Acute psychosis secondary to isoniazid in pediatric pulmonary tuberculosis: A case report and literature review.

Isoniazid (INH) is a first-line tuberculosis (TB) drug and is currently recommended as part of active and latent TB treatment in all ages. INH adverse reactions range from mild hepatitis to severe neurological symptoms and psychosis. Since its introduction in the 1950s, many case reports have explored INH-induced psychosis. We describe a 12-year-old girl with acute onset hallucinations and delusions as a rare complication of INH and review previous case reports and identified risk factors. Pediatricians need to be aware of this less common side effect as they work through a differential of acute psychosis in children.

Acute septic arthritis in children.

BACKGROUND: Acute septic arthritis is a health-care problem in growing children. The aim of the present study was to determine the demographic features, clinical presentation, diagnostic evaluation, treatment and outcome of children suffering from acute septic arthritis. METHODS: Retrospective review of consecutive admissions of children < or =14 years of age with a bacteriologically and/or radiologically confirmed diagnosis of septic arthritis during the 10 year period, January 1997-December 2006 at King Fahad Hospital, King Abdulaziz Medical City was undertaken. RESULTS: Sixty-five patients (male : female, 2.4:1), 10 days-14 years of age (mean +/- SD: 3.3 +/- 3.2 years), met the inclusion criteria. More than half of the patients were under 2 years. The most frequent clinical features were pain (92%), fever (77%), limitation of joint movement (77%) and joint swelling (72%). Joint involvement was monoarticular in 97% of knees, and hips were affected in 75% of patients. Bacteria were isolated from joint aspirate or blood in 28 patients (43%), and Staphylococcus aureus was the most common organism, comprising 39% of the total bacterial isolates. Radiological diagnostic findings were observed in 19 (32%) of 60 patients with plain radiographs, nine (69%) of 16 patients with sonograms of the hip, 36 (80%) of 45 patients with Tc-labeled bone scan and nine (100%) of nine patients with magnetic resonance imaging. The joint infection resolved with no sequelae in 46 patients who were followed up for 6-36 months, but two had bone deformity and 17 were lost to follow up. CONCLUSION: According to the present series, septic arthritis is most common in young infants, mainly monoarticular, and is frequently localized in the knee and hip joints. Early diagnosis and appropriate treatment are associated with excellent outcome.

Prevalence of influenza vaccine hesitancy at a tertiary care hospital in Riyadh, Saudi Arabia.

BACKGROUND: Influenza vaccine hesitancy is a major problem worldwide, with significant public health consequences. We aimed to determine the prevalence of influenza vaccine hesitancy and the effect of vaccine awareness campaigns on vaccine acceptance among three groups (parents, adult patients, and healthcare workers [HCWs]) at King Abdulaziz Medical City, a tertiary care hospital in Riyadh, Saudi Arabia. METHODS: The study was conducted during the 2015-2016 winter season. Participants anonymously completed a validated questionnaire on influenza vaccine hesitancy. RESULTS: Of the 300 study participants, 17% (n=51) expressed vaccine hesitancy. The most common reasons given for vaccine refusal were: "It doesn't have any positive effect or benefit" (n=11 [21%]), "I don't need it because I'm healthy" (n=9 [17%]), and "I think it causes serious side effects" (n=7 [13%]). The most common sources of information about the vaccine were awareness campaigns (98/267 [36%]) and medical staff (98/267 [36%]). One hundred and sixty-three [54%] respondents knew that the effect of the influenza vaccine lasts up to 1year. There was no significant relationship between education level and receiving influenza vaccination. The study showed that confidence towards the Saudi Ministry of Health and medical doctors among three groups of participants was very high; 97% of adults, 95% of parents, and 93% of HCWs expressed trusted information provided to them by the Ministry of Health, and 97% of adults, 99% of parents, and 90% of HCWs trusted their physicians' information. CONCLUSION: Influenza vaccine hesitancy was low at KAMC. The most common reason for vaccine refusal was believing that it had no positive effect and that it is unnecessary. The most common sources of information for influenza vaccine were awareness campaigns and medical staff. Participants had high levels of trust in both the Saudi Ministry of Health and doctors.

