Recurrent Infective Endocarditis in an Adolescent due to Streptococcus agalactiae: A Rare Presentation of a Common Pathogen

Streptococcus agalactiae is known to cause invasive infections in risk groups such as pregnant women, newborns, and immunosuppressed patients but it is uncommon in older children. We describe a case of recurrent infective endocarditis due to S. agalactiae in an 11-year-old boy with Loeys-Dietz syndrome who was successfully treated with long-term antimicrobial therapy for one year.

External quality assessment of laboratory performance in bacteriology in the Eastern Mediterranean Region, 2011-2019

Background

Since 2007, national public health laboratories in the WHO Eastern Mediterranean Region (EMR) have participated in a regional external quality assessment scheme in bacteriology to improve testing proficiency.

Aims

To assess laboratory performance in bacteriology in the EMR between 2011 and 2019 using the regional external quality assessment scheme.

Methods

We analysed the accuracy of participant-reported data in bacterial identification, Gram stain microscopy, and antimicrobial susceptibility testing. For each category, we assessed the performance over time, the performance on multiple organisms, and whether a laboratory repeatedly failed to attain satisfactory results.

Results

Between 2011 and 2019, 70% of laboratories achieved satisfactory performance for bacterial identification and antimicrobial susceptibility testing, and 85% performed satisfactory Gram stain microscopy. Testing did not improve on multiple organisms and results were consistently low for some pathogens and test categories. Twenty-nine percent of laboratories underperformed throughout the study period.

Conclusion

The unchanged performance over time and underperformance of laboratories highlight the need for improvements in the regional external quality assessment scheme. Participating laboratories and WHO need to work more actively to strengthen the problem areas.

COVID-19-Associated Mucormycosis: An Opportunistic Fungal Infection. A Case Series and Review

BACKGROUND

A surge in COVID-19-associated mucormycosis cases has been observed during the second wave of COVID-19 in summer of 2021. Most cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at that time. Mucormycosis is an opportunistic angioinvasive fungal infection with high morbidity and mortality.

METHODS

We present 10 cases of COVID-19-associated rhino-orbital and rhino-orbital-cerebral mucormycosis managed in a secondary hospital in Oman.

RESULTS

The median time for developing mucormycosis was two weeks after COVID-19 diagnosis. All patients were newly diagnosed or already known to have poorly controlled diabetes mellitus. Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 and died of severe acute respiratory distress syndrome and septic shock. Another three patients died of advanced mucormycosis and cerebral involvement. Despite aggressive medical and surgical intervention, the mortality rate was 60% (6/10).

CONCLUSION

Mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention. Uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to COVID-19 are all important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.

Control of the 2018-2019 dengue fever outbreak in Oman: A country previously without local transmission

BACKGROUND

In December 2018, routine surveillance identified an autochthonous outbreak of dengue fever in Muscat Governorate, Oman, a region previously free of dengue fever.

METHODS

Routine surveillance confirmed locally acquired cases in the second week of December, leading to a rapid public health response including case management guidance and epidemiological investigations. The main activity was the vector survey using systematic sampling to assess extent of previously unreported Aedes aegypti presence followed by a campaign aimed to eliminate breeding sites of A. aegypti".

RESULTS

During a 5-month period, 343 suspected cases were reported from Muscat Governorate with 122 from the outbreak affected area. Out of 207 probable cases eligible for laboratory testing as per guidelines issued, 59 cases were confirmed. The vector elimination campaign started on January 8, 2019 after a media advocacy using television and social media and concluded on January 23. By the end of campaign, the case load had decreased significantly in the affected area with no reports of locally acquired cases from adjoining areas of Muscat Governorate, indicating no further spread.

CONCLUSIONS

Rapid notification and early community-wide, extensive vector control activities effectively contained the autochthonous dengue fever virus outbreak.

Pertussis and Pertussis like Illness: Pediatric Experience in Oman

OBJECTIVES

A resurgence of pertussis or whooping cough has been observed worldwide despite broad vaccination coverage. Pertussis like illness (PLI) refers to a clinical syndrome compatible with pertussis infection but lacking laboratory confirmation or an epidemiological link to a confirmed case. Our study aimed to estimate the contribution of Bordetella pertussis infection and identifying predictors of its diagnosis in a cohort of children with PLI.

METHODS

Demographic and clinical information were retrospectively collected from the medical records of children < 13 years old and hospitalized for PLI in two pediatric units in Oman from 1 January 2012 to 31 December 2013. The laboratory data of all cases were reviewed and confirmed cases of pertussis were identified, analyzed, and compared with non-confirmed cases.

RESULTS

A total of 131 patients were enrolled in this study. The majority (95.4% [125/131]) were infants. Only 54.1% (71/131) of admitted children with PLI were tested for pertussis. The incidence of pertussis infection among the tested group was 16.9% (12/71) with a 95% confidence interval 8.2-25.6. Severe illness occurred in 56.4% (74/131) of patients, and six were confirmed to have pertussis. Pediatric intensive care unit admission was required for one confirmed case of pertussis and eight cases from the PLI group (three were negative for pertussis, and five were not tested). Receiver operator characteristic curve analysis revealed that a white blood cell count ³ 23.5 × 10⁹/L had 96.6% specificity and lymphocytes ³ 17 × 10⁹/L had 98.3% specificity.

CONCLUSIONS

Taking into consideration that the number tested for pertussis was limited, the incidence of pertussis was 16.9% (12 out of 71 patients). Lymphocytosis can be used as a reliable predictor for the diagnosis of pertussis especially in the absence of specific confirmatory tests or until their results are available.