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Objectives: To estimate the incidence, risk factors, and outcome of cytomegalovirus (CMV) infection during the first year following hematopoietic stem cell transplant (HSCT) among Omani patients. Methods: This retrospective study included allogenic HSCT recipients between January 2006 and December 2018. We investigated the possible factors associated with CMV infection and CMV impact on one-year mortality.Results: Among 556 recipients of allogenic HSCT, 308 (55.4%) were male, the median age was 12 years, and 366 (65.8%) had benign conditions. One-year after transplants, the prevalence of CMV infection was 59.4%, and that of CMV disease was 1.8%. Multivariate analyses revealed significant relationships between CMV infection and haploidentical transplant (p =0.006), graft versus host disease (p =0.013), myeloablative conditioning (p =0.001), and patient age ≥ 12 years (p < 0.001). CMV infection was associated with an increased risk of one-year mortality (p =0.001). One-year overall mortality was 8.3%. Conclusions: The incidence of CMV infection in this Omani cohort was comparable with earlier findings, but the disease incidence and overall mortality were lower. Older age, haploidentical transplant, myeloablative conditioning, and graft versus host disease were significantly associated with a higher risk of CMV infection. In addition, CMV infection was associated with an increased risk of overall mortality in the first year post-transplant. Our findings support early initiation of preemptive therapy at low-level CMV viremia.

The use of immunosuppressive agents has recently been raised during the COVID-19 pandemic to manage the COVID-19-induced systemic inflammatory response and improve mortality. This widespread use of steroids and other immunomodulators for severe COVID-19 diseases might pose a potential risk of reactivation of latent diseases and the emergence of opportunistic infections such as strongyloidiasis. We report a case of strongyloidiasis with cholestasis in a middle-aged man; who was otherwise healthy and had no history of recent travel, developed three weeks after a prolonged course of steroids for the management of severe COVID-19 pneumonia. The patient was managed with a combination of albendazole and ivermectin. A high index of suspicion of strongyloidiasis in symptomatic patients post immunosuppressant therapy for severe COVID-19 is required to prevent unfavorable outcomes. In selected high-risk patients, post prolonged steroid therapy for COVID-19 pneumonia screening for strongyloidiasis and ivermectin empirical treatment might be considered even in non-endemic areas.

Non-tuberculous mycobacteria (NTM) are an unusual cause of osteomyelitis. Mycobacterium farcinogenes is an uncommon cause of human disease. We describe here the first case of M. farcinogenes osteomyelitis in a 49-year-old man who underwent left knee anterior cruciate ligament and medial meniscal repair which was complicated by recurrent septic arthritis and surgical site infection. As a consequence, he underwent multiple surgical debridements. Ultimately, left proximal tibial osteomyelitis was diagnosed and M. farcinogenes was recovered from the tissue biopsy culture. Clinical improvement was achieved following surgical removal of the prosthesis along with prolonged combination antimicrobial therapy.

Introduction: Complicated malaria is a medical emergency with a high mortality if untreated. Aim: To describe the clinical spectrum, treatment practices and outcome of severe malaria cases admitted to an intensive care unit. Method: Thirteen severe malaria cases admitted to the ICU over a 6 years period (2012 – October 2018) were included. The data was retrospectively extracted from the hospital patient data management system. Results: Nine patients had P. falciparum malaria, three had P.Vivax, and one had both. Only one had received malarial chemoprophylaxis. The median time of attending to medical health facility after symptoms started was 7 days (range: 2–21 days). All cases responded to antimalarial therapy and supportive management. Complications included shock 54%, kidney failure 38%, respiratory failure 69%, cerebral malaria 61%, hypoglycemia 23%, coagulation derangement 8%, and acidosis 23%. There were no fatal outcomes but one case had permanent brain damage and the rest recovered completely. Conclusion: The median treatment delay of seven days explains why these patients ended in intensive care with multiple symptoms of severe malaria and often multiorgan failure. Pretravel advice and use of malaria chemoprophylaxis when visiting high risk areas would probably have prevented infection and timely attendance to healthcare once symptomatic would have reduced the morbidity associated with infection, reduced length of stay in hospital and hence resources. Keywords: Severe malaria, Plasmodium falciparum, Vivax, ICU

Septic arthritis is an orthopedic emergency that is commonly caused by Staphylococcus aureus. Old age, diabetes mellitus, rheumatoid arthritis, prosthetic joint, and recent surgery are the main predisposing risk factors. Most cases of septic arthritis are caused by hematogenous spread of infection. Infectious sacroiliitis is a rare form of septic arthritis which is often clinically challenging to diagnose due its various and nonspecific presentations. Streptococcus mitis belongs to viridans group streptococci (VGS) bacteria, which is a component of body flora that is commonly involved in bacterial endocarditis. VGS in general and S. mitis specifically is an uncommon cause of osteoarticular infections. Here, we report a case of spontaneous Streptococcus mitis bacteremia complicated by septic sacroiliitis in a healthy teenager in the absence of infective endocarditis or a clear source of bacteremia.