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Zaqout A, Daghfal J, Munir W, Abdelmajid A, Albayat SS, Abukhattab M, Al-Maslamani MA. Clinical manifestations and outcome of Mpox infection in Qatar: An observational study during the 2022 outbreak. J Infect Public Health 2023; 16:1802-1805. [PMID: 37741014 DOI: 10.1016/j.jiph.2023.09.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/25/2023] Open
Abstract
Mpox emerged in May 2022 as a global outbreak, mostly in hitherto non-endemic countries. To describe the epidemiological and clinical characteristics of mpox in Qatar, data were retrospectively retrieved for all laboratory-confirmed mpox cases diagnosed in Qatar between May and November 2022. Twelve cases were identified; of which 10 were males, and the median age was 33.5 years (IQR 24.5-37.5). Recent sexual exposure was reported in 9 patients, 6 of which were outside Qatar. Seven individuals reported exclusive heterosexual contact. Pleomorphic skin lesions were present in all cases, with anogenital involvement in 11. Fever (7/12) and lymphadenopathy (4/12) were relatively common. All cases were HIV-negative. The majority of cases had an uncomplicated and self-limiting clinical illness. In conclusion, the majority of early mpox infections in Qatar were purportedly acquired through heterosexual contact, primarily among middle-aged men. The clinical course was mostly uneventful. In the absence of active case finding and the mild and self-limiting nature of the clinical illness, undetected community transmission cannot be ruled out.
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Affiliation(s)
- Ahmed Zaqout
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Joanne Daghfal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
| | - Waqar Munir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Alaaeldin Abdelmajid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Soha S Albayat
- Department of Public Health, Ministry of Public Health, Doha, Qatar.
| | - Mohammed Abukhattab
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Muna A Al-Maslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
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Rahhal A, Najim M, Aljundi AH, Mahfouz A, Alyafei SM, Awaisu A, Habib MB, Obeidat I, Faisal MM, Alanzi MA, Nair AP, Elhassan A, Al-Dushain A, Abdelmajid AA, Abdelgader AE, Moursi AMA, Alharafsheh AEN, Kamar MRA, Goravey W, Omar AS, Abukhattab M, Khatib MY, Mohamedali MG, AlMaslamani MAR, Alemadi S. Adding colchicine to tocilizumab in hospitalized patients with severe COVID-19 pneumonia: An open-label randomized controlled trial. Medicine (Baltimore) 2022; 101:e30618. [PMID: 36181009 PMCID: PMC9524530 DOI: 10.1097/md.0000000000030843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Colchicine acts upstream in the cytokines cascade by inhibiting the nod-like receptor protein 3 (NLRP3) inflammasome while interleukin 6 (IL-6) receptor antagonists, such as tocilizumab, block the end result of the cytokines cascade. Hence, adding colchicine to tocilizumab with the aim of blocking the early and end products of the cytokines cascade, might reduce the risk of developing cytokine storm. METHODS AND ANALYSIS We aim to conduct an open-label randomized controlled trial to evaluate the efficacy and safety of adding colchicine to tocilizumab among patients with severe COVID-19 pneumonia to reduce the rate of invasive mechanical ventilation and mortality. We will include patients with severe COVID-19 pneumonia who received tocilizumab according to our local guidelines. Enrolled patients will be then randomized in 1:1 to colchicine versus no colchicine. Patients will be followed up for 30 days. The primary outcome is the rate of invasive mechanical ventilation and will be determined using Cox proportional hazard model. DISCUSSION Given colchicine's ease of use, low cost, good safety profile, and having different anti-inflammatory mechanism of action than other IL-6 blockade, colchicine might serve as a potential anti-inflammatory agent among patients with severe COVID-19 pneumonia. This study will provide valuable insights on the use of colchicine in severe COVID-19 when added to IL-6 antagonists. ETHICS AND DISSEMINATION The Medical Research Center and Institutional Review Board at Hamad Medical Corporation in Qatar approved the study protocol (MRC-01-21-299). Results of the analysis will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
- *Correspondence: Alaa Rahhal, Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar (e-mail: )
| | - Mostafa Najim
- Internal Medicine Department, Rochester Regional Health - Unity Hospital, NY, USA
| | | | - Ahmed Mahfouz
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Mhd, Baraa Habib
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Obeidat
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Areeg Elhassan
