Epidemiology, clinical features, and outcomes of coronavirus disease among children in Al-Madinah, Saudi Arabia: A retrospective study.

Background and Objective: Coronavirus disease (COVID-19) is milder with favorable outcomes in children than in adults. However, detailed data regarding COVID-19 in children from Saudi Arabia are scarce. This study aimed to describe COVID-19 among children in Al-Madinah, Saudi Arabia. Methods: This retrospective observational study included children <14 years old hospitalized with COVID-19 between May 1, 2020 and July 31, 2020. Clinical data, COVID-19 disease severity, and outcomes were collected. The total number of presenting symptoms and signs were computed by counting those recorded upon presentation. The Kruskal-Wallis non-parametric test was used to compare the number of symptoms and signs across all levels of COVID-19 severity. Result: Overall, 106 patients met the inclusion criteria; their ages ranged from 2 weeks to 13 years. Most patients were ≤12 months of age (43.4%). Bronchial asthma was the most common comorbidity (9.4%). Among 99 symptomatic patients, fever was the most common symptom (84.8%); seven patients (7%) were diagnosed with febrile seizure. Most COVID-19 cases were mild (84%); one patient (0.94%) was in critical condition and one patient (0.94%) met the Multisystem Inflammatory Syndrome in children criteria. The mean number of symptoms and signs in children with severe or critical COVID-19 was significantly higher than that in children with mild cases or non-severe pneumonia (P < .001). One patient died owing to COVID-19 (0.94%). Conclusions: COVID-19 mortality in children is rare; however, while most children exhibit mild disease with favorable outcomes, children with chronic lung disease may be at higher risk for severe disease.

A matched case-control study to assess the carbapenem-resistant Enterobacteriaceae infections among hospitalized children at King Fahad Medical City, Riyadh, Saudi Arabia.

OBJECTIVES: To identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) infections among hospitalized children at King Fahad Medical City, Riyadh, Saudi Arabia. METHODS: A retrospective matched case-control study was conducted in pediatric patients with CRE infection at King Fahad Medical City, Riyadh, Saudi Arabia between January 2016-2017. RESULTS: During the study period, 19 CRE cases and 37 controls were identified for analysis. Children  ≤17 years (mean age±SD for cases was 43.9±46 months and controls was 29.2±52.2 months) were included in the study. Several factors associated with CRE infections were identified, which included, central venous catheter (CVC) line placement (p=0.023; confidence interval [CI]: 0.97-85.77), recent surgical procedures (p=0.006; CI: 1.30-9.28), invasive procedures (p greater than 0.001; CI: 1.98-21.18), use of prior antibiotics (p=0.008; CI: 1.38-24.62), and carbapenem exposure in the past 3 months (p=0.004; CI: 1.09-12.20). Among the cases, Klebsiella pneumonia was the most commonly identified (47%) followed by Escherichia coli (31%). Carbapenem-resistant Enterobacteriaceae was associated with increased comorbidities and prolonged hospitalization however, no mortalities were reported. CONCLUSION: This study identified prior antibiotic exposure, recent surgery and the use of invasive procedures as significant risk factors for colonization or infection with CRE. Also, the need for public awareness, continuing education for healthcare professionals, optimum use of invasive devices, enhanced surveillance, and antimicrobial stewardship are highlighted here which can limit CRE transmission in healthcare facilities.

Human immunodeficiency virus infection in Saudi Arabian children: transmission, clinical manifestations and outcome.

BACKGROUND: Vertical transmission from mother to infant is the most common mode of transmission of HIV infection in children. Data on pediatric HIV in the Middle East and Gulf region are scarce. We describe the spectrum, characteristics and outcome of HIV infection in Saudi children. METHODS: We collected descriptive data on HIV-infected or exposed children seen at the King Faisal Hospital and Research Centre (KFSH&RC) between 1986 and 2003. RESULTS: Sixty-three children had proven HIV infection. The source of infection was perinatal transmission in 63.5% of cases and contaminated blood or blood products transfusion in 34.5%. Median age at diagnosis was 6 years. In 42 patients for whom complete records were available, 90% were delivered by spontaneous vaginal delivery and 10% by cesarean delivery. Ninety-three percent of infected infants were breastfed throughout infancy. The complete medical records were available for 66% of children; for the remainder, part of the records could not be retrieved. Thirteen percent had an AIDS-defining opportunistic infection, with disseminated cytomegalovirus (CMV) infection being the most common (37.5%). All cases received antiretroviral therapy starting in 1997. Of those who received highly active antiretroviral therapy, 79% were compliant with treatment and had a sustained virologic response below the detectable level. Seventy-five percent of those diagnosed before 1995 died compared with 7.7% diagnosed later. CONCLUSION: Effective preventive measures, such as antiretroviral prophylaxis, cesarean delivery, and abstention from breastfeeding are not being applied. This could be largely due to lack of knowledge among patients and healthcare providers. Physicians must recognize the signs and symptoms of HIV infection, and have a high index of suspicion so that infected children are diagnosed early and referred to a specialized center for treatment and follow-up.

Invasive mucormycosis in chronic granulomatous disease.

Mucormycosis is a rare opportunistic fungal infection that occurs in certain immunocompromised patients. We present 2 cases of invasive mucormycosis due to Rhizopus spp. in patients with chronic granulomatous disease (CGD) and discuss their clinical presentation, management challenges, and outcomes.

Group B streptococcal endocarditis.

Group B Streptococcus can cause early onset neonatal disease. Beyond neonatal life, group B Streptococci are unusual pathogens. It can cause septicemia, epiglottis, fascitis, and endocarditis. A male Saudi child with group B endocarditis who has congenital heart disease is discussed.