Four hundred and eleven (411) confirmed hepatitis B surface antigen (HBsAg) positive individuals were tested for hepatitis delta antibodies (anti HDV) by the enzyme immunoassay method (EIA) from June 1988 through December 1993. An overall prevalence rate of 4.87% was recorded while rates for liver diseased patients, subjects on hemodialysis programs, intravenous drug addicts and blood donors showed 7.69%, 6.85%, 5.77% and 2.75% respectively. Breaking down rates according to the country of origin of our subjects showed the highest prevalence among Middle Easterners (8.22%) and Saudis (6.22%), while it was 2.63% among the India subcontinent subjects. No HDV case has been recorded from the Southeastern Asia samples despite the known higher HBsAg anemia in this region. This study could suggest that although HDV infection is limited to HBV carriers, the HDV prevalence does not seem to be a simple function of HBV, as some other factors (environmental, genetic, cultural, and/or viral strains) could modify the HDV/HBV relationship. However, limitation of the currently available tests for HDV could be the cause of the underestimation of HDV prevalence here as well as elsewhere. Ann Saudi Med 1994;14(6):503-506. This single strand RNA virus is considered as a mini-defective virus that requires a complementary helper function of hepatitis B virus (HBV) for its synthesis; hence, it can only develop in persons infected with HBV and it is well established that the HDV pathology is mainly due to its direct cytopathic effect on the hepatocytes as opposed to the immunological damage of HBV.2,3

The clinical and bacteriological findings in a case of neonatal meningitis caused by Achromobacter xylosoxidans are presented. This appears to be only the second report of meningitis caused by this species. Achromobacter xylosoxidans was described in 1971 (11). The literature on the organism since then and earlier literature on possibly similar organisms have been surveyed recently by Reverdy et al. (6). Their survey shows that meningitis caused by A. xylosoxidans has been rarely reported. In 1971 Sindhu (9) described three casés of neonatal meningitis caused by an organism which was described as Achromobacter sp., but no characteristics of the organism were presented. Similarly, in 1972 Lee and Tan (5) also described three cases of neonatal meningitis attributed to an organism they described as Achromobacter sp. but for which they presented no characteristics. Given the lack of a proper definition of the genus Achromobacter at that time, the absence of characteristics of the organism, and the fact that these authors (5, 9) would not at that time have seen the description of A. xylosoxidans (11), there is no evidence that the strains described by Sindhu (9) and by Lee and Tan (5) were A. xylosoxidans strains. The first and only authenticated case of meningitis caused by this species was described in 1974 in a 9-year-old girl (7). A fuller description of the species was based on additional strains (including three from spinal fluid and one from brain), but no clinical details were given for these strains (13). The only other relevant report was of six cases of cerebral ventriculitis, probably nosocomially acquired, which appeared in 1978 (8). We describe here a second case of meningitis definitely attributable to A. xylosoxidans. A premature (33 weeks) male infant (weight, 1,600 g) who was delivered spontaneously but normally at home immediately developed difficulty in breathing and cyanosis and was soon admitted to the Special Care Baby Unit of the Childrens' Hospital, Dammam, Saudi Arabia. The hemoglobin level was 16.5 g/dl, and the leukocyte count was 8.0 x 109/liter, with a normal differential. The chest X ray was suggestive of aspiration pneumonia. The child improved after endotracheal intubation, aspiration of chest secretions, and a short period of intermittent positive-pressure ventilation. Antibiotic therapy with gentamicin (5 mg/kg per day intravenously) and ampicillin (200 mg/kg per day intravenously) was started, and the child was placed in an incubator.

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