Cutaneous leishmaniasis in Al Hassa,Saudi Arabia: Epidemiological trends from 2000 to 2010

ObjectiveTo study epidemiological trends related to cutaneous leishmaniasis (CL) in Al Hassa, an endemic area in Saudi Arabia.MethodsThis retrospective study included the spatial/temporal analysis of the reported cases of CL using the available surveillance database for the disease at the regional Vector Control Unit, from 2000 to 2010.ResultsThe incidence of CL was declining at a stable rate especially during the last 3 years of the study (2008-2010). An interesting finding was the percentage of expatriates affected was increasing over the last 10 years compared to that of the Saudis.ConclusionsA definite declining trend in the incidence of CL was observed in Al Hassa. Further studies are warranted to assess whether special public health measures are needed for better control of CL in expatriate populations in Saudi Arabia.     

Cutaneous leishmaniasis: a 46-year study of the epidemiology and clinical features in Saudi Arabia (1956-2002).

OBJECTIVE: The aim of this study was to evaluate the epidemiology of cutaneous leishmaniasis in the Eastern Province of Saudi Arabia. In addition, the clinical spectrum of the disease was evaluated. METHODS: This is a retrospective study of cutaneous leishmania cases from 1956 to 2002. RESULTS: In the study period, there were 1862 patients with cutaneous leishmaniasis in the Saudi Aramco health care system. The disease is more prevalent in the Al-Hasa Oasis (Eastern Province of Saudi Arabia) and affects males and females equally. Cutaneous leishmaniasis follows a seasonal distribution in parallel with the known activity of the sandfly. The majority (76%) of cases occurred in patients < 15 years of age and the disease affected the extremities more frequently than the face. Seventy-one percent of patients presented with a single lesion and 27% presented with two lesions. Ulcerative cutaneous leishmaniasis was the predominant morphology (89%). CONCLUSION: Cutaneous leishmaniasis attained epidemic proportions in 1973 and subsequently declined and reached a plateau in the mid-1980s. Skin involvement is the major clinical picture, with no evidence of dissemination or viscerotropic syndrome.     

Phlebotomine sand fly population dynamics in a leishmaniasis endemic peri-urban area in southern Italy

A 2-year survey was carried out from May to November 2008 and 2009 to study the sand fly species composition, its seasonal phenology and density in Apulia region (southern, Italy). The study was conducted in a dog shelter located in a new residential urban district where Leishmania infantum is endemic. Sand flies were collected using sticky traps from May to November, at about 7-day intervals. Temperature and relative humidity were recorded daily. In December 2008, general environmental improvements (e.g., the ground was covered with gravel and the vegetation present inside the cages was removed to facilitate cleaning) were made in the study area. The most diffused species during the whole study period were Phlebotomus perniciosus (2008, n = 248, 49.4%; 2009, n = 254, 50.6%) followed by Phlebotomus neglectus (2008, n = 76, 39.8%; 2009, n = 115, 60.2%) and Phlebotomus papatasi (2008, n = 5, 50.0%; 2009, n = 5, 50.0%). Four specimens of Phlebotomus perfiliewi were collected only in the first year. The number of Sergentomyia minuta specimens collected increased considerably in the second (n = 548, 86.2%) in comparison to the first year (n = 88, 13.8%). The highest number of phlebotomine sand flies was collected in July and August when a mean temperature from 27.09 to 28.02 °C and mean relative humidity from 47.28 to 56.36% were recorded. The variations in phlebotomine sand fly species diversity and abundance recorded in this study were related to climatic and environmental factors. Data here presented confirm that sand flies easily adapt to the urban environments and that the may represent a public health concern for L. infantum and other pathogen transmission also in similar urban environment of southern Europe.     

Epidemiological and clinical features of 62 patients with visceral leishmaniasis

<正>Objective To analyze the epidemiological and clinical features of patients with visceral leishmaniasis(VL),and to improve the understanding of the disease and standardize the diagnosis and treatment.Methods The clinical data and diagnosis and treatment process of62 patients with VL admitted to The First Hospital of Lanzhou University from January 2010 to December 2020were retrospectively analyzed.The clinical symptoms and laboratory data,     

Some aspects of the epidemiology of cutaneous leishmaniasis in the Al-Kharaj area of Saudi Arabia

Four hundred and thirteen patients with skin ulcers were clinically diagnosed as suffering from cutaneous leishmaniasis; 82 (approximately 20%) of these cases were confirmed microscopically. Ulceration occurred mainly on the exposed parts of the body. Of the total cases 69% were Egyptian labourers, 14% Saudis and the remaining 17% Syrian, Pakistani, Yemeni or Filippino. Most of the Saudi patients were children aged up to ten years. Two Rattus rattus collected during the study had skin ulcerations on the face, indicating possible infection with leishmaniasis. Poor living conditions on the farms seem partly responsible for the high rate of incidence of cutaneous leishmaniasis among the labourers.     

