Intestinal Parasitic Infections among Long-Term-Residents and Settled Immigrants in Qatar in the Period 2005 to 2011

Abstract. The expanding economy of Qatar in the last two decades has attracted immigrants, often from countries with poor socio-economic levels. Many arrive with patent intestinal parasitic infections, and recent analyses have indicated consistently rising trends in the prevalence of some infections. Here, we examined 18,563 hospital records of subjects in Qatar seeking medical assistance for a variety of ailments, combining data from 2009 to 2011 with the earlier dataset from 2005 to 2008 to enable trends to be identified across a 7-year period. We found that 8.6% were infected with one or more species of parasites, however in contrast to the earlier period (2005–2008), in the latter 3 years there were falling trends of prevalence providing some optimism that parasitic infections among the resident immigrants have begun to decline. We identified also geographic regions from which resident workers still maintain a relatively high prevalence of helminth infections despite their long-term residence in Qatar.This publication was made possible by a grant from Qatar National Research Fund (QRNF) at Qatar Foundation through National Priorities Research Program (NPRP) (Project No. NPRP 4-1283-3-327

Polymerase chain reaction ribotyping of Clostridium difficile isolates in Qatar: a hospital-based study

Background Clostridium difficile infection (CDI) is not generally reported to public health authorities in the Middle East and its true prevalence remains largely unknown. The aims of this study were to determine the prevalence of CDI and its associated ribotypes among C. difficile isolates in Qatar. Influence of age and correlation with other risk factors e.g. proton pump inhibitor use, antibiotic use, existence of chronic conditions, etc was also investigated for CDI positive patients. Methods A total of 1,532 patients with suspected CDI were recruited from two hospitals between 2011 and 2012. C. difficile was identified using glutamate dehydrogenase (GDH) lateral flow assay and toxins A and B Enzyme Immunoassay (EIA). The C. difficile positive samples were then cultured for PCR-ribotyping. Results 122 of the 1,532 (7.9%) samples from individual patients were identified as C.difficile positive; and 79 of these were viably cultured (~65%). From these, 36 different PCR ribotypes were isolated, of which strains 258 (6 [7.6%]), 01/014/046 (5 [6.3%]), and 011/053/056/107 (4 [5%]) were the most prevalent. The prevalence of PCR-ribotype 027 was 1.3% (n = 1). An age of ≥65 years and treatment with proton pump inhibitors correlated with higher frequency of CDI. Treatment with third generation cephalosporins (50 [41%]) and piperacillin/tazobactam antibiotics (55 [45.1%]) was most frequently associated with CDI. Conclusion The most common C. difficile ribotype identified in Qatar was 258, which is different from those found in North America, Europe and Asia. The prevalence of CDI was higher in Qatar than Europe; though comparable to other Middle Eastern countries. These findings underscore the importance of local surveillance to detect and control C. difficile infection

Helminth infections among long-term residents and settled immigrants in Qatar in the decade from 2005 to 2014: temporal trends and varying prevalence among subjects from different regional origins

Background: Travel and migration from developing regions, where tropical diseases are common, to more developed industrialised nations can contribute to the introduction and subsequent spread of infections. With its rapidly expanding economy, Qatar has attracted vast numbers of immigrant workers in the last two decades, often from countries with poor socio-economic levels. Many used to arrive with patent intestinal parasitic infections. Methods: We analysed the prevalence of helminth infections in a dataset of 29,286 records of subjects referred for stool examination at the Hamad Medical Corporation over the course of a decade (2005 to 2014, inclusive). Results: Overall prevalence of combined helminth infections was low (1.86 %) but there were significant temporal trends, age and sex effects and those arising from the region of origin of the subjects. The most common helminths were hookworms (overall prevalence 1.22 %), which accounted for 70.1 % of cases, and therefore patterns for combined helminth infections were largely driven by hookworms. In both cases, and also in Trichuris trichiura and Ascaris lumbricoides, prevalence peaked in 2008, since when prevalence has been steadily falling. Helminth infections were largely concentrated among subjects from five Asian countries (Nepal, Bangladesh, Sri Lanka, India and Pakistan), and there was a highly biased prevalence in favour of male subjects in all cases. Prevalence of all three nematodes peaked in age class 7 (mean age 25.5 years, range = 20–29) and there were significant interactions between region of origin, sex of subjects and prevalence of hookworms. Conclusion: These results offer optimism that prevalence will continue to decline in the years ahead, especially if control is targeted at those most at risk of carrying infections.Qatar National Research Fund (QRNF) at Qatar Foundation for supporting this study through the National Priorities Research Program (NPRP) (Project No. NPRP 4-1283-3-327)

