Aplikasi pengujian antibodi anti-nuklear dalam menentukan penyakit autoimun reumatik sistemik dan penyakit berkaitan

Antibodi anti-nuklear (ANA) merupakan salah satu contoh autoantibodi yang boleh terbentuk sebelum berlakunya penyakit autoimun terutamanya penyakit autoimun reumatik sistemik. Disebabkan itu, ANA telah menjadi satu ujian penting yang dipohon oleh pakar klinikal apabila seseorang pesakit tersebut disyaki mempunyai penyakit autoimun. Terdapat pelbagai kaedah makmal yang boleh digunakan untuk mengesan kehadiran ANA dalam darah seseorang pesakit tetapi kaedah imunofluoresen telah dianggap sebagai kaedah makmal yang piawai untuk tujuan penyaringan ANA. Kehadiran ANA ini tidaklah khusus kepada penyakit autoimun kerana tahap kesensitifan dan kekhususannya adalah berbeza-beza bergantung kepada jenis penyakit autoimun. Penggunaan kaedah makmal yang berbeza juga telah menunjukkan kadar kesensitifan dan kekhususan yang berbeza-beza dalam mengesan ANA. Pentafsiran keputusan ANA untuk sesuatu penyakit autoimun juga terbatas dengan kehadiran ANA yang boleh dikesan dalam kalangan pesakit yang tidak mempunyai penyakit autoimun malah boleh juga dikesan dalam kalangan mereka yang sihat. Maklumat klinikal pesakit menjadi satu unsur yang penting untuk membolehkan pentafsiran ANA yang berkesan dan juga boleh memberikan panduan kepada ujian selanjutnya jika diperlukan. Dalam beberapa tahun kebelakangan ini, pengujian ANA menggunakan kaedah imunofluoresen telah mengalami beberapa pembaharuan termasuklah penubuhan Kesepakaran Corak ANA Antarabangsa (ICAP) dan pembacaan slaid ANA IF secara automasi. Pembaharuan yang berlaku ini adalah ke arah penyeragaman pelaporan pengujian ANA IF. Ulasan ini merangkumi pelbagai kaedah makmal yang boleh digunakan untuk mengesan ANA, kegunaan klinikal keputusan ANA positif dan perkembangan terkini dalam pengujian ANA

Evaluation of rapid antigen detection test for group A Streptococci pharyngitis among children in an out-patient clinic in Malaysia

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis

Exophiala dermatitidis, ‘the real black fungus’ fungemia in a patient with COVID-19

The second wave of the COVID-19 pandemic in India had brought with it a surge of ‘black fungus’ co- infection, which is a misnomer for mucormycosis. The present case illustrates the ‘real black fungus’ infection in a 50-year old male patient with COVID-19 pneumonia, who otherwise had no significant previous medical history. He was admitted on day 8 of COVID-19 illness and was intubated due to persistently low oxygen saturation. Blood cultures were positive for flask-shaped dematiaceous budding yeasts with pseudohyphae formation, which grew as brown-black fuzzy colonies on Sabouraud dextrose agar. The isolate was identified as Exophiala dermatitidis based on phenotypic characterization. Despite antifungal therapy with amphotericin B and itraconazole, the patient deteriorated rapidly and succumbed to acute respiratory distress syndrome and multiorgan failure. A review of reported cases of Exophiala dermatitidis fungemia over the last 5-years is discussed

A fatal case of cerebral malaria complicated with Gemella bergeri bacteremia: role of Plasmodium mitochondrial cox3 gene and MALDI-TOF mass spectrometry for species identification

Here, we described a fatal case of a 37-year-old returning traveller from Burkina Faso, West Africa, who presented with an acute fitting episode later diagnosed as cerebral malaria induced by Plasmodium falciparum based on microscopic examination and Plasmodium mitochondrial cytochrome c oxidase III (cox3) gene PCR target. Unfortunately, the patient passed away due to severe malaria with multi organ failure complicated with Gemella bergeri bacteremia. G. bergeri was identified using MALDI-TOF mass spectrometry

