Nasser Behbehani

Changing Prevalence of Asthma and Allergic Diseases among Kuwaiti Children

Objectives: To estimate the prevalence of asthma and allergic diseases in 13- and 14-year-old schoolchildren and to compare it with previous phase I data. Subjects and Methods: A survey of 2,922 third and fourth grade students from randomly selected intermediate level schools across Kuwait was conducted. Supervised, self-administered, written and video questionnaires of the International Study of Asthma and Allergies in Childhood (ISAAC) was used. Results: Of the 2,922 students, 2,882 (96.3%) completed the questionnaires. The prevalence (95% CI) in the written questionnaire for wheeze ever, current wheeze (within the last 12 months) and physician diagnosis of asthma were 13.4, 7.6 and 15.6%, respectively. The prevalence (95% CI) for symptoms of allergic rhinitis (AR) ever, current symptoms of AR, and diagnosis of AR was 41.4, 27.6 and 22.2%, respectively. The prevalence (95% CI) for itchy rash ever, current itchy rash, and diagnosis of eczema was 10.6, 8.3 and 12.8%, respectively. Comparing to ISAAC phase I data (1995–1996), the prevalence of current wheeze has decreased from 16.1 to 7.6% (p < 0.001). Current symptoms of AR decreased from 30.7 to 27.6 (p = 0.008) and current itchy rash decreased from 17.5 to 10.6% (p < 0.001). However, physician diagnoses of asthma and eczema remained the same as in the previous study, but physician diagnosis of AR increased from 17.1 to 22.2% (p < 0.001). Conclusion: The findings show that there is a decrease in the self-reported symptoms of allergic diseases over a 5-year period while physician diagnoses of these diseases remained the same over the same period.

Significance of Atypical Pathogens among Community-Acquired Pneumonia Adult Patients Admitted to Hospital in Kuwait

Objectives: The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia (CAP) in Kuwait. Subjects and Methods: The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team (PORT) severity index. The microbial etiology was determined using standard methods for bacteria and serological tests for atypical and viral pathogens. Results: The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3 ± 18 years. The severity class distribution was: class I 31%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients (35%), with one pathogen in 31 (25%), two in 9 (7%), and three or more in 4 (3%). The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients (11%), Legionella pneumophila in 10 (8%), Chlamydia pneumoniae in 8 (6%), influenza B virus in 8 (6%), influenza A virus in 5 (4%), Haemophilus influenzae in 4 (3%), Streptococcus pneumoniae in 3 (2%), Staphylococcus aureus in 3 (2%), gram-negative enterobacteria in 5 (4%), Moraxellacatarrhalis in 2 (2%), and viruses in 4 (3%). The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Conclusion: Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait. Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides.

Factors responsible for asthma and rhinitis among Kuwaiti schoolchildren.

Objective: The aim of this study was to assess the prevalence of asthma among schoolchildren and to determine the level house dust mites in Kuwaiti homes and its role in asthma and rhinitis. Subjects and Method: The International Study of Asthma and Allergy in Children questionnaire was distributed to schoolchildren in the age group of 5–7 years, after random sampling from all the five governorates of Kuwait. The questionnaires were completed and initiated by parents with the help of the investigator and parents. House dust was collected from the bedroom floor of 549 houses in the same geographical areas where the schoolchildren were sampled, extracted and assayed for mite Der p 1 by ELISA method. Results: The estimated prevalence of asthma was 22.4% and that of rhinitis was 23%. House dust collected from the bedroom floor was found to contain low levels of Der p 1. There was no significant difference (p = 0.969) in the level of Der p 1 between areas in Kuwait. The highest levels of Der p 1 ranged from 0.02 to 0.10 mg/g in 3.5% of the total samples examined. Conclusions: There is a high prevalence of asthma and rhinitis among the schoolchildren in Kuwait. However, the level of dust mitogens investigated in this study was below the level of concern, thus undermining their role in increasing asthma cases in Kuwait. Therefore, further studies are needed to understand the role of other mite allergens and other factors that contribute to the increased prevalence of allergic diseases in Kuwaiti children.

