1
|
Albayat S, Almaslamani M, Alromaihi H, Khogali H, Mundodan J, Joury J, Haridy H. Key Lessons from COVID-19: A Narrative Review Describing Qatar's Multifactorial Approach in Executing a Vaccination Campaign. Vaccines (Basel) 2023; 11:vaccines11050953. [PMID: 37243057 DOI: 10.3390/vaccines11050953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Widespread vaccination programs have been implemented in many countries to curtail the COVID-19 pandemic, with varying success and challenges. To better understand the successes and challenges of the global COVID-19 response in the face of emerging new variants and epidemiologic data, we discuss how Qatar engaged the healthcare sector, governmental bodies, and the populace to combat COVID-19, with a focus on the country's vaccination strategy. This narrative provides the history and timeline of the Qatar COVID-19 vaccination campaign; factors that helped the vaccination campaign and the transferable lessons learned are discussed. Details regarding how Qatar responded to challenges, such as vaccine hesitancy and mitigation of misinformation, are highlighted. Qatar was one of the first countries to procure the BNT162b2 (Comirnaty®; Pfizer-BioNTech, Pfizer Inc., New York, NY, USA) and mRNA-1273 (Spikevax®; Moderna, Cambridge, MA, USA) COVID-19 vaccines. A relatively high vaccination rate and low case mortality rate (0.14% as of 4 January 2023) was observed in Qatar compared with other countries (global case mortality rate, 1.02%). Learnings will be carried forward as a basis for addressing this evolving pandemic and any future national emergencies in Qatar.
Collapse
Affiliation(s)
- Soha Albayat
- Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Muna Almaslamani
- Communicable Disease Center, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | | | | | | | - Jean Joury
- Pfizer Gulf FZ LLC, Dubai P.O. Box 502749, United Arab Emirates
| | - Hammam Haridy
- Pfizer Gulf FZ LLC, Dubai P.O. Box 502749, United Arab Emirates
| |
Collapse
|
2
|
Salah H, Houbraken J, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Molecular epidemiology of clinical filamentous fungi in Qatar beyond Aspergillus and Fusarium with notes on the rare species. Med Mycol 2023; 61:6967136. [PMID: 36592959 PMCID: PMC9874029 DOI: 10.1093/mmy/myac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Due to an increasing number of patients at risk (i.e., those with a highly compromised immune system and/or receiving aggressive chemotherapy treatment), invasive fungal infections (IFI) are increasingly being reported and associated with high mortality rates. Aspergillus spp., particularly A. fumigatus, is the major cause of IFI caused by filamentous fungi around the world followed by Fusarium spp., however, other fungi are emerging as human pathogens. The aim of this study was to explore the epidemiology and prevalence of the non-Aspergillus and non-Fusarium filamentous fungi in human clinical samples over an 11-year period in Qatar using molecular techniques. We recovered 53 filamentous fungal isolates from patients with various clinical conditions. Most patients were males (75.5%), 9.4% were immunocompromised, 20.7% had IFI, and 11.3% died within 30 days of diagnosis. The fungal isolates were recovered from a variety of clinical samples, including the nasal cavity, wounds, respiratory samples, body fluids, eye, ear, tissue, abscess, and blood specimens. Among the fungi isolated, 49% were dematiaceous fungi, followed by Mucorales (30%), with the latter group Mucorales being the major cause of IFI (5/11, 45.5%). The current study highlights the epidemiology and spectrum of filamentous fungal genera, other than Aspergillus and Fusarium, recovered from human clinical samples in Qatar, excluding superficial infections, which can aid in the surveillance of uncommon and emerging mycoses.
Collapse
Affiliation(s)
- Husam Salah
- To whom correspondence should be addressed. Husam Salah, M.Sc. Division
of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical
Corporation, Doha, Qatar, PO Box 3050. Tel: +97-444-391-047. E-mail: ;
| | - Jos Houbraken
- Applied and Industrial Mycology, Westerdijk Fungal Biodiversity
Institute, Utrecht, Netherlands
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute,
Utrecht, Netherlands,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of
Amsterdam, Amsterdam, The
Netherlands
| | | | - Saad J Taj-Aldeen
- Division of Microbiology, Department of Laboratory Medicine and
Pathology, Hamad Medical Corporation, Doha,
Qatar,Department of Biology, College of Science, University of
Babylon, Hilla, Iraq
| |
Collapse
|
3
|
Alzibdeh AH, Alamami AA, Adam M, Almaslamani M, Hadi HA. A complex presentation of an uncommon disease: Gas-forming pyogenic liver abscess complicated by septic pulmonary emboli and muscle abscesses, a case report and review of the literature. IDCases 2022; 31:e01673. [PMID: 36632483 PMCID: PMC9827024 DOI: 10.1016/j.idcr.2022.e01673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Pyogenic liver abscess (PLA) is the most common type of visceral abscess. Its variable clinical presentation depends on patient demography, underlying conditions, causative pathogens as well as the size of the abscess. Most cases are secondary to enteric pathogens that cause focal liver disease. Gas-forming pyogenic liver abscess (GFPLA) is a rare subgroup of PLA characterized by the presence of gas within the abscess. The disease is associated with diabetes mellitus (DM) while Klebsiella penumoniae is the most frequently isolated pathogen. Despite appropriate evaluation and management, secondary complications are common with significant morbidity and mortality that necessitate prompt recognition and management. Case presentation We present a case of a 46-year-old gentleman from Bangladesh who presented to the emergency department with fever, chills, and right upper quadrant abdominal discomfort. Evaluation revealed elevated inflammatory markers with high blood glucose and a subdiaphragmatic lucency on a plain chest radiograph. The suspected underlying visceral infection was confirmed by abdominal ultrasonography and computed tomography which demonstrated an emphysematous abscess of 8 cm in diameter in the right liver lobe.Because of clinical instability, the patient was admitted to the medical intensive care unit (MICU) where he received appropriate supportive management with antimicrobials and percutaneous drainage of the abscess. Cultures collected from blood, the abscess, and urine grew a sensitive strain of Klebsiella pneumoniae. During his stay in the MICU, he complained of dyspnea. A CT pulmonary angiography was suggestive of septic emboli. A few days later, the patient started to complain of left gluteal pain and an US revealed a deep left gluteal abscess which required drainage. Cultures of the pus grew the same sensitive strain of Klebsiella pneumoniae. After receiving 6 weeks of parenteral antimicrobial therapy a repeated US revealed complete resolution of the abscess in the liver. Outpatient follow up showed favorable recovery. Conclusion Gas-forming pyogenic liver abscess (GFPLA) is a rare manifestation of pyogenic liver abscess that usually occurs in patients with poorly controlled DM. Despite appropriate evaluation, morbidity remains high therefore timely recognition and anticipation of complications is important.
