Clostridium septicum infection of hepatic metastases following alcohol injection: a case report

Clostridium septicum infections are generally associated with gastrointestinal or hematologic malignancies. We report the first case of hepatic metastases infection with Clostridium septicum that followed alcohol injection of liver lesion. Clinicians should consider this possibility in patients with underlying malignancy who present with hepatic abscess, as prompt surgical drainage and empiric antibiotics may be life saving

Musculoskeletal Brucellosis in Adults in the United Arab Emirates: A Retrospective Study

Introduction: Brucellosis is a zoonotic infection caused by the aerobic Gram-negative bacteria coccobacilli, and is considered a public health problem in the Mediterranean region and Arabian Peninsula. This paper studied the clinical characteristics of musculoskeletal brucellosis and the outcomes of treatment in Al Ain City, United Arab Emirates. Method: A retrospective chart review study was conducted at Tawam Hospital over seven years: January 2009–January 2016. Risk factors for brucellosis, musculoskeletal (MSK) manifestations, duration of Brucella infection (acute, subacute, chronic), and treatment were studied. Results: A total of 99 patients were diagnosed with brucellosis during the study period; the mean age was 44 years, the majority were males (71%), and the male to female ratio was 3:1. The most common risk factor for Brucella infection in the cohort was drinking raw milk (43.4%). Fever was the most common presenting symptoms (93%), followed by arthralgia, fatigue, and loss of appetite in 35, 21, and 14%, respectively. The clinical manifestations of brucellosis in the cohort were MSK involvement (30%), hepatitis (17%), epididymo-orchitis (2%), and endocarditis (1%). Thirty percent of patients (n=30) had MSK-specific symptoms and only one-third (n=10) had confirmatory positive radiographic findings. The majority of patients had lumbar and sacroiliac joint involvement. Most of the patients received antibiotics for a 4–8-week duration and the overall relapse rate of Brucella infection was 10%. Conclusion: This study demonstrates that MSK involvement is a common manifestation in brucellosis, occurring in one-third of the cases. The index of suspicion should be high in brucellosis-endemic countries for early recognition and treatment

Multihospital occurrence of pan-resistant Klebsiella pneumoniae sequence type 147 with an ISEcp1-directed blaOXA-181 insertion in the mgrB gene in the United Arab Emirates

The emergence of pan-resistant Klebsiella pneumoniae strains is an increasing concern. In the present study, we describe a cluster of 9 pan-resistant K. pneumoniae sequence type 147 (ST147) isolates encountered in 4 patients over nearly 1 year in 3 hospitals of the United Arab Emirates (UAE). The isolates exhibited highly similar genotypes. All produced chromosomally encoded OXA-181, and the majority also produced the NDM-5 carbapenemase. As with the previously described single isolate from the UAE, MS6671, the mgrB was disrupted by a functional, ISEcp1-driven blaOXA-181 insertion causing resistance to carbapenems. The mutation was successfully complemented with an intact mgrB gene, indicating that it was responsible for colistin resistance. blaNDM-5 was located within a resistance island of an approximately 100-kb IncFII plasmid carrying ermB, mph(A), blaTEM-1B, rmtB, blaNDM-5, sul1, aadA2, and dfrA12 resistance genes. Sequencing this plasmid (pABC143-NDM) revealed that its backbone was nearly identical to that of plasmid pMS6671E from which several resistance genes, including blaNDM-5, had been deleted. More extensive similarities of the backbone and the resistance island were found between pABC143C-NDM and the blaNDM-5-carrying IncFII plasmids of two K. pneumoniae ST147 isolates from South Korea, one of which was colistin resistant, and both also produced OXA-181. Notably, one of these strains was isolated from a patient transferred from the UAE. Our data show that this pan-resistant clone has an alarming capacity to maintain itself over an extended period of time and is even likely to be transmitted internationally

Personal, Occupational, and Public Health Perspectives on Dealing with the First Case of Influenza A (H1N1) in the United Arab Emirates

New epidemics of infectious diseases often involve health care workers. In this short communication we present a case report of a health care professional who became the first case of influenza H1N1 virus to be notified in the United Arab Emirates. There are several issues related to workplace considerations and general public health, including preventive measures, the need for isolation of the patient, dealing with contacts, return to work, and communication with the workforce

Prospective cross-sectional study of tuberculosis screening in United Arab Emirates

Objectives: Intense migrations from tuberculosis endemic areas to Gulf countries create special risks for people in the region. The purpose of this study was to provide data that could justify implementing universal, regular TB screening in UAE. Design: This prospective, cross-sectional study used interferon-γ release assay (IGRA) to screen for TB among Emirati citizens between August-2016 and May-2017; expatriates were not included in this study. Participants were recruited from Emiratis attending Tawam Hospital Polyclinics for problems unrelated to TB risk assessment. IGRA was requested for all enrolled participants. A risk-assessment questionnaire was completed by all participants. In addition, a retrospective review of IGRA results (January-2011 to April-2016) was conducted to compare prevalence of positive IGRA in the ‘prospective sample’ with that in ‘patients screened in the past’. Results: Four hundred fifty-five participants (69% females) were enrolled in this study. Participants’ age (mean ± SD) was 42 ± 16y. The majority of participants had traveled to or had helpers from TB-endemic areas. Two hundred forty (53%) participants had IGRA test. Forty-five (18.8%) participants had positive IGRA, similar to the retrospective results of 12.4% to 23.5%. Conclusions: The prevalence of positive-IGRA in this study is high. Keywords: TB screening, Latent TB infection, TB disease, United Arab Emirates, Gulf region, Interferon-γ release assa

Plasmid-mediated colistin resistance in Escherichia coli from the Arabian Peninsula

AbstractObjectivesSearching for the presence of the mcr-1 gene in colistin resistant Enterobacteriaceae in countries of the Arabian Peninsula.MethodsSeventy-five independent, colistin resistant Enterobacteriaceae strains isolated from clinical cases in Bahrain, Kuwait, Oman, Saudi Arabia and the United Arab Emirates were tested by PCR for the mcr-1 gene. mcr-1 positive strains were genotyped, and their antibiotic susceptibility was established. The mcr-1 containing plasmids were mobilized into Escherichia coli K-12 and their sequence was determined.ResultsFour E. coli isolates (two from Bahrain, one from Saudi Arabia and one from the United Arab Emirates) were identified carrying the mcr-1 gene on conjugative plasmids. They belonged to global multidrug resistant E. coli clones, i.e. ST648, ST224, ST68 and ST131, respectively. One strain carried the blaNDM-1 carbapenemase gene. Three strains carried mcr-1 on IncI2 type plasmids, one of them also harboring a blaCTX-M-64 gene. In the fourth strain mcr-1 was located on a 240kb IncHI2 plasmid co-harboring 13 other resistance genes.ConclusionsThis is the first report on the presence of the plasmid-coded mcr-1 gene in a variety of multi-resistant clinical isolates from the Arabian Peninsula indicating that several commonly used antibiotics can potentially facilitate the spread of mcr-1 carrying strains, or directly, mcr-1 containing plasmids

Antibiotic susceptibility of the strains by country, by resistance mechanism and by species.

<p>ERT-ertapenem, IMI—imipenem, MER—meropenem, CAZ—ceftazidime, TIG—Tigecycline, COL—colistin, XDR—extensively drug resistant</p><p>* without <i>Proteus</i> and <i>Morganella</i></p><p>Antibiotic susceptibility of the strains by country, by resistance mechanism and by species.</p