Epidemiological aspects and clinical implications of malaria as seen in Jeddah, Saudi Arabia

A review is presented of 242 patients with acute malaria seen at two hospitals in Jeddah. Jeddah should be regarded as the malaria outpost of the South Western region of Saudi Arabia since nearly all of these patients contracted the disease while travelling within that area during the previous month. Plasmodium falciparum was the predominant infection (77%). There was a marked seasonal incidence with a peak during December to April; 84% of the patients were male. In contrast to the common impression that the total white cell count is low or normal in malaria, one-third of a sample of 124 patients had a total count of at least 10 000 mm-3; approximately 40% of the patients did not have a palpable spleen. Evidence is presented to show the danger of treating patients with falciparum malaria on an out-patient basis. Ideally, all such patients should be hospitalized and observed in order to ensure effective treatment. The Kingdom of Saudi Arabia has many medical and paramedical personnel who have little practical experience in the diagnosis of malaria. We therefore recommend that training programmes in the laboratory diagnosis of malaria should be initiated in specialized centres in the Kingdom or abroad.     

Epidemiologic aspects of American visceral leishmaniasis in an endemic focus in Eastern Venezuela

An endemic focus of American visceral leishmaniasis (AVL) in eastern Venezuela has been evaluated in terms of patients (n = 48), immunologic reactivity to Leishmania in household contacts (n = 187) and neighborhood controls (n = 170), detection of Leishmania (L. donovani complex) in dogs and wild animals by the polymerase chain reaction (PCR) and characteristics of the sandfly population. The male:female ratio of patients was 1.18:1; 89.6% were < or =12 years old. Serologic reactivity was significantly higher in household contacts than in controls (P = 0.0008), as was the size of leishmanin reactions in contacts < or =10 years of age (P = 0.0141). Leishmania donovani complex-specific PCRs were positive in dogs, an opossum (Didelphis marsupialis), and a black rat (Rattus rattus). Lutzomyia longipalpis and Lu. evansi, both implicated in the transmission of AVL, were identified among the 386 sand flies examined. These observations provide the bases for an active control program as well as further studies of reservoirs and vector-host relationships in this area.     

Cutaneous leishmaniasis following local trauma: a clinical pearl.

Cutaneous leishmaniasis is acquired from the bite of an infected sand fly and can result in chronic skin lesions that develop within weeks to months after a bite. Local trauma has been implicated as a precipitating event in the development of skin lesions in patients who have been infected with Leishmania species. Here we report a case series and review the literature on patients who developed cutaneous leishmaniasis after local trauma, which may familiarize clinicians with this presentation.     

Prevalence and clinical features of colonic diverticulosis in a Middle Eastern population

AIM: To determine the prevalence, location, associations and clinical features of colonic-diverticulosis and its role as a cause of lower-gastroenterology-bleeding. METHODS: We retrospectively reviewed the medical records of 3649 consecutive patients who under-went a colonoscopy for all indications between 2007 and 2011 at King Khalid University Hospital, Riyadh, Saudi Arabia. The demographic data were collected retrospectively through the hospital’s information system, electronic file system, endoscopic e-reports, and manual review of the files by two research assistants. The demographic information included the age, sex, comorbidities and indication for the colonoscopy. The association among colonic polyps, comorbidities and diverticular disease was also measured.RESULTS: A total of 270 patients out of 3649 were diagnosed with colonic diverticulosis, with a prevalence of 7.4%. The mean age was 60.82 years ± 0.833, (range 12-110). Females comprised 38.89% (95%CI: 33-44.7) of the study population. The major symp-toms were rectal bleeding in 33.6%, abdominal pain in 19.3%, constipation in 12.8% and anemia in 6%. Diverticula were predominantly left-sided (sigmoid and descending colon) in 62%, right-sided in 13% and in multiple locations in 25%. There was an association between the presence of diverticulosis and adenomatous polyps (Pvalue < 0.001), hypertension (P-value < 0.0001) and diabetes mellitus (P-value < 0.0016). Diverticular disease was the second most common cause of lower gastrointestinal bleeding, in 33.6% (95%CI: 27.7-39.4), after internal hemor-rhoids, in 44.6% (95%CI: 40.3-48.9). On multivariable logistic regression, hypertension (OR = 2.30; 95%CI: 1.29-4.10), rectal bleeding (OR = 2.57; 95%CI: 1.50-4.38), and per year increment in age (OR = 1.05; 95%CI: 1.03-1.07) were associated with diverticulosis but not with bleeding diverticular disease. Limitations: A small proportion of the patients included had colo-noscopies performed as a screening test.CONCLUSION: Colonic-diverticulosis was found to have a low prevalence, be predominantly left-sided and associated with adenomatous-polyps. Age, hypertension and rectal bleeding predict the presence of diverticular disease.     

