Original articleAcute rhinosinusitis during Hajj season 2014: Prevalence of bacterial infection and patterns of antimicrobial susceptibility
Introduction
Hajj is one of the five pillars of Islam and the largest annual gatherings of humans hosted in Makkah, Saudi Arabia. The presence of large number of pilgrims in a small area at a specific time increases the risk of introducing potentially harmful communicable diseases with subsequent fast magnification [1].
Changes in routine healthy activities (lack of sleep, bad hygiene, physiological habits and malnutrition, etc.) as well as fatigue and anxiety resulting from traveling, performing pilgrimage ceremonies and overcrowding [2], [3], make the pilgrims even more susceptible to diseases [4].
Respiratory diseases are very prevalent during Hajj [5]. The exact incidence of upper respiratory tract infections (URTI) among pilgrims is not known. In previous study, it was reported that about 20% of pilgrims will experience respiratory symptoms [6].
Alherabi reported that a total of 78.5% of the patients presenting to the Emergency Departments, or to the Ear, Nose and Throat Clinics, in Hajj season of 2009, had URTI including pharyngitis, viral URTI, and tonsillitis between the hours of 12pm to 12am during Hajj days [5]. Many patients develop one form of respiratory tract infection or another during Hajj season and this leads to high morbidity, imposes high costs on the health system, and is among the major obstacles for pilgrims to perform Hajj duties [7].
In this study, we aimed to assess the bacteriology of acute rhinosinusitis (ARS) during Hajj season and to demonstrate the antimicrobial susceptibility patterns that should guide the clinicians towards more appropriate antibiotic use.
Section snippets
Patient selection
Study protocol was approved by our Institutional Review Board (IRB) prior to commencement of the study. This paper had the final approval from the committee of bio-medical ethics, Umm al Qura University. The study was conducted in Alnoor Specialized Hospital, a 500-bed tertiary care facility in Makkah. The hospital also provided primary health care services to all pilgrims during the Hajj season. Three hundred forty three patients presenting to the emergency or outpatient departments at this
Results
According to EPOS2012 diagnostic criteria, 229 patients were diagnosed as ARS (66.8% of the screened patients); 3 patients declined to participate in the study, and the remaining 226 patients were enrolled. Age ranged from 9 to 77 years (Mean ± SD; 34.6 ± 13.9). Of all ARS patients, 176 (77.9%) were males. The percentages of patients from each geographical location are summarized in Table 1.
The most common presenting symptom was nasal obstruction followed by nasal discharge and facial pain.
Discussion
ARS is one of the most common infections worldwide and is usually bacterial or viral in origin. The incidence of bacterial infections varies and may depend on patients' immune status, previous vaccinations, hospitalization, geographical distribution, and specific environmental conditions [12], [13]. A recent systematic review showed that bacterial pathogens were identified in 53.7% of 9595 patients with ARS reported in 29 studies [14]. In our study, bacterial pathogens were identified in 41.2%
Conclusion
The present study updates our knowledge about the prevalence of bacterial infections in patients presenting with ARS during Hajj season. It also highlights the increasing role of S. aureus, MRSA and Enterobacteriaceae in bacterial ARS during Hajj, and the current trends in antimicrobial resistance and susceptibility. It is important to conduct similar studies on a larger scale and on annual basis to further establish guidelines for selecting the proper antibiotics for treatment and hopefully
Financial disclosures
This research was supported by a research grant from the Institute of Scientific Research and Revival of Islamic Heritage, Umm Al-Qura University, Makkah, Saudi Arabia.
Conflict of interest
None.
Acknowledgement
We would like to acknowledge our group of medical students for their valuable help with patients' counseling and sampling. These include: Abdulwahab K. Neyazi, Ahmed G. Al-ahdal, Ahmed H. Al-Abbasi, Elham A. Hasan, Bayan Z. Hafiz, Abdullah A. Al-Erinan, Fatmah M. Hawsawi, Lujain S. Babker, Mohammed A. Khan, Hashem M. Bin Samman, Waed S. Jameel, Moayad A. Al-Manabri, Salman A. Turkastani, Feras K. Al-Jabri, Anas A. Al-Khotani, Basel A. Dahlawi, and Ahmed A. Mirza.
References (32)
Hajj, Umrah and other mass gatherings: which pathogens do you expect? Beware of the tree that hides the forest!
Travel Ned Infet Dis
(2014)- et al.
Non-pharmaceutical inteventions for the prevention of respiratory tract infections during Hajj pilgrimage
Travel Men Infect Dis
(2014) - et al.
Pattern of diseases among visitors to Mina health centers during the Hajj season, 1429 H (2008 G)
J Infect Public Health
(2012) Acute bacterial rhinosinusitis and otitis media: changes in pathogenicity following widespread use of pneumococcal conjugate vaccine
Otolaryngol–Head Neck Surg
(2008)- et al.
Microbiology of rhinosinusitis in immunosuppressed patients from the University Hospital
Braz J Otorhinolaryngol
(2011) - et al.
Sinogenic orbital and subperiosteal abscesses: microbiology and methicillin-resistant Staphylococcus aureus incidence
Otolaryngol Head Neck Surg
(2010) - et al.
Medical and surgical management of subperiosteal abscess secondary to acute sinusitis in children
Int J PediatrOtorhinolaryngol
(2006) - et al.
Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis
Otolaryngol Head Neck Surg
(2006) - et al.
Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis
Otolaryngol Head Neck Surg
(2006) - et al.
Hajj and the risk of influenza
BMJ
(2006)
Road map of an ear, Nose, and Throat clinic during the 2008 Hajj in Makkah, Saudi Arabia
Saudi Med J
Influenza a common viral infection among Hajj pilgrims: time for routine surveillance and vaccination
J Travel Med
Pattern of admission to hospitals during Muslim pilgrimage (Hajj)
Saudi Med J
European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists
Rhinology
The introduction and validation of a modified Arabic Sino-Nasal outcome test (MA-SNOT)
PAN Arab J Rhinol
Microbiology and antimicrobial susceptibility patterns of commensal flora in the middle nasal meatus
Ann Otol Rhinol Laryngol
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