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BACKGROUND: Sexually transmitted infections are a serious public health problem. Syphilis, a multistage, curable chronic disease caused by the spirochete Treponema pallidum , remains a major health problem worldwide. The disease re-emerged in the era of HIV in many countries despite the accessibility of curative therapy and continuing public health efforts to eliminate it. OBJECTIVE: Analyse the seropositivity for syphilis. DESIGN: Retrospective cross-sectional. SETTING: Tertiary hospital. PATIENTS AND METHODS: We retrospectively studied individuals who underwent screening tests for syphilis between January 2014 and December 2018. The samples that were positive by both screening and confirmatory tests were considered as confirmed positive for syphilis. MAIN OUTCOME MEASURES: Syphilis positivity identified by chemiluminescence immunoassay, the rapid plasma reagin test, and specific antibodies against Treponema pallidum . SAMPLE SIZE: 11 832. RESULTS: Of the 11 832, 54 (0.45%) were confirmed as seropositive for syphilis. Thirty-three (61.1%) were non-Saudi; 21 (38.9%) were Saudis. Thirty (55.6%) cases were males. Twenty-two (40.74%) were married and 29 (53.70%) were unmarried. Of the 54 diagnosed as syphilis positive, 28 (51.9%) were expatriate workers screened for pre-employment. The percentage of syphilis among Saudis was 0.36%. In an overall chi-square analysis, a P P =.004) and Sudanese ( P =.005) differed significantly from other nationalities. CONCLUSION: The study showed that syphilis was low among the screened population. More than half of the syphilis positive cases in this study were household employees. Screening for syphilis assists in planning complementary services for target populations and improves syphilis control. LIMITATIONS: Retrospective design. Hospital-based findings may not be representative of the seroprevalence of syphilis in the general population. CONFLICT OF INTEREST: None.

Background: Hepatitis C virus (HCV) is a major health problem, particularly in high-risk groups such as kidney transplant recipients, where it can adversely affect graft survival and increase the relative risk for mortality. Recently, the role of genetic variation among HCV patients in determining the outcome of infections has been under investigation. Objective: To investigate the association of single-nucleotide polymorphisms (SNPs) rs12979860 (located within the interleukin-28B locus), rs2228145 (interleukin-6 receptor) and rs1800795 (interleukin-6 promoter) with HCV viremia in renal transplant patients. Materials and Methods: In this analytical cross-sectional study, 149 kidney transplant recipients, 82 males (median age: 41 years) and 67 females (median age: 45 years), were screened for HCV RNA in blood using real-time polymerase chain reaction and genotyped by sequencing (rs12979860) and restriction fragment length polymorphism (rs2228145 and rs1800795). Results: HCV RNA was detected in 17 (11.41%) of the 149 patients. There was no statistically significant association between the studied SNPs and HCV viremia. However, a combination of the CT/AC/GG genotype was significantly associated with HCV viremia (odds ratio: 5.4). The genotype AA of rs2228145 in the IL-6 receptor was associated with viremia levels of >105 copies/ml (odds ratio: 5.96). Conclusion: To the best of the authors' knowledge, this is the first study that has shown that the CT/AC/GG genotype has an impact on HCV viremia in kidney transplant patients. Therefore, such SNP genotypes may potentially be used to identify transplant patients at risk of HCV infection.

Background: The relationship among cytomegalovirus (CMV) infection and the serum level of chemokines and soluble adhesion molecules is not well studied. This study aimed to assess chemokines and soluble adhesion molecules in CMV-positive Saudi renal transplant recipients. Methodology: The study was conducted in a tertiary hospital in Eastern Saudi Arabia over a 12-month period. All kidney transplant recipients who regularly attended the nephrology clinics were included (n = 150). Randomly selected age- and sex-matched individuals served as a control group (n = 158). CMV antibodies (IgG and IgM), chemokines and soluble adhesion molecules were measured using standard enzyme-linked immunosorbent assay (ELISA). CMV viral DNA was detected using real time polymerase chain reaction (PCR). Results: Of the 150 patients studied, 149 (n = 150) had detectable levels of Anti-CMV IgG antibodies (99.3%). In the control group, 113 (n = 158), blood donors had anti-CMV IgG antibodies (71.5%). Forty-one (n = 150) kidney transplant recipients were positive for anti-CMV IgM antibodies (27.3%), whereas only one (n = 158) blood donor had detectable anti-CMV IgM antibodies. All IgM positive samples contained CMV viral DNA. MCP-1, IL-8, ICAM-1, and VCAM-1 levels were measured using ELISA. Of those, only MCP-1 and IL-8 were detectable. Eighteen kidney transplant recipients were positive for MCP-1 (12%). All MCP-1 patients were also anti-CMV IgM positive, while 5 patients had detectable levels of IL-8 (3.3%). All these patients were CMV IgM-positive. Conclusions: The increase in chemokine levels during CMV infection may reflect a possible role for these molecules in the immunopathogenesis of CMV infection in this study population.