Collapse
Affiliation(s)
- Aseel H. Alzibdeh
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar,Weill Cornell Medicine Qatar, Qatar,Correspondence to: Hamad Medical Corporation, P O Box 3050, Doha, Qatar.
| | - Ans A. Alamami
- Department of Critical Care, Hamad General Hospital, Hamad Medical Corporation, Qatar
| | - Mohammad Adam
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Muna Almaslamani
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar,Weill Cornell Medicine Qatar, Qatar
| | | |
Collapse
|
4
|
Ali M, Alamin MA, A. Ali G, Alzubaidi K, Ali B, Ismail A, Daghfal J, Almaslamani M, Hadi HA. Microbiological and clinical characteristics of invasive Group B Streptococcal blood stream infections in children and adults from Qatar. BMC Infect Dis 2022; 22:881. [PMID: 36434535 PMCID: PMC9701022 DOI: 10.1186/s12879-022-07801-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Group B Streptococci (GBS) colonize almost one third of human gastrointestinal and genitourinary tracts, particularly in females. The aim of this study is to evaluate the epidemiology, microbiological characteristics, and clinical outcomes of invasive GBS disease in Qatar from all age groups. METHODS A retrospective study was conducted on patients with confirmed GBS blood stream infections during the period between January 2015 and March 2019. Microbiological identification was performed using automated BD PhoenixTM system, while additional antimicrobial susceptibility tests were performed using E test and disc diffusion methods. RESULT During the four years period, the incidence steadily rose from 1.48 to 2.09 cases per 100.000 population. Out of 196 confirmed cases of invasive GBS infections, the majority were females (63.7%, 125/196) of which 44.8% were pregnant and 53.6% were colonized. Three distinct affected age groups were identified: children ≤ 4 years of age (35.7%), young adults 25-34 (20.9%) and the elderly ≥ 65 year (17.4%). Presenting symptoms were mild with fever in 53% of cases while 89% of cases had Pitt bacteraemia score of ≤ 2. Isolates were universally sensitive to penicillin, ceftriaxone, and vancomycin at 100% but with significant resistance to erythromycin (49%) and clindamycin (28.6%) while 16.8% had inducible clindamycin resistance. Clinical outcomes showed cure rate of 87.25% with complications in (8.76%) and 4% mortality. CONCLUSION There is a rising trend of Group B Streptococcal blood stream infections in Qatar with significantly high clindamycin and erythromycin resistance rates. Universal susceptibility rates were demonstrated for penicillin, ceftriaxone, and vancomycin.
Collapse
Affiliation(s)
- Maisa Ali
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Mohammed A. Alamin
- grid.413548.f0000 0004 0571 546XInternal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Gawahir A. Ali
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Khalid Alzubaidi
- grid.467063.00000 0004 0397 4222Paediatric Infectious Diseases, Sidra Medicine, Doha, Qatar
| | - Bashir Ali
- grid.413548.f0000 0004 0571 546XInternal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdellatif Ismail
- grid.413548.f0000 0004 0571 546XInternal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Joanne Daghfal
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Muna Almaslamani
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Hamad Abdel Hadi
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| |
Collapse
|
5
|
Alsaed O, Chaponda M, Elsayed E, Ashour H, Almaslamani M, Al Emadi S. POS1252 DURABILITY OF THE HUMORAL RESPONSE TO m-RNA BASED ANTI-SARS-CoV-2 VACCINES IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASE, A COMPARATIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and its impact on disease outcome in patients with autoimmune rheumatic disease (ARD) are lacking. Also, whether patients with ARD receiving immunomodulators have different viral loads compared to the general population is unknown.ObjectivesTo compare the viral load of SARS-CoV-2 and its trending between patients without and with ARD.MethodsRetrospectively, patients with ARD infected with SARS-CoV-2 were matched by age and sex at a ratio of 1:2 to patients without ARD and not receiving immunosuppression or immunomodulator drugs. Viral load was determined by the cycle threshold (CT) value measured by a number of platforms: (a) Automated Platforms - the Roche Cobas 6800 system using the Cobas SARS-CoV-2 Test targeting the E and orf1a/b genes (Roche, Switzerland) and the Xpert Xpress SARS-CoV-2 targeting the E and N genes (Cepheid, USA); (b) Manual platforms - EZ1 (QIAGEN, USA), QIAsymphony (QIAGEN, USA), and Bioneer ExiPrepTM 96 Virus DNA/RNA kits Catalogue No K4614 (Bioneer, South Korea) extraction with thermal cycling using TaqPath™ PCR COVID-19 Combo Kit targeting the N, S and orf1a/b genes (Thermo Fisher Scientific, USA) on ABI 7500 thermal cyclers. Independent samples t-test was used to compare the mean CT values of the study groups at baseline and at 5 subsequent intervals (1 – 5.9, 6 – 11.9, 12 – 17.9, 18 – 23.9 and 24 – 30 days).ResultsMean age (SD) of 197 cases and 420 controls were 45.2 (11.8) and 44.1 (12.3) years, respectively. Females were predominant in both groups 60% vs. 52%, P=0.053. The most common ARD was rheumatoid arthritis in 82 cases (41.6%), followed by spondyloarthropathy in 33 (16.8%) and systemic lupus erythematosus in 31 (15.7%). Of the cases, 67% were on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), 15.2% on biological DMARDs and 4.6% patients were on rituximab. The mean CT values was significantly lower in the ARD group at baseline and persisted till day 24.Table 1.Demographic characteristics and comparison of the mean CT values in the study groups at baseline and at different intervals with the corresponding OR (95% CI)Case (N=197)Control (N=420)OR (95% CI)Mean (SD) age, years45.2 (11.8)44.1 (12.3)1.008 (0.994–1.022)Sex, female N (%)120 (60.9%)221 (52.6)0.713 (0.505–1.006)Mean (SD) CT values at Baseline22.9 (5.5)30 (5.2)0.799 (0.745–0.858) 1 – 5.9 days22.1 (4.6)25.7 (6.3)0.901 (0.842–0.963) 6 – 11.9 days26.9 (4.9)31.5 (3.9)0.802 (0.724–0.888) 12 – 17.9 days29.6 (4.1)32.3 (3.2)0.827 (0.743–0.921) 18 – 23.9 days32.1 (4)32.9 (2.5)0.903 (0.728–1.119) 24 – 30 days31.2 (1.2)32.7 (2.6)0.824 (0.589–1.151)ConclusionCompared to patients without ARD, the viral load of SARS-CoV-2 in patients with ARD is significantly higher at baseline testing and persists till day 24. This finding may indicate that patients with ARD are at higher risk of severe SARS-CoV-2 infection and prolonged potential transmission. Clinical outcome correlation is needed.ReferencesNoneDisclosure of InterestsNone declared
Collapse
|
6
|
