No abstract

Multisystem inflammatory syndrome in children has become a recognised syndrome, whereas a parallel syndrome in adults, multisystem inflammatory syndrome in adults (MIS-A), has not been well defined. Most cases occur several weeks following confirmed or suspected SARS-CoV-2 infection, but none have been reported in association with SARS-CoV-2 vaccines. Here we describe the case of a 22-year-old man, who received the inactivated SARS-CoV-2 vaccine 6 weeks following a mild COVID-19 infection. He presented after his second dose of the vaccine with a clinical picture of a multisystem inflammatory syndrome-like illness. Additionally, there was laboratory evidence of acute inflammation. The patient’s condition markedly improved after initiation of steroids. Whether the vaccine augmented an already-primed immunity from the infection and contributed to the occurrence of MIS-A is difficult to prove. Understanding the pathogenesis of this condition will shed light on this question and entail major implications on treatment and prevention.

We describe our experience in handling six cases of pyogenic sacroiliitis. Two were males and four were females with a mean age of 24.9 years. None had a history of i.v. drug abuse. Blood cultures were positive in half of the patients. The sacroiliac joint aspirate was positive in one additional patient. Staphylococcus aureus was recovered from three of four culture positive cases. Bone and CT scans revealed abnormalities in all patients. Response to antibiotic therapy was satisfactory in all except one patient who had an early relapse. Early diagnoses and proper treatment would result in improved outcomes.

Multiresistant Salmonella seems to be a growing problem in Qatar and its treatment remains problematic. Of 100 Salmonella bacteraemias that occurred between 1 October 1989 and 30 September 1990, 30 were caused by S. typhi resistant to one or more of the conventional antibiotics usually recommended for the treatment of typhoid fever (ampicillin, chloramphenicol, and trimethoprim-sulphamethoxazole). Of those, 25 (83%) were acquired by patients during visits to the Indian subcontinent. Two patients with isolates sensitive to ampicillin were successfully treated with amoxicillin, 6 paediatric patients were cured with cefotaxime, and 20 adult patients responded favourable to ciprofloxacin. A 9 year old boy failed initial therapy with cefuroxime but responded well to ciprofloxacin. One adult patient was treated successfully with a combination of ciprofloxacin and cefotaxime. We conclude that cefotaxime and ciprofloxacin can serve as first line therapy for typhoid fever in areas where multi-resistant Salmonella is prevalent.

Sixty-two patients with blood culture-proven typhoid fever were randomly assigned to receive either 500 or 750 mg of ciprofloxacin orally, twice daily for 7 days or for two days following defervescence, whichever was greater. Thirty-four and 28 patients received 500 mg and 750 mg respectively. Strains of Salmonella typhi resistant to ampicillin, chloramphenicol and co-trimoxazole were isolated from the blood of 27 patients (43.5%). No resistance to ciprofloxacin was encountered. Both regimens were equally effective; fever subsided in mean times of 4.9 +/- 1.7 days in the 500 mg group and 5.2 +/- 2.2 days in the 750 mg group (P = 0.54). All patients were cured, although one patient in the 750 mg group experienced a presumed relapse two months following completion of therapy. Ciprofloxacin administered for 7-10 days was adequate treatment for 57 of the 62 patients (92%); only five patients required therapy for more than 10 days. Patients with pretreatment symptoms of > or = 10 days duration defervesced in a mean of 5.7 +/- 2.3 days compared with 4.5 +/- 1.3 days (P = 0.01) for those with symptoms of shorter duration. We conclude that 500 mg of ciprofloxacin taken orally twice daily is adequate treatment for typhoid fever.