Infective Endocarditis Caused by Corynebacterium striatum: Navigating Challenges and Treatment Strategies in an Emerging Threat.

Corynebacterium striatum is a type of bacteria normally found in the environment and is considered a benign microbe on the human body surface. However, it can induce severe medical conditions, including bacteremia, infective endocarditis, osteomyelitis, and infections, in other organs. This case study focuses on a 56-year-old male patient with multiple comorbidities who presented with an ischemic stroke. Several days after the insertion of a right internal jugular line, the patient developed fever and tachycardia. Blood cultures revealed the presence of Corynebacterium striatum, a Gram-positive bacilli. Transesophageal echocardiography confirmed the diagnosis of complicated infective endocarditis (IE) with mitral valve vegetation and moderate mitral regurgitation. Prompt treatment with appropriate antibiotics, including linezolid and later vancomycin, led to the patient's improvement and eventual discharge in good condition. This case highlights the importance of early recognition, aggressive management, and accurate diagnosis in cases of IE caused by Corynebacterium striatum. Proper antibiotic selection is crucial, considering the emerging antibiotic resistance patterns associated with this pathogen. By addressing these aspects, patient outcomes can be improved, and potential complications such as IE can be prevented.

Risk factors, outcomes and time to detect positive blood culture among cases with acute brucellosis.

BACKGROUND: Brucellosis causes a disabling human disease and loss of animals' lives. The clinical significance of Brucella bacteremia is still unclear and Brucella identification in blood culture is suboptimal. METHODS: This was a retrospective study conducted in Medina in Saudi Arabia from August 2016 to May 2019. We included cases with brucellosis symptoms and a positive culture or serological evidence for brucellosis, comparing bacteremic with non-bacteremic brucellosis cases for the rates of complications, infection relapses and brucellosis development. Also, we estimated blood culture positivity rates and the time to detect Brucella in an automatic blood culture instrument. RESULTS: Of the total number of 147 cases, 62 (42%) had a positive blood culture for Brucella, and the blood culture instrument (BACT/ALERT 3D) detected all positive blood cultures within 3 d of incubation. We found higher rates of chronic brucellosis in bacteremia than non-bacteremia cases (OR 7.25, 95% CI 1.41 to 37.23; p=0.018). Patients aged <15 y developed a higher rate of bacteremia than those aged ≥15 yr (OR 11.93 95% CI 1.37 to 103.75; p=0.025). CONCLUSION: Brucella bacteremia is an independent predictor for the development of chronic infection. Brucella bacteremia cases may need long follow-up periods and a more thorough evaluation to exclude deep-seated infection.

Efficacy of favipiravir in adults with mild COVID-19: a randomized, double-blind, multicentre, placebo-controlled clinical trial.

OBJECTIVE: To evaluate whether favipiravir reduces the time to viral clearance as documented by negative RT-PCR results for severe acute respiratory syndrome coronavirus 2 in mild cases of coronavirus disease 2019 (COVID-19) compared to placebo. METHODS: In this randomized, double-blinded, multicentre, and placebo-controlled trial, adults with PCR-confirmed mild COVID-19 were recruited in an outpatient setting at seven medical facilities across Saudi Arabia. Participants were randomized in a 1:1 ratio to receive either favipiravir 1800 mg by mouth twice daily on day 1 followed by 800 mg twice daily (n = 112) or a matching placebo (n = 119) for a total of 5 to 7 days. The primary outcome was the effect of favipiravir on reducing the time to viral clearance (by PCR test) within 15 days of starting the treatment compared to the placebo group. The trial included the following secondary outcomes: symptom resolution, hospitalization, intensive care unit admissions, adverse events, and 28-day mortality. RESULTS: Two hundred thirty-one patients were randomized and began the study (median age, 37 years; interquartile range (IQR): 32-44 years; 155 [67%] male), and 112 (48.5%) were assigned to the treatment group and 119 (51.5%) into the placebo group. The data and safety monitoring board recommended stopping enrolment because of futility at the interim analysis. The median time to viral clearance was 10 days (IQR: 6-12 days) in the favipiravir group and 8 days (IQR: 6-12 days) in the placebo group, with a hazard ratio of 0.87 for the favipiravir group (95% CI 0.571-1.326; p = 0.51). The median time to clinical recovery was 7 days (IQR: 4-11 days) in the favipiravir group and 7 days (IQR: 5-10 days) in the placebo group. There was no difference between the two groups in the secondary outcome of hospital admission. There were no drug-related severe adverse events. CONCLUSION: In this clinical trial, favipiravir therapy in mild COVID-19 patients did not reduce the time to viral clearance within 15 days of starting the treatment.

