Cryptosporidiosis in two regions of Saudi Arabia

This is the first study on human and animal infections with Cryptosporidillm spp. in I Gizan and Maddina regions of Saudi Arabia. Between March 2005 and September 2006, stool Isamples from 1641 people (predominantly children) were screened for Cryptosporidillm spp. , These included 454 patients with diarrhoea and 62 controls in Gizan and 1125 patients from IMaddina. In addition, 279 animal samples were examined from Gizan, including cows, goats and i sheep. j The human samples from Gizan were initially screened by miGroscopy using modified j Ziehl-Neelsen (ZN) and Safranin Methylene Blue staining techniques, while the animal samples ; were only screened using a modified ZN staining technique. The control samples were all i negative by both methods. ZN identified Cryptosporidium oocysts in 21 (4.6%) samples and i SM-B identified oocysts in 26 (5.7%) out of454 human samples from Gizan. ZN only identified i Cryptosporidium oocysts in one sheep sample. Stools from Maddina were not routinely examined j by microscopy unless positive by other means. . All 1920 faecal samples (human or animal) were evaluated using an Enzyme Immunoassay (EIA), which detected Cryptosporidium Specific Antigen in 104 (5.4 %) ofthe samples (103 human and one animal). Comparison ofthe detection rates between the diagnostic methods, Le. microscopy and EIA, using a subgroup of454 samples from Gizan, showed 100% agreement in specificity between the two methods, but EIA was more sensitive (5.7% vs 9.9%). In both Gizan and Maddina regions, cryptosporidiosis was more common in children less than two years ofage and the maximum prevalences were observed during the cooler months. All 104 samples (46 from Gizan, 58 from Maddina) containing Cryptosporidium oocysts were initially amplified by I8S rRNA-based PCR. The 101 (97.1%) samples positive for Cryptosporidium were further genotyped by an 18S rRNA-based PCR-Restriction Fragment Length Polymorphism (RFLP) technique. The 104 samples were also amplified using PCR for GP60 and HSP70 genes, for multilocus sub-genotyping. Among the 101 samples which were positive by 18S rRNA PCR, 79 (78.2 %) isolates were subsequently classified by RFLP as C. parvum, 13 (12.9 %) as C. hominis and one (1 %) was C.fe/is (from a sheep in the Gizan area). 8 human samples from the Gizan area contained mixed infections with C. parvum and C. hominis, as determined using RFLP of I8S rRNA gene. 95 (91.3%) and 88 (84.6%) ofthe 104 samples containing Cryptosporidium oocysts were successfully amplified for sub-genotype studies, using PCR for the GP60 and HSP70 genes respectively. Sequence analysis of study isolates ofthese two loci in general confirmed the species identification obtained by thel8S rRNA gene PCR- RFLP analysis. In total, allele groups IIa, IIc and IId of C. parvum and allele groups Ib and Ie of C. hominis were obtained by GP60 sequencing. HSP70 sequence analysis was less successful and did not add much to discrimination. Cryptosporidiosis was common in children, and screening of stools by EIA was twice as sensitive as light microscopy after special staining. The predominant species in humans was zoonotic C. parvum, with some C. parvum subtypes associated with anthroponotic spread also identified by multilocus sequencing. PCR amplification of both GP60 and HSP70 genes was successful, but GP60 was the most useful additional tool, showing extensive genetic heterogeneity in Cryptosporidium spp. at the subtype level. Although this may correlate with origin of the infection, studies in local animals were unsuccessful in confirming possible animal sources

Knowledge of basic life support among the students of Jazan University, Saudi Arabia: Is it adequate to save a life?

Background: Basic Life Support [BLS; including cardiopulmonary resuscitation (CPR)] is a part of medical skills utilized in case of an emergency medical care to save human lives. It is well established that the young students can become major healthcare supportive workforce for a community including the cases of emergency. Therefore, adequate knowledge of BLS is necessary for all the university attending students. This study evaluated the awareness of BLS knowledge and attitude towards BLS training among the students of Jazan University, Saudi Arabia.Methods: A self-administered survey questionnaire using cross-sectional design was employed.Results: Out of 360 participants, the majority were male students (84.2%). The participants have mediocre knowledge of BLS, and their mean score was 7.83 out of 14. The knowledge score, i.e., correct response of male and female students was almost similar. Not a single student answered all the questions correctly. About 28% participants had received BLS training previously during their study course and showed better BLS knowledge (mean score 10.41) in comparison with the other participants. In contrast with the students of health science related courses, the highest mean knowledge score (11.5) was opted by the students of emergency medical services, whereas the lowest score (6.58) was opted by the students of nursing background.Conclusions: Overall, a majority of the students of Jazan University did not have complete knowledge of BLS (CPR). The outcomes of this study will be helpful for education and healthcare service providers of the Saudi kingdom as a whole and for Jazan region.Keywords: Basic life support, Health occupations, Students’ knowledge, Medical education, Saudi Arabi

In silico CD4+, CD8+ & humoral immunity associated antigenic epitope prediction and HLA distribution analysis of HTLV-I