- Infectious Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | | | | | - Wael Goravey
- Infectious Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | - Amr Salah Omar
- Cardiothoracic Surgery/Cardiac Anaesthesia Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Abukhattab
- Cardiothoracic Surgery/Cardiac Anaesthesia Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Samar Alemadi
- Rheumatology Department, Hamad Medical Corporation, Doha, Qatar
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Zaqout A, Almaslamani MA, Chemaitelly H, Hashim SA, Ittaman A, Alimam A, Rustom F, Daghfal J, Abukhattab M, AlMukdad S, Kaleeckal AH, Latif AN, Butt AA, Bertollini R, Al-Khal A, Omrani AS, Abu-Raddad LJ. Effectiveness of the neutralizing antibody sotrovimab among high-risk patients with mild to moderate SARS-CoV-2 in Qatar. Int J Infect Dis 2022; 124:96-103. [PMID: 36218031 PMCID: PMC9484101 DOI: 10.1016/j.ijid.2022.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 10/31/2022] Open
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Nair AP, Sasi S, Al Maslamani M, Al-khal A, Chacko K, Deshmukh A, Abukhattab M. Clinical and Epidemiological Characteristics of Stenotrophomonas maltophilia Associated Lower Respiratory Tract Infections in Qatar: A Retrospective Study. Cureus 2022; 14:e23263. [PMID: 35449666 PMCID: PMC9013242 DOI: 10.7759/cureus.23263] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stenotrophomonas maltophilia is a rapidly emerging nosocomial pathogen with intrinsic or acquired resistance mechanisms to several antibiotic classes. It can cause life-threatening opportunistic pneumonia, particularly among hospitalized patients. Incidence of infections by S. maltophilia has been reported as 0.07-0.4% of hospital discharges, but its mortality is 20 -60%. This is the first study from Qatar indexing the clinical and epidemiological characteristics and antibiotic susceptibility of S. maltophilia. Materials and methods This retrospective descriptive epidemiological study was conducted in 6 tertiary care hospitals under Hamad Medical Corporation in Doha, Qatar, analyzing inpatient respiratory isolates of S. maltophilia during 2016-17. Out-patients, children below 14 years, and non-respiratory samples except blood cultures in patients with pneumonia were excluded. Clinical records were reviewed to identify possible risk factors. Infection and colonization were identified using the Centers for Disease Control and Prevention (CDC) algorithm for clinically defined pneumonia and statistically analyzed using the chi-square test and Pearson's correlation. Results S. maltophilia was isolated from 2.07% (317/15312) of all respiratory samples received in the microbiology lab during our study period. Three hundred seventeen patients studied had a mean age of 60 ± 20 years, and 68% were men. Most of the isolates were from sputum (179), followed by tracheal aspirate (82) and bronchoscopy (42). Fourteen blood culture samples from patients diagnosed with pneumonia were also included. 67% were hospitalized for more than two weeks, 39.1% were on mechanical ventilators, and 88% had received a broad-spectrum antibiotic before the event. 29.1% were deemed to have an infection and 70.9% colonization. Incidence of infection in those with Charlson’s Co-morbidity Index (CCI) ≥ 3 was 36.5% compared to 24.2% in those with CCI < 3 (Relative Risk (RR)=1.52; 95% CI: 1.04,2.18; p=0.01). Patients with recent chemotherapy, immunosuppressant, or steroid use had a significantly higher infection risk than those without (69.2% v/s 23.3% RR=2.96; 95% CI:2.2,3.9; p<0.005). The most common symptoms in patients with infection were fever (96%) and expectoration (61.9%). The most common radiological finding was lobar consolidation (71.6%). Mean CRP and procalcitonin were 106.5±15.5 mg/l and 12.3 ± 14 ng/ml. Overall mortality was 16.3%. Patients on mechanical ventilator with IBMP-10 score ≥ 2 had 22.8% mortality compared to 5.7% in those with score < 2 (RR=3.9;95%CI:0.9,16.6; p<0.015). As per The US Clinical and Laboratory Standards Institute (CSLI) breakpoint values, Trimethoprim-Sulfamethoxazole (TMP-SMX) showed the highest sensitivity (97.8%), followed by levofloxacin (71.6%). 0.3% of samples were pan-drug resistant. Conclusions S. maltophilia is a frequent nosocomial colonizer, but it can cause nosocomial pneumonia in almost one-third of cases, specifically in immunocompromised and patients with CCI ≥ 3 with a high risk of mortality due to ventilator-associated pneumonia (VAP) in those with IBMP-10 ≥ 2. Prolonged hospital stay is a risk factor for colonization by S. maltophilia, while recent chemotherapy, immunosuppressant, or steroid use are risk factors for hospital-acquired pneumonia due to S. maltophilia. TMP-SMX and levofloxacin are the only reliable agents for monotherapy of respiratory infections due to S. maltophilia in Qatar.