Injecting drug users are at increased risk of infection with hepatitis viruses and blood-borne pathogens. The aim of this study was to examine HBV, HCV, HDV, and TTV infections in Saudi drug users (N = 344). Extraction of nucleic acid from serum, reverse-transcription, amplification of viral nucleic acids, and HBV and HCV genotyping were done using established techniques. Of the analyzed samples, 41 (12%) contained detectable HBV DNA, 131 (38%) contained detectable HCV RNA, and 174 (51%) had detectable TTV DNA. The predominant HBV genotype was found to be genotype D and the predominant HCV genotype was found to be genotype 1b. All the samples were negative for HDV. Twelve samples (3.5%) were found to contain mixed HBV and HCV genomes, 24 samples (7%) were found to contain mixed HBV and TTV genomes, 82 samples (24%) were found to contain mixed HCV and TTV genomes, and 9 samples (2.6%) were found to contain mixed HBV, HCV, and TTV genomes. Identification of various infections in drug users will help the control of these infections in this group as well as in the community. J. Med. Virol. 81:1343–1347, 2009. © 2009 Wiley-Liss, Inc.

We used a lentiviral vector bearing the viral spike protein to detect neutralizing antibodies against Middle East respiratory syndrome coronavirus (MERS-CoV) in persons from the Eastern Province of Saudi Arabia. None of the 268 samples tested displayed neutralizing activity, which suggests that MERS-CoV infections in humans are infrequent in this province.

Background Kaposi's sarcoma herpesvirus (KSHV) causes Kaposi's sarcoma (KS), primary effusion lymphoma, and multicentric Castleman's disease in immunocompromised patients including allograft recipients. Detection of KSHV DNA in blood, as well as host genetic polymorphisms has been found to be associated with an increased risk for KS. We investigated an association between single nucleotide polymorphisms (SNPs) in vascular endothelial growth factor A (VEGFA) gene region and KSHV viremia in kidney transplant recipients (KTR) in Saudi Arabia. Methods In total, 152 KTR who have survived kidney transplantation for at least 6 months were included in the study. KSHV viremia was determined by real-time polymerase chain reaction (PCR). Genotyping of SNPs in the VEGFA region was performed by PCR and direct sequencing, as well as by restriction fragment length polymorphism. Results KSHV DNA was detected in 28.9% (n = 44) of the study population. The A-allele at position C172A VEGFA gene promoter region was found to be associated with KSHV viremia (odd ratio [OR] = 4.8, P = 0.005). In addition, the G-allele at position C+405G in the 5′-untranslated region was associated with KSHV viremia in women, but not in men (OR = 3.98, P = 0.004). Conclusions Our results suggest an association of VEGFA polymorphisms with KSHV viremia among KTR in this study population. A limitation of our study is that the results can only be predicated for patients 6 months after kidney transplantation and should be validated in another cohort with larger sample size.

