The presence of atypical mycobacteria in the mouthwashes of normal subjects: role of tap water and oral hygiene

BACKGROUND:

The nontuberculous mycobacteria (NTM) have been found in different environmental sources. They tend to colonize different body surfaces and secretions. The purpose of this study is to evaluate the presence of NTM in the oral cavity of healthy individuals and its relationship to tap water or oral hygiene.

MATERIALS AND METHODS:

One hundred sixty-seven healthy subjects were recruited. Three consecutive early morning mouthwashes using tap water were performed and examined for the presence of Mycobacterium tuberculosis (MTB) and NTM. In addition we obtained mouthwashes from 30 control healthy individuals with good oral hygiene using sterile water and examined these for the presence of MTB and NTM.

RESULTS:

NTM was isolated from the mouthwash of 44 (26.3%) subjects that used tap water. On the other hand, NTM was isolated from the mouthwash of 10 (33%) subjects that used sterile water. Age, gender, social class oral hygiene and the regular use of toothbrush made no statistically significant differences in the isolation rate of NTM.

CONCLUSION:

The rate of isolation of NTM from mouthwash is high in normal subjects. It is independent of oral hygiene, the use of tap water or teeth brushing. Smear-positive sputum could be NTM rather than M. tuberculosis. Tuberculosis polymerase chain reaction or culture confirmation is essential in developing countries to avoid the unnecessary use of antituberculosis therapy when the clinical suspicion is very low.

The diagnostic challenge and management of pulmonary Kaposi's sarcoma in renal transplant recipients

Kaposi's sarcoma is a multicentric low grade tumor that usually begins with the development of violaceous skin lesions and is associated with the presence of human herpes virus 8. Kaposi's sarcoma has been described in immunocompromised patients, particularly following renal transplantation, with cutaneous involvement being the most salient finding. Infectious and non-infectious pulmonary disorders in immunocompromised patients can simulate the radiological manifestations of pulmonary Kaposi's sarcoma. This report highlights the dilemma in reaching an accurate diagnosis of pulmonary Kaposi's sarcoma as a complication of immunosuppression post-renal transplant and reviews the management of immunosuppression related Kaposi's sarcoma.

The diagnostic challenge of pulmonary Kaposi's sarcoma with pulmonary tuberculosis in a renal transplant recipient: a case report

We report a case of a 39-year-old, HIV-negative, post renal transplant patient who developed mucocutaneous Kaposi's sarcoma with lung parenchymal involvement and concurrently culture proven pulmonary tuberculosis. To the best of our knowledge, this is the first case report of this combination, which presented with cavitating lung nodules and responded well to withdrawal of immunosuppressive drugs beside antituberculous treatment.

Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion : case report

We describe a rare case of a 29-year-old woman with chronic eosinophilic pneumonia (CEP) presenting with massive bilateral pleural effusion leading to respiratory failure, a complication that was not reported before with CEP. The patient was successfully managed with ventilatory support and steroid therapy. On long-term follow-up, she remained well, receiving a low maintenance dose of prednisone without evidence of relapse of the disease.

Sleep disorders in Saudi health care workers

BACKGROUND

The objective of the study was to screen for sleep habits and various sleep disorders, using a standard questionnaire.

PATIENTS AND METHODS

The questionnaire was designed to assess sleep habits, the degree of daytime sleepiness using the Epworth Sleepiness Scale (ESS), and specific sleep problems. A random sample of Saudi employees working as medical or paramedical personnel was selected.

RESULTS

There were 163 respondents (65%) comprising 33 females and 130 males. The mean ESS score was 9.4. Sixty-four respondents (39.3%) had an ESS score of more than 10, i.e., excessive daytime sleepiness (EDS). When subjects with poor sleep habits and/or sleep problems were excluded, there were 65 ânormalâ sleepers, with a mean ESS score of 8.9+/-3.6. This did not differ from the rest of the sample population, who had a score of 9.8+/-3.7 (P=0.15). Subjects with inadequate sleep or insomnia consisted of 17 females (51.5%) and 45 males (34.6%). There were seven subjects, all males (5.4%), with habitual snoring. Ten males (7.7%) and two females (6.1%) reported having breathing pauses while asleep. Symptoms of restless leg syndrome, sleep paralysis, and cataplexy were reported by 21 (12.9%), 26 (16.0%) and two (1.2%) subjects, respectively.

CONCLUSION

The prevalence of EDS in the Saudi population is higher compared to that reported from other populations when a Western ESS normal range is used. Nevertheless, the range of normal score of ESS is probably broader for Saudis compared to other populations. In general, sleep disorders are common but unrecognized in our community.