Ali M, Razok A, Gassim M, Elmaki N, Goravey W, Alkhal A, Almaslamani M, Alsoub H. HIV and AIDS-defining opportunistic illnesses in the state of Qatar: A cohort population-based retrospective study covering 17 years (2000-2016). Ann Med Surg (Lond) 2022; 78:103842. [PMID: 35734645 PMCID: PMC9207101 DOI: 10.1016/j.amsu.2022.103842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background and introduction Human immune deficiency virus (HIV) infection remains a major health problem since discovery of the virus in 1981. Globally, since introduction of antiretroviral therapy, AIDS-related mortality was reduced by 47% since 2010. Also, HIV-related opportunistic infections (OIs) became less common, especially with use of prophylaxis to prevent such infections. In this study, we aim to assess the incidence of HIV infection and related OIs in Qatar for 17-year period, and to assess the spectrum of these infections, risk factors and treatment outcomes. Methods This is a retrospective cohort study for all HIV infected patients registered in the state of Qatar from 2000 to 2016. Incidence of HIV infection and related opportunistic illness was calculated per 100,000 population. Demographic and Clinical characteristic were compared between two groups of patients with and without opportunistic illness. Results of 167 cases with HIV infection 54 (32.3%) had opportunistic illness. The average incidence rate of HIV infection over 17 years is 0.69 per 100,000 population, and the incidence rate for opportunistic illness is 0.27 per 100,000 population. The most common opportunistic illness is pneumocystis jirovecii pneumonia (PCP) which constituted 25% of cases, followed by cytomegalovirus (CMV) retinitis 7.2%, Tuberculosis 5.4%, Toxoplasmosis 4.2% and, less than 2% for each of Kaposi sarcoma, lymphoma and cryptococcal infection. The outcome of treatment of cases with opportunistic illness showed cure rates of 59.3%, one year relapse rates of 8.76% and overall, 90-day mortality of 3.7% however, 33.4% of patients left the country before completion of therapy. Most of our patients in both groups were of young age, majority males, and almost half of them were Qatari. The CD4 count, CD4%, CD4/CD8 ratio and viral load were statistically significant risk factors in cases with opportunistic illness with a p value < 0.05, however presence of comorbidities was lower in patients with opportunistic illness P value of 0.032. Conclusion Qatar has a low prevalence rate for HIV infection and related opportunistic illness. Early diagnosis and use of antiretroviral therapy are important measures to decrease the rate of opportunistic illness. HIV is a widely spread infection with special interest to public health. HIV-related morbidity is associated with a large burden to health systems. It is associated with opportunistic infections that affect all body systems. Population-based studies are essential for understanding its complications.
Collapse
Affiliation(s)
- Maisa Ali
- Department of Infectious Diseases, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| | - Almurtada Razok
- Department of Internal Medicine, Hamad Medical Corporation, P.O 3050, Doha, Qatar
- Corresponding author. Department of Internal Medicine, Hamad Medical Corporation, Hamad General Hospital, Hamad Medical City, 3050, Doha, Qatar.
| | - Mahmoud Gassim
- Department of Pharmacology, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| | - Nada Elmaki
- Department of Infectious Diseases, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| | - Wael Goravey
- Department of Infectious Diseases, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| | - Abdulatif Alkhal
- Department of Infectious Diseases, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| | - Muna Almaslamani
- Department of Infectious Diseases, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| | - Hussam Alsoub
- Department of Infectious Diseases, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| |
Collapse
|
7
|
Ali M, Alamin M, Alzubaidi K, Ali B, Ismail AL, Abass G, Al Wali W, Daghfal J, Almaslamani M, Abdle Hadi H. Epidemiology, Microbiological Characteristics and Clinical Outcomes of Invasive Blood Stream Infections of Group B Streptococcal Isolates From Qatar. Journal of Emergency Medicine, Trauma and Acute Care 2022. [DOI: 10.5339/jemtac.2022.qhc.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Maia Ali
- Division of Infectious Diseases, Medicine Department, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Mohammed Alamin
- Division of Internal Medicine, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Alzubaidi
- Division of Infectious Diseases, Pediatric Department, Sidra Hospital, Doha, Qatar
| | - Bashir Ali
- Division of Internal Medicine, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdel-Latif Ismail
- Division of Internal Medicine, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Gwahir Abass
- Division of Infectious Diseases, Medicine Department, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Walid Al Wali
- Division of Infectious Diseases, Pediatric Department, Sidra Hospital, Doha, Qatar
| | - Joanne Daghfal
- Microbiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Muna Almaslamani
- Division of Infectious Diseases, Medicine Department, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Hamad Abdle Hadi
- Division of Infectious Diseases, Medicine Department, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar E-mail:
| |
Collapse
|
8
|
Alattar RA, Ahmed SA, Abdallah T, Kazman R, Qadmour AN, Ibrahim T, Alhariri B, Shaar SH, Bajwa A, Alimam A, Qazi R, Abid FB, Daghfal J, Eldeeb AM, Shukri K, Elsayed A, Rustom F, AlSamawi MS, Abdelmajid AA, Basulto M, Cobian A, Khattab MA, Almaslamani M, Khal AA, Omrani AS. 508. Title Favipiravir for the Treatment of Coronavirus Disease 2019; A Propensity Score Matched Cohort Study. Open Forum Infect Dis 2021. [PMCID: PMC8644787 DOI: 10.1093/ofid/ofab466.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We investigated clinical outcomes of favipiravir in patients with COVID-19 pneumonia. Methods Patients who between 23 May 2020 and 18 July 2020 received ≥24 hours of favipiravir were assigned to the favipiravir group, while those who did not formed the non-favipiravir group. The primary outcome was 28-day clinical improvement, defined as two-category improvement from baseline on an 8-point ordinal scale. Propensity scores (PS) for favipiravir therapy were used for 1:1 matching. Cox regression was used to examine associations with the primary endpoint. Results The unmatched cohort included 1,493 patients, of which 51.7% were in the favipiravir group, and 48.3% were not receiving supplemental oxygen at baseline (table 1). Favipiravir was started within a median of 5 days from symptoms onset. Significant baseline differences between the two unmatched groups existed, but not between the PSmatched groups (N = 774) (table 1). After PS-matching, there were no significant differences between the two groups in the proportion with 28-day clinical improvement (93.3% versus 92.8%, P 0.780), or 28-day all-cause mortality (2.1% versus 3.1%, P 0.360) (Table 2). Favipiravir was associated with more viral clearance by day 28 (79.8% versus 64.1%, P < 0.001) (table 2). In the adjusted Cox proportional hazards model, favipiravir therapy was not associated 28-day clinical improvement (adjusted hazard ratio 0.978, 95% confidence interval 0.862 –1.109, P 0.726) (Table 3). ![]()
