Burden of Invasive Group B Streptococcus Infection Among Omani Infants Less Than 90 Days Old: A Multicenter Study.

BACKGROUND: Group B Streptococcus (GBS) infection is the leading cause of neonatal morbidity and mortality worldwide. This study aims to investigate the incidence of invasive GBS disease among infants less than 90 days old in Oman and to describe their risk factors, clinical presentations and clinical outcomes. METHODS: We retrospectively collected the data of less than 90-day-old Omani infants with culture-positive GBS from sterile samples. This study was conducted in 3 tertiary hospitals in Oman from 2009 to 2018. RESULTS: Over 10 years, we identified 92 cases of culture-confirmed invasive GBS infection from 178,285 live births in the 3 hospitals, giving an overall incidence of 0.53 per 1000 live births [95% confidence interval (CI): 0.4-0.7)]. Of those, 59 (64.1%) had early-onset neonatal GBS disease and 33 (35.9%) had late-onset neonatal GBS disease. The incidence of invasive GBS disease was significantly higher in the last 5 years from 2014 to 2018 (0.69 per 1000 live births, 95% CI: 0.5-0.9) compared to the previous years from 2009 to 2013 (0.36 per 1000 live births, 95% CI: 0.2‒0.5), (P = 0.004). Infants with late-onset neonatal GBS disease had a higher risk of meningitis compared to infants with early-onset neonatal GBS disease (30.3% vs. 10.2%, P = 0.021). The mortality rate was 13.5%. CONCLUSIONS: The incidence of invasive GBS disease in Oman is similar to what was reported worldwide, however, the burden of the disease in terms of mortality is high. In addition, a significant increase in the annual incidence of invasive GBS disease in Omani infants was found over the study period.

Disseminated Basidiobolomycosis Caused by Basidiobolus omanensis in a Child with Acute Lymphoblastic Leukemia (ALL). Case Report and Literature Review.

Basidiobolomycosis is an uncommon fungal infection caused by the genus Basidiobolus. In immunocompetent children, it usually causes cutaneous infection and rarely affects the gastrointestinal tract, and it is extremely rare for the disease to spread. The present study reports the first case of disseminated basidiobolomycosis caused by Basidiobolus omanensis in a child with acute lymphoblastic leukemia who died as a result of uncontrolled infection and multi-organ failure despite surgical and antifungal therapy with L-AMB and voriconazole. A review of the literature yielded 76 cases, including the current case with the majority of which were reported as invasive gastrointestinal infection. The median age was 4 years (61 male and 15 female) and the majority of these children were from the Middle East (80%), specifically Saudi Arabia (45%). Most patients were treated with systemic antifungal agents (mostly itraconazole and amphotericin B). Surgical intervention was done in 25% of these patients and the death rate was 12%.

Case Series of Cystic Echinococcosis Over a Twelve-year Period at Sultan Qaboos University Hospital, Oman.

Objectives: Cystic echinococcosis is a worldwide zoonosis that is endemic in many countries including some in the Middle East. Exact prevalence rates for human echinococcosis are unknown for Oman. Methods: Following obtaining ethical approval, data from January 2010 to December 2021 were retrieved from hospital electronic records of Sultan Qaboos University Hospital, Muscat. Results: Over a 12-year period we saw nine cases of hydatid disease; two cases in females and seven cases in males. The median age of our patients was 31 years old. Four patients had pulmonary cysts, four had hepatic cysts, and one patient had pulmonary and hepatic cysts. The majority of patients were from the Ad Dakhiliyah governorate. Contact with animals was reported by three patients, denied by two, and unknown for four. Albendazole was prescribed to three patients with pulmonary cysts that subsequently ruptured reflecting the unfamiliarity of clinicians to best manage pulmonary hydatid cysts. Conclusions: The prevalence of cystic echinococcosis in Oman is unknown but appears rare. For optimal management of this disease, clinicians must become more aware of its diagnosis and management.

Favourable outcomes of non-O1, non-O139 Vibrio cholerae bacteraemia in vulnerable populations: a case series.

Background: Non-O1, non-O139 Vibrio cholerae (NOVC) bacteraemia is an uncommon infection and could be associated with life-threatening conditions in susceptible hosts. Definitive management guidelines are lacking. Aim: To describe the clinical spectrum, treatment practices and outcome of NOVC bacteraemia. Methods: Eight patients with NOVC bacteraemia admitted to two large tertiary care hospitals in Oman were identified over a 10-year period (2010-2020). Data were extracted retrospectively from the hospital patient data management. Results: Six (75.0%) patients were male, and the median age of patients was 67.5 years. The majority of cases (87.5%) were not associated with travel and no clear sources were identified. All patients had predisposing factors including diabetes mellitus, chronic liver disease or malignancies. Gastrointestinal symptoms were the predominant manifestations in 75.0% of cases, but diarrhoea was only reported in one patient. Conclusions: Early presentation (median interval from symptom onset to presentation 1.5 days), appropriate management and highly susceptible isolates may have contributed to the favourable outcome, as there were no cases of death or severe course of infection. All patients were discharged home after a median of 9 days of hospitalization.

