Chikungunya masquerading as acute rheumatism in an Omani traveler

Chikungunya is a mosquito-borne viral disease. It typically presents as an acute febrile illness associated with a varying degree of arthralgia and musculoskeletal sequelae. Cases of chikungunya have been reported from more than 40 countries in several continents. Chikungunya is often reported in travelers returning to non-endemic/epidemic countries. With increasing international travel, it is vital that clinicians in non-endemic areas are made aware of this rapidly spreading infection. Increasing international travel [for social, leisure, and business] between Oman and several chikungunya endemic countries including Pakistan may facilitate the introduction of chikungunya to Oman. We report the first imported case of chikungunya in an Omani traveler with a link to the current outbreak in Pakistan

Dermatitis artefacta

Dermatitis artefacta [DA] is an intentional self-inflicted dermatitis produced by patients for unconscious psychological gain. Characteristically, patients deny the responsibility for their creation. It is a poorly understood condition and, in most cases, goes on for a long period of time before a diagnosis is made. This condition creates a lot of anxiety for physicians due to a lack of awareness of the disorder and involves a considerable amount of time and resources to deal with. Suspicion usually arises when there is an unconvincing history of the evolution and recurrence of these lesions, their locations on the body, and their bizarre shapes. Here we report a typical case of DA in a 33-year-old male who repeatedly presented with oddly shaped recurrent skin lesions in the left lower leg for nine years. He had numerous doctors' visits and tests, and was admitted to a number of different hospitals without reaching a diagnosis or a cure

Severe pulmonary involvement in leptospirosis. Alternate antibiotics and systemic steroids

Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem [1 g every 8 hours], moxifloxacin [400 mg once daily], and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions

Cerebro-rhino orbital mucormycosis: an update

Mucormycosis is an uncommon fungal infection which can lead to fulminant necrotizing infection under optimal host condition. Fungi have the ability to invade blood vessels and can affect different parts of the body. The most common, though the most aggressive, form is cerebro-rhino-orbital mucormycosis that occurs in debilitated patients, in conjunction with sinus or para-sinus involvement. Due to increased number of newly diagnosed cases of mucormycosis world-wide resulting from uncontrolled metabolic conditions, this paper intends to widen the reader's scope and knowledge about the nature of the disease and its multicomplexity that require a collaborative effort for careful management. Patients who are at risks both at the onset of the disease and during its management have been identified in the paper

Unmasking immune reconstitution inflammatory syndrome [IRIS] A report of five cases and review of the literature

Immune reconstitution inflammatory syndromes [IRIS] in patients with acquired immune deficiency syndrome [AIDS] are characterised by atypical manifestations of opportunistic pathogens. These occur in patients experiencing improvement in CD4 cell counts following receipt of highly active anti-retroviral therapy [HAART]. Although well established as a syndrome, IRIS still presents challenges in diagnosis and management. We report five cases of IRIS with diverse clinical presentations and due to different infectious aetiologies. A review of the published literature on this syndrome is also included

case of disseminated tuberculosis with adrenal insufficiency

We present the case of a 37 year-old female who had disseminated tuberculosis [TB] with bilateral adrenal involvement resulting in primary adrenal failure [Addison's disease] with refractory hyponatraemia and possible extrapontine 'myelinolysis'. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB

Antibiotic combination as empirical therapy for extended spectrum beta-lactamase

extended spectrum beta-lactamase [ESBL] producing gram negative bacilli are becoming a growing problem worldwide with difficulties in designing a national formulary for empirical treatment of gram negative sepsis. In this study, we investigated the in vitro activity of Carbapenems, Pipracillin-Tazobactam, Ciprofloxacin alone or in combination with aminoglycosides against ESBL-producing strains isolated from clinical samples. Three hundred and one ESBL-producing Escherichia coli and K. pneumoniae strains isolated from clinical samples were investigated. Isolates were screened initially for ESBL production using an automated system. All ESBL isolates were further confirmed using the double-disk diffusion method. The overall Piperacillin-Tazobactam susceptibility was 57.9 [64.4% E. coli and 43.6% Klebsiella pneumoniae]. Only 29.6% of ESBLs [24.9% E. coli and 39.6% Klebsiella pneumoniae] were ciprofloxacin susceptible. 98.1% E. coli and 93.1% of Klebsiella pneumoniae were susceptible to Piperacillin-Tazobactam plus Amikacin combination. 73.7% E. coli and 61.4% of Klebsiella pneumoniae were susceptible to Piperacillin-Tazobactam plus Gentamicin combination. 96.7% E. coli and 91.1% of Klebsiella pneumoniae were susceptible to Ciprofloxacin plus Amikacin combination. 41.2% E. coli and 51.5% of Klebsiella pneumoniae were susceptible to Ciprofloxacin plus Gentamicin combination. ESBLs have high resistance profile against Piperacillin/Tazobactam and Ciprofloxacin. The ESBLs from Oman have similar resistantce pattern as those reported from UK and USA. This resistance decreases when these drugs are combined with Amikacin. All ESBLs are susceptible to Carbapenems. However, carbepenam overuse can lead to emergence of carbapenems resistant gram negative bacilli and ESBLs. Combination of Amikacin plus Piperacillin/Tazobactam is a feasible empirical therapy for ESBLs

Extended-spectrum beta-lactamase [ESBL] in Omani Children: Study of prevalence, risk factors and clinical outcomes at Sultan Qaboos University Hospital, Sultanate of Oman

Antimicrobial resistance is a growing problem worldwide, which imposes difficulties in the selection of appropriate empirical antimicrobial therapy. This study evaluated extended-spectrum ?-lactamase [ESBL] isolates in 2005 in The Department of Child Health at Sultan Qaboos University Hospital [SQUH], Oman. During the 12 month period from January 2005 to December 2005, ESBL isolates from paediatrics inpatients were identified and analysed. Risk factors for the patients who grew ESBLs were analysed. 13.3% of E. coli and 16.6% of Klebsiella pneumoniae isolated were ESBL producers. Most of the ESBLs were from urine [46.2%] and blood [42.6%]. The main risk factors for ESBL in these children were previous exposure to antimicrobials [100%], prolonged hospital stay, severe illness [92.3%] and female gender [84.6%]. Sensitivity of 100% was observed to carbapenems whereas 92% of the isolates were susceptible to amikacin. The oximino-cephalosporins were 100% resistant. Klebsiella pneumoniae were 100% resistant to piperacillin-tazobactam and nitrofurantoin. E. coli was 100% resistant to trimethoprim-sulfamethoxazole and ciprofloxacin. No resistance was recorded for the following combinations: amikacin plus piperacillin-tazobactam, amikacin plus nitrofurantoin and gentamicin plus nitrofurantoin. ESBL-producing organisms are becoming a major problem in Omani children. Exposure to antimicrobials and long admissions are modifiable risk factors that should be targeted for better control. Carbapenems are the most sensitive and reliable treatment options for infections caused by ESBLs. Amikacin plus piperacillin-tazobactam or nitrofurantoin are good alternatives

Fulminant Varicella zoster infection with multiorgan involvement: a case report

Varicella zoster infections are considered to be mild and ubiquitous infections predominantly affecting the paediatric population. However, in adults and in specific groups of patients, such as those who are immunosuppressed, varicella infections can be fulminant and life threatening. We here present a case report of a young female patient with a normal immune system who had a fulminant varicella infection with multiorgan involvement