![]()
![]()
Conclusion Favipiravir therapy for COVID-19 pneumonia is well tolerated but is not associated with an increased likelihood of clinical improvement or reduced all-cause mortality by 28 days. Disclosures All Authors: No reported disclosures
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Abeer Bajwa
- Hamad Medical corporation, Doha, Ad Dawhah, Qatar
| | - Abeir Alimam
- Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | - Rabia Qazi
- Hamad Medical corporation, Doha, Ad Dawhah, Qatar
| | | | | | - Ali M Eldeeb
- Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | - Kinda Shukri
- Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | | | | | | | | | | | | | | | | | | | - Ali S Omrani
- Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| |
Collapse
|
9
|
Ali M, Alamin M, Ali G, Alzubaidi K, Ali B, Waqqad A, Almaslamani M, Hadi HA. 192. Epidemiology, Microbiological Characteristics and Clinical Outcomes of Invasive Blood Stream Infections of Group B Streptococcal Isolates From Qatar. Open Forum Infect Dis 2021. [PMCID: PMC8645015 DOI: 10.1093/ofid/ofab466.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Group B Streptococci (GBS) or Streptococcus agalactiae colonize humans genitourinary and gastrointestinal tracts particularly of females. The pathogen is capable of causing invasive disease primarily in infants, pregnant and postpartum women as well as the elderly and patients with comorbidities. There is paucity of studies of the disease with regional differences in prevalence and presentation of invasive blood stream infection (BSI). In this study, we aim to assess prevalence, microbiological characteristics as well as clinical outcomes of invasive GBS disease from all ages groups at Hamad Medical Corporation (HMC), Qatar. Methods A retrospective study was conducted on all patients with microbiologically confirmed GBS bacteraemia between January 2015–March 2019. Demographic, microbiological characteristics as well as clinical data were extracted from hospital information system. Results Out of 196 confirmed cases of GBS blood stream infection, 63.7 % were females (125/196) of whom 44.8 % were pregnant (56/125), 53.6 % (30/56) were colonized while 36.3 % (71/196) were males. There were three distinct age group populations, paediatric less than 4 years of age at 35.7 %, young adults 25-34 (20.9 %) and the elderly > 65 year (17.4 %). Presenting symptoms were mild with fever recognised in only 53 % of cases (104/196) while 89% of cases had low Pitt bactermia score of 0-2. Microbiological characteristic using disc diffusion tests demonstrated all isolates were universally sensitive to penicillin (100%, 196/196) with significant resistance to clindamycin at 28.6 % (56/196) and erythromycin at 49 % (96/196) of which 34.4 % (33/96) had inducible clindamycin resistance. Clinical outcome showed high cure rate of 87.25% (171/196) with low complications at 8.76 % (17/196) and 4% (8/196) 30-day mortality. ![]()
Antibiotic sensitivity profile for GBS isolates ![]()
Conclusion Streptococcus agalactiae blood stream infection in Qatar is common in females, affects the very young, young adults and the elderly. Almost half of affected pregnant women are colonized. The organism remains universality sensitive to pencilling with significant resistance to clindamycin and erythromycin. Patients presents with mild symptoms with high cure rates, low complications and safe outcome for the majority of cases. Disclosures All Authors: No reported disclosures
Collapse
|
10
|
Tsui C, Abid FB, McElheny CL, Almaslamani M, Khal AA, Omrani AS, Doi Y, Doi Y. 1247. Molecular Epidemiology of Multi-drug Resistant Klebsiella pneumoniae and K. quasipneumoniae in Qatar. Open Forum Infect Dis 2021. [PMCID: PMC8643872 DOI: 10.1093/ofid/ofab466.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The molecular epidemiology of carbapenem-resistant Klebsiella species is not well investigated in Qatar. The objective of this work was to characterize the genetic context of carbapenemase-producing Klebsiella isolates recovered from clinical specimens.
Methods
Klebsiella isolates (n=100) were collected at 7 tertiary hospitals from 2015-2017. Identification and susceptibility testing were performed using MALDI-TOF MS and BD Phoenix system, respectively. Whole Genome Sequencing was performed on the Illumina NextSeq platform. Phylogenomic analysis, screening of resistance and virulence genes, and comparison of genetic environment of carbapenemase were carried out.
Results
Klebsiella pneumoniae was common (80), followed by K. quasipneumoniae (16), K. aerogenes (3) and K. oxytoca (1). The most prevalent were genes encoding NDM-1 (39), OXA-48 (20), OXA-232 (10) and OXA-181 (12). KPC-2 (3) and KPC-3 (2) were also identified; no carbapenemase-encoding genes could be identified in 15 isolates. Plasmid locations of 24 carbapenemase-encoding genes were determined; blaNDM-1 was localized on IncFII replicon, while blaOXA-181 and blaOXA-232 were commonly associated with ColKP3 plasmids. pOXA-48-like plasmid was detected in 17/20 isolates harboring blaOXA-48. blaKPC-3 was located on a contig with ‘traditional’ Tn4401a mobile genetic element. Sequence types (STs) were diverse and the ‘traditional’ clonal group (CG) 258 was rare. K. pneumoniae ST147 was predominant (13), followed by ST231 (7) and ST11 (5). Nine K. quasipneumoniae isolates belonged to ST196 and were highly clonal. The virulence loci such as yersiniabactin (ybt) and rmpA were not detected within the study’s K. quasipneumoniae isolates. Amongst K. pneumoniae, there were 50 ybt+ isolates; 8 isolates had rmpA, and of these, 3 belonged to ST383. K. pneumoniae serotype K2, the capsular serotype associated with invasive liver abscess syndrome, was detected in 5 isolates. Genetic relationship of carbapenem-resistant Klebsiella pneumoniae and K. quasipneumoniae isolates in Qatar inferred from core genome SNPs.
The tree is overlaid with predicted antimicrobial resistance genes and virulence factors for each isolate.
Conclusion
The predominant carbapenemases among clinical Klebsiella species isolates in Qatar are NDM and OXA-48 like enzymes, disseminated through various plasmids. The detection of carbapenemase-producing isolate bearing rmpA and serotype K2 reflect the presence of both multidrug resistance and hypervirulence in K. pneumoniae.
