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We present the case of a 37 year-old female who had disseminated tuberculosis (TB) with bilateral adrenal involvement resulting in primary adrenal failure (Addison's disease) with refractory hyponatraemia and possible extrapontine 'myelinolysis'. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB.

Varicella zoster infections are considered to be mild and ubiquitous infections predominantly affecting the paediatric population. However, in adults and in specific groups of patients, such as those who are immunosuppressed, varicella infections can be fulminant and life threatening. We here present a case report of a young female patient with a normal immune system who had a fulminant varicella infection with multiorgan involvement.

Objectives: Antimicrobial resistance is a growing problem worldwide, which imposes difficulties in the selection of appropriate empirical antimicrobial therapy. This study evaluated extended-spectrum β-lactamase (ESBL) isolates in 2005 in The Department of Child Health at Sultan Qaboos University Hospital (SQUH), Oman., Methods: During the 12 month period from January 2005 to December 2005, ESBL isolates from paediatrics inpatients were identified and analysed. Risk factors for the patients who grew ESBLs were analysed., Results: 13.3% of E. coli and 16.6% of Klebsiella pneumoniae isolated were ESBL producers. Most of the ESBLs were from urine (46.2%) and blood (42.6%). The main risk factors for ESBL in these children were previous exposure to antimicrobials (100%), prolonged hospital stay, severe illness (92.3%) and female gender (84.6%). Sensitivity of 100% was observed to carbapenems whereas 92% of the isolates were susceptible to amikacin. The oximino-cephalosporins were 100% resistant. Klebsiella pneumoniae were 100% resistant to piperacillin-tazobactam and nitrofurantoin. E. coli was 100% resistant to trimethoprim-sulfamethoxazole and ciprofloxacin. No resistance was recorded for the following combinations: amikacin plus piperacillin-tazobactam, amikacin plus nitrofurantoin and gentamicin plus nitrofurantoin., Conclusion: ESBL-producing organisms are becoming a major problem in Omani children. Exposure to antimicrobials and long admissions are modifiable risk factors that should be targeted for better control. Carbapenems are the most sensitive and reliable treatment options for infections caused by ESBLs. Amikacin plus piperacillin-tazobactam or nitrofurantoin are good alternatives.

Background: extended spectrum β-lactamase (ESBL) producing gram negative bacilli are becoming a growing problem worldwide with difficulties in designing a national formulary for empirical treatment of gram negative sepsis., Objectives: In this study, we investigated the in vitro activity of Carbapenems, Pipracillin-Tazobactam, Ciprofloxacin alone or in combination with aminoglycosides against ESBL-producing strains isolated from clinical samples., Methods: Three hundred and one ESBL-producing Escherichia coli and K. pneumoniae strains isolated from clinical samples were investigated. Isolates were screened initially for ESBL production using an automated system. All ESBL isolates were further confirmed using the double-disk diffusion method., Results: The overall Piperacillin-Tazobactam susceptibility was 57.9 (64.4% E. coli and 43.6% Klebsiella pneumoniae). Only 29.6% of ESBLs (24.9% E. coli and 39.6% Klebsiella pneumoniae) were ciprofloxacin susceptible. 98.1% E. coli and 93.1% of Klebsiella pneumoniae were susceptible to Piperacillin-Tazobactam plus Amikacin combination. 73.7% E. coli and 61.4% of Klebsiella pneumoniae were susceptible to Piperacillin-Tazobactam plus Gentamicin combination. 96.7% E. coli and 91.1% of Klebsiella pneumoniae were susceptible to Ciprofloxacin plus Amikacin combination. 41.2% E. coli and 51.5% of Klebsiella pneumoniae were susceptible to Ciprofloxacin plus Gentamicin combination., Conclusion: ESBLs have high resistance profile against Piperacillin/Tazobactam and Ciprofloxacin. The ESBLs from Oman have similar resistantce pattern as those reported from UK and USA. This resistance decreases when these drugs are combined with Amikacin. All ESBLs are susceptible to Carbapenems. However, carbepenam overuse can lead to emergence of carbapenems resistant gram negative bacilli and ESBLs. Combination of Amikacin plus Piperacillin/Tazobactam is a feasible empirical therapy for ESBLs.

Adreno-cortical insufficiency in the context of an adrenal mass can be a challenging clinical problem. The two main possibilities are either a benign mass or a malignant pathology. We describe here a patient who was investigated for chronic adreno-cortical insufficiency and was found to have a left adrenal mass that was later confirmed histopathologically to be tuberculous in nature.