The First Confirmed Pediatric Chronic Osteomyelitis due to Coxiella Burnetii in Oman.

We describe here the first confirmed case in Oman of chronic osteomyelitis due to Coxiella burnetii, in a previously healthy four-year-old Omani girl. After laboratory confirmation of C. burnetii infection using molecular and qualitative and quantitative serological assays, the case was successfully managed with a combination of oral ciprofloxacin and cotrimoxazole and thereafter followed up for a long period without remission.

Non-Respiratory Droplet Transmission of COVID-19 in the Isolation Ward of a Secondary Hospital in Oman: A Return to Isolation Basics.

Front-line health care workers are among the most vulnerable groups at risk for acquiring COVID-19, yet the exact mechanisms of how infections occur in health care settings are yet to be identified. OBJECTIVES: To review the epidemiologic and environmental factors surrounding a cluster of nosocomially acquired COVID-19 cases with possible non respiratory droplet transmission indicating the importance of strict adherence with isolation procedures for patients and staff. METHODS: Contact and environmental investigations were completed to determine the source and possible routes of hospital transmission of COVID-19. RESULTS: Seven cases of COVID-19 occurred in the COVID-19 isolation ward of a secondary hospital from 12/04/2020 to 01/05/2020. Analysis also included first four COVID-19 patients admitted to this facility. Epidemiologic links included exposure to massive bowel movements of two infected patients in adjoining rooms on the same day. Serious gaps in infection control practices lead to further spread the virus and cross infection between the staff. CONCLUSION: Despite preparedness to combat pandemics, the infection control precautions taken at this facility were found not sufficient to prevent nosocomial spread of COVID-19. Issues were identified with compliance, enforcement, and failure to update to the most current guidance. Urgent review of ongoing hygiene and isolation practices in hospitals of this type is indicated. Further studies are required to better understand the role of fecal oral transmission and environmental contamination in the transmission of COVID-19.

Evaluation of Four Rapid Antigen Tests for Detection of SARS-CoV-2 virus.

OBJECTIVES: Considering the increasing, significant burden that coronavirus disease 2019 (COVID-19) imposes on the healthcare system, the need for simple, rapid, and affordable diagnostic tests to support the existing costly and demanding polymerase chain reaction (PCR) assay becomes required. This prospective diagnostic test accuracy study aims to evaluate the performance of four different COVID-19 rapid antigen tests compared to real-time reverse transcription PCR (rRT-PCR) between June and July 2020 to determine the feasibility of integrating these tests into the diagnostic algorithm in clinical settings. METHODS: Swabs were collected from 306 patients and analyzed using rRT-PCR and antigen tests from four different providers. RESULTS: The antigen tests' sensitivities were 65.8%, 69.8%, 64.0%, and 64.3% for the STANDARD™ Q COVID-19 Ag test, PCL COVID-19 Ag Rapid fluorescent immunoassay (FIA) test, BIOCREDIT COVID-19 Ag test, and Sofia SARS-CoV-2 antigen FIA test, respectively. Specificity was 94.1% for PCL COVID-19 Ag Rapid test and 100% for the other three assays. All assays showed a significant negative correlation between the reference rRT-PCR Ct values and Ag test results. Besides, sensitivities of the STANDARD™ Q COVID-19 Ag test, PCL COVID-19 Ag Rapid FIA test, and BIOCREDIT COVID-19 Ag test improved to ≥ 85% after exclusion of samples with PCR Ct values > 30. CONCLUSIONS: The high specificity of the rapid antigen tests and other parameters like simplicity, rapidity, and affordability suggest that antigen tests are likely to be helpful if integrated and interpreted appropriately in stepwise diagnostic algorithms. Given the low sensitivity of 64.0-69.8% of the antigen tests, we recommend that clinically relevant negative results undergo further testing Ag to confirm or exclude a COVID-19 diagnosis.

Validation of GeneXpert testing for SARS-CoV-2 RNA in eight hospital laboratories in Oman.

In response to the current COVID-19 pandemic, numerous commercial assays have been developed for the detection of SARS-CoV-2 for use in the clinical diagnostic laboratories. To date, there is limited comparison of testing methods performed in different hospital laboratory sites. The aims of the study were to evaluate the analytical performance of Cepheid Xpert Xpress SARS-CoV-2 when compared to RT-PCR. This is a cross-sectional study. A total of 155 nasopharyngeal swabs were taken in duplicate from patients presenting with suspected COVID-19 to 8 hospitals in Oman. One swab was tested by the hospital laboratory and the duplicate swab was sent to the national Central Public Health Laboratory (CPHL) for testing. We compared the analytical performance of the commercially available point of care Cepheid Xpert Xpress SARS-CoV-2 assay which was used in the 8 different hospitals with assays including Liferiver, Sansure, TIB MOL BIOL, Kingfisher and COBAS 6800 by Roche which were performed at the CPHL. Testing of the duplicate swabs revealed excellent agreement of results with the viral loads of Ct values ranging from 16-43 for the E gene, 18-44 for the N gene and 17-44 for the ORF gene using the Liferiver assay. The overall sample sensitivity and specificity of the Cepheid Xpert Xpress SARS-CoV-2 assay were both 100% and there was 100% agreement across specimens. We conclude that the rapid GeneXpert and RT-PCR kits assessed in this study may be used for routine diagnostic testing of COVID-19 patients by experienced clinical microbiology diagnostic laboratories. Our results highlight the importance of rapid molecular testing at different sites within a country in a public health emergency.

Chest Radiography Findings of COVID-19 Patients: Differences between the Intubated and Non-intubated Groups.

OBJECTIVES: We sought to identify the chest radiography differences at presentation between two groups of hospitalized confirmed COVID-19 patients; intubated group compared to non-intubated group. METHODS: We retrospectively collected the data of confirmed hospitalized COVID-19 patients at the Royal Hospital, Muscat, Oman, from March to April 2020. Radiographic and clinical data were collected from the hospital and radiology information systems and compared between two groups based on intubation status. RESULTS: Twenty-six patients confirmed to have COVID-19 by reverse-transcriptase polymerase chain reaction test were included in the study; 15/26 were non-intubated, and 11/26 were intubated. Overall, 88.5% were males in the intubated group. Respiratory symptoms were the most common presentation (84.6%) followed by fever (76.9%), with no statistical difference between the two groups. There was a statistically significant difference in having diabetes mellitus (p = 0.020) in which 8/11 and 4/15 were recorded to have diabetes mellitus in the intubated and non-intubated groups, respectively. Other comorbidities showed no statistically significant difference. The radiographic analysis redemonstrates the peripheral lower zone distribution but no statistically significant difference among the two groups. There were no differences between the intubated and non-intubated chest radiography in laterality involvement, central and peripheral distribution, and lesions type. However, upper zones involvement was more noted in the intubated group with 10/11 (90.9%) compared to 7/15 (46.7%) in non-intubated cases (p = 0.036). There were higher numbers of zone involvement in intubated cases than non-intubated cases: 9/11 (81.8%) of intubated patients had 10-12 areas of involvement on chest radiographs compared to 3/15 (20.0%) in the non-intubated group. Half of the cases were discharged home; 3/11 from the intubated group and 10/15 from the non-intubated group. Five patients died from the intubated group (5/11) versus 3/15 from the non-intubated group. Five patients are still hospitalized (three from the intubated group and two from the non-intubated group). CONCLUSIONS: The radiographic findings among intubated and non-intubated hospitalized COVID-19 patients demonstrate differences in the number of zones involved. More upper zone involvement was noted in the intubated group. Male sex and diabetes mellitus carried a poorer prognosis and were more associated with the intubated group.