Subclinical pulmonary haemorrhage causing a restrictive lung defect in three siblings with a unique urticarial vasculitis syndrome.

Three siblings with urticarial vasculitis syndrome (UVS) are described. All had restrictive lung function abnormalities caused by subclinical pulmonary haemorrhage. The latter was suspected after finding haemosiderin-laden macrophages and a friable bronchial mucosa during elective bronchopulmonary alveolar lavage (BAL). The chest radiographs were normal at presentation but after steroid withdrawal symptoms worsened, haemoglobin levels fell, and Case 1 developed acute pulmonary haemorrhage. This was documented by lung biopsy, which also revealed evidence of old haemorrhage and fibrosis. We concluded that these patients had a unique familial variant of UVS with a previously unreported restrictive lung disease due to subclinical pulmonary haemorrhage.

Q Fever in human and livestock populations in Oman.

In 2000, Q fever was documented for the first time in the Sultanate of Oman in two patients, one with chronic pericarditis and the other with acute pneumonia. In 2001, a study of a randomly selected group of 102 adult patients from different provinces in northern Oman, presenting to the University Hospital in Muscat with unrelated conditions (e.g., diabetes mellitus, ischemic heart disease), revealed that 10 (9.8%) were seropositive for previous Coxiella burnetii infection. Examination of sera from a randomly selected group of 54 healthy goats from eight different herds from three different provinces of Oman, obtained by the Veterinary Research Center in Muscat, revealed that 28 (52%) had been infected, and 5 sheep, each from one of four herds, were seropositive for C. burnetii. We suspect that Q fever is widely prevalent in human populations in Oman, and that infection is widespread in goat, and probably sheep and other livestock populations, throughout the country.

Schistosomiasis in patients in the Sultanate of Oman.

BACKGROUND: Following an intensive public health eradication program, the focus of schistosomiasis mansoni at Salalah in Southern Oman (the only focus of schistosomiasis in Oman), appeared to have been eradicated in 1994. Since the vector snails for Schistosoma mansoni (and also for S. haematobium) were widely endemic in freshwater springs at Salalah, and reintroduction of infection (or introduction in the case of S. haematobium) was possible, we undertook a prospective study in 1995 for schistosomiasis in patients at the Sultan Qaboos University Hospital (SQUH), and to obtain evidence of visits by these patients to Salalah. PATIENTS AND METHODS: From May 1995 to May 2000, Omani and expatriate patients presenting at SQUH were evaluated for possible schistosomiasis (residence in an endemic region, suggestive clinical features) by a search for ova in stool, urine, or in tissue biopsies, or when ova were absent, by serodiagnosis. A retrospective survey of schistosomiasis patients diagnosed in SQUH from 1990 to April 1995 was also performed. Ministry of Health (MOH) data on reports of schistosomiasis (a notifiable disease) in Oman from 1991 to 2000, were obtained. RESULTS: Thirty patients with schistosomiasis were identified, 10 retrospectively and 20 in the prospective study. Patients were aged 9 to 60 years, and 25 of them (10 Omanis, 14 Egyptians, 1 Sudanese) contracted the infection in Africa, while 5 Omanis became infected in Salalah (3 in 1999). Twelve patients had schistosomiasis mansoni, 6 had schistosomiasis haematobia, and in the rest, infection by both parasites was confirmed or possible. The most common presentation (23%) was hepatosplenic schistosomiasis with portal hypertension. No patient admitted to contaminating freshwater with excreta in Salalah. MOH data revealed 3 to 14 cases of schistosomiasis were reported annually between 1991 and 2000, and that all schistosomiasis cases reported from 1994 to 1998 originated from Africa. CONCLUSION: Schistosomiasis remains an important health problem in Oman. Many doctors are unfamiliar with the clinical features and methods of diagnosis, thereby frequently causing delays in diagnosis. Because vector snails are endemic in Salalah, schistosomiasis patients must be detected and treated early. At infested freshwater sites at Salalah, mollusciciding should continue indefinitely, and notices should warn visitors not to contaminate the spring water.

First report of Q fever in Oman.

Although serologic evidence suggests the presence of Q fever in humans and animals in Saudi Arabia and the United Arab Emirates, acute Q fever has not been reported on the Arabian Peninsula. We report the first two cases of acute Q fever in Oman.