Purpose: The linkage of human T-cell leukemia virus type 1 (HTLV-1) to fatal diseases is a well known fact for many years. However, there has been no significant progress in the field of the treatment that can lead to the development of a successful vaccine. Furthermore, there are no means of assessing the risk of disease and its prognosis in the infected people. Methods:The current study has taken the cognizance of the importance of host’s immune response in reducing the risk of infectious diseases to carry out immunoinformatics driven epitope screening strategy of vaccine candidates against HTLV-1. In this study, a genetic variability and HLA distribution analysis among the documented HTLV-1 genotypes I, II, III, IV, V & VI was performed to ensure the coverage of the vast majority of population, where vaccine would be employed. The meticulous screening of effective dominant immunogens was done with the help of ABCPred and Immune Epitope Database. Results: The results showed that the identified epitopes might be protective immunogens with high conservancy and potential of inducing both protective neutralizing antibodies and Tcell responses. The peptides “PSQLPPTAPPLLPHSNLDHI”, “PCPNLVAYSSYHATY”, and “YHATYSLYLF”, were 100% conserved among different isolates from far and wide separated countries, suggesting negligible antigenic drift in HTLV-1. Conclusions: Overall, the mentioned epitopes are soluble, non-toxic suitable candidates for the development of vaccine against HTLV-1 and warrant further investigation and experimental validation

In silico CD4+, CD8+ T-cell and B-cell immunity associated immunogenic epitope prediction and HLA distribution analysis of Zika virus

Zika virus (ZIKV) is a mosquito-borne flavivirus distributed all over Africa, South America and Asia. The infection with the virus may cause acute febrile sickness that clinically resembles dengue fever, yet there is no vaccine, no satisfactory treatment, and no means of evaluating the risk of the disease or prognosis in the infected people.In the present study, the efficacy of the host’s immune response in reducing the risk of infectious diseases was taken into account to carry out immuno-informatics driven epitope screening strategy of vaccine candidates against ZIKV. In this study, HLA distribution analysis was done to ensure the coverage of the vast majority of the population. Systematic screening of effective dominant immunogens was done with the help of Immune Epitope & ABCPred databases. The outcomes suggested that the predicted epitopes may be protective immunogens with highly conserved sequences and bear potential to induce both protective neutralizing antibodies, T & B cell responses. A total of 25 CD4+ and 16 CD8+ peptides were screened for T-cell mediated immunity. The predicted epitope "TGLDFSDLYYLTMNNKHWLV" was selected as a highly immunogenic epitope for humoral immunity. These peptides were further screened as non-toxic, immunogenic and non-mutated residues of envelop viral protein. The predicted epitope could work as suitable candidate(s) for peptide based vaccine development. Further, experimental validation of these epitopes is warranted to ensure the potential of B- and T-cells stimulation for their efficient use as vaccine candidates, and as diagnostic agents against ZIKV

In silico CD4+, CD8+ T-cell and B-cell immunity associated immunogenic epitope prediction and HLA distribution analysis of Zika virus

Zika virus (ZIKV) is a mosquito-borne flavivirus distributed all over Africa, South America and Asia. The infection with the virus may cause acute febrile sickness that clinically resembles dengue fever, yet there is no vaccine, no satisfactory treatment, and no means of evaluating the risk of the disease or prognosis in the infected people. In the present study, the efficacy of the host\u27s immune response in reducing the risk of infectious diseases was taken into account to carry out immuno-informatics driven epitope screening strategy of vaccine candidates against ZIKV. In this study, HLA distribution analysis was done to ensure the coverage of the vast majority of the population. Systematic screening of effective dominant immunogens was done with the help of Immune Epitope & ABCPred databases. The outcomes suggested that the predicted epitopes may be protective immunogens with highly conserved sequences and bear potential to induce both protective neutralizing antibodies, T & B cell responses. A total of 25 CD4+ and 16 CD8+ peptides were screened for T-cell mediated immunity. The predicted epitope TGLDFSDLYYLTMNNKHWLV was selected as a highly immunogenic epitope for humoral immunity. These peptides were further screened as non-toxic, immunogenic and non-mutated residues of envelop viral protein. The predicted epitope could work as suitable candidate(s) for peptide based vaccine development. Further, experimental validation of these epitopes is warranted to ensure the potential of B- and T-cells stimulation for their efficient use as vaccine candidates, and as diagnostic agents against ZIKV

Hospital adoption of antimicrobial stewardship programmes in Gulf Cooperation Council countries: A review of existing evidence

© 2018 International Society for Chemotherapy of Infection and Cancer Antimicrobial resistance is increasing at an alarming rate in the Gulf Cooperation Council (GCC) owing to the overuse and misuse of antimicrobials. Novel and rare multidrug-resistant strains can spread globally since the region is host to the largest expatriate population in the world as well as a pilgrimage destination for more than 4 million people annually. Adoption of antimicrobial stewardship programmes (ASPs) could improve the use of antimicrobials and reduce antimicrobial resistance in the region. However, despite the established benefits of these interventions, little is known about the level of their adoption in the region and the impact of these programmes on antimicrobial use and resistance. This study aimed to review existing evidence on the level of adoption of ASPs, the facilitators and barriers to their adoption, and outcomes of their adoption in GCC hospitals

