Streptococcus agalactiae (Group B Streptococci) carriage in late pregnancy in Kuwait.

Al-Sweih N, Maiyegun S, Diejomaoh M, Rotimi V, Khodakhast F, Hassan N, George S, Baig S.

Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.

OBJECTIVES: This study investigated the vaginal colonization rate of Streptococcus agalactiae (group B streptococci, GBS) in an antenatal population in a maternity hospital. SUBJECTS AND METHODS: Anal, vaginal and combined anal and vaginal specimens were obtained from 110 pregnant women (mean age 30.7 +/- 5.5 years) at 35-37 weeks of gestation, using a commercially prepared culturette, and transported in 0.5 ml of Stuart's transport medium. The specimens were then cultured in standard selective Todd-Hewitt broth medium, supplemented with gentamicin and nalidixic acid. After 36 h of incubation, the broth culture was subcultured onto sheep blood agar and incubated in 5% carbon dioxide for 18-24 h. Representative colonies morphologically resembling GBS were tested with latex agglutination kit. Each culture-positive woman was given ampicillin or piperacillin prophylactically and followed up through labour and postpartum. Detailed records of biodata, antecedent antenatal events and pregnancy outcome were reviewed. RESULTS: The combined vaginal and anal specimens were positive for GBS in 18 (16.4%) women. Gestational age at delivery was 39.01 +/- 1.79 weeks. The deliveries were uneventful and no neonate developed sepsis. Diabetes mellitus and pregnancy-induced hypertension/hypertension were detected antenatally in 16.6 and 11.5%, respectively. GBS carriage was not associated with adverse outcome of pregnancy. CONCLUSION: The colonization rate of GBS in pregnant women in Kuwait is high, and on the basis of the documented benefits of antenatal screening in Western countries, we recommend routine screening especially for our at-risk patients.

 

Tuberculous pericardial effusion--mediastinal lymph glands: the cause and clue to the etiology.

Cherian G, Habashy AG, Uthaman B, Hanna RM.

Department of Medicine and Cardiology, Chest Hospital, Kuwait.

BACKGROUND: Tuberculous pericardial effusion is most often due to the spread of tuberculosis from the mediastinal lymph glands; however, no attempt has yet been made to study these glands. We studied the mediastinal glands in proven tuberculous pericardial effusion patients and hypothesized that the findings may be of use in the etiological diagnosis of pericardial effusion. METHODS AND RESULTS: We studied 45 patients with large pericardial effusion or tamponade. All underwent chest computed tomographic studies that were reviewed by radiologists blinded to the diagnosis. Of these 45 patients, 27 had tuberculosis and 18 had viral or idiopathic effusion. Pericardial biopsy was done in 25/27 and tuberculin skin test in 22/27 patients with tuberculosis, and all received specific treatment. In patients with tuberculosis the skin test measured 17+/-3.3 mm. All 27 had mediastinal lymph glands > or = 10 mm in size. The mean size of the mediastinal glands was 19.5+/-8.6 mm and the mean number was 2.5+/-1.2. The aortopulmonary glands were the most frequently enlarged (63%), and hilar the least often (14.8%). The glands showed a hypodense center in 52% of the patients. On follow-up of 15.8+/-10.4 months, glands were not seen in 80.9%, and were smaller in size in 19%; none had a hypodense center. Marked lymphadenopathy was not seen in any patient with viral/idiopathic pericardial effusion. Two had glands < or = 5 mm in size. CONCLUSIONS: Only patients with tuberculosis had substantial mediastinal lymph gland enlargement and not those with viral or idiopathic pericardial effusion. Such glands disappeared or regressed on treatment. In the appropriate clinical context, marked nonhilar mediastinal lymphadenopathy on chest computed tomographic studies along with a strongly positive tuberculin skin test could be of value in the noninvasive diagnosis of pericardial effusion due to tuberculosis.

 

Species prevalence and antibacterial resistance of Enterococci isolated in Kuwait hospitals.

Udo EE, Al-Sweih N, Phillips OA, Chugh TD.

Department of Microbiology, Faculty of Medicine, Kuwait University.

This study investigated the species prevalence and antibacterial resistance among Enterococci isolated in Kuwait hospitals. They consisted of 415 isolates of Enterococcus faecalis (85.3 %), Enterococcus faecium (7.7 %), Enterococcus casseliflavus (4.0 %), Enterococcus avium (1.2 %), Enterococcus durans (1.0 %), Enterococcus gallinarium (0.5 %) and Enterococcus bovis (0.2 %) isolated from urine (36.6 %), blood (10.4 %), wound swabs (11.0 %), stool samples (12.0 %), high vaginal swabs (9.0 %), endocervical swabs (3.0 %) and miscellaneous sources (18.0 %). All of them were susceptible to linezolid. Fifty-two (12.5 %) isolates were ampicillin resistant but none of them produced beta-lactamase. They were resistant to erythromycin (63.3 %), tetracycline (60.5 %), ciprofloxacin (40.0 %), chloramphenicol (28.0 %), vancomycin (2.6 %), and teicoplanin (2.6 %). Fourteen, 19 and 20 % of them expressed high-level resistance to gentamicin, kanamycin and streptomycin, respectively. All of the vancomycin-resistant strains carried the vanA phenotype and genotype. There was no evidence of clonal spread of the vancomycin-resistant isolates.

 

Molecular fingerprinting of isoniazid-resistant Mycobacterium tuberculosis isolates from chest diseases hospital in Kuwait.
 Mokaddas E, Ahmad S, Abal AT.
Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait.

Touchdown double-repetitive-element-PCR (DRE-PCR) was carried out for typing 38 consecutive isoniazid-resistant Mycobacterium tuberculosis strains isolated at Chest Diseases Hospital, Kuwait, during 1998-2000. The polymorphism at codon 463 in the katG gene was also determined and correlated with genotypic relationships among the isolates. The isolates exhibited 21 distinct patterns in DRE-PCR. Nearly half of the isolates (18 of 38) exhibited unique patterns. Majority of isolates (16 of 20) yielding multiple DNA fragments in DRE-PCR were unique strains while most of the isolates (16 of 18) yielding a single DNA fragment in DRE-PCR clustered together. The prevalence of L463 in the katG gene was much higher in isolates from Middle Eastern (mostly Kuwaiti) patients than is reported for this ethnic group. The data indicate the possibility of some strains of South Asian/Southeast Asian origin spreading among local populations.

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