Disclosures
Yohei Doi, MD, PhD, AstraZeneca (Speaker’s Bureau)bioMerieux (Consultant)FujiFilm (Advisor or Review Panel member, Speaker’s Bureau)Gilead (Consultant)GSK (Consultant)Meiji (Consultant)MSD (Consultant)Shionogi (Consultant) Yohei Doi, MD, PhD, Astellas (Individual(s) Involved: Self): Grant/Research Support; AstraZeneca (Individual(s) Involved: Self): Speakers’ bureau; bioMerieux (Individual(s) Involved: Self): Consultant, Speakers’ bureau; Chugai (Individual(s) Involved: Self): Consultant; Entasis (Individual(s) Involved: Self): Consultant; FujiFilm (Individual(s) Involved: Self): Advisor or Review Panel member; Gilead (Individual(s) Involved: Self): Consultant; GSK (Individual(s) Involved: Self): Consultant; Kanto Chemical (Individual(s) Involved: Self): Grant/Research Support; MSD (Individual(s) Involved: Self): Speaking Fee; Pfizer (Individual(s) Involved: Self): Grant/Research Support; Shionogi (Individual(s) Involved: Self): Grant/Research Support, Speakers’ bureau; Teijin Healthcare (Individual(s) Involved: Self): Speakers’ bureau; VenatoRx (Individual(s) Involved: Self): Consultant
Collapse
Affiliation(s)
- Clement Tsui
- Weill Cornell Medicine-Qatar, Doha, Ar Rayyan, Qatar
| | | | | | | | | | - Ali S Omrani
- Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | - Yohei Doi
- University of Pittsburgh, Pittsburgh, PA
| | - Yohei Doi
- University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
11
|
iqbal F, Ahmed SA, Mushtaq K, Howady FS, Rustom F, Almaslamani M. 562. Tocilizumab Use in the Second Trimester Pregnant Patients with Severe Covid-19 Pneumonia and their Maternal and Fetal Outcomes: Two Case Reports. Open Forum Infect Dis 2021. [PMCID: PMC8690671 DOI: 10.1093/ofid/ofab466.760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Tocilizumab is an interleukin-6 monoclonal antibody with widespread use in rheumatologic conditions. Observational studies have shown a promising role of Tocilizumab in severe COVID-19 patients with cytokine storm syndrome. Data about tocilizumab use in pregnant patients is limited. We report two outcomes of two pregnant patients with COVID-19 in the second trimester who received tocilizumab
Methods
A 24-year-old 20 weeks pregnant lady with a history of asthma and gestational diabetes mellitus presented with three days history of fever, cough and shortness of breath (Figure 1). She was clinically stable but later developed ARDS and developed increased oxygen demand up to 10 liters/min. She received Tocilizumab on. Patient was observed in a high dependency unit but did not require mechanical ventilation. Patient was discharged home with full recovery and later delivered a healthy baby. Timeline of medicines used during hospital (Figure 2). Case 2: 39-year-old 23 weeks pregnant lady presented with seven days history of fever cough and shortness of breath (Figure 1). On presentation, she had progressive worsening hypoxic respiratory failure and was intubated. Patient had her nasopharyngeal swab for CODI-19 RT PCR was positive. The patient had severe ARDS requiring ECMO (extracorporeal membrane oxygenation) for respiratory support. Tocilizumab 400 mg was given on the presentation, along with other medications (Figure 3). Patient had regular monitoring of fetus; however, she had intrauterine fetal demise on day 14. Patient It is unclear if IUFD was due to using of tocilizumab or severity of COVID19 itself. The patient stayed in ICU for 20 days and was discharged after full recovery.
Figure 1. Case 1 treatment timeline. Abberviations: Azithro: Azithromycin, HCQ: Hydroxychloroquine, CQ: Chloroquine, LPV/r: lopinavir/Ritonavir, Osel: Oseltamivir, MP: Methylprednisolone, Ampi-sulb: Ampicillin-sulbactam, TCZ: tocilizumab
Figure 2. Case 2 treatment timeline
Results
Learning points: Tocilizumab use in pregnant patients with severe COVID-19 pneumonia during the second trimester improved maternal outcomes in our cases. Tocilizumab use may be associated with worse fetal outcomes, including intrauterine fetal demise (IUFD).
Figure 3. Table of clinical characteristics, pregnant outcomes. Abbreviations: LRTI: lower respiratory tract infection, HCQ: Hydroxychloroquine, CQ: chloroquine, Osel: Oseltamivir, Cef: Ceftrixone, Ampi-Sulb: ampicillin-sulbactam, Azithro: Azithromycin, TCZ: tocilizumab, MP: methylpredinisolone, H/O: History of, LSCS: C-section, NA: not available. Pip-tazo: Piperacillin-tazobactam, Mero: Meropenem, Sulfa-trim: Sulfamethoxazole-Trimethoprim, IUFD: Intrauterine fetal death.
Conclusion
The pharmacological management of pregnant patients with severe COVID-19 pneumonia poses significant challenges. The use of Tocilizumab may improve maternal outcomes but may also increase the risk of worse fetal outcomes. Caution should be exercised in using this agent, and risks and benefits should be discussed with the patients.
Disclosures
All Authors: No reported disclosures
Collapse
Affiliation(s)
- Fatima iqbal
- Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| | | | | | | | | | | |
Collapse
|
12
|
Mushtaq K, Khan MU, Iqbal F, Alsoub DH, Chaudhry HS, Ata F, Iqbal P, Elfert K, Balaraju G, Almaslamani M, Al-Ejji K, AlKaabi S, Kamel YM. NAFLD is a predictor of liver injury in COVID-19 hospitalized patients but not of mortality, disease severity on the presentation or progression - The debate continues. J Hepatol 2021; 74:482-484. [PMID: 33223215 PMCID: PMC7836329 DOI: 10.1016/j.jhep.2020.09.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Kamran Mushtaq
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation; Harvard T.H Chan School of Public Health, USA.
| | - Muhammad Umair Khan
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation,Harvard T.H Chan School of Public Health, USA
| | - Fatima Iqbal
- Harvard T.H Chan School of Public Health, USA,Department of Infectious Disease, Communicable Disease Center, Doha, Qatar
| | | | | | - Fateen Ata
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Phool Iqbal
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Elfert
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation
| | - Girisha Balaraju
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation
| | - Muna Almaslamani
- Department of Infectious Disease, Communicable Disease Center, Doha, Qatar,Weill Cornell Medicine, Qatar (WCM-Q), Doha, Qatar
| | - Khalid Al-Ejji
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation
| | - Saad AlKaabi
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation
| | | |
Collapse
|
13
|
El Beltagi AH, Vattoth S, Abdelhady M, Ahmed I, Paksoy Y, Abou Kamar M, Alsoub H, Almaslamani M, Alkhal AL, Own A, Elsotouhy A. Spectrum of neuroimaging findings in COVID-19. Br J Radiol 2020; 94:20200812. [PMID: 33305996 PMCID: PMC7774681 DOI: 10.1259/bjr.20200812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An outbreak of corona virus disease 2019 (COVID-19) began in China in December 2019, and rapidly spread to become a worldwide pandemic. Neurological complications encountered in hospitalized patients include acute arterial ischemic cerebrovascular stroke, cerebral venous thrombosis, critical illness-associated cerebral microbleeds, hypertensive hemorrhagic posterior reversible encephalopathy, meningoencephalitis/flare up of infections, flare up of multiple sclerosis, acute disseminated encephalomyelitis, cerebral hemodynamic/hypoxic changes such as watershed ischemic changes and hypoxic ischemic encephalopathy, and spine manifestations of Guillain Barre syndrome and viral myelitis. The purpose of our study is to illustrate the different neuroimaging features in critically ill hospitalized COVID-19 positive patients in the State of Qatar.