Anthroponotic transmission of Cryptosporidium parvum predominates in countries with poorer sanitation - a systematic review and meta-analysis

Background: Globally cryptosporidiosis is one of the commonest causes of mortality in children under 24 months old and may be associated with important longterm health effects. Whilst most strains of Cryptosporidium parvum are zoonotic, C. parvum IIc is almost certainly anthroponotic. The global distribution of this potentially important emerging infection is not clear. Methods: We conducted a systematic review of papers identifying the subtype distribution of C. parvum infections globally. We searched PubMed and Scopus using the following key terms Cryptospor* AND parvum AND (genotyp* OR subtyp* OR gp60). Studies were eligible for inclusion if they had found C. parvum within their human study population and had subtyped some or all of these samples using standard gp60 subtyping. Pooled analyses of the proportion of strains being of the IIc subtype were determined using StatsDirect. Meta-regression analyses were run to determine any association between the relative prevalence of IIc and Gross Domestic Product, proportion of the population with access to improved drinking water and improved sanitation. Results: From an initial 843 studies, 85 were included in further analysis. Cryptosporidium parvum IIc was found in 43 of these 85 studies. Across all studies the pooled estimate of relative prevalence of IIc was 19.0% (95% CI: 12.9–25.9%), but there was substantial heterogeneity. In a meta-regression analysis, the relative proportion of all C. parvum infections being IIc decreased as the percentage of the population with access to improved sanitation increased and was some 3.4 times higher in those studies focussing on HIV-positive indivduals. Conclusions: The anthroponotic C. parvum IIc predominates primarily in lower-income countries with poor sanitation and in HIV-positive individuals. Given the apparent enhanced post-infectious virulence of the other main anthroponotic species of Cryptosporidium (C. hominis), it is important to learn about the impact of this subtype on human health

Anthroponotic transmission of Cryptosporidium parvum predominates in countries with poorer sanitation - a systematic review and meta-analysis

Background: Globally cryptosporidiosis is one of the commonest causes of mortality in children under 24 months old and may be associated with important longterm health effects. Whilst most strains of Cryptosporidium parvum are zoonotic, C. parvum IIc is almost certainly anthroponotic. The global distribution of this potentially important emerging infection is not clear. Methods: We conducted a systematic review of papers identifying the subtype distribution of C. parvum infections globally. We searched PubMed and Scopus using the following key terms Cryptospor* AND parvum AND (genotyp* OR subtyp* OR gp60). Studies were eligible for inclusion if they had found C. parvum within their human study population and had subtyped some or all of these samples using standard gp60 subtyping. Pooled analyses of the proportion of strains being of the IIc subtype were determined using StatsDirect. Meta-regression analyses were run to determine any association between the relative prevalence of IIc and Gross Domestic Product, proportion of the population with access to improved drinking water and improved sanitation. Results: From an initial 843 studies, 85 were included in further analysis. Cryptosporidium parvum IIc was found in 43 of these 85 studies. Across all studies the pooled estimate of relative prevalence of IIc was 19.0% (95% CI: 12.9–25.9%), but there was substantial heterogeneity. In a meta-regression analysis, the relative proportion of all C. parvum infections being IIc decreased as the percentage of the population with access to improved sanitation increased and was some 3.4 times higher in those studies focussing on HIV-positive indivduals. Conclusions: The anthroponotic C. parvum IIc predominates primarily in lower-income countries with poor sanitation and in HIV-positive individuals. Given the apparent enhanced post-infectious virulence of the other main anthroponotic species of Cryptosporidium (C. hominis), it is important to learn about the impact of this subtype on human health

Cryptosporidiosis in Saudi Arabia and neighboring countries

Cryptosporidium is a coccidian protozoan parasite of the intestinal tract that causes severe and sometimes fatal watery diarrhea in immunocompromised patients, and self-limiting but prolonged diarrheal disease in immunocompetent individuals. It exists naturally in animals and can be zoonotic. Although cryptosporidiosis is a significant cause of diarrheal diseases in both developing and developed countries, it is more prevalent in developing countries and in tropical environments. We examined the epidemiology and disease burden of Cryptosporidium in Saudi Arabia and neighboring countries by reviewing 23 published studies of Cryptosporidium and the etiology of diarrhea between 1986 and 2006. The prevalence of Cryptosporidium infection in humans ranged from 1% to 37% with a median of 4%, while in animals it was different for different species of animals and geographic locations of the studies. Most cases of cryptosporidiosis occurred among children less than 7 years of age, and particularly in the first two years of life. The seasonality of Cryptosporidium varied depending on the geographic locations of the studies, but it was generally most prevalent in the rainy season. The most commonly identified species was Cryptosporidium parvum while C. hominis was detected in only one study from Kuwait. The cumulative experience from Saudi Arabia and four neighboring countries (Kuwait, Oman, Jordan and Iraq) suggest that Cryptosporidium is an important cause of diarrhea in humans and cattle. However, the findings of this review also demonstrate the limitations of the available data regarding Cryptosporidium species and strains in circulation in these countries