Predictors of pulmonary involvement in patients with extra-pulmonary tuberculosis

The aim of this study is to assess the value of chest radiographs [CXRs] and sputum examinations in detecting pulmonary involvement of tuberculosis [TB] in patients with extra-pulmonary tuberculosis [EPTB]. A retrospective analysis was performed among 248 EPTB patients with culture-proven diagnosis of tuberculosis seen between January 2001 and December 2007 at a tertiary teaching hospital, Riyadh, Saudi Arabia. Demographics, clinical, laboratory and radiological findings were reviewed and assessed. This study was approved by the hospital ethics and research committee. One hundred twenty five of 233 EPTB patients [53.6%] had abnormal CXR findings. There was a significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings [30/57] and those with normal CXR findings [4/17] [P = 0.04]. Of 17 HIV-negative/unknown HIV-status EPTB patients with normal CXR results, 4 patients [23.5%] had positive sputum culture results. Intrathoracic lymphadenopathy [P < 0.001], pleural TB [P < 0. 001] and disseminated TB [P = 0.004] were associated with an increased risk of abnormal CXR findings. Patients with cough [52.9%], weight loss [41.2%] and night sweats [26.5%] are more likely to have positive sputum culture results. CXR findings are predictive of positive sputum culture results. However, the rate of normal CXR among EPTB patients with positive sputum culture results was relatively high. Therefore, respiratory specimen cultures should be obtained in TB suspects with a normal CXR to identify potentially infectious cases of TB

Panton-Valentine leukocidin Staphylococcus aureus osteomyelitis of the femur in a Saudi child

Staphylococcus aureus producing Panton-Valentine leukocidin [PVL] is well recognized to cause severe skin and soft tissue infections. Recently, it has been increasingly recognized as causing life-threatening musculoskeletal infection. We reported previously 3 children who had osteomyelitis caused by methicillin resistant Staphylococcus aureus. We report and discuss a case of Methicillin sensitive Staphylococcus aureus encoding the PVL genes isolated from a child with acute osteomyelitis from Saudi Arabia

Severe community-acquired infection caused by methicillin-resistant Staphylococcus aureus in Saudi Arabain Children

Community acquired methicillin-resistant Staphylococcus aureus [CA-MRSA] infection has become a major pathogen causing significant infection in children in Saudi Arabia. It has emerged as a frequent cause of skin and soft tissue infections and can be associated with life-threatening complications such as necrotizing pneumonia and sepsis. Between January 2005 and March 2008, 5 [6%] previously healthy children with invasive CA-MRSA infections were identified from 80 children with community-onset MRSA infections. Three children had osteomyelitis, with one patient presenting a fulminant and extensive soft tissue and bone destruction complicated by deep vein thrombosis and pathological fracture. One child had deep-seated infection, and one infant had severe orbital cellulitis and bilateral orbital abscess complicated by subdural empyema. The median age was 4-years [range 3 months to 17 years]. Only one patient had a risk factor. Two patients were initially treated with ineffective antimicrobial therapy [beta-lactam]. One isolate showed inducible clindamycin resistance. The recovery was uneventful in all patients. This report should increase the awareness of clinicians regarding severe CA-MRSA infections and highlight the challenges encountered in the choice of therapy of serious infections caused by this organism

Bloodstream infections in pediatric patients

Blood stream infection [BSI] is the leading cause of morbidity and mortality in pediatric patients. This study aims to describe the clinical, microbiological characteristics and outcome of BSI in pediatric patients. We collected the clinical data from all pediatric patients with positive blood cultures. We identified all isolates from these patients from January 2004 to December 2004 at King Khalid University Hospital [KKUH], Riyadh, Saudi Arabia, and determined antimicrobial susceptibilities by MicroScan Walk Away 96 [Dade Behring Inc., West Sacramento, CA95691, USA]. Two hundred and twenty pediatric patients had BSI, of whom 147 [67%] were males and 71 [32.2%] were from intensive care units [ICUs]. Two hundred and ten [95.4%] had single blood culture isolate. One hundred and seventy-three [78.6%] of the isolates were Gram positive bacteria and included the following: Staphylococcus epidermidis [55.4%], Staphylococcus aureus [9.5%] of which 14% were methicillin resistant, Streptococcus pneumoniae [S. pneumoniae] [4.5%], 40% of which were resistant to penicillin and Enterococcus faecalis [4%]. Gram negative bacteria were 44 [20%] and included Escherichia coli and Klebsiella pneumoniae [K.pneumoniae] [3.6% each]. Three isolates [1.3%] were Candida glabrata. None of the Gram positive isolates were vancomycin resistant. Three K. pneumoniae and one Pseudomonas spp. isolates were multiresistant. One hundred and ninety-four [88%] of BSI isolates were hospital acquired. Fever was the most common presentation of pediatric patients [26%] with positive blood culture with no apparent focus of infection. Respiratory tract infections 26 [12%] were the next most common. We seen sepsis in [7.7%] children between 8 days and 6 months of age. Bone and joint infections, cardiac, renal, gastrointestinal diseases, malignancy and surgical cases were other associated clinical diagnoses of BSI in pediatric patients. Patients with immuno- suppressive disorders with BSI had isolates such as Salmonella spp., S. pneumoniae and Pseudomonas spp. Overall mortality was 13 [6%] [p<0.005] and those patients had underlying serious medical conditions with associated risk factors such as prolonged hospital stay, intensive care unit [ICU] admission, indwelling catheterization, mechanical ventilation and prior antimicrobial use. Bloodstream infection is an important cause of morbidity and mortality in pediatric patients. Risk factors for hospital acquired infection include: prematurity, prolonged hospitalization, ICU admission, indwelling catheterization, mechanical ventilation and prior antimicrobial therapy

Enterococcal bacteremia in a teaaching hospital in the central region of Saudi Arabia.

To study enterococcal blood stream infection including the different species isolated, their antibiotic resistance associated risk factors and outcome of treatment. A retrospective and prospective study was carried out over a 12 month period between June 2001 and May 2002 in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Sixty episodes of enterococcal bacteremia with clinical significance detected in adults and neonates were included. Statistical analysis of the epidemiological characteristic, etiologic risk factors and mortality were determined. Fifty-four [90%] of the episodes were hospital acquired. Fifty-five% of patients were elderly males and 20% were neonates. Patients usually have severe underlying diseases [57%] and the mortality rate was 28%. The estimated duration of hospital stay after acquiring the Enterococcal bacteremia was 40 days. The source of bacteremia remained undetermined in 72% of the episodes. Gastrointestinal tract, urinary tract and intravascular catheter were the most frequently recognized associated sites of infection. Thirty-three patients [55%] had previously received antimicrobial agents [mainly cephalosporins]. In this study, intravascular catheter [p=0.0002], urinary catheter [p=0.00001], mechanical ventilation [p=0.002], previous surgery [digestive tract surgery [p=0.01] and prior stay in an intensive care unit [p=0.03] were the factors associated with Enterococcal bacteremia and mortality. Efforts to reduce the occurrence of enterococcal bacteremia should be focused on appropriate use of cephalosporins and external devices

Isolation of salmonella paratyphi a from a patient with nephrolithiases

We describe a case of Salmonella paratyphi A isolated from urine of a 37-year-old Saudi patient who is a known case of nephrolithiasis and hydronephrosis with frequent admission for management of renal stones. History of enteric fever was not documented and urinary schistosomiasis in such a patient from endemic area is a strong possibility. Relevant literature was discussed