Collapse
Affiliation(s)
- Ahmed H El Beltagi
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.,Clinical Imaging, Weill Cornell Medicine University - Qatar, Doha, Qatar
| | - Surjith Vattoth
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mohamed Abdelhady
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Islam Ahmed
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahya Paksoy
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abou Kamar
- Infectious and Communicable Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Alsoub
- Infectious and Communicable Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | - Muna Almaslamani
- Infectious and Communicable Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Latif Alkhal
- Infectious and Communicable Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elsotouhy
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.,Clinical Imaging, Weill Cornell Medicine University - Qatar, Doha, Qatar
| |
Collapse
|
14
|
Imam YZ, Ahmedullah H, Chandra P, Almaslamani M, Alkhal A, Deleu D. Accuracy of clinical scoring systems for the diagnosis of tuberculosis meningitis in a case mix of meningitides a retrospective cohort study. J Neurol Sci 2020; 416:116979. [DOI: 10.1016/j.jns.2020.116979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/20/2023]
|
15
|
Zaqout A, Mohammed S, Thapur M, Al Soub H, Almaslamani M, Al Khal A, Omrani AS. 163. Infective Endocarditis in Qatar: Risk Factors, Clinical Characteristics, Microbiology, and Outcomes. Open Forum Infect Dis 2019. [PMCID: PMC6810782 DOI: 10.1093/ofid/ofz360.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) is a serious and life-threatening disease. The aim of the study is to describe the epidemiology, clinical characteristics and outcomes of patients with IE in Qatar.
Methods
Patients were identified from the electronic records of Hamad Medical Corporation hospitals, the national referral center for the State of Qatar. Those aged ≥18 years with Duke Criteria-based diagnosis of IE during the period from January 2015 to September 2017 were included. Data were analyzed using STATA software Version 15.
Results
Fifty-seven cases were included, of which 70% were males. Mean age was 51 years (± 16.8). Eleven (19%) were in association with prosthetic valves and 6 (11%) with implantable cardiac devices (Table 1). Fever (84%), dyspnea (46%) and heart failure were the commonest presentations. The majority of patients had preexisting valvular heart disease or intra-cardiac devices (Table 1). Skin infections (10, 18%) were the most prevalent portals of infection, followed by venous catheters, recent valve surgery and implantable cardiac devices (Table 1). Staphylococcus species were implicated in 19 (34%) and Streptococcaceae in 9 (16%); whereas 21 (37%) were culture-negative (Table 2). Left-side IE (49, 86%) was predominant. Acute kidney injury (AKI) (17, 30%) and heart failure (11, 19%) were common complications. The most frequently used treatment regimens included glycopeptides or Β-lactams (Table 2). Only 9 (16%) patients underwent surgical intervention. Fourteen (25%) patients died of any cause before hospital discharge. Logistic regression analysis identified septic shock and AKI as the only risk factors independently associated with in-hospital mortality (Table 3).
Conclusion
Skin infections are an important risk for IE in Qatar. The majority of patients with IE have preexisting cardiac conditions. Staphylococci are the commonest confirmed bacterial etiology of IE in Qatar, but nearly one-third of cases are culture-negative. Only a small proportion of patients with IE undergo surgical intervention and overall mortality is high. The findings suggest that efforts should be directed toward improving IE prevention strategies in high-risk patients, encourage early microbiological investigations and improved medical and surgical management.
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
- Ahmed Zaqout
- hamad medical corporation, Doha, Al Khawr, Qatar
| | | | | | | | | | | | - Ali S Omrani
- Hamad Medical Corporation, Doha, Ad Dawhah, Qatar
| |
Collapse
|
16
|
Salah H, Lackner M, Houbraken J, Theelen B, Lass-Flörl C, Boekhout T, Almaslamani M, Taj-Aldeen SJ. The Emergence of Rare Clinical Aspergillus Species in Qatar: Molecular Characterization and Antifungal Susceptibility Profiles. Front Microbiol 2019; 10:1677. [PMID: 31447794 PMCID: PMC6697061 DOI: 10.3389/fmicb.2019.01677] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/08/2019] [Indexed: 12/31/2022] Open
Abstract
Aspergillus are ubiquitous mold species that infect immunocompetent and immunocompromised patients. The symptoms are diverse and range from allergic reactions, bronchopulmonary infection, and bronchitis, to invasive aspergillosis. The aim of this study was to characterize 70 Aspergillus isolates recovered from clinical specimens of patients with various clinical conditions presented at Hamad general hospital in Doha, Qatar, by using molecular methods and to determine their in vitro antifungal susceptibility patterns using the Clinical and Laboratory Standards Institute (CLSI) M38-A2 reference method. Fourteen Aspergillus species were identified by sequencing β-tubulin and calmodulin genes, including 10 rare and cryptic species not commonly recovered from human clinical specimens. Aspergillus welwitschiae is reported in this study for the first time in patients with fungal rhinosinusitis (n = 6) and one patient with a lower respiratory infection. Moreover, Aspergillus pseudonomius is reported in a patient with fungal rhinosinusitis which is considered as the first report ever from clinical specimens. In addition, Aspergillus sublatus is reported for the first time in a patient with cystic fibrosis. In general, our Aspergillus strains exhibited low MIC values for most of the antifungal drugs tested. One strain of Aspergillus fumigatus showed high MECs for echinocandins and low MICs for the rest of the drugs tested. Another strain of A. fumigatus exhibited high MIC for itraconazole and categorized as non-wild type. These findings require further analysis of their molecular basis of resistance. In conclusion, reliable identification of Aspergillus species is achieved by using molecular sequencing, especially for the emerging rare and cryptic species. They are mostly indistinguishable by conventional methods and might exhibit variable antifungal susceptibility profiles. Moreover, investigation of the antifungal susceptibility patterns is necessary for improved antifungal therapy against aspergillosis.
Collapse
Affiliation(s)
- Husam Salah
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.,Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jos Houbraken
- Applied and Industrial Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Bart Theelen
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Netherlands
| | - Muna Almaslamani
- Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Netherlands
| | - Saad J Taj-Aldeen
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
17
|
Ali M, Alhowady F, Munir W, Almaslamani M, Alkhal A, Alswaidi Z, Ziglam H. 800. Drug-Resistant TB: An Experience From Qatar. Open Forum Infect Dis 2018; 5. [PMCID: PMC6253567 DOI: 10.1093/ofid/ofy210.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
Collapse
Affiliation(s)
- Maisa Ali
- Infectious Disease, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | | | - Hisham Ziglam
- Infectious Disease, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
18
|
Al Samawi MS, Khan FY, Eldeeb Y, Almaslamani M, Alkhal A, Alsoub H, Ghadban W, Howady F, Hashim S. Acinetobacter Infections among Adult Patients in Qatar: A 2-Year Hospital-Based Study. Can J Infect Dis Med Microbiol 2016; 2016:6873689. [PMID: 27433169 PMCID: PMC4940524 DOI: 10.1155/2016/6873689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/23/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022]
Abstract
This retrospective study was conducted at Hamad General Hospital, Qatar, to describe the demographic data, clinical features underlying diseases, antimicrobial susceptibility, and outcome of A. baumannii infection. It involved all adult patients 15 years of age or older who were managed at Hamad General Hospital for A. baumannii infection from January 1, 2012, to December 31, 2013. We identified a total of 239 patients with A. baumannii infection, of which 182 (76.2%) were males. The mean age was 49.10 ± 19.57 years. The majority of the episodes (25.1%) occurred in elderly patients (≥65 years) and the most commonly identified site of A. baumannii infection was the respiratory tract, 117 (48.9%). Most episodes of infection, 231 (96.7%), were hospital-acquired and high rate of nosocomial infections occurred in the medical intensive care unit, 66 (28.6%). All patients had underlying medical conditions. Maximum resistance was seen to cefotaxime, 147 (58.3%), and minimum resistance was seen to colistin, 2 (1.4%). Of the 239 isolates, 102 (42.7%) were susceptible and 137 (57.3%) were multidrug-resistant. The in-hospital mortality in our study was 31%. Male gender, multidrug resistance, and septic shock were found to be independent mortality predictors.