Dynamic Modeling of Hydrogen Production from Photo-Fermentation in Microbial Electrolysis Cell using Sago Waste

Hydrogen has a great potential as an alternative energy and produces zero emissions, but most of hydrogen is produced from non-renewable fossil fuels via reforming. Thus, biomass is a promising replacement to fossil fuels where hydrogen can be sourced from. In this project, sago waste is chosen as raw material in a microbial electrolysis cell (MEC) to produce hydrogen fuel. A mathematical model with the integration of MEC with photo-fermentation has been developed and modified by using sago effluent as a substrate in a batch process. The main parameter such as concentration of microbial community has been observed in this project as it gives a huge influence on the gas product of MEC. In conclusion, the develop model was to observe the behavior of the microbial electrolysis cell where a maximum of 3.8 L/day (t = 4 days) of hydrogen production and 0.38A of MEC current were obtained

Helminthiasis among Indian Preschoolers from Urban Areas in Penang

Introduction Helminthiasis is a common parasitic condition particularly among children in rural areas in developing countries where poor hygiene standard is practiced. The study aimed to determine the prevalence of helminthiasis among Indian preschoolers in urban areas in Penang and its associated factors. Methods A total of 194 urban Indian preschoolers aged 4 to 6 years old were selected randomly from 11 kindergartens in the state of Penang for this cross sectional study. Data collection was carried out in 2 phases. First, microscopic stool examinations were done to examine the presence of helminths. Second, self administered questionnaires which inquired about human, environment and socioeconomic factors were completed by the parents/guardians. Results The overall prevalence of helminthiasis was 7.2% and the most frequently encountered infective agent was Ascaris lumbricoides (57.1%) and followed by the tapeworms (42.86%). The logistic regression indicated that habitual thumb sucking (AOR= 5.6. 95%CI: 1.73-18.39) and families owning domestic pets (AOR= 3.2; 95%CI: 1.03-10.14) were the significant contributing factors to helminthiasis among the Indian pre-schoolers in urban Penang. Although the prevalence of helminth infection among the urban Indian preschoolers is lower than rural area, it is still a public health concern. Children habitual thumb sucking and rearing domestic pets at home were the significant contributing factors in helminthiasis. Conclusion Prevention strategy should focus on health education and promotion among adults and children, awareness on domestic animal hygiene and maintaining good environmental sanitation. Multi agency collaboration is clearly essential, especially between state health, education and veterinary departments in curbing this disease

Frequency and Clinical Significance of Elevated IgG4 in Rheumatoid Arthritis: A Systematic Review

Immunoglobulin (Ig)G4 is a unique protein molecule and its role in autoimmune diseases remains elusive and controversial. Accumulating evidence suggests a pathogenic role of IgG4 in rheumatoid arthritis (RA). Rheumatoid factors (RF) in RA can recognize the Fc domains of IgG4 to form RF-IgG4 immune complexes that may activate the complement system leading to synovial injury. The aim of this article was to systematically review the literature from the past 2 decades to determine the frequency of elevated IgG4 and its clinical significance in RA. We comprehensively searched the Pubmed, Scopus, and Web of Science databases with the following terms: “IgG4”, “rheumatoid arthritis”, and “immunoglobulin G4”, and scrutinized all of the relevant publications. Based on the selection criteria, 12 studies were incorporated, which involved a total of 1715 RA patients. Out of 328 subjects from three studies, the pooled frequency of elevated non-specific IgG4 was 35.98%. There was a significant positive correlation between the IgG4 levels and the RA disease activity based on DAS-28 measurements (r = 0.245–0.253) and inflammatory markers, i.e., erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels (r = 0.262–0.389). Longitudinal studies that measured the serial levels of IgG4 consistently showed a decline in the concentrations (up to 48% less than baseline) with disease modifying anti-rheumatic drug (DMARD) treatment. Current evidence suggests that serum IgG4 levels are significantly elevated in RA compared to the general population. This review indicates that IgG4 is a promising biomarker of disease activity and tends to decline in response to DMARD therapies. Biologic therapies have revolutionized the therapeutic armamentarium of RA in the recent decade, and IgG4 appears to be a potential treatment target

