Atif H. Asghar

Viral respiratory infections among Hajj pilgrims in 2013

Middle East respiratory syndrome coronavirus (MERS-CoV) has emerged in the Arabian Gulf region, with its epicentre in Saudi Arabia, the host of the ‘Hajj’ which is the world’s the largest mass gathering. Transmission of MERS-CoV at such an event could lead to its rapid worldwide dissemination. Therefore, we studied the frequency of viruses causing influenza-like illnesses (ILI) among participants in a randomised controlled trial at the Hajj 2013. We recruited 1038 pilgrims from Saudi Arabia, Australia and Qatar during the first day of Hajj and followed them closely for four days. A nasal swab was collected from each pilgrim who developed ILI. Respiratory viruses were detected using multiplex RT-PCR. ILI occurred in 112/1038 (11%) pilgrims. Their mean age was 35 years, 49 (44%) were male and 35 (31%) had received the influenza vaccine pre-Hajj. Forty two (38%) pilgrims had laboratory-confirmed viral infections; 28 (25%) rhinovirus, 5 (4%) influenza A, 2 (2%) adenovirus, 2 (2%) human coronavirus OC43/229E, 2 (2%) parainfluenza virus 3, 1 (1%) parainfluenza virus 1, and 2 (2%) dual infections. No MERS-CoV was detected in any sample. Rhinovirus was the commonest cause of ILI among Hajj pilgrims in 2013. Infection control and appropriate vaccination are necessary to prevent transmission of respiratory viruses at Hajj and other mass gatherings.

Methicillin Resistance among Staphylococcus aureus Isolates from Saudi Hospitals

Objective: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains among clinical isolates collected from the 4 tertiary hospitals in Makkah, Saudi Arabia, and to test the antimicrobial susceptibility patterns of S. aureus isolates against 9 antimicrobial agents. Materials and Methods: A total of 512 S. aureus clinical isolates were collected during a period of 1 year starting in April 2003 in Al-Noor, King Abdul-Aziz, Hera and King Faisal Hospitals, Makkah, Saudi Arabia. The sensitivity patterns of these isolates were determined using the Kirby-Bauer disk diffusion method. Results: The prevalence of MRSA among S. aureus isolates was 38.9% (199/512). Among 199 MRSA isolates, 78.8% showed multidrug resistance to erythromycin, gentamicin and oxytetracycline. Conclusion: The rate of MRSA resistance in this study was much higher than what had been reported in other areas of Saudi Arabia emphasizing the need for local or country-based surveillance to characterize and monitor MRSA and to develop strategies that will improve MRSA treatment and control.

Demographic distribution and transmission potential of influenza A and 2009 pandemic influenza A H1N1 in pilgrims

INTRODUCTION The World Health Organizations persistent reporting of global outbreaks of influenza A viruses, including the 2009 pandemic swine A H1N1 strain (H1N1pdm09), justified the targeted surveillance of pilgrims during their annual congregation that pools more than two million people from around 165 nations in a confined area of Makkah city in the Kingdom of Saudi Arabia (KSA). METHODOLOGY A total of 1,600 pilgrims were included in the targeted surveillance of influenza A and the 2009 pandemic swine H1N1 strain in the Hajj (pilgrimage) season of 2010. Each pilgrim responded to a demographic and health questionnaire. Collected oropharyngeal swabs were analyzed by real-time PCR for influenza A viruses, and positive samples were further analyzed for the presence of H1N1pdm09. Fishers exact test was applied in the analysis of the significance of the distribution of influenza-positive pilgrims according to demographic characters. RESULTS A total of 120 pilgrims (7.5%) tested positive for influenza A viruses by real-time PCR. Nine out of the 120 influenza-A-positive pilgrims (7.5%) were positive for H1N1pdm09. Demographics played a significant role in those pilgrims who tested positive for influenza A. CONCLUSIONS The detection of H1N1pdm09 in pilgrims at their port of entry to the KSA was alarming, due to the high potential of trans-boundary transmission. This situation necessitates the implementation of specific prevention and control programs to limit infection by influenza A viruses.

Comparison of three DNA extraction methods for polymerase chain reaction (PCR) analysis of bacterial genomic DNA

Rapid isolation of high-purity microbial genomic DNA is necessary for genome analysis. In this study, the authors compared a one-hour procedure using a microwave with enzymatic and boiling methods of genomic DNA extraction from Gram-negative and Gram-positive bacteria. High DNA concentration and purity were observed for both MRSA and ESBL strains (80.1 and 91.1 µg/ml; OD260/280, 1.82 and 1.70, respectively) when the extraction protocol included microwave pre-heating. DNA quality was further confirmed by PCR detection of mecA and CTX-M. In conclusion, the microwave-based procedure was rapid, efficient, cost-effective, and applicable for both Gram-positive and Gram-negative bacteria. Key words: DNA, MRSA, ESBL, gene, enzymatic, boiling, microwave.

