Epidemiology and antimicrobial resistance patterns of bacterial meningitis among hospitalized patients at a tertiary care hospital in Saudi Arabia: a six-year retrospective study.

INTRODUCTION: Bacterial meningitis poses significant medical challenges due to its acute inflammatory nature and potential for severe neurological complications, emphasizing the need for prompt diagnosis and treatment. Limited data exists on its epidemiology and antimicrobial resistance trends among hospitalized patients in Saudi Arabia. This study aimed to investigate these factors at a tertiary care hospital over six years. METHODS: A retrospective analysis was conducted on cerebrospinal fluid samples results from 222 bacterial meningitis cases among hospitalized patients between 2018 and 2023. Demographic, clinical, microbiological data, and antibiotic susceptibility patterns were collected and analyzed. RESULTS: Pseudomonas aeruginosa (43%) was the predominant pathogen isolated. Neonates (16%) and children (47%) were most affected population. Nosocomial meningitis accounted for 92% of cases, mainly in the intensive care settings (50.45%). Extended-spectrum beta-lactamase was the leading resistance pattern (12.2%). Seasonal variation was observed, with a peak incidence in October-November. CONCLUSION: The study highlights the substantial burden of bacterial meningitis among hospitalized patients, especially among high-risk groups. Emerging antimicrobial resistance emphasizes the need for optimized surveillance and stewardship. Future prospective research employing molecular techniques across multiple centers in the country is warranted to enhance understanding and guide public health strategies in Saudi Arabia.

Mendelian Susceptibility to Mycobacterial Disease Caused by a Novel Founder IL12B Mutation in Saudi Arabia.

PURPOSE: Mendelian susceptibility to mycobacterial disease (MSMD) is a rare primary immunodeficiency predisposing congenitally affected individuals to diseases caused by weakly virulent mycobacteria, such as Bacillus Calmette-Guérin (BCG) vaccine strains and environmental mycobacteria. IL-12p40 deficiency is a genetic etiology of MSMD resulting in impaired IL-12- and IL-23-dependent IFN-γ immunity. Most of the reported patients with IL-12p40 deficiency originate from Saudi Arabia (30 of 52) and carry the recurrent IL12B mutation c.315insA (27 of 30). METHODS: Whole-exome sequencing was performed on three patients from two unrelated kindreds from Saudi Arabia with disseminated disease caused by a BCG vaccine substrain. RESULTS: Genetic analysis revealed a homozygous mutation, p.W60X, in exon 3 of the IL12B gene, resulting in complete IL12p40 deficiency. This mutation is recurrent due to a new founder effect. CONCLUSIONS: This report provides evidence for a second founder effect for recurrent mutations of IL12B in Saudi Arabia.

Case report of congenital neutropenia type 4 with glucose-6-phosphatase catalytic subunit 3 (G6PC3) deficiency.

Congenital neutropenia syndromes encompass a group of genetic disorders characterized by persistent neutropenia and recurrent infections inherited in an autosomal recessive, dominant, or X-linked manner. These syndromes arise from mutations in various genes, and one of the significant genes involved is glucose-6-phosphatase catalytic subunit 3 (G6PC3), giving rise to a condition known as Dursun syndrome. As per existing knowledge, a total of 92 cases of Dursun syndrome have been reported globally, including eight cases from Saudi Arabia. Our study identified two additional cases exhibiting neutropenia since the early postnatal period and recurrent admissions due to infections. Additionally, these patients presented with oral ulcers, chronic diarrhea, and anomalies affecting the cardiac and genitourinary systems. The rising incidence of congenital neutropenia on a global scale necessitates heightened vigilance among clinicians to ensure thorough follow-up of patients with neutropenia. This proactive approach can lead to early detection and appropriate management of associated complications, ultimately improving patient outcomes.

Pediatric Gastrointestinal Basidiobolomycosis: A Retrospective Study from Jazan Province, Saudi Arabia.

Introduction: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum, and its incidence is poorly understood due to its rarity. Gastrointestinal Basidiobolomycosis (GIB) is an uncommon presentation with limited reports in Saudi Arabia. This retrospective study aims to describe risk factors, clinical findings, diagnosis, and management of GIB in the pediatric population. Methods: We conducted a retrospective analysis of all pediatric patients diagnosed with GIB at a tertiary hospital between 2010 and 2022. Patients were identified based on their diagnosis of GIB. A self-administered questionnaire was distributed to assess risk factors associated with GIB. Results: We analyzed 25 cases of pediatric GIB, with approximately half of the cases (56%) occurring during the COVID-19 pandemic. The mean age of affected patients was 6.6 years, with a male predominance (60%, n=15). About 100% of parents acknowledged gecko existence in their residence, and their children were exposed to insect bites. Poor appetite was reported in all patients, and high counts of eosinophils and erythrocyte sedimentation rate were observed. Thrombocytosis was present in approximately 90% of patients, and 87% had anemia. Abdominal computerized tomography scans and ultrasound-guided biopsies were the most used diagnostic tools, with cases being diagnosed based on histopathological findings and confirmed via fungal culture. Conclusion: Our study provides valuable information on the potential risk factors, clinical features, diagnosis, and management of pediatric GIB in the Jazan region. The observed increase in cases during the COVID-19 pandemic highlights the need for continued surveillance and research to understand better the epidemiology and associated risk factors with this rare fungal infection. These findings emphasize the need for heightened awareness, early detection, and effective prevention strategies to mitigate the impact of pediatric GIB.

Rare presentation of infective endocarditis due to Salmonella entrica subspecies salamae (subgroup ll) in a sickle cell anemia girl.

Sickle cell anemia (SCA) is a common inherited kind of hemolytic anemia in Africa and some areas of Asia. In Saudi Arabia, SCA is prevalent as well. The patient of SCA is prone to some bacteria species more than the others, and Salmonella is one of the most prevalent infections in SCA that were known to cause bacteremia, osteomyelitis, septic arthritis, and gastroenteritis. Herein, we report a 7-years old girl who presented with a history of fever for five days and jaundice with abdominal pain and mild respiratory distress. Later, the patient was diagnosed to have infective endocarditis due to Salmonella enterica subspecies salamae (subgroup II). The patient improved completely after receiving proper antibiotics. To the best of our knowledge, there is only one case of adult SCA that has been reported with infective endocarditis due to Salmonella entrica but no reported case in pediatric.

First confirmed case of local human rabies in Saudi Arabia.

Rabies is a common zoonotic viral infection worldwide. Numerous animals can transmit the virus to humans, but dogs are the main ones. Despite the high incidence of animal bites overall in Saudi Arabia, of which most are dog bites, no single case of confirmed local human rabies has been reported. This article reports the case of a 12-year-old boy who lived with his family in a village in Jazan region in the southeast area of Saudi Arabia. He presented with signs suggestive of rabies. Saliva testing by rabies PCR was positive, confirming this as the first case of local human rabies in Saudi Arabia. The management plan followed the Milwaukee protocol, but the patient unfortunately died after 13 days of admission.