Primary Giant Cerebral Hydatid Cyst in an 8-year-old Girl.

Echinococcosis, also called hydatid disease, is a parasitic disease that passes from animals to humans. Literature reports suggest very rare cases of cerebral hydatid cysts. Brain involvement with hydatid disease occurs in 1%-2% of all Echinococcus infections. In this report, we aim to emphasize the presentation of such an isolated primary cerebral hydatid cyst, discuss its radiological features, Emergency department management, inpatient medical management, referral to neurosurgery, consequent operative procedures, postoperative care, and outcome.

Characteristics and risk factors of hospital acquired - Methicillin-resistant Staphylococcus aureus (HA-MRSA) infection of pediatric patients in a tertiary care hospital in Riyadh, Saudi Arabia.

BACKGROUND AND OBJECTIVES: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections has been steadily increasing. These infections are considered to be either hospital-acquired MRSA (HA-MRSA) or community-acquired MRSA (CA-MRSA). Children are at higher risk of infection than adults. HA-MRSA has been reported to have more serious outcomes than CA-MRSA. However, there are not enough studies in Saudi Arabia to study the characteristics of HA-MRSA in children. We aim to describe the characteristics of HA-MRSA infection, including risk factors, culture site, clinical manifestations, complications, and outcomes among pediatric patients in a tertiary care hospital in Riyadh, Saudi Arabia. DESIGN AND SETTINGS: This is a retrospective chart review study. It was conducted in King Abdulaziz medical city in Riyadh. PATIENTS AND METHODS: The study included all patients 14 years of age or younger who were culture-positive from any site in the body during the period from January 1, 2009 to December 31, 2011. The time of culture compared to admission time was used to differentiate between CA-MRSA (within 72 h of admission) and HA-MRSA (more than 72 h after admission). The final sample size was 39 patients. RESULTS: We found HA-MRSA to be more common in males and those with risk factors such as previous surgery and previous hospitalization. Patients had a high Pediatric intensive care unit (PICU) admission rate and were commonly septic with positive blood cultures. Seventy-four percent of patients fully recovered, 10% recovered with complications and 15% died. CONCLUSION: HA-MRSA is an infection that can cause serious complications and a high rate of PICU admissions. Clinical manifestations such as shock are associated with higher mortality and morbidity rates. Special care should be given to those admitted to PICU, as they have high rates of mortality and morbidity.

Acute brucellosis in Saudi families: relationship between brucella serology and clinical symptoms.

OBJECTIVE: To determine if screening family members of patients with acute brucellosis will enhance the detection rate of brucellosis and also to determine the relationship between symptoms and brucella serology. MATERIALS AND METHODS: Family members from patients with acute brucellosis were interviewed and serologically screened. All seropositive family members were clinically and serologically followed for six months. RESULTS: Twenty-five acute brucellosis patients and their 178 family members were enrolled from January 2001 to February 2002. Of the 178 family members, 40 (23%) manifested various symptoms, 138 (77%) were asymptomatic, with an overall seroprevalence rate of 34 (19%). The rate of seropositivity among the symptomatic family members was 23 (58%) and for the asymptomatic was 11 (8%) (P<0.001). The majority of the symptomatic family members (13 (57%)) had a high Brucella titer in comparison to one (9%) of the asymptomatic group (P<0.001). Acute brucellosis was diagnosed and treated in 18 (78%) of the symptomatic seropositive family members and in four (36%), of the asymptomatic seropositive family members with an acute brucellosis prevalence rate of 22 (12%). All family members with acute infection recovered without sequelae; one patient relapsed (5%). CONCLUSION: Symptomatic family members are more likely to be seropositive with a high titer in comparison to the asymptomatic members.

Necrotizing pneumonia following cardiac surgery in a neonate.

In this report, we discuss the case of a male neonate who underwent surgical correction for coarctation of the aorta. The recovery of this patient was complicated by postsurgical necrotizing pneumonitis that resolved completely after a prolonged hospital stay with recurrent deterioration.