Mixed Viral Infections Circulating in Hospitalized Patients with Respiratory Tract Infections in Kuwait

The aim of this study was to determine the frequency of viral mixed detection in hospitalized patients with respiratory tract infections and to evaluate the correlation between viral mixed detection and clinical severity. Hospitalized patients with respiratory tract infections (RTI) were investigated for 15 respiratory viruses by using sensitive molecular techniques. In total, 850 hospitalized patients aged between 3 days and 80 years were screened from September 2010 to April 2014. Among the 351 (47.8%) patients diagnosed with viral infections, viral mixed detection was identified in 49 patients (14%), with human rhinovirus (HRV) being the most common virus associated with viral mixed detection (7.1%), followed by adenovirus (AdV) (4%) and human coronavirus-OC43 (HCoV-OC43) (3.7%). The highest combination of viral mixed detection was identified with HRV and AdV (2%), followed by HRV and HCoV-OC43 (1.4%). Pneumonia and bronchiolitis were the most frequent reason for hospitalization with viral mixed detection (9.1%). There were statistical significance differences between mixed and single detection in patients diagnosed with bronchiolitis (P = 0.002) and pneumonia (P = 0.019). Our findings might indicate a significant association between respiratory virus mixed detection and the possibility of developing more severe LRTI such as bronchiolitis and pneumonia when compared with single detection.

Clinical patterns of diffuse parenchymal lung disease in Kuwait: a prospective study.

Objective: To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease (DPLD). Subjects and Methods: Over a 4-year period, 75 patients (41 males, 34 females), aged 13–76 years, who were referred to Mubarak Al-Kabeer and the Chest Diseases Hospitals, Kuwait with a diagnosis of diffuse lung disease, were included in the study. After a comprehensive history and physical examination, further investigations were done, including hematological and immunological profiles, sputum and bronchoalveolar lavage fluid examination, chest radiograph, high resolution computed tomography (HRCT), pulmonary function test and lung biopsy. Results: Of the 75 patients 60 (80%) were over 40 years of age. The duration of symptoms in 34 patients (45%) was less than 6 months and longer than 1 year in 28 (37.7%) patients. Twenty-five of the patients were cigarette smokers. The mean forced lung capacity (FVC), total lung capacity and diffusing capacity for carbon monoxide were less than 60% of the predicted values in most patients. There was a significant difference in mean FVC value between smokers and nonsmokers (p < 0.05). The HRCT findings were at an advanced stage in 65 patients, with additional honeycombing in 21 of the 65 patients. Idiopathic pulmonary fibrosis was the most common cause of DPLD, occurring in 52 patients, followed by sarcoidosis and collagen vascular diseases. Conclusion: DPLD was observed predominantly in middle aged and elderly patients, due probably to increasing industrialization in the country. The role of cigarette smoking as a contributory factor remains unclear.

The Prevalence of Human Bocavirus, Human Coronavirus-NL63, Human Metapneumovirus, Human Polyomavirus KI and WU in Respiratory Tract Infections in Kuwait

Objective: The aim of this study was to investigate the prevalence of human coronavirus (HCoV)-NL63, human metapneumovirus (hMPV), human bocavirus (Boca), human polyomavirus KI (KIV) and human polyomavirus WU (WUV) in respiratory tract infections (RTI) in Kuwait. Materials and Methods: Respiratory samples from 735 hospitalized patients with RTI from September 2010 to April 2013 were evaluated for the presence of HCoV-NL63, hMPV, Boca, KIV and WUV using molecular assays, polymerase chain reaction (PCR) and reverse-transcription PCR. Results: Of the 735 patients, 285 (38.8%) were diagnosed with viral RTI. The distribution of respiratory viruses was hMPV: 15 (5.3%), Boca: 14 (4.9%), WUV: 10 (3.5%) and KIV: 4 (1.4%). HCoV-NL63 was not detected in any of the samples. Conclusions: These newly discovered viruses were associated with the development of RTI in Kuwait. The rapid identification of these viral infections could aid in the control of nosocomial transmission, reduce the use of antibiotics and improve treatment and management strategies.

797Viral co-infections in hospitalized patients with respiratory tract infections

infections Widad Al-Nakib, FRCPath, FIDSA; Sahar Essa, BSc, MSc, PhD; Haya Altawalah, BSc, MBBS, FRCPath; Abdullah Owayed; Mousa Khadadah; Nasser Behbehani; Microbiology Department Kuwait University, Faculty of Medicine, Kuwait; Virology Unit, Ministry of Health, Mubarak Hospital, Kuwait; Paediatrics, Kuwait University, Faculty of Medicine, Kuwait; Medicine, Kuwait University, Faculty of Medicine, Kuwait