Analysis of Resistance to Antimicrobials and Presence of Virulence/Stress Response Genes in Campylobacter Isolates from Patients with Severe Diarrhoea

Campylobacter infections are a major cause of diarrhoea world-wide and two of the antimicrobials used for their control (erythromycin and ciprofloxacin) have been losing efficacy in recent years. In a sample of 174 genotyped isolates from the stools of patients with severe diarrhoea in Qatar, collected between 2005 and 2012, 63.2%showed resistance to ciprofloxacin, 8.6% to erythromycin, 0.57%to chloramphenicol and all were sensitive to gentamycin. While 33.9%of isolates were sensitive to all four antimicrobials, 59.8% were resistant to at least one, 6.3% were resistant to two and none showed resistance to three antimicrobials. There was no host sex- or age-dependence among isolates resistant to ciprofloxacin and erythromycin and no significant variation was found with the region of origin of the patients. All isolates were screened for the presence of 3 virulence factors (ciaB, cadF and cdtB) and two stress-response factors (htrB and clpP), all of which were present in more than 50% of the isolates. Host sex-, age- and region of origin-dependent variations in prevalence were found for some of these factors. Data analysis for the combination of virulence factors and their effect on antimicrobial resistance indicated that the prevalence of resistance to both erythromycin and ciprofloxacin was higher in isolates harbouring ciaB but not clpP. Prevalence of resistance to ciprofloxacin was similar in clpP positive and negative isolates also possessing htrB, while for htrB-negative isolates prevalence was higher in the absence of clpP. These results are discussed and their implications are highlighted.National Priority Research Program grant number NPRP4-1283-3-327 from the Qatar National Research Fund, Hamad Medical Corporation grant #13334/1

Epidemiology of urinary tract infection in adults caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae - a case-control study from Qatar

Background: Community-acquired urinary tract infection (UTI) is the most common infection caused by extended-spectrum beta-lactamase (ESBL)-producing organisms. Aim: to estimate the prevalence of ESBL-UTI in adults and to identify potential risk factors that may predispose to ESBL-UTI. Methods: A retrospective study involving adult patients with UTI caused by ESBL-producing organisms was undertaken. Patients with UTI caused by non-ESBL-producing organisms represented the control group. Results: In total, 1100 UTI isolates were included in the study, 277 of which were ESBL positive. The prevalence rate was 25.2%. The mean age of patients was 55.87 years. On univariate analysis, prior history of UTI or ESBL-UTI, invasive urological procedure within preceding 3 months, hospital admission within preceding 3 months, and exposure to antibiotics were found to be significant risk factors for ESBL-UTI. On multi-variate analysis, use of cephalosporins [adjusted odds ratio (OR) 1.61, P=0.048], previous ESBL-UTI (adjusted OR 2.67, P<0.001), and invasive urological procedure in the preceding year (adjusted OR 1.61, P=0.022) were found to be independent risk factors for ESBL-UTI. Conclusions: In Qatar, the prevalence of ESBL-UTI in adults is modest. Recent exposure to antibiotics, previous ESBL-UTI and invasive urological procedures were found to be independent risk factors for ESBL-UTI.None. This study was approved by the Institutional Review Board of Medical Research Centre, Hamad Medical Corporation (Approval No. MRC-01-20-006).Scopu