Collapse
Affiliation(s)
- Musaed Saad Al Samawi
- Infectious Diseases Division, Department of Medicine, Al Khor Hospital, Al Khor, Qatar
| | | | - Yasser Eldeeb
- Infectious Diseases Division, Department of Medicine, Al Khor Hospital, Al Khor, Qatar
| | - Muna Almaslamani
- Infectious Diseases Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Abdullatif Alkhal
- Infectious Diseases Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Hussam Alsoub
- Infectious Diseases Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Wissam Ghadban
- Department of Medicine, Al Khor Hospital, Al Khor, Qatar
| | - Faraj Howady
- Infectious Diseases Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Samar Hashim
- Infectious Diseases Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| |
Collapse
|
19
|
Salah H, Al-Hatmi AMS, Theelen B, Abukamar M, Hashim S, van Diepeningen AD, Lass-Florl C, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Phylogenetic diversity of human pathogenic Fusarium and emergence of uncommon virulent species. J Infect 2015; 71:658-66. [PMID: 26348828 DOI: 10.1016/j.jinf.2015.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Fusarium species cause a broad spectrum of infections. However, little is known about the etiological agents to the species level. We identified Fusarium species isolated from clinical specimens including those of high risk patients to better understand the species involved in the pathogenesis. METHODS A set of 44 Fusarium isolates were identified by two-locus sequence typing using partial sequences of the second largest subunit of RNA polymerase (RPB2) and translation elongation factor 1 alpha (TEF-1α). RESULTS The identified species belonged to four species complexes (SC); the most common SC was Fusarium solani (FSSC) (75%), followed by Fusarium oxysporum (FOSC) (4.5%), Fusarium fujikuroi (FFSC) (13.6%), and Fusarium dimerum (FDSC) (6.8%). Sites of infections were nails (n = 19, 43.2%), skin (n = 7, 15.9%), cornea (n = 6, 13.6%), blood (n = 3, 9%), wound (n = 4, 6.8%), burn (n = 2, 4.5%), tissue (n = 2, 4.5%), and urine (n = 1, 2.27%). Fusarium acutatum was rare and seem restricted to the Middle East. Comorbidities associated with invasive infections were hematological malignancy and autoimmune disorders. CONCLUSIONS Members of the FSSC predominantly caused cornea, nail and bloodstream infections. Less frequently encountered were the FOSC, FFSC and FDSC. More accurate molecular identification of Fusarium species is important to predict therapeutic outcome and the emergence of these species.
Collapse
Affiliation(s)
- Husam Salah
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar; CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Abdullah M S Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands; Directorate General of Health Services, Ministry of Health, Ibri Hospital, Ibri, Oman
| | - Bart Theelen
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Mohammed Abukamar
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Samar Hashim
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | | | - Cornelia Lass-Florl
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
| | - Teun Boekhout
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Institute of Dermatology and Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; Institute of Microbiology, Chinese Academy of Science, Beijing, People's Republic of China
| | - Muna Almaslamani
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Saad J Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar.
| |
Collapse
|
20
|
Al-Abdely HM, Alothman AF, Salman JA, Al-Musawi T, Almaslamani M, Butt AA, Al Thaqafi AO, Raghubir N, Morsi WE, Yared NA. Clinical practice guidelines for the treatment of invasive Aspergillus infections in adults in the Middle East region: Expert panel recommendations. J Infect Public Health 2014; 7:20-31. [DOI: 10.1016/j.jiph.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/05/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022] Open
|
21
|
Taj-Aldeen SJ, Kolecka A, Boesten R, Alolaqi A, Almaslamani M, Chandra P, Meis JF, Boekhout T. Epidemiology of candidemia in Qatar, the Middle East: performance of MALDI-TOF MS for the identification of Candida species, species distribution, outcome, and susceptibility pattern. Infection 2013; 42:393-404. [PMID: 24352810 DOI: 10.1007/s15010-013-0570-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Bloodstream infections (BSIs) due to Candida spp. constitute the predominant group of hospital-based fungal infections worldwide. A retrospective study evaluated the performance of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for the identification of BSI Candida isolates. The epidemiology, risk factors, demographic features, species distribution, and clinical outcome associated with candidemia in patients admitted to a single tertiary-care hospital in Qatar, were analyzed. METHODS A single-center, retrospective analysis covering the period from January 1, 2004 to December 31, 2010 was performed. Molecular identification used sequence analysis of the D1/D2 domains of the large subunit ribosomal DNA (LSU rDNA) and the ITS1/2 regions of the rDNA. MALDI-TOF MS-based identification of all yeast isolates was performed with the ethanol/formic acid extraction protocol according to Bruker Daltonics (Bremen, Germany). The susceptibility profiles of 201 isolates to amphotericin B, itraconazole, fluconazole, voriconazole, anidulafungin, caspofungin, posaconazole, and isavuconazole were tested using CLSI standard broth microdilution method (M27-A3 and M27 S4) guidelines. Statistical analyses were performed with the statistical package SPSS 19.0. RESULTS A total of 187 patients with 201 episodes of candidemia were identified. Candida albicans was the most common species isolated (33.8 %; n = 68), whereas non-albicans Candida species represented 66.2 % (n = 133) of the episodes. The species distribution and outcome of candidemia showed a difference in the crude mortality between patients infected with C. albicans (n = 30; 45.5 %) and non-albicans Candida species. For example, C. parapsilosis candidemia was associated with the lowest mortality rate (40.6 %), and patients with other non-albicans species had the highest mortality rate (68-71.4 %). High mortality rates were observed among pediatric (<1 year of age) and elderly patients (>60 years of age). All strains showed low minimum inhibitory concentrations (MICs) (MIC90 of 0.063 μg/ml) to isavuconazole. The overall resistance to voriconazole in vitro antifungal activity was 2.5 %. C. glabrata (n = 38) had an MIC90 of 8 μg/ml for fluconazole. Most yeast isolates were susceptible to anidulafungin (>99.5 %) and 81.1 % to caspofungin. Resistance to anidulafungin was detected in 1/8 (12.5 %) isolates of C. orthopsilosis. According to new Clinical and Laboratory Standards Institute (CLSI) breakpoints, C. glabrata (n = 38) showed 100 % resistance, and 37/68 (54.4 %) C. albicans isolates were susceptible dose dependent (SDD) to caspofungin. Identification by MALDI-TOF MS was in 100 % concordance with molecular identification. CONCLUSION The Middle East epidemiology of candidemia has a unique species distribution pattern distinct from other parts of the globe. High mortality rates were observed among pediatric (<1 year of age) and elderly patients (>60 years of age). All strains were susceptible to isavuconazole. All isolates of C.glabrata were resistant to caspofungin based on M27 S4. MALDI-TOF MS is a highly useful method for the routine identification of yeast isolates in clinical setting to achieve successful therapeutic treatment.
