A study on knowledge, perception and practice (KPP) of preventive measures against respiratory tract infections, factors associated with hand hygiene practices and the effect of supplying handrub among Malaysian Hajj pilgrims 2013

Introduction: Every year, approximately 2 million pilgrims from all over the world gathered in Mecca to participate in Hajj, one of the pillar of Islam. Extreme congestion of people and heat represent an important risk for local or widespread outbreak of infectious diseases. Acute respiratory infections (ARIs) are the most common cause of hospital admission during hajj. Respiratory illness refers to influenzalike illness (ILI ) defined as the presence of fever and cough with and without other respiratory symptoms; nasal congestion, sore throat, sneezing or breathing problems. Protective behaviors such as using facemask, frequent usage of handrub, cough etiquette, social distancing and contact avoidance have been used to prevent its spread. Previous studies showed that hajj pilgrims that engaged in the recommended protective behaviors particularly hand hygiene and social distancing to have lower rate o

Lumbar tinea versicolor and spinal anaesthesia

Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section. Keywords: Tinea versicolor, Spinal anaesthesia, Caesarean sectio

Acute bacteremic pneumonia due to melioidosis developing in the intensive care setting

In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive Burkholderia pseudomallei infection can involve multidisciplinary unit mainly, microbiologist, infectious disease team and intensive care as it may be quite difficult to distinguish melioidosis from a number of other diseases on the clinical setting alone. Laboratory diagnosis plays a vital role in determining the direction of management. Investigations such as culture, polymerase chain reaction (PCR) and serology should be evaluated once the disease is suspected. In this particular case, the patient is a young adult involved in a road traffic accident. Unlike any other cases with melioidosis, he had no potential risk factors which may have contributed to the severity of the disease and it is likely that the site of the accident was the source of acquisition of this gram negative bacterium

Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient’s hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient’s condition worsened, and she succumbed to death on day 7 of hospitalization