10/12/2018 Sultan Quaboo has been in power Infectious Disease cases - PDF document

10/12/2018 Sultan Quaboo has been in power Infectious Disease cases in migrants since 1970. At that time, there was 50 km tarred road in the country Eskild Petersen, MD, DMSc, DTM&H Adjunct Professor of Tropical Medicine and Parasitology Institute for Clinical Medicine Aarhus University & Senior Consultant Infectious Diseases The Royal Hospital Muscat Sultanate of Oman Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital ProMed map: 320 global alerts (18 th - 24 th June 2018) IRN CCHF AFG PLS 3 +ve env WPV1 Foot & Mouth Total WPV1: 8 PAK 2 +ve env WPV1 Total WPV1: 3 KSA 11 cholera Jazan YMN 10/ Jun-cholera 1107144 2291 Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital Malaria Oman immunized 1.7 million Chinese women, worked people since April at a cost 2 months in South Sudan of 5 mil. OR = 15 mil USD without malaria prophylaxis. Last case in April 2017 Admitted with 8 days fever P. falciparum 46% ! Probably introduced from Recount: 20% Yemen. Treated with artesunate Left hospital day 5 Lost to follow up http://www.muscatdaily.com/Archive/Oman/44-cases-of-measles-registered-till-April-end-Ministry-of-Health-50m4 Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital 1

10/12/2018 Malaria, the present challenge 16th April 2014 600 imported cases in 2013 Several cases in the International City 2788 cases diagnosed since 2011 26th June 2012 2731 imported cases in 2011 Yemen 12 April 2014 1440 cases reported in 2013. 11 autochthonous cases World WHO, World Malaria Report 2016 Malaria Report 2016 Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital Funded by an ESCMID grant Mabela (greaterMuscat) outbreak 2015 Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital 25 years old Bangla Deshi Rabies working in construction. Admitted from private hospital with Rabies in the final stage with fever, agitated but oriented hydrophobia. Labs: Cat bite 6 months ago, arr. Oman 3 months. Na+ 145 K+ 3.7 Milwauke Protokol: Creat 118 Deep sedation, supportive treatment eGFR 69 and Amantadine. pCO2 40 mmHg (35 – 48) pO2 sat 80% Pt had a cardiac arrest when we attempted Lactate 5.9 to intubate him. Autonomic disturbancies in this stage not unusual. Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital 2

10/12/2018 Tetanus Bangla Deshi male admitted with 28‐year old old man from Bangla Desh Fever and pain in the right upper Quadrant. Thread on nail 2 days previously Increased tonus including typical stiff abdominal muscles. No autonome problems Bangla No tetanus immunoglobulin available in country Managed by Mg++ infusions and recovered after 2.5 weeks in the ventilator ‐ discharged and repatriated ICU day 3: Acinetobacter baumanii in trachea Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital 40 year old Indian male admitted with bilateral pneumonia and respiratory failure One abcess is drained No known previous illness. WBC 12.2 with 9.2 Neutrophiles Culture negative CRP 60 Intubated and sedated immediately Entamoeba histolytica antibodies HIV screening: Pos 1:8,000 VL pending CD4+ 96 BAL: M. tuberculosis (PCR) Rifampicine resistance: Not detected Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital TB incidence in the country of origin for many migrants TB incidence in Oman 2016  TB incidence rate for all cases 7.7 /100,000  For sputum positive 2.3/100000  Total No of cases 346 including new cases and 6 relapse cases  MDRTB new cases 6 including 3 XDR WHO, Global TB Report 2017 Courtesy: Dr Fatma al Yaquobi, TB coordinator, MOH Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital 3

10/12/2018 22 years old female from Uganda, This is what we should prevent ! Indian female, 5 years in Oman, screened at entry and every 2 years with chest X ray Cough and weight loss over several months. admit night sweats and fever the last 2 weeks. AFB 3+, PCR pos., Rifampicin sensitive Miliary TB 2018 2016 Screening 3+ AFB Chest X‐ray show old TB. INH resistant Sputum negative Repatriated IGRA or Mantoux not done Family contacts IGRA positive If screening with IGRA and preventive treatment given this could have been prevented Could this have been prevented by treament of latent TB in 2016 ? Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital Tracheal secretion from ventilator pt in Intensive care Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital 4

10/12/2018 Comparison of IncI2 plasmids carrying mcr‐1 The grey area represents ≥95% similarity. The GenBank accession numbers for the plasmids are KP347127 for pHNSHP45, KY693674 for pOM97‐mcr‐1, KY012274 for pEc_20COE13, and KX013539 for pBA77‐mcr‐1, respectively. Department of Infectious Diseases, The Royal Hospital Department of Infectious Diseases, The Royal Hospital Infectious Diseases: A Geographic Guide Edited by Eskild Petersen, Lin Hwei Chen and Patricia Schlagenhauf‐Lawlor “Where have you been” is a critical question leading the infectious disease specialist to a correct diagnosis when seeing the ill returned traveler. Nizwa fort “Where are you going?” in the pre-travel setting, this book is Thank you very much an indispensible reference for travel medicine practitioners” Infectious Diseases: a Geographic Guide by Eskild Petersen, Lin H. Chen, and Patricia Schlagenhauf will be the first resource most of us reach for when those questions are fielded.” - Alan J. Magill MD, FACP, FIDSA, President of the ISTM May 2017 / 491 pages / Paperback Order online at www.wiley.com Digital edition available Nahkl Fort Idri Fort Nahkl Fort Department of Infectious Diseases, The Royal Hospital jopeter@rm.dk Department of Infectious Diseases, The Royal Hospital 27 5