Introduction: Few reports about the prevalence and genetic basis of extended spectrum beta-lactamases (ESBLs) are available from Saudi Arabia. We sought to determine the prevalence of ESBL-producing Enterobacteriaceae in a university hospital in eastern Saudi Arabia and to characterize the ESBLs produced by these isolates at the molecular level. Methodology: All clinical isolates of Escherichia coli, Klebsiella spp., and Proteus spp. collected over two years were evaluated for susceptibility to a panel of antimicrobials and were analyzed for the ESBL phenotype using screening and confirmatory tests. ESBL-positive isolates were then screened for the presence of genes encoding CTX-M, SHV, and TEM beta-lactamases by PCR. Results and conclusions: The overall prevalence of ESBL-producing isolates was 4.8% (253/5256). Most isolates (80%) were from the inpatient department. The ESBL phenotype was more frequently detected in K. pneumonia. CTX-M genes were the most prevalent ESBL genes, detected in 82% of the studied isolates. The ESBL producers demonstrated a high multidrug resistance rate (96.6%). In transconjugation assay, the same ESBL gene pattern was transmitted from 29.7% of K. pneumoniae donors to the recipient strain, and the latter exhibited concomitant decreased aminoglycosides and co-trimoxazole susceptibility. We observed the presence of ESBL screen-positive but confirmatory-negative isolates (8.9%). Phenotypic tests for the production of AmpC β-lactamase tested positive in 52% of these isolates. Further studies are needed for appropriate detection of concomitant ESBL and AmpC enzyme production among such isolates. Continued surveillance and judicious antibiotic usage together with the implementation of efficient infection control measures are absolutely required.

Background: The simultaneous detection of antigen and antibody was originally described for the early detection of the human immunodeficiency virus (HIV). The same approach was applied to detect the hepatitis C virus (HCV). The aim of this work was to use the antigen and antibody combination assay for the detection of HCV and HIV infections in expatriates in Eastern Saudi Arabia. Methodology: The study group (N = 875) included expatriate workers of both sexes who were undergoing mandatory pre-employment testing. Detection of anti-HCV antibodies, HCV core antigen, HCV viral RNA, HIV antigens and antibodies was conducted using commercially available kits. Results: Of the 875 samples that were screened for HCV-specific antibodies, four (0.46%) tested positive (two from Pakistan, one from India, and one from the Philippines) and two (0.23%) were equivocal (one from Egypt and one from Nepal). All four samples that were positive for HCV-specific antibodies also tested positive using HCV RNA assay and the HCV antigen-antibody combination assay. The two samples that were equivocal tested positive using the HCV RNA assay and the HCV antigen-antibody combination assay. Of the 875 samples that were tested for HIV antibodies, only one (0.11%) sample gave repeatedly positive results. The same sample also tested repeatedly positive using the HIV combination assay. These results were subsequently confirmed by HIV western blot assay. Conclusions: Our study indicates that the addition of antigen detection to the screening of HCV and HIV may lower the risk of transmission of these viruses in the host country and contribute to the overall control of HCV and HIV in Saudi Arabia.

Human bocavirus (HBoV) is a major etiology of lower respiratory tract infection (LRTI) in young children. We tested 149 patients admitted to King Fahd Hospital of the University with diagnosis of LRTI. Viremia caused by the different studied viruses was detected in 31.5% of the total cases by Real-time Polymerase chain reaction. We report five patients who were positive for HBoV in serum samples. Clinical presentation ranged from mild to severe disease as one of them required admission to intensive care unit. Wheezing was a striking feature in most of our patients, but fever was not a consistent finding.

Background. Human herpes virus-8 (HHV-8) is a herpes virus that is always associated with Kaposi’s sarcoma. Previous studies suggested a high rate of Kaposi’s sarcoma in renal transplant patients in Saudi Arabia. The aim of this study was to investigate the prevalence of HHV-8 in Saudi renal transplant recipients and healthy controls. Methods. An immunofluorescence technique was used to detect antibodies to the latent nuclear antigen (LANA) of HHV-8 in renal transplant patients, members of a family affected with Kaposi sarcoma, as well as healthy controls. Results. A significantly higher HHV-8 seroprevalence was detected in renal transplant recipients from Saudi Arabia (27 out of 150; 18%) and in members of a family affected with Kaposi sarcoma (seven out of 10; 70%) relative to the seroprevalence in healthy controls (10 out of 577; 1.7%). Seropositivity for HHV-8 in these transplant patients was not significantly influenced by: the existence of relatives with kidney failure, the donors’ country of origin, the recipients’ home region within Saudi Arabia, the haemodialysis centre, the time that elapsed since the renal transplantation operation and the immunosuppressive regimen used. Conclusion. The present results provide some explanation for the previously noted high incidence of Kaposi’s sarcoma in Saudi transplant patients.