ABSTRACT
OBJECTIVES: Brucellosis is a highly contagious zoonotic disease which can have serious health implications for affected humans and livestock. This study aimed to evaluate the clinical presentation, geographical distribution and risk factors of brucellosis cases admitted over a four-year period to two hospitals in Muscat, Oman. METHODS: This observational study was conducted from January 2015 to December 2018 at the Sultan Qaboos University Hospital and Armed Forces Hospital in Muscat. All patients with probable or definitive diagnoses of brucellosis according to the diagnostic criteria of the World Health Organization were included. Relevant data were gathered from the patients' medical records, including results from standard agglutination tests, Brucella enzyme-linked immunosorbent assays, bacterial blood or tissue/aspirate cultures and Brucella polymerase chain reaction tests. RESULTS: A total of 64 patients were diagnosed with brucellosis over the study period. The median age was 31.5 years and 73.4% were male. The majority (95.2%) presented with fever, followed by weight loss (51%), transaminitis (48.4%), peripheral arthritis/arthralgia (15.9%) and back pain (spondylodiscitis/sacroiliitis; 23.4%). Overall, 75.5% reported having consumed raw dairy products, while only 25.9% gave a positive history of animal contact. CONCLUSION: Patients with brucellosis presented with a wide range of clinical features, the most predominant of which was fever. The majority of patients were residents of or had recently visited Salalah and had consumed raw dairy products. These findings highlight the need for healthcare practitioners to maintain a high index of suspicion for this diagnosis. Moreover, further regulatory measures are necessary to oversee the sale of raw/unpasteurised dairy products.
Subject(s)
Brucella/isolation & purification , Brucellosis/diagnosis , Adult , Animals , Bacterial Zoonoses/epidemiology , Brucella/genetics , Brucellosis/epidemiology , Enzyme-Linked Immunosorbent Assay , Female , Fever/etiology , Hospitals, University , Humans , Male , Middle Aged , Oman/epidemiology , Polymerase Chain Reaction , Retrospective Studies , Risk FactorsABSTRACT
Parvimonas micra (P. micra) infections causing spinal cord compression are extremely rare. We report an occult oesophageal pleural fistula presenting with spinal epidural and brain abscesses resulting in severe neurological deficits caused by P. micra. Molecular detection proved to be instrumental in identifying the causative pathogen. Essential management with decompression, drainage, antibiotics and fistula repair lead to a good outcome.
Subject(s)
Brain Abscess/etiology , Epidural Abscess/etiology , Esophageal Fistula/complications , Firmicutes/isolation & purification , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/diagnosis , Pleural Diseases/complications , Aged , Anti-Bacterial Agents/administration & dosage , Brain/pathology , Brain Abscess/pathology , Brain Abscess/therapy , Debridement , Drainage , Epidural Abscess/pathology , Epidural Abscess/therapy , Esophageal Fistula/surgery , Firmicutes/classification , Gram-Positive Bacterial Infections/therapy , Humans , Male , Molecular Diagnostic Techniques , Neck/pathology , Pleural Diseases/surgery , Treatment OutcomeABSTRACT
Results from 3,263 QuantiFERON-TB Gold in-tube (QFT-GIT) assays were analyzed to determine the impact of age on test performance. The proportion of indeterminate results was significantly higher in pediatric and elderly (9.1% and 7.4%, respectively) than in adult (2.6%; chi-square test, P < 0.0001) patients. A detailed analysis of indeterminate QFT-GIT assay results is presented.
Subject(s)
Interferon-gamma Release Tests/methods , Tuberculosis/diagnosis , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Sensitivity and Specificity , Young AdultABSTRACT
We describe an unusual case of visceral Leishmaniasis affecting the gastrointestinal tract in a young immunocompetent patient whose only recent foreign travel was a trip to Mexico 9 months previously. She presented insidiously with diarrhoea, weight loss and developed subacute intestinal failure. Interestingly, she lacked most of the typical features of acute infection, including visceromegaly, fevers and hypergammaglobulinaemia. Atypical visceral involvement involving the gastrointestinal tract is well recognized in HIV coinfection, but very rare in immunocompetent patients. Repeated microscopy and culture of endoscopic biopsies failed to identify Leishmania parasites. Serological tests - direct agglutination test and anti-K39 antibody tests - were negative. This case highlights a very rare presentation of the condition with the absence of other visceral involvement and diagnosis being eventually made solely on polymerase chain reaction of rectal tissue, with a subsequent excellent response to therapy with intravenous liposomal amphotericin.