Patterns of Bacterial Isolates and their Resistance to Antibiotics in Patients with Chemotherapy-induced Febrile Neutropenia at a University Hospital.

OBJECTIVES: Febrile neutropenia is a major complication of cytotoxic chemotherapy and is associated with a high rate of mortality and morbidity if not treated appropriately. Consequently, it is important to know the bacterial spectrum and pattern of its resistance in each hospital to formulate an appropriate empiric antibiotic regimen. We sought to study the bacterial spectrum in patients with chemotherapy-induced neutropenia and report their resistance patterns. METHODS: We conducted a retrospective study on patients admitted with febrile neutropenia between January 2010 and December 2016 in the oncology unit at Sultan Qaboos University Hospital in Oman. Consecutive patients diagnosed with non-hematological malignancies who had febrile neutropenia and positive blood culture were included in this study. RESULTS: A total of 76 bacterial isolates were documented in 67 episodes in 62 patients. There were 26 male and 36 female patients. The median age was 51 (14-81) years. The most common cancers were breast cancer (17.7%), non-Hodgkin lymphoma (16.1%), and colon cancer (14.5%). Gram-negative and gram-positive organisms accounted for 73.7% and 26.3% of all isolates, respectively. The most common gram-negative organisms were Pseudomonas aeruginosa (26.8%), Escherichia coli (23.2%), Klebsiella species (17.9%), and Acinetobacter baumannii (12.5%). The most common gram-positive organisms were Staphylococcus aureus (30.0%), followed by coagulase-negative Staphylococcus (25.0%). There were 14 multidrug-resistant organisms and eight extended-spectrum beta-lactamases (ESBL). The resistance among gram-negative organisms to the commonly used broad-spectrum antibiotics was 23.5-55.6%. No resistance was recorded against vancomycin amongst the gram-positive organisms. Eight (12.1%) patients died while neutropenic. CONCLUSIONS: Gram-negative organisms were the predominant organisms. There is a high rate of resistance to the commonly used antibiotics. Using a combination of antibiotics is warranted in patients presenting with chemotherapy-induced febrile neutropenia.

Basidiobolus omanensis sp. nov. Causing Angioinvasive Abdominal Basidiobolomycosis.

Human infectious fungal diseases are increasing, despite improved hygienic conditions. We present a case of gastrointestinal basidiobolomycosis (GIB) in a 20-year-old male with a history of progressively worsening abdominal pain. The causative agent was identified as a novel Basidiobolus species. Validation of its novelty was established by analysis of the partial ribosomal operon of two isolates from different organs. Phylogeny of ITS and LSU rRNA showed that these isolates belonged to the genus Basidiobolus, positioned closely to B. heterosporus and B. minor. Morphological and physiological data supported the identity of the species, which was named Basidiobolus omanensis, with CBS 146281 as the holotype. The strains showed high minimum inhibitory concentrations (MICs) to fluconazole (>64 µg/mL), itraconazole and voriconazole (>16 µg/mL), anidulafungin and micafungin (>16 µg/mL), but had a low MIC to amphotericin B (1 µg/mL). The pathogenic role of B. omanensis in gastrointestinal disease is discussed. We highlight the crucial role of molecular identification of these rarely encountered opportunistic fungi.

Mycobacterium farcinogenes osteomyelitis of the proximal tibia: A case report.

Non-tuberculous mycobacteria (NTM) are an unusual cause of osteomyelitis. Mycobacterium farcinogenes is an uncommon cause of human disease. We describe here the first case of M. farcinogenes osteomyelitis in a 49-year-old man who underwent left knee anterior cruciate ligament and medial meniscal repair which was complicated by recurrent septic arthritis and surgical site infection. As a consequence, he underwent multiple surgical debridements. Ultimately, left proximal tibial osteomyelitis was diagnosed and M. farcinogenes was recovered from the tissue biopsy culture. Clinical improvement was achieved following surgical removal of the prosthesis along with prolonged combination antimicrobial therapy.

Pandemic Influenza A H1N1 in Oman: Epidemiology, Clinical Features, and Outcome of Patients Admitted to Sultan Qaboos University Hospital in 2009.

OBJECTIVES: Oman experienced the H1N1 pandemic in 2009 that initially started in Mexico and the United States. We present the epidemiology, clinical features, and outcome of cases admitted to Sultan Qaboos University Hospital. METHODS: We retrospectively reviewed all patients admitted with confirmed influenza A H1N1 infection from August to December 2009. The study included adults and pediatric patients. We looked at the clinical and laboratory factors associated with increased length of hospital stay. RESULTS: There were 68 patients admitted with influenza A H1N1 infection, and their median age was 23 years. The most common symptoms were fever (100%) and cough (79.4%). The most common reason for admission was the severity of illness (69.1%). Lymphopenia was the most common hematological abnormality (41.8%). All patients received treatment with oseltamivir. One patient died secondary to multi-organ failure. On multivariate analysis, severity of illness, use of steroids, anemia, lymphopenia, and abnormal alanine amino transferase levels were associated with increased length of stay. CONCLUSIONS: The H1N1 pandemic in Oman followed the international trends in terms of clinical presentation and laboratory values for patients admitted to the hospital.