Case Series of Cystic Echinococcosis Over a Twelve-year Period at Sultan Qaboos University Hospital, Oman.

Objectives: Cystic echinococcosis is a worldwide zoonosis that is endemic in many countries including some in the Middle East. Exact prevalence rates for human echinococcosis are unknown for Oman. Methods: Following obtaining ethical approval, data from January 2010 to December 2021 were retrieved from hospital electronic records of Sultan Qaboos University Hospital, Muscat. Results: Over a 12-year period we saw nine cases of hydatid disease; two cases in females and seven cases in males. The median age of our patients was 31 years old. Four patients had pulmonary cysts, four had hepatic cysts, and one patient had pulmonary and hepatic cysts. The majority of patients were from the Ad Dakhiliyah governorate. Contact with animals was reported by three patients, denied by two, and unknown for four. Albendazole was prescribed to three patients with pulmonary cysts that subsequently ruptured reflecting the unfamiliarity of clinicians to best manage pulmonary hydatid cysts. Conclusions: The prevalence of cystic echinococcosis in Oman is unknown but appears rare. For optimal management of this disease, clinicians must become more aware of its diagnosis and management.

First case report of Mycobacterium canariasense native mitral valve endocarditis.

Mycobacterium canariasense is a relatively newly discovered, rapidly growing nontuberculous Mycobacterium first described in 17 patients with fever in the Canary Islands, Spain, in 2004. To date, there have been very few case reports in literature, and to our knowledge, infective endocarditis due to M. canariasense has not been reported. In this case report, we present a 33-year-old man who was an intravenous drug user with native mitral valve infective endocarditis caused by M. canariasense after presenting with septic emboli to the toes and kidneys. The rapidly growing mycobacterium isolated from blood culture and valve tissue was identified by 16S rRNA sequencing as M. cosmeticum but was finally identified as M. canariasense by rpoB gene sequencing. The patient underwent mitral valve replacement surgery and received combined antibiotic therapy of intravenous ciprofloxacin, intravenous amikacin, and oral clarithromycin with a successful outcome. This case highlights the importance of molecular identification of nontuberculous Mycobacterium to guide antimicrobial therapy in such serious infections.

A novel method for treatment of pseudomonas pyogenic hepatic abscess complicating an echinococcal cyst by irrigation with acetic acid. A case report and literature review.

Hepatic hydatid cysts can be complicated by pyogenic abscesses. We report a case of hepatic hydatid cysts presenting to Sultan Qaboos University Hospital (SQUH) on 29 June 2010 complicated by secondary infection with fully sensitive Pseudomonas aeruginosa. The infection persisted despite standard treatment (drainage and systemic antibiotics) and was eventually cured with a novel method using acetic acid. METHODS: Instillation of acetic acid (in the form of white vinegar) into the hepatic abscess through the pig tail drainage tube. RESULTS: The administration of acetic acid (6%) in the form of white vinegar was well tolerated and safe to the patient and resulted in complete clinical and radiographic resolution of the hepatic abscess. CONCLUSION: Acetic acid (vinegar) irrigation can be used to clear a refractory pyogenic hepatic abscess due toP aeruginosa infection.

Prevalence of Nephrotoxicity in HIV Patients Treated with Tenofovir Disoproxil Fumarate: A Single-center Observational Study.

OBJECTIVES: Tenofovir disoproxil fumarate (TDF) has been reported to cause nephrotoxicity necessitating cessation in some patients. No information is available on the nephrotoxic effect of TDF in Omani or regional patients with HIV infection. We sought to determine the prevalence of the nephrotoxic effects of TDF in our cohort of Omani patients with HIV and investigate the nephrotoxic effects of other cofactors. METHODS: We conducted an observational cohort study on 83 Omani patients currently on TDF-containing antiretroviral therapy. Renal dysfunction was monitored by measuring the serum creatinine estimated glomerular function rate (eGFR), urinary protein creatinine ratio (uPCR), and fractional excretion of phosphate (FEPi). Fisher's exact test was used to determine any additional nephrotoxic effects of cofactors. RESULTS: The median values for the duration of TDF use, patient age, and body mass index (BMI) at the time of the study were 178 weeks (range = 3-554), 42 years (range = 21-80), and 27 (range = 17.4-42.7), respectively. The median initial CD4 count and viral load were 205 × 106/L (range = 3-1745) and 37 250 copies/mL (range = undetectable-9 523 428), respectively. FEPi was high in two (2.4%) patients, moderate in 26 (31.3%), and low in 55 (66.3%) patients. uPCR was high in 10 (12.0%) patients, moderate in 28 (33.7%), and low in 45 (54.2%) patients. No cofactors added to the nephrotoxicity except hypertension (p = 0.045). CONCLUSIONS: Better definitions for TDF-associated toxicity are needed. uPCR is not a very good indicator of TDF-associated tubular dysfunction. Omani patients with HIV on TDF have a 4% prevalence of renal toxicity, but a study with a larger number of patients is required to explore this observation further. Cofactors like duration of TDF use, age, BMI, gender, diabetes mellitus, and use of protease inhibitors did not have an impact on the severity of FEPi and uPCR.