Group A streptococcal bacteraemia: experience at a university hospital in Riyadh.

A recent increase in the frequency and severity of group A beta-haemolytic streptococcal (GABHS) infections has been reported from several parts of the world. A retrospective analysis of bacteraemic GABHS infections encountered at a major teaching hospital in Riyadh, Saudi Arabia between 1982 and 1993 was performed. The epidemiologic, clinical and laboratory aspects of 29 episodes of GABHS bacteraemia were reviewed, and the differences between frequency and severity of these episodes were compared between the initial (1982-1989) and the late (1990-1993) periods of the study. The overall frequency of GABHS bacteraemia was 0.14 episodes per 1000 admissions with no difference between the initial and the late periods. Seventeen patients were adults and 12 were paediatrics. Adults were mostly females (82%) and paediatrics were predominantly males (75%). Seven episodes (24%) were nosocomial. Most patients (72%) had a predisposing factor for GABHS infections. Primary bacteraemia occurred in 13 patients (45%); and the skin and throat were the major sources of the bacteraemia in the rest of the patients. Shock complicated five episodes (17%) and acute renal failure developed in six (21%) patients. The overall case fatality rate was 21%. All five episodes complicated by shock were in the late period, and the rate of acute renal failure as well as the case fatality rate have doubled in the late vs. the early periods. Although no recent increase in frequency of GABHS bacteraemia was found, invasive GABH infections may have become more severe.

Mucormycosis of the upper limb.

A rare case of mucormycosis of the upper limb in a patient with AIDS is described. The pathophysiology and natural history of the disease are described along with a classification of its clinical stages.

Prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia.

The prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia, was determined through a randomized multistage sampling of 8000 preschool children. Duplicate specimens from each child were examined using a simple sedimentation technique. The overall prevalence of intestinal parasites among children screened was 18.4%. The most common parasite isolated was Giardia lamblia (14.5%). This was followed by Entamoeba histolytica (2.7%), Enterobius vermicularis (1.4%), Ascaris lumbricoides (1.0%) and others. Out of the 1462 children positive for parasites, 183 (12.5%) had mixed parasitic infections. Prevalence among preschool children was highly associateed with older age, rural residence, non-municipal water supply, inadequate latrine type, low level of parental education, abdominal pain, and diarrhea.

Streptococcal toxic shock-like syndrome: case report and review of the literature.

Streptococcal toxic shock-like syndrome is a newly recognized complication of infections by group A beta-haemolytic streptococci (GABHS). Previous reports of this syndrome have originated from developed countries, predominantly North American and Europe. This report describes a 5-year-old Saudi child who developed this syndrome in association with streptococcal pharyngitis. It indicates that the recent resurgence of severe GABHS diseases is a global phenomenon.

The haematological manifestations of visceral leishmaniasis in infancy and childhood.

The haematological manifestations were reviewed in 94 patients (55 males and 39 females) with visceral leishmaniasis. Their ages ranged from 4 months to 12 years (mean per cent 1.8 years). All patients had splenomegaly and were anaemic, while (73 per cent) were neutropenic and (56 per cent) thrombocytopenic. Coagulation abnormalities were encountered in 10 (11 per cent) patients; in four patients this was associated with disseminated intravascular coagulopathy. Bone marrow was hypercellular in (90 per cent), normocellular in (5 per cent), and hypocelluar in (4 per cent). Also variable degrees of erythrophagocytosis and leukophagocytosis were noted with preponderance of histiocytes (46 per cent) and granulomatous formation (25 per cent). Low haemosiderin content in the bone marrow was noted, which together with the finding of high serum ferritin is consistent with anaemia of chronic inflammation. Hypersplenism, haemophagocytosis and granulomatous lesions of the bone marrow, chronic inflammation, and dietary factors appear to be the most important factors in the causation of the haematological changes in visceral leishmaniasis.