Low-Level Viremia Predicts Virological Failure in HIV-Infected Omani Patients Receiving Antiretroviral Therapy.

BACKGROUND: The implication and clinical significance of low-level viremia (LLV) in HIV patients are still not clear. This study aimed to characterize the clinical outcomes and to evaluate whether LLV could predict future virological failure in a well-defined cohort of HIV-infected Omani patients attending a large HIV clinic. METHODS: Patients on regular antiretroviral therapy (ART) for at least 12 months, and had at least 2 HIV RNA measurements 1 year after starting ART, were prospectively enrolled in a cohort study. LLV was defined as plasma HIV RNA between 50-200 copies/mL that persists after at least 2 consecutive measurements after 12 months of ART. Multivariate Cox proportional hazards regression model was used to measure the association among virological failure, LLV and potential predictors. RESULTS: After 12 months of starting ART, 60 patients (40%) had undetectable viral load (UVL) < 50 copies/mL, while 37 patients (24%) had LLV and 53 patients (35%) had primary virological failure > 200 copies/mL. The incidence rates of subsequent secondary virological failure for UVL and LLV groups, were 3 and 7 cases per 1000 patient-months, respectively. Compared to UVL group, LLV group had increased risk of subsequent secondary virological failure with hazard ratio of (4.437 [95% CI, 1.26-15.55]; p = 0.02). Age, duration of HIV infection, pretreatment HIV RNA level, pretreatment CD4+ cell count, and ART adherent were associated with subsequent secondary virological failure. CONCLUSION: Collectively, Omani HIV patients with LLV were at a higher risk for HIV virological failure, and should be monitored closely. Further studies are need to assess whether ART modification in LLV patients would lower the risk of virological failure.

Pulmonary Cystic Echinococcosis: Two Cases, Two Treatment Options.

Cystic echinococcosis (CE) is a zoonotic infection caused by the tapeworm of the genus Echinococcus, a cestode endemic in many parts of the world. CE can affect any organ, with the lung being the second most commonly affected organ after the liver. For the management of pulmonary CE, guidelines recommend surgical resection of cysts with adjuvant anti-helminthic therapy. In cases where surgery is not possible, medical therapy alone can be used. However, to date, there is a paucity of data to advocate for one modality over the other. Here, we report two cases of pulmonary CE caused by E. granulosus, one was managed with surgery and adjuvant anti-helminthic therapy while the other was managed with medical therapy alone. Both patients had clinical and radiological resolution outlining the role and efficacy of both modalities of therapy.

Comparative Analysis of two Methods of Measuring Antiretroviral Therapy Adherence in HIV-Infected Omani Patients.

BACKGROUND: Antiretroviral therapy (ART) adherence is crucial to achieve HIV suppression and to prolong survival of HIV-infected patients. Although monitoring of ART adherence is standard of HIV care, there is yet no optimal method to measure ART adherence. Therefore, it is essential to compare the effectiveness of different adherence measurement tools to predict HIV suppression. METHODS: In this study, we measured ART adherence using pharmacy refill prescription and self-reported adherence questionnaire. Both the methods were compared for predicting HIV suppression in adult Omani HIV-infected patients attending the outpatient clinics at Sultan Qaboos University Hospital. RESULTS: A total of 141 HIV-infected patients were included. The pharmacy refill-based measure showed a median adherence rate of 98.90% (interquartile range [IQR]: 86%-99.45%). The self-report adherence questionnaire revealed a median adherence rate of 100% (IQR: 75-100). A significant positive correlation was found between the adherence rates measured by the 2 methods (r = 0.32, P = .01). The pharmacy refill and self-report questionnaire adherence measures were both negatively correlated with plasma HIV RNA levels (r = -0.20, P = .01 and r = -0.26, P = .04, respectively). CONCLUSION: Collectively, these findings suggest that pharmacy refill measure could serve as a valid and practical tool of ART adherence in routine clinical practice.

Chikungunya Masquerading as Acute Rheumatism in an Omani Traveler.

Chikungunya is a mosquito-borne viral disease. It typically presents as an acute febrile illness associated with a varying degree of arthralgia and musculoskeletal sequelae. Cases of chikungunya have been reported from more than 40 countries in several continents. Chikungunya is often reported in travelers returning to non-endemic/epidemic countries. With increasing international travel, it is vital that clinicians in non-endemic areas are made aware of this rapidly spreading infection. Increasing international travel (for social, leisure, and business) between Oman and several chikungunya endemic countries including Pakistan may facilitate the introduction of chikungunya to Oman. We report the first imported case of chikungunya in an Omani traveler with a link to the current outbreak in Pakistan.