Determining the Relationship of Meteorological Factors and Severe Pediatric Respiratory Syncytial Virus (RSV) Infection in Central Peninsular Malaysia

Respiratory syncytial virus (RSV) is the most common pathogen causing viral respiratory tract infections among younger children worldwide. The influence of meteorological factors on RSV seasonal activity is well-established for temperate countries; however, in subtropical countries such as Malaysia, relatively stable temperate climates do not clearly support this trend, and the available data are contradictory. Better understanding of meteorological factors and seasonality of RSV will allow effective strategic health management relating to RSV infection, particularly immunoprophylaxis of high-risk infants with palivizumab. Retrospectively, from 2017 to 2021, we examined the association between various meteorological factors (rainfall, rainy days, temperature, and relative humidity) and the incidence of RSV in children aged less than 12 years in Kuala Lumpur, Malaysia. RSV activity peaked in two periods (July to August and October to December), which was significantly correlated with the lowest rainfall (p < 0.007) and number of rainy days (p < 0.005). RSV prevalence was also positively associated with temperature (p < 0.006) and inversely associated with relative humidity (p < 0.006). Based on our findings, we recommend that immunoprophylaxis with palivizumab be administered in children aged less than 2 years where transmission of RSV is postulated to be the highest after the end of two monsoon seasons

Clonal Diversity of Methicillin-resistant Staphylococcus aureus in UKM Medical Centre: characterisation by Multilocus Sequence Typing of different SCCmec type representatives

Multilocus sequence typing (MLST) has been used to characterise methicillin-resistant Staphylococcus aureus (MRSA) isolates into sequence types (STs) and together with SCCmec typing, form the clonal nomenclature for MRSA. MLST was conducted as per the standard protocol on ten out of 236 isolates collected previously from January to December 2009 representing four different SCCmec types. Relationship analysis was performed with eBURST via the MLST website. Four unlinked ‘singleton’ STs were detected: ST30, ST239, ST772 and ST1178. Together with SCCmec typing, five MRSA clones were identified: ST30-IV, ST239-II, ST239-III, ST772-V and ST1178-IV. Clones ST239-III and ST30-IV are already established in Malaysian hospitals and in the local community, respectively. ST772-V is an emerging clone reported previously to have a propensity to displace pre-existing predominant clones. A clone involving the predominant ST in Malaysia (ST239) with SCCmec type II is the first of its kind to be identified. MRSA clones in our centre are very diverse and clone surveillance with large sample sizes should be undertaken as collaborative efforts between local institutions to maximise detection coverage

Cellulitis due to shewanella algae: crucial diagnostic clues from basic microbiological tests

Shewanella spp. are infrequently implicated in human infections but they are emerging pathogens with particular significance in regions with warm climates, such as Southeast Asia. This is a case of a middle-aged diabetic and hypertensive man who presented with worsening congestive heart failure symptoms associated with fever and a painful right leg. His right leg had numerous scabs and was tender, warm and erythematous. He was provisionally diagnosed with decompensated heart failure precipitated by cellulitis and uncontrolled hypertension. His blood grew non-fermentative, oxidase-positive and motile gram-negative bacilli which produced hydrogen sulfide on triple sugar iron agar. When cultured on blood agar, mucoid and weakly β-haemolytic colonies were observed after 48 hours. API 20 NE named the isolate as Shewanella putrefaciens but 16S rRNA sequence analysis identified the organism as Shewanella algae. The patient was treated with a 10-day course of ceftazidime, which resulted in the resolution of the cellulitis