Epidemiology, clinical characteristics and risk factors of COVID-19 among children in Saudi Arabia: a multicenter chart review study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) has affected over 100 million cases worldwide. Children accounted for 1-5% of all cases with less reported symptoms and better prognosis compared to adults. This study aimed to describe the epidemiological characteristics and outcomes of pediatric COVID-19 cases in Saudi Arabia in addition to identifying risk factors associated with disease severity. METHODS: This was a multicenter, cross-sectional retrospective study that included confirmed SARS-CoV-2 infection among pediatric patients (< 14 years) from the time of initial identification in March 2020 to the end of July 2020 in 6 centers across the country. Patients were classified based on clinical severity. Study outcomes included time to recovery, need for invasive ventilation, and mortality. Multivariate logistic regression analysis was conducted to explore factors associated with increased disease severity. RESULTS: The study enrolled 567 children with (51.5%) were males, and (44.6%) aged from 6 to 14 years old. Asymptomatic patients accounted for 38.98% of the cases: while 319 patients (56%) had mild disease, and 27 patients (4.76%) had moderate-to-severe disease. Only 10 patients (1.76%) required Pediatric Intensive Care Unit admission. The calculated case-fatality was 0.7%. After performing multivariate regression analysis, chronic lung conditions [adjusted OR = 12.73, 95% CI (2.05-79.12)] and decreased red blood cells (RBCs) count [adjusted OR = 2.43, 95% CI (1.09-5.41] were found to be significant predictors for moderate-to-severe disease (p = 0.006 and 0.030, respectively). CONCLUSION: Most COVID-19 cases in the current study had a benign course of illness and carried an excellent prognosis. Children with chronic lung conditions or low RBCs count are at higher risk to develop moderate-to-severe COVID-19 disease.

Furuncular Myiasis in a Child: A Case Report and Literature Review.

Myiasis is an ectoparasitic infestation of tissue. Most cases of furuncular myiasis in Saudi Arabia are acquired from the Southern region of Saudi Arabia, including the Al Baha and Asir regions. Some authors consider these areas to be part of the Afro-tropical zoogeographical belt where infection is most likely to occur. Some studies have reported posttrauma myiasis in oral cavities in children. However, myiasis is rarely reported in children who do not suffer from skin erosion or trauma. We are reporting the case of a young, otherwise healthy girl who visited Al Taif, in the Western region of Saudi Arabia, who acquired an accidental infestation of fly larvae. To the best of our knowledge, this is the first report of indigenously acquired myiasis outside the Southern region of Saudi Arabia. This is significant in the epidemiology of this parasite, which appears to have expanded from the Southern to the Western region of Saudi Arabia.

Pediatric Gastrointestinal Basidiobolomycosis: Case Report and Review of Literature.

Basidiobolus ranarum is an environmental saprophyte found worldwide. It is a member of the order Entomophthorales of the class zygomycete. The infection is generally restricted to subcutaneous tissues. However, the disease can involve visceral organs, causing gastrointestinal basidiobolomycosis (GIB). GIB usually has nonspecific clinical manifestations and its diagnosis is challenging. Missed and delayed diagnosis of GIB increases the risk of morbidity and mortality, especially in pediatric patient. Previously, most of the cases in Saudi Arabia have been reported from southern region (Tohama, Aseer Region); the current study reports cases from different regions. We report a case of severe GIB and four other cases of pediatric GIB in western region of Saudi Arabia. The aim of our report is to describe the wide range of clinical presentations, diagnosis, management and outcomes. Our case series includes the youngest case report of GIB, a 16-month-old infant and highlights two important points. First, the need of high index of suspicious for diagnosis of GIB and its inclusion in the differential diagnosis of any abdominal mass, fever and eosinophilia. Second, it gives additional supportive evidence that medical management with voriconazole without surgical intervention (intervention if the condition is diagnosed early) is curative.

Severe blastomycosis in infants.

Blastomycosis is a dimorphic fungal infection that can be manifested as pulmonary or extrapulmonary disease. Disease in infants is rare, even in endemic areas. We report a case of severe blastomycosis in a 4-month-old infant, as well as details of 2 other cases from our center and a brief review of infant blastomycosis.

Differential time to positivity: vascular catheter drawn cultures for the determination of catheter-related bloodstream infection.

BACKGROUND: Vascular access catheter-related infections are common. The purpose of this study was to evaluate the accuracy of differential time to positivity (DTP) comparing 2 blood cultures drawn through different lumens of a multi-lumen central venous catheter (CVC DTP) for the diagnosis of catheter-related bloodstream infection (CRBSI). METHODS: This study was performed at a single institution (Health Sciences Centre, Winnipeg, Manitoba, Canada). Microbiology laboratory blood culture records for the period January to November 2009 were retrospectively reviewed. All adult patients with a positive peripheral blood culture and a minimum of 2 positive central line cultures (same organism) drawn from separate lumens of a multi-lumen CVC, all obtained at the same time on the same day, were included in the study. DTP supporting CRBSI diagnosis was defined as a difference in time to positivity of ≥ 2 h between a peripheral blood culture and a CVC blood culture (peripheral DTP), or between 2 CVC blood cultures from different lumens of a multi-lumen catheter (CVC DTP). Peripheral DTP was used as the reference standard for CRBSI diagnosis. RESULTS: Thirty-five episodes of bacteremia from 33 patients were included in this study. CVC DTP had a sensitivity of 76.5% and a specificity of 88.9% for CRBSI diagnosis, using peripheral DTP as the reference standard. CONCLUSIONS: These data suggest that CVC DTP may be of benefit in the diagnosis of CRBSI. Further study is required to better define the patient population/catheter type for which CVC DTP would be of greatest benefit.