Incidence and risk factors of nephrotoxicity in patients on colistimethate sodium.

Background Colistin is used to treat gram-negative infections but it's highly associated with nephrotoxicity. Objectives To determine the incidence and risk factors as well as mortality in patients on colistin. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods This was a retrospective cohort study of patients admitted and who received colistin for ≥ 48 h. The exclusion criteria included inhaled colistin therapy, cystic fibrosis, or pregnancy. The study period was from January 2010 to June 2016. Main outcome measures Nephrotoxicity using the Risk, Injury, Failure, Loss and Endstage kidney disease (RIFLE) criteria. The secondary outcomes were incidence, risk factors and mortality in patients on colistin. Results A total of 123 patients were included. Colistin-associated nephrotoxicity (CAN) occurred in 57 (46%) patients after colistin therapy. As per the RIFLE criteria, 22 (18%) patients were classified as 'at risk', 17 (14%) as 'injury', and 18 (15%) as 'failure'. Multivariate analysis indicated that increasing age (adjusted odds ratio (aOR), 1.03; 95% confidence interval (CI) 1.01-1.06; p = 0.004) and higher APACHE II score (aOR 1.08; 95% CI 1.01-1.16; p = 0.040) were significant predictors for the development of nephrotoxicity. Factors associated with mortality included ICU admission (aOR 23.3; 95% CI 5.04-106; p < 0.001), vasopressin use (aOR 5.54; 95% CI 1.56-19.6; p = 0.008) and higher APACHE II score (aOR 1.15; 95% CI 1.03-1.30; p = 0.027). Conclusions The incidence of CAN was 46%. Increasing age and higher APACHE II score were the risk factors for CAN. Factors associated with mortality at 28 days included ICU admission and higher APACHE II score.

Epidemiology of extrapulmonary and disseminated tuberculosis in a tertiary care center in Oman.

BACKGROUND: The incidence of extrapulmonary and disseminated tuberculosis (TB) cases is increasing worldwide, and this growth significantly impacts TB-related morbidity and mortality. Little is known about the host risk factors for extrapulmonary and disseminated TB. In this study, we examined those risk factors. MATERIALS AND METHODS: We conducted a retrospective review of all TB cases admitted to Sultan Qaboos University Hospital from 2006 to 2015. We compared extrapulmonary TB (EPTB) cases with pulmonary and disseminated TB cases. We evaluated the risk factors associated with the development of extrapulmonary and disseminated TB using logistic regression analysis. RESULTS: We reviewed 260 TB cases, of which EPTB comprised 37%, PTB comprised 53%, and disseminated TB comprised 10%. The most common sites of infection in the EPTB group were the lymph nodes and the abdomen. Disseminated TB and TB meningitis were more common in expatriates than in Omanis. Patients with EPTB were less likely to smoke compared to a patient with PTB. Patients with disseminated TB had a higher mortality when compared to patients with EPTB (adjusted odds ratio [OR], 0.004; 95% confidence intervals [CI]: 0.001-0.054;P = 0.001) and PTB (adjusted OR, 0.022; 95% CI: 0.004-0.115;P = 0.001). Human immunodeficiency virus (HIV) was the main risk factor for patients with disseminated TB when compared to patients with extrapulmonary and PTB. CONCLUSION: The rates of extrapulmonary and disseminated TB in Oman are higher than what has been recognized. Expatriates, patients with HIV, and smokers are at high risk for disseminated TB. In these patients, suspected extrapulmonary sites should be evaluated and sampled to exclude disseminated TB.

Risk factors for tuberculosis mortality in a tertiary care center in Oman, 2006-2016.

BACKGROUND: Mortality from tuberculosis (TB) remains high despite its declining global incidence. Host risk factors of TB death have not been fully identified. The aim of this study is to explore some of the host risk factors associated with TB mortality. METHODS: We conducted a retrospective cross-sectional review of patients with TB admitted to Sultan Qaboos University Hospital in Oman from July 2006 to February 2016. Multivariate logistic regression analyses were used to evaluate the risk factors for TB mortality. RESULTS: Of the 205 TB cases reviewed, we identified 31 (15%) TB deaths during TB treatment. The median time of death from starting TB drugs was 30 days. Fifty-one percent of the TB deaths occurred in the 1st month of TB diagnosis. The main risk factors for TB mortality were advanced age, low body weight, negative sputum TB smear, pulmonary involvement, human immunodeficiency virus infection, and noncitizen status. CONCLUSION: To improve TB outcome in this high-risk group, abrupt clinical management approaches should be applied when TB is suspected. Public health measures that increase community awareness of TB mortality and reduce barriers to TB care are crucial to reducing TB mortality.