A decade of intestinal protozoan epidemiology among settled immigrants in Qatar

Background: The World Health Organization estimates that about 3.5 billion people worldwide are affected by intestinal parasitic infections. Reports have already emphasized the role of immigrants in outbreaks of parasitic diseases in industrialized countries. With the mass influx of immigrants to Qatar, patent intestinal parasitic infections have been observed. Herein, the prevalence of intestinal protozoan infections was analysed in 29,286 records of subjects referred for stool examination at the Hamad Medical Corporation over the course of a decade (2005 to 2014, inclusive). Results: Overall prevalence of combined protozoan infections was 5.93 % but there were significant temporal trends, age and sex effects and those arising from the region of origin of the subjects. The most common protozoan was Blastocystis hominis (overall prevalence 3.45 %). Giardia duodenalis, Chilomastix mesnili, Entamoeba coli, Entamoeba hartmanni, Endolimax nana, Iodamoeba butschlii, Entamoeba histolytica/dispar, Cryptosporidium sp. and a single case of Isospora were also detected. The prevalence of combined protozoan infections, G. duodenalis and the non-pathogenic amoebae all declined significantly across the decade. That of B. hominis varied between years but showed no directional trend across years and there was no evidence that prevalence of E. histolyitica/ dispar changed significantly. Protozoan infections were observed among all regional groups, but prevalence was higher among subjects from the Arabian Peninsula, Africa and Asia compared to those from the Eastern Mediterranean and Qatar. Prevalence was higher among male subjects in all cases, but age-prevalence profiles differed between the taxa. Conclusion: These results offer optimism that prevalence will continue to decline in the years ahead.Qatar National Research Fund (QRNF) at Qatar Foundation through the National Priorities Research Program (NPRP) (Project No. NPRP 4-1283-3-327)

Acute myelopathy with sudden paraplegia as the sole manifestation of meningococcal meningitis

Acute myelopathy with sudden paraplegia is a very rare manifestation of meningococcal meningitis, with only a few cases reported in the literature. In almost all previously reported cases, other clinical manifestations of meningitis, such as fever, headache, and neck stiffness preceded acute myelopathy. In this paper, we report a case of acute myelopathy with sudden paraplegia as the sole manifestation of meningococcal meningitis, in the absence of other clinical manifestations of meningitis

Salmonellosis among Pediatric Population in Qatar: Prevalence, Antibiotic Resistance and Molecular Epidemiology

Objectives: This study aims to characterize at the molecular level the genes encoding resistance in Salmonella and explain the molecular mechanisms underlying resistance to ceftriaxone, cefepime, amoxicillin-clavulanate, tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, colistin and azithromycin in Salmonella. It aims as well to characterize the 16S rRNA gene region by restriction fragment length polymorphism (RFLP) to investigate if this region constitutes an appropriate 'coincidental' marker to distinguish important pathogenic Salmonella species. Finally, determine the lineages of Salmonella species and evolutionary relationships among bacteria classified within the same genus. Methodology: 246 Salmonella isolates were collected from children under 16 years old during Jan. 2018 - Dec 2019, presented with gastroenteritis at Hamad Medical Corporation. Isolates were tested for antibiotic susceptibility against nineteen relevant antibiotics using E-test. Isolates that harbor antibiotic resistance were confirmed using PCR specific primers for 38 genes. In addition, the variable region of class 1 and 2 integrons were identified by PCR among amoxicillin-clavulanate (AMC) resistant samples. RFLP targeting16S rRNAwas performed using seven restriction enzymes including AluI, Bgl I, Bgl II, EcoR I, SmaI, Hinf I & Hae III. Results: Resistance was detected against 15 antibiotics and (38.2%) of isolates were resistant to at least one antibiotic. Overall, high resistance was reported to tetracycline (23.9%), ampicillin (21.1%), AMC (18.7%) and sulfamethoxazole-trimethoprim (13%). Further, 22.4% of the isolates were multidrug-resistant (MDR), with 4.1% being ESBL producers. 90 % of ESBL producers had one of bla CTX-M-Group. Class (1) AMC resistant samples showed the highest resistance to different antibiotics. 16S rRNA-RFLP analysis divided Salmonella isolates into two main groups. Conclusions: Our results indicate a high antimicrobial resistance pattern of Salmonella, which necessities the development of regulatory programs to combats antimicrobial resistance. In particular, our results showed high resistance to Class (1) AMC cassette that involves the transmission and expression of the resistance. This might lead to a concern of increased multidrug resistance in the future. This study provides evidence guidance to activate and implement the pillars of an antimicrobial stewardship program in animal and human health to reduce MDR salmonellosis