Frequency and antibiotic susceptibility of gram-positive bacteria in Makkah hospitals

Background and Objective :Gram-positive bacteria are important nosocomial pathogens. The objective of this study was to estimate the frequencies and resistance rates of gram-positive pathogens isolated from hospitals in Makkah, Saudi Arabia. Design and Setting :Prospective study at three Makkah hospitals from May 2008 to April 2009. Patients and Methods : Clinical isolates were collected and demographic and laboratory data were recorded. Standard microbiological methods were used to identify the organisms and test for antimicrobial susceptibility. The results were interpreted according to the Clinical Laboratory Standards Institute (CLSI) guidelines. Results : Clinical isolates were collected from 1087 patients. Gram-positive pathogens infected all age groups, but had no gender predominance. Staphylococcus aureus was the most common cause of wound infection and accounted for more than half of the clinical isolates (688 cases). Coagulase-negative staphylococcus (CONS) was a common isolate from blood cultures. Wounds were the most common site of infection (37.6%). Enterococcus spp. and Streptococcus agalactiae were the second most common bacteria (26%). The resistance rates of S aureus and CONS isolates were 39.4% and 82.4% for oxacillin, respectively. Among the streptococci, the resistance rates of Streptococcus pneumoniae were 21.1% and 16.7% for ampicillin and erythromycin, respectively. Conclusions : S aureus infections were found to be very common in the Makkah hospitals. Infection prevention, control measures and continuous monitoring for antibiotic susceptibility are necessary to reduce these and other nosocomial infections.

Bacteriological and serological survey of infectious diseases among food handlers in Makkah.

Ann Saudi Med 2006;26(2):141-144 in the food industry, contamination from microorganisms can be responsible for infectious disease outbreaks passed from food employees to consumers through food. The origins of microbial contaminants in food surface facilities include the environment, food workers, the source of the food, and the food itself. According to a report by the Centers for Disease Control and prevention (CDC), hands may be the most important means by which enteric pathogens are transmitted if employees do not wash their hands adequately.1,2 Hands, arms and fingers of food handlers may become contaminated with fecal microorganisms after using the toilets. These organisms include Staphylococcus aureus, Salmonella, Shigella and hepatitis A virus. According to Buzby and roberts these organisms account for approximately 3.3 to 12.3 million cases of illness and 39 000 deaths in the United State each year. They estimated that the annual cost of these foodborne illnesses, which includes costs to individuals, industry and the public health sector, is US

Detection of Salmonella in Food Samples by Culture and Polymerase ChainReaction Methods

6.5 to

POTENTIAL RISK OF STREPTOCOCCUS PNEUMONIAE IN NASOPHARYNGEAL CARRIAGE DURING UMRAH AND HAJJ SEASONS IN MAKKAH, SAUDI ARABIA.

35 billion.3 Staphylococcal food poisoning resulting from the growth of enterotoxigenic staphylococci in foods with the production of enterotoxin is the most common food illness found in almost all parts of the world.4 enterotoxin produces symptoms similar to acute gastroenteritis. Staphylococcus aureus is widely distributed in nature and is commonly found in the nose, throat, hair, and skin of humans and animals. foods such as bakery products, containing custards or cream, ham, poultry products, milk and milk products and eggs have been frequently reported as the source in outbreaks of staphylococcal food poisoning. Several staphylococcal enterotoxins have been identified and differentiated by serological techniques and have been given letter designations, SeA through Sef in which SeA is responsible for the majority of staphylococcal food illness.5 Salmonella is one of the most frequently isolated bacterial foodborne illnesses resulting from the ingestion of viable bacteria. Symptoms mainly consist of nausea, vomiting, abdominal pain, headache, chills and diarrhea. The primary habitat of Salmonella is the intestinal tract of humans and farm animals such as chicken, cattle and sheep.4 Hepatitis A virus (HAV) is another foodborne illness characterized by its ability to survive well on environmental surfaces and on human hands for up to 7 hours and be easily transferred to and from hands and surfaces. Additionally, this virus is resistant to many disinfectants used in food establishments. HAV is transmitted typically from person-toperson by the fecal-oral route. foodborne transmission occurs when an HAV-infected food handler contaminates food during preparation, or when food is contaminated during harvesting or processing before reaching the food service establishment or home. presentation of hepatitis A infection typically includes flu-like symptoms, which cannot be distinguished from other types of acute hepatitis.6-10 Bacteriological and serological survey of infectious diseases among food handlers in Makkah

Influenza vaccination among Saudi Hajj pilgrims: Revealing the uptake and vaccination barriers

Conventional culture methods for the isolation and identification of food borne bacterial pathogens are rather sensitive and quite inexpensive, but at the same time they are labor-intensive and time-consuming. Molecular techniques are more rapid and highly sensitive for identification of food pathogens. This study was carried out to evaluate a 12 hour PCR method for detection of Salmonella in food samples. The results showed that out of 150 food samples, 32 (21.3%) were positive by culture, 35 (23.3%) were positive by PCR, the sensitivity of PCR was 100% while specificity was 97.5%. The study concluded that the 6-h enrichment followed by PCR was rapid, simpler method that allowed the detection of Salmonella spp. within a maximum of 12 h.