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Zaqout A, Daghfal J, Alaqad I, Hussein SAN, Aldushain A, Almaslamani MA, Abukhattab M, Omrani AS. The initial impact of a national BNT162b2 mRNA COVID-19 vaccine rollout. Int J Infect Dis 2021; 108:116-118. [PMID: 33992763 PMCID: PMC8117665 DOI: 10.1016/j.ijid.2021.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objective This study examined the initial impact of a national BNT162b2 vaccine rollout on SARS-CoV-2 infections in Qatar. Methods All individuals who had completed ≥14 days of follow-up by 16 March 2021 after receiving the BNT162b2 vaccine were included. This study calculated incidence rates (IR) and their 95% confidence intervals (CI) during days 1–7, 8–14, 15–21, 22–28, and >28 days post-vaccination. Poisson regression was used to calculate incidence rate ratios (IRR) relative to the first 7-day post-vaccination period. Results A total of 199,219 individuals with 6,521,124 person-days of follow-up were included. SARS-CoV-2 infection was confirmed in 1877 (0.9%), of which 489 (26.1%) were asymptomatic and 123 (6.6%) required oxygen support. The median time from first vaccination to SARS-CoV-2 confirmation was 11.9 days (IQR 7.7–18.2). Compared with the first 7-day post-vaccination period, SARS-CoV-2 infections were lower by 65.8–84.7% during 15–21, 22–28, and >28 days (P < 0.001 for each). For severe COVID-19, the incidence rates were 75.7–93.3% lower during the corresponding time periods (P < 0.001 for each). Conclusion The results were consistent with an early protective effect of BNT162b2 vaccine against all degrees of SARS-CoV-2 severity.
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Affiliation(s)
- Ahmed Zaqout
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Joanne Daghfal
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Israa Alaqad
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Muna A Almaslamani
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Abukhattab
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ali S Omrani
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
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Omrani AS, Almaslamani MA, Daghfal J, Alattar RA, Elgara M, Shaar SH, Ibrahim TBH, Zaqout A, Bakdach D, Akkari AM, Baiou A, Alhariri B, Elajez R, Husain AAM, Badawi MN, Abid FB, Abu Jarir SH, Abdalla S, Kaleeckal A, Choda K, Chinta VR, Sherbash MA, Al-Ismail K, Abukhattab M, Ait Hssain A, Coyle PV, Bertollini R, Frenneaux MP, Alkhal A, Al-Kuwari HM. The first consecutive 5000 patients with Coronavirus Disease 2019 from Qatar; a nation-wide cohort study. BMC Infect Dis 2020; 20:777. [PMID: 33076848 PMCID: PMC7570422 DOI: 10.1186/s12879-020-05511-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background There are limited data on Coronavirus Disease 2019 (COVID-19) outcomes at a national level, and none after 60 days of follow up. The aim of this study was to describe national, 60-day all-cause mortality associated with COVID-19, and to identify risk factors associated with admission to an intensive care unit (ICU). Methods This was a retrospective cohort study including the first consecutive 5000 patients with COVID-19 in Qatar who completed 60 days of follow up by June 17, 2020. The primary outcome was all-cause mortality at 60 days after COVID-19 diagnosis. In addition, we explored risk factors for admission to ICU. Results Included patients were diagnosed with COVID-19 between February 28 and April 17, 2020. The majority (4436, 88.7%) were males and the median age was 35 years [interquartile range (IQR) 28–43]. By 60 days after COVID-19 diagnosis, 14 patients (0.28%) had died, 10 (0.2%) were still in hospital, and two (0.04%) were still in ICU. Fatal COVID-19 cases had a median age of 59.5 years (IQR 55.8–68), and were mostly males (13, 92.9%). All included pregnant women (26, 0.5%), children (131, 2.6%), and healthcare workers (135, 2.7%) were alive and not hospitalized at the end of follow up. A total of 1424 patients (28.5%) required hospitalization, out of which 108 (7.6%) were admitted to ICU. Most frequent co-morbidities in hospitalized adults were diabetes (23.2%), and hypertension (20.7%). Multivariable logistic regression showed that older age [adjusted odds ratio (aOR) 1.041, 95% confidence interval (CI) 1.022–1.061 per year increase; P < 0.001], male sex (aOR 4.375, 95% CI 1.964–9.744; P < 0.001), diabetes (aOR 1.698, 95% CI 1.050–2.746; P 0.031), chronic kidney disease (aOR 3.590, 95% CI 1.596–8.079, P 0.002), and higher BMI (aOR 1.067, 95% CI 1.027–1.108 per unit increase; P 0.001), were all independently associated with increased risk of ICU admission. Conclusions In a relatively younger national cohort with a low co-morbidity burden, COVID-19 was associated with low all-cause mortality. Independent risk factors for ICU admission included older age, male sex, higher BMI, and co-existing diabetes or chronic kidney disease. Supplementary information Supplementary information accompanies this paper at 10.1186/s12879-020-05511-8.