A prospective study of visceral leishmaniasis in an endemic area of Brazil

The epidemiology, clinical patterns, and risk factors for visceral leishmaniasis were prospectively studied in an endemic area of Brazil. The prevalence of disease was 3.1% for children less than 15 years of age, and the annual incidence was 4.3 cases per 1,000 children. The number of children with disease fluctuated yearly and seasonally, and distribution of the disease varied within the endemic area. Risk factors included young age (median, three years) and malnutrition before the onset of disease. Intestinal parasitism, recent migration into the area, and house location within the area did not influence the progression of infection to disease. Serological testing indicated that 7.5% of children were infected with Leishmania each year and that the ratio of disease to infection was 1:18.5 for the whole area and 1:6.5 for the section with the highest prevalence of disease. Early diagnosis and therapy altered clinical patterns of the disease.     

Lymphocyte subpopulations in malaria infected individuals living in an endemic area

Development of partial immunity in people living in malaria endemic area is complex. For better understanding, the lymphocyte subpopulations from infected patients were evaluated by flow cytometer before any antimalarial treatment. In P. vivax infection, the frequency of T-helper type 1 (Th1) was decreased significantly (p = 0.042). In contrast, the number of T- helper type 2 (Th2) was increased significantly (p = 0.001). These trends have also been observed in P. faciparum infection. The Th2 predominant response to the natural malaria infection is likely due to persistent stimulation by Plasmodium species. In P. falciparum infection, CD8+ cytotoxic lymphocytes were significantly reduced (p = 0.007). However, such changes were not found in P. vivax infection. This might suggest that CD8+ cell responses to different Plasmodium spp in a different way. Both Th2 activation and CD8+ cell suppression may reflect less protective effects and chronic malaria infection could be established.     

Epidemiology and clinical features of methicillin-resistant Staphylococcus aureus in the University Hospital, Jeddah, Saudi Arabia.

OBJECTIVE: To describe the prevalence, demography and clinical characteristics of patients who were colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA) in 1998 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. PATIENTS AND METHODS: Results of MRSA-positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the King Abdulaziz University Hospital Infection Control Department's records. Charts of patients were reviewed. RESULTS: Of 292 S aureus isolates identified, 111 (38%) were MRSA, or 6.0 MRSA isolates/1000 admissions, which represented a marked increase over MRSA prevalence in 1988 (less than 2%). Nosocomial acquisition occurred in 74.8% of isolates. All age groups were affected, but 45.9% of patients were in the 'extremes of age' group (younger than one or older than 60 years of age). The prevalence was highest in the medical ward (27%), followed by the paediatrics combined medical and surgical ward (20.7%), the outpatient department (18%), the adult surgical ward (17.1%) and the intensive care units (17.1%). Two-thirds (66.7%) of cases represented infection and the remainder represented colonization. Surgical wounds (31.1%), the chest (27%) and endovascular catheters (20.3%) were the most common sites of infection. Bacteremia occurred in 27% of patients. Local signs (68.9%) and fever (60.8%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 28.4% and 6.8% of cases, respectively. Of 74 patients with MRSA infection and 37 patients with MRSA colonization, 91.9% and 56.8% received antibiotics in the preceding six weeks, respectively (P<0.0001). The total mortality of patients with MRSA infection was 60.8%; 37.8% of deaths were the result of MRSA infection and 23% were the result of other diseases. CONCLUSIONS: The prevalence of MRSA is high and rapidly increasing at King Abdulaziz University Hospital, as it is worldwide. Control measures to prevent the spread of MRSA in hospitals should continue with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.     

