Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
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Year : 2012  |  Volume : 136  |  Issue : 2  |  Page : 304-305

Authors' response

1 The Custodian of the two Holy Mosques, Institute of Hajj Research, Umm Al-Qura University, Makkah, Saudi Arabia
2 Department of Laboratory, Hera General Hospital, Makkah, Saudi Arabia

Date of Web Publication7-Sep-2012

Correspondence Address:
Atif H Asghar
The Custodian of the two Holy Mosques, Institute of Hajj Research, Umm Al-Qura University, Makkah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Asghar AH, Bukhari SZ. Authors' response. Indian J Med Res 2012;136:304-5

How to cite this URL:
Asghar AH, Bukhari SZ. Authors' response. Indian J Med Res [serial online] 2012 [cited 2021 May 7];136:304-5. Available from:


We are thankful to Karabay and Yahyaoglu for commenting on our article [1] . It is a basic principle of epidemiology that the prevalence of any infectious disease varies between agent, host and environment, time, place and person. Our study population was the pilgrims who came from long distances, were elderly, exhausted and with low immunity, and suffered from overcrowding and fatigue. Unfortunately, Karabay and Yahyaoglu quoted a reference of a textbook [2] which reflects predominant organisms of CAP mentioned in the general population, not our study population. The high prevalence of Pseudomonas aeruginosa and Candida albicans in our study [1] was supported by another major factor of co-morbidity, i.e. diabetes mellitus. Of the total 141 patients, 55 (>39%) were diabetic and such patients are prone to get opportunistic infections due to P. aeruginosa and C. albicans. Regarding Legionella pneumophila, we would like to mention that L. pneumophila was not diagnosed on routine microbiology laboratory; additional diagnostic kits and other material mentioned [1] were used. For other similar national or international studies and studies conducted during the period of pilgrimage, the diagnostic methodology of L. pneumophila was not included for aetiological identification. Lung biopsy and Candida mannan antigen testing were not included in study protocol. Again, we would like to emphasize that our study population was the pilgrims; more than 2.5 million people staying in a Makkah for a short period of time. All government and private hospitals were overcrowded; the invasive procedures like lung biopsy were not possible. These patients were admitted for a short period of time and were discharged either on their request or due to high turnover of patients.

At the time of collection of clinical data for surveillance of healthcare associated infection (HAI), the Centers for Disease Control and Prevention (CDC) [3] definition was used and the cases were clearly defined as HAI and community acquired pneumonia. All those positive cultures which were not supported by radiological and clinical diagnosis were defined as colonized and excluded from the study.

   References Top

1.Asghar AH, Ashshi AM, Azhar EI, Bukhari SZ, Zafar TA, Momenah AM. Profile of bacterial pneumonia during Hajj. Indian J Med Res 2011; 133 : 510-3.   Back to cited text no. 1
2.Donowitz GR, Mandell GL. Acute pneumonia. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett's principle and practice of infectious diseases, 6 th ed. Philadelphia: Elsevier; 2005. p. 819-45.  Back to cited text no. 2
3.Centers for Disease Control and Prevention (CDC). Surveillance definition of healthcare associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36 : 309-32.  Back to cited text no. 3


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