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Affiliation(s)
- Ali S Omrani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050.
| | - Muna A Almaslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Joanne Daghfal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Rand A Alattar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Mohamed Elgara
- Medical Education Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Shahd H Shaar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Tawheeda B H Ibrahim
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Ahmed Zaqout
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Dana Bakdach
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Abdelrauof M Akkari
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Anas Baiou
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Bassem Alhariri
- Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Reem Elajez
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Ahmed A M Husain
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Mohamed N Badawi
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Fatma Ben Abid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Sulieman H Abu Jarir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Shiema Abdalla
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Anvar Kaleeckal
- Business Intelligence Unit, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Kris Choda
- Business Intelligence Unit, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | | | | | - Khalil Al-Ismail
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Mohammed Abukhattab
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Ali Ait Hssain
- Division of Critical Care, Department of Medicine, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Peter V Coyle
- Division of Virology, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | | | - Michael P Frenneaux
- Scientific, Academic and Faculty Affairs, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
| | - Abdullatif Alkhal
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar, PO Box 3050
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Abukhattab M, Al-Maslamani M, Al-Khal AL. Risk Assessment and Travelers Characteristics: 6-Month Travel Clinic Experience From Qatar. Int J Travel Med Glob Health 2018. [DOI: 10.15171/ijtmgh.2018.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The number of international travelers is increasing, yet currently, there is no data on risk assessment and travelers’ characteristics from Qatar. To identify and minimize the risks associated with travel, a detailed knowledge of travelers’ characteristics is needed. Methods: This retrospective descriptive study was conducted in a travel clinic in the Communicable Disease Center, Qatar. All patients seen in the clinic from February 2017 to August 2017 were included. Data was analyzed using SPSS version 22 software. Results: A total of 279 travelers were included in this study. The top 2 most visited countries were Tanzania and Kenya. Tourism (57.3%) was the number one purpose for travel, while travelers visiting friends and relatives (VFRs) accounted for 10.7% of travel. Among the study population, 21% of participants had pre-existing medical conditions with hypertension and diabetes as the most common comorbidities. Mean travel duration was 46.5 days (range = 3 to 90 days). Vaccinations were required by 97% of the study population with the most commonly prescribed vaccines being the typhoid (69%), Tdap (62%), hepatitis A (55%), flu (49.3%), and yellow fever (39%) vaccines. Conclusion: Travelers from Qatar tend to visit high-risk destinations; the lack of proper travel medicine services and awareness among travelers may increase the risk of illness, especially in Qatar where a large number of expatriates reside and travel frequently to and from their home countries (VFRs).