Longitudinal study of dogs living in an area of Spain highly endemic for leishmaniasis by serologic analysis and the leishmanin skin test

The literature contains few longitudinal studies that have assessed areas endemic for canine leishmaniasis and over the same time interval Leishmania-specific cellular and humoral immunity in healthy dogs. Fourteen dogs, three mixed breed and 11 Ibizian hounds, living in an area of Spain that was highly endemic for leishmaniasis were followed-up over a three-year period by serologic analysis and the leishmanin skin test (LST). All but one of these dogs remained clinically healthy during the study period. Seroconversion was observed in four dogs. The three mixed breed dogs had a negative reaction in the LST in the first and third years. The general trend in the Ibizian hounds was an increase in the diameter of the LST reaction at both the 48- and 72-hour readings in the third year. This study demonstrates that in addition to an increase in Leishmania-specific humoral immune response in Ibizian hounds, a parallel increase in cellular immune response was observed.     

Situation analysis of cutaneous leishmaniasis in an endemic area,south of Iran

Objective: To update current situation of the cutaneous leishmaniasis(CL) in Kazerun County,southwest of Iran and to analyze the epidemiological aspects of the disease during 2005-2015,Methods: Data on CL were obtained from the Health Center of Kazerun County,and then were analyzed and mapped using SPSS and Arc GIS 10.3,Results: A total of 700 cases of CL were recorded during the study period with an overall decreasing trend from 2005 to 2015,More than 60% of the patients were inhabitants of rural areas and males were infected more than females,Although there was not a significant difference between gender,job categories,residence and CL infection(P0.05),age groups were significantly different(P0.05),But there was no significant correlation between monthly cases of the disease with average temperature(P0.05),Most of the acute lesions were found to be present on the hand,leg and face,respectively,The average CL incidence in the study area was calculated as 24.9/100 000 population,A hot spot for the disease was found in southern part of the area(P0.05),Conclusions: This study revealed that CL is present in Kazerun country,Thus,effective monitoring and sustained suveillance system is crucial in counteracting the disease,and if possible,to eliminate it.     

The epidemiology of human brucellosis in a well defined urban population in Saudi Arabia.

A retrospective survey was undertaken to provide the first reported estimate of the incidence of human brucellosis in Saudi Arabia. The study population was unusually well defined and consisted of all individuals resident in the Riyadh and Al Kharj regions and registered for treatment in the Riyadh-Al Kharj Hospital Program. Cases satisfying predetermined case criteria were identified initially from a retrospective review of hospital laboratory records, and this was supported by a review of individual medical case-notes. Brucellosis was found to be much more common in Saudi nationals than expatriate nationals. Among Saudi nationals the study demonstrated a remarkable increase in brucellosis with increasing age, and a higher incidence amongst women than men in some age groups. This was felt to have been due either to an increased exposure to infected livestock, or to an increased susceptibility to the disease in women, and with increasing age. There was a seasonal fluctuation in the occurrence of brucellosis with the largest number of cases occurring in spring and summer.     

Systemic lupus erythematosus in Saudi Arabia: morbidity and mortality in a multiethnic population

The objective of this study is to summarize the features of patients with Lupus erythematosus in Saudi Arabia. Racial differences of patients and predictors of mortality are assessed. Ninety-three patients treated for SLE at the University Hospital in Jeddah were reviewed. Frequencies of clinical manifestations, causes of admission and causes of death were analysed. Variables predicting mortality were assessed by logistic regression and survival probabilities were estimated by the Kaplan-Meier method. The most frequent presenting symptoms were arthritis (68%) and fever (58%). Renal involvement was seen in 61% of patients. The majority of patients (61%) showed ANA titers higher than 1:1280. C4 levels were significantly lower in patients who died during the observation period than in survivors. The overall five-year survival rate was 92%. Variables predicting early death (<2 years after diagnosis) were young age at diagnosis, male sex and skin involvement. Death after more than two years correlated with older age at diagnosis and renal involvement. Patients of African descent had higher rates of neurological involvement and renal failure. The mortality in this group was highest, though this was not statistically significant. The overall survival in our cohort compares with mortality rates reported from western countries. However, renal disease tends to be common and has a severe prognosis, and thus merits additional attention.