Epidemiology of Drug-resistant Tuberculosis in a Tertiary Care Center in Oman, 2006-2015.

OBJECTIVES: The aim of this study was to estimate the prevalence and identify the risk factors for the development of drug-resistant Mycobacterium tuberculosis infection in a tertiary care center in Oman. METHODS: We performed a cross-sectional review of culture-confirmed tuberculosis (TB) cases diagnosed at Sultan Qaboos University Hospital between August 2006 and March 2015. We compared drug-resistant TB cases with drug-sensitive cases to identify predictors of drug-resistant TB using univariate and multivariate logistic regression analysis. RESULTS: Of the 260 TB cases reviewed, 73.1% were confirmed by culture. The proportion of multi-drug resistant TB was 1.8%. TB isolates resistant to any of the first-line TB drugs comprised (7.5%) of cases. Pyrazinamide monoresistance was the most frequently reported drug monoresistant pattern (3.5%). Previous treatment for TB (odds ratio (OR) 14.81; 95% CI 3.09-70.98, p < 0.001), female gender (OR 3.85; 95% Cl 1.07-13.90, p < 0.039), and younger age (OR 6.80; 95% Cl 1.61-28.75, p < 0.009) were found to be risk factors for development of first-line antituberculosis drug-resistant TB in multivariate analysis. CONCLUSIONS: Our results show that the rate of drug-resistant TB in our population is a public health issue of great concern. Previous treatment with antituberculosis drugs, female gender, and younger age are risk factors for the development of drug-resistant TB. These findings are useful adjuvants to guide clinicians and public health professionals in the early detection and appropriate treatment of cases of drug-resistant TB.

Multi-system manifestations of Mycoplasma pneumoniae infection in a young patient.

Introduction.Mycoplasma pneumoniae is a small cell-wall-lacking bacterium that belongs to the mycoplasma (Mollicutes) prokaryote micro-organisms. It is a common cause of both upper and lower respiratory tract infections in all age groups. Respiratory illness is the most common manifestation of M. pneumoniae infection; however, extrapulmonary involvement may be present or predominant. The skin, mucus membranes, central nervous system, cardiovascular system, haematopoietic system, kidneys and musculoskeletal system are the most commonly involved extrapulmonary sites. Immune thrombocytopenia purpura has been reported as a rare haematological manifestation of mycoplasma infection. Here, we report, with a literature review, the case of a young adult with M. pneumoniae infection, presenting with acute febrile illness, myringitis, erythema multiforme, mild Raynaud's phenomenon symptoms and severe thrombocytopenia. Case presentation. Our patient was a 24-year-old healthy man who presented to an emergency department with acute febrile illness, upper respiratory tract infection symptoms, myringitis, erythema multiforme skin lesions, severe thrombocytopenia, and pale and cold hands. Mycoplasma serology suggested acute M. pneumoniae infection. The patient had a complete resolution of symptoms and gradual recovery from the thrombocytopenia after a course of anti-Mycoplasma therapy with azithromycin. Our case illustrates the multi-system involvement of M. pneumoniae infection. Conclusion.M. pneumoniae is a frequent cause of upper and lower respiratory tract infections in children and young adults. Multi-system involvement including the skin, vascular and haematological systems in young adults with upper or lower respiratory tract infection, as in our patient, should raise the suspicion of Mycoplasma infection. Our case also illustrates an excellent clinical response and recovery from thrombocytopenia shortly after anti-Mycoplasma antimicrobial therapy.

Leishmania Infantum and Epstein-Barr Virus Co-Infection in a Patient with Hemophagocytosis.

The authors describe a rare case of a 27- year old previously healthy male presenting with high grade fever, pancytopenia, hepatosplenomegaly, high levels of ferritin and triglyceride, suggesting a diagnosis of hemophagocytic lymphohistiocytosis (HLH) syndrome. Other investigations showed a positive Leishmania infantum serology and high Epstein-Barr virus (EBV) viremia. The diagnosis of a visceral leishmaniasis was confirmed by bone morrow biopsy, which showed Leishman-Donovan bodies and evidence of HLH. The patient received liposomal amphotericin B and he had a complete resolution of his symptoms and clearance of EBV viremia. This case of HLH associated with visceral leishmaniasis and EBV co-infection raises the question about the significance of EBV in patients with HLH. The treatment of actual etiological agent can lead to complete cure while using current recommend chemotherapy for HLH-related EBV in a patient with hidden infection may have deleterious effects.