Collapse
Affiliation(s)
- S J Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar,
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Khalaf H, Derballa M, Elmasry M, Khalil A, Yakoob R, Almohannadi M, Almaslamani M, Fadhil R, Al-Kaabi S, Al-Ansari A, Almaslamani Y. First Liver Transplant in Qatar: An Evolving Program Facing Many Challenges. EXP CLIN TRANSPLANT 2013; 11:423-5. [DOI: 10.6002/ect.2013.0194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
23
|
Alothman AF, Al-Musawi T, Al-Abdely HM, Salman JA, Almaslamani M, Yared N, Butt AA, Raghubir N, Morsi WE, Al Thaqafi AO. Clinical practice guidelines for the management of invasive Candida infections in adults in the Middle East region: Expert panel recommendations. J Infect Public Health 2013; 7:6-19. [PMID: 24035607 DOI: 10.1016/j.jiph.2013.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/05/2013] [Accepted: 08/12/2013] [Indexed: 11/26/2022] Open
Abstract
Invasive Candida infections contribute to significant morbidity and mortality in patients with healthcare-associated infections. They represent a major burden on the public health system, and are challenging to diagnose and treat. A multidisciplinary expert panel critically reviewed available evidence to provide consensus recommendations for the management of invasive Candida infections in the Middle East. Based on diagnosis, recommendations were provided for the management of Candida infections in non-neutropenic and neutropenic patients. Polyenes (amphotericin B-deoxycholate [AmB-d] and lipid formulations amphotericin B [LFAmB]), triazoles (fluconazole, itraconazole and voriconazole), echinocandins (caspofungin, anidulafungin, and micafungin) and flucytosine are the recommended categories of antifungal agents for treatment of Candida infections. Echinocandins are preferred for treatment of proven and suspected Candida infections, especially in critically ill patients or those with previous exposure to azoles. Recommendations were also provided for infections caused by specific Candida species as well as management of different disease conditions. The experts highlighted that the guidelines should be used along with clinical judgment. Given the paucity of published data from the region, research in the form of randomized clinical trials should be given priority.
Collapse
Affiliation(s)
- Adel F Alothman
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | | | - Hail M Al-Abdely
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | | | - Muna Almaslamani
- Hamad Medical Corporation (HMC), Weill Cornell Medical College, Qatar, State of Qatar.
| | - Nadine Yared
- Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon.
| | - Adeel A Butt
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
| | | | | | | |
Collapse
|
24
|
Khan FY, Elshafie SS, Almaslamani M, Abu-Khattab M, El Hiday AH, Errayes M, Almaslamani E. Epidemiology of bacteraemia in Hamad general hospital, Qatar: a one year hospital-based study. Travel Med Infect Dis 2010; 8:377-87. [PMID: 21074495 DOI: 10.1016/j.tmaid.2010.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 10/10/2010] [Accepted: 10/12/2010] [Indexed: 11/15/2022]
Abstract
We conducted a one-year observational study from July 2007 to June 2008 to describe the epidemiology of bacteraemia at Hamad general hospital. During this period, a total of 452 episodes of bacteraemia occurred, which corresponds to a rate of 19/1000 hospital admissions. Most patients 58.8% (266/452) had community acquired bacteraemia, and primary bacteraemia accounted for 62.2% (281/452) of the cases. The most common source of bacteraemia was intravenous catheterization in 19.2% (87/452) but no source was identified in 42.9% (194/452) of the episodes. Gram-negative organisms were isolated in 63.1% (285/452) episodes with Escherichia coli being the most frequent 21.5% (97/452). Multidrug resistance was observed in 33.3% (7/21) of all Pseudomonas aeruginosa isolates, 50% (6/12) of Acinetobacter isolates and 28.6% (6/21) of Enterobacter isolates, whereas all ESBL producing Klebsiella spp. and E. coli were multiresistant. The percentages of oxacillin resistant coagulase negative Staphylococci isolates and methicillin-resistant Staphylococcus aureus isolates were 81.8% (27/33) and 13.2% (7/53) respectively. In hospital mortality was 22.5% (102/452), and inadequate treatment and septic shock were found to be independent predictors of mortality. Therefore, bloodstream infection surveillance is crucial to produce meaningful guidelines for prevention (e.g., catheter-related) and empirical treatment of bacteraemia in Qatar.
Collapse
|
25
|
Taj-Aldeen SJ, Almaslamani M, Alkhalf A, Al Bozom I, Romanelli AM, Wickes BL, Fothergill AW, Sutton DA. Cerebral phaeohyphomycosis due toRhinocladiella mackenziei(formerlyRamichloridium mackenziei): a taxonomic update and review of the literature. Med Mycol 2010; 48:546-56. [DOI: 10.3109/13693780903383914] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Al Soub H, Taha RY, El Deeb Y, Almaslamani M, Al Khuwaiter JY. Pneumocystis carinii Pneumonia in a patient without a predisposing illness: Case report and review. ACTA ACUST UNITED AC 2009; 36:618-21. [PMID: 15370678 DOI: 10.1080/00365540410017608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A case of Pneumocystis carinii pneumonia in a patient without an underlying immunosuppressing condition is reported, and 12 other previously reported cases are reviewed. When compared with Pneumocystis carinii pneumonia in association with AIDS and in other immunosuppressing conditions, Pneumocystis carinii pneumonia in patients without predisposing conditions resembles more closely that seen in immunosuppressing conditions other than AIDS.
Collapse
Affiliation(s)
- H Al Soub
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
| | | | | | | | | |
Collapse
|
27
|
Khan FY, Lutof AK, Yassin MA, Khattab MA, Saleh M, Rezeq HY, Almaslamani M. Imported malaria in Qatar: A one year hospital-based study in 2005. Travel Med Infect Dis 2009; 7:111-7. [DOI: 10.1016/j.tmaid.2009.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 01/04/2009] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
|
28
|
Almaslamani M, Taj-Aldeen SJ, Garcia-Hermoso D, Dannaoui E, Alsoub H, Alkhal A. An increasing trend of cutaneous zygomycosis caused byMycocladus corymbifer(formerlyAbsidia corymbifera): report of two cases and review of primary cutaneousMycocladusinfections. Med Mycol 2009; 47:532-8. [DOI: 10.1080/13693780802595746] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
29
|
Affiliation(s)
- Y El Deeb
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | |
Collapse
|