The impact of importation of live ruminants on the epizootiology of foot and mouth disease in Saudi Arabia: -EN- -FR- L’impact des importations de ruminants vivants sur l’épizootiologie de la fièvre aphteuse en Arabie saoudite -ES- Efectos de la importación de rumiantes vivos en la epizootiología de la fiebre aftosa in Arabia Saudí

A cross sectional prospective study was carried out over a period of one year from (April 2008-March 2009 ), depending on prestructured questionnaire, study was carried out on a total of two hundred patients with different age, sex and with clinically suspected cases with tinea capitis and corporis. Specimens were obtained from skin scales of the lesion. Hair specimens were collected by plucking the hair with forceps. The aim of this study to identify the etiological agents involved in these infections. Out of 200 patients who presented with suspected superficial fungal and to determine prevalence of tinea capitis and tinea corporis in Benghazi population. Infected, 113 (56.5%) were male and 87 (43.5%) were female. Out of these, 117 children (65 male and 52 female) were provisionally diagnosed with tinea capitis and corporis. The youngest patient was a 5 months old infant, whereas the eldest patient a 71 year old man. Greater number of positive cases of dermatophytes is seen in children under the age of 15 year. Tinea capitis was predominant in 31 (57.4%) children, while tinea corporis were (14.8%) children. 125 (62.5%), were found to be positive by direct microscopic examination only, while 50 (25%) by culture only and 45 (22.5%) positive by both techniques. In addition 36 (18%) patients give positive family history of dermatophytosis, 9 patients of them were positive culture while 55 (27.5%) patients had history of contact with animals 16 of them were positive culture. Also17 (8.5%) were foreign patients, of these 8 were soudanense. In this study, the most common sites where dermatophytes in Tinea corporis isolated were the neck and back. Also we observed that, T. violaceum was the most common dermatophyte isolated 13 (24%) (mainly among children under age of 15 years). T. soudanense 9 (16%) was the second common isolated, followed by T. schoenleinii 8 (14.8%), other dermatophytes in descending order, were M. canis 5 (9.3%), T. mentagrophytes 4 (7.4%), M. ferrugineum 3 (5.5%), T. rubrum 3 (5.5%), T. tonsurans 2 (3.7%), M. nanum 2 (3.7%), T. yaoundi 1 (1.8%), T. terrestre 1 (1.8%), T. verrucosum 1 (1.8%), M. audouinii 1 (1.8%) and 1 (1.8%) were unidentified. Culture the isolates were a mixed of dermatophytes, in 2 cases of tinea capitis the culture revealed in mixed of T. violaceum and T. mentagrophytes, while 2 cases of tinea corporis; T. tonsurans and T. schoenleinii where the culture revealed a growth of T. rubrum and M. nanum. The infection was found to occur more frequently in males (29 cases than in females (25 cases). In the present study, grey patch was the predominant type of tinea capitis 32 (16%), black dot 2 (1%) and kerion 2 (1%) was the least common types.W investigated the anti-influenza virus activity of Acacia nilotica and possible mechanisms of action in vitro. We found that Acacia nilotica has anti-influenza-virus activity and both pre-incubation of virus prior to infection and post-exposure of infected cells with Acacia nilotica extract significantly inhibited virus yields. Influenza-virus-induced hemagglutination of chicken red blood cells was inhibited by Acacia extract treatment, suggesting that Acacia can inhibit influenza A virus infection by interacting with the viral hemagglutinin. Furthermore, Acacia extract significantly affect nuclear transport of viral nucleoprotein (NP). To best of our knowledge, this study revealed for the first time that Acacia nilotica extract can inhibit both viral attachment and replication and offers new insights into its underlying mechanisms of antiviral action. The fruit husk of Acacia nilotica collected from Sudan and extracted with 70% methanol. The crude extract was screened for its cytotoxicity against MDCK cell line by alamarBlue assay and WST-1 assay. Antiviral properties of the plant extract were determined by cytopathic effect inhibition assay and virus yield reduction assay (plaque assay). Time of addition assay and nuclear export mechanism were also performed.