It was distributed among them on specific days and times in a tertiary care center located in Riyadh, Saudi Arabia. Results: The study included a total number of 201 physicians and dentists, of which 189 were physicians and 19 were dentists. Most of them (69%) are Saudis. Around 99% of the participants know that AIDS is viral in etiology. Around 127 (63%) of them know the estimated chance of transmitting HIV from a needle stick injury correctly. Also, all physicians and dentists believe that confidentiality is important for patients with AIDS. Approximately 36 (18%) think that AIDS is a curable disease. Conclusion: There is an acceptable level of information and knowledge about HIV infection among our physicians and dentists. However, regular educational assistance by specialists would be beneficial to improve the current perception. This result can give us some knowledge for further studies in order to advance HIV-related awareness among healthcare workers and the community.

Acute Brucellosis Presenting as Gastroenteritis: Case Report

Brucellosis is a systemic infection with multiple presentations. In spite of its oral mode of transmission and gastrointestinal pathogenesis, systemic symptoms are usually more prominent than gastrointestinal ones. Acute brucellosis presenting as gastroenteritis is rare in adults and could be the only manifestation of the disease. We report a case of gastroenteritis caused by Brucella species.