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Affiliation(s)
- Mohammed Abukhattab
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Abdul Latif Al-Khal
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
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Ben Abid F, Abukhattab M, Ghazouani H, Khalil O, Gohar A, Al Soub H, Al Maslamani M, Al Khal A, Al Masalamani E, Al Dhahry S, Hashim S, Howadi F, Butt AA. Epidemiology and clinical outcomes of viral central nervous system infections. Int J Infect Dis 2018; 73:85-90. [PMID: 29913285 DOI: 10.1016/j.ijid.2018.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) viral infections are an important cause of morbidity and mortality. No data are available regarding their epidemiology in Qatar. DESIGN We retrospectively evaluated all cerebrospinal fluid findings from January 2011-March 2015 at Hamad Medical Corporation. Those with abnormal CSF finding were included in our study. We excluded those with missing medical records, no clinical evidence of viral CNS infection, or proven bacterial, fungal or tuberculosis CNS infection. CNS clinical findings were classified as meningitis, encephalitis or myelitis. RESULTS Among 7690 patients with available CSF results, 550 cases met the inclusion criteria (meningitis 74.7%; encephalitis 25%; myelitis 0.4%). Two-thirds (65%) were male and 50% were between 16-60 years old. Viral etiology was confirmed in 38% (enterovirus, 44.3%; Epstein-Barr virus, 31%; varicella zoster virus, 12.4%). The estimated incidence was 6.4 per 100,000 population. Two persons died and the rest were discharged to home. Among those with confirmed viral etiology, 83.8% received ceftriaxone (mean duration 7.3±5.2 days), 38% received vancomycin (mean duration 2.7±5.4 days) and 38% received at least one other antibiotic. Intravenous acyclovir was continued for more than 48h in patients with confirmed negative viral etiology (mean duration 5±5.6 days). CONCLUSION Viral etiology is not uncommon among those evaluated for CNS infection in Qatar. Clinical outcomes are excellent in this group of patients. Antibiotics and acyclovir are overly used even when a viral etiology is confirmed. There is a need for clinician education regarding etiology and treatment of viral CNS infections.
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Affiliation(s)
- Fatma Ben Abid
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar.
| | - Mohammed Abukhattab
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Hafedh Ghazouani
- Department of Bioinformatics, Department of Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Obada Khalil
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Gohar
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Al Soub
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
| | - Muna Al Maslamani
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
| | - Abdullatif Al Khal
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
| | - Eman Al Masalamani
- Department of Pediatrics, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Said Al Dhahry
- Department of Laboratory Medicine and Pathology, Section of Virology and Molecular Biology, Hamad Medical Corporation, Doha, Qatar
| | - Samar Hashim
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Faraj Howadi
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Adeel A Butt
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
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Abid FB, Abukhattab M, Salameh O, Gohar A, Al Masalmani M, Al-Khal A, Butt A. Viral Infections of the Central Nervous System in Qatar: Epidemiology, Pathogenesis and Clinical Outcomes. Open Forum Infect Dis 2017. [PMCID: PMC5632044 DOI: 10.1093/ofid/ofx163.707] [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: 12/01/2022] Open
Abstract
Background Viral central nervous system (CNS) infections are common causes of morbidity and mortality globally. There are no existing data about viral CNS infections in Gulf Cooperation Council countries. We conducted this study to determine the etiology, clinical and epidimiological characteristics, and outcomes of viral central nerveous system infection in patients in Qatar. Methods We retrospectively evaluated all cerebrospinal fluid findings from January 2011–March 2015 at any of the 7 hospitals in the Hamad Medical Corporation. We included those with an abnormal CSF findings and excluded those with missing medical records, no clinical evidence of CNS infection and those with proven bacterial infection. Based on pre-defined clinical and CSF (lab, culture, PCR) criteria, patients were classified as having meningitis, meningoencephalitis, encephalitis or myelitis. We reviewed the laboratory results to determine the proportion of persons with confirmed viral etiology. Results Among 7690 patients with available CSF results, 550 cases met the case definition criteria for viral CNS infection (meningitis 75%; meningoencephalitis 16%; encephalitis 9%; myelitis 0.4%). Two-thirds (65%) were male and 50% were between 16-60 years old. The most common presenting signs and symptoms are listed in the table. Persons of Southeast Asian origin accounted for 39.6% of all infections. A definitive virologic etiologic agent was found in 38%, with enterovirus being the most common (44.3%) followed by Epstein–Barr virus (31%) and varicella-zoster virus (12.4%). The clinical outcome was overall good, only 2 cases died and the rest were discharged to home. Among those with confirmed viral etiology, 83.8% received ceftriaxone (mean duration 7.3 ± 5.2 days), 38% received vancomycin (mean duration 2.7 ± 5.4 days) and 38% received at least one other antibiotic. Conclusion Viral etiology is common among those evaluated for CNS infection in Qatar, and is most commonly seen in Southeast Asian immigrants. Clinical outcomes are generally excellent in this group of patients. Antibiotics are overly used even when a viral etiology is confirmed. There is a need for clinician education regarding etiology and treatment of CNS infections. Disclosures A. Butt, Merck: Investigator, Grant recipient
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Affiliation(s)
| | | | | | - Ahmed Gohar
- Medicine, Hamad Medical Corporation, Doha, Qatar
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Abstract
Patient: Female, 45 Final Diagnosis: Primary pituitary tuberculosis Symptoms: Headache • vomiting • vomiting Medication: — Clinical Procedure: Pituitary biospy Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Fatma Ben Abid
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohammed Abukhattab
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Hanfa Karim
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohamed Agab
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Issam Al-Bozom
- Department of Pathology, Hamad General Hospital, Doha, Qatar
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Khan FY, Abukhattab M, AbuKamar M, Anand D. Adult Klebsiella pneumoniae meningitis in Qatar: clinical pattern of ten cases. Asian Pac J Trop Biomed 2014; 4:669-72. [PMID: 25183339 DOI: 10.12980/apjtb.4.201414b100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/03/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe the clinical presentation, underlying diseases, antimicrobial susceptibility, treatment and outcome of Klebsiella pneumoniae meningitis patients. METHODS This retrospective study involved all patients with 15 years of age or older who admitted to Hamad General Hospital with culture proven Klebsiella pneumoniae meningitis from January 1, 2007 to December 31, 2012. RESULTS A total of ten cases were identified (nine males and one female). Their mean age was (43.3±12.8) years. Eight patients (80%) had nosocomial meningitis with neurosurgery being the most frequent associated condition. Fever and altered consciousness were the most frequent symptom. Cerebrospinal fluid showed elevated protein and glucose levels. Gram stain showed Gram-negative rods in 50% of cases, while positive cerebrospinal fluid culture results were found in all patients. Multidrug resistance was observed in two cases, and all patients had received appropriate empirical and definitive antibiotic treatments. The mean duration of intravenous antimicrobial treatment was (19.3±7.0) d and all patients with external ventricular drains underwent removal of the device, while in-hospital mortality was 50%. CONCLUSIONS The number of cases was too small to come up with therapeutic and prognostic conclusions. Further large-scale prospective study is needed.
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Affiliation(s)
| | - Mohammed Abukhattab
- Infectious Diseases Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohammed AbuKamar
- Infectious Diseases Division, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Deshmukh Anand
- Microbiology Laboratory, Hamad General Hospital, Doha, Qatar
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Khan F, Abukhattab M, AbuKamar M, Anand D. Adult Klebsiella Pneumoniae Meningitis in Qatar: Clinical Pattern of Ten Cases. Mater Sociomed 2014. [DOI: 10.5455/msm.2014.26.208-210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
We report four cases of nosocomial E. coli meningitis, in male patients with accidental and neurosurgical trauma. The interval between accidents/neurosurgical procedures and the onset of meningitis was 2-15 days (mean 6.25 days). The most consistent clinical features were fever and deterioration of consciousness level. Emergence of extended spectrum beta lactamase E. coli strains had been observed in two (50%) of our cases and the mean duration of antimicrobial treatment was 16.5 days (range: 6-24 days). Two of the four patients (50%) died in the hospital.
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