MIXED NON-ALBICANS CANDIDA FUNGEMIA: AN UNCOMMON BUT EASILY OVERLOOKED CLINICAL ENTITY

The increasing use of invasive medical devices and broad-spectrum antimicrobial agents has resulted in rising candidemia rates throughout the world. A 70-year-old diabetic and schizophrenic woman was admitted initially for staphylococcal sepsis secondary to an infected sacral sore but developed a catheter-related bloodstream infection caused by extended-spectrum β-lactamase-producing Klebsiella sp. which necessitated the administration of meropenem. Unfortunately, after a week on the carbapenem, the bacterial sepsis was followed by candidemia. Parenteral fluconazole therapy was started pending identification of the yeast(s). Two distinct Candida species were isolated from her blood which were identified biochemically using ID 32 C as Candida tropicalis and Candida lipolytica. Both yeasts possessed elevated minimal inhibitory concentrations toward fluconazole and although amphotericin B was eventually administered, the patient succumbed to her illness

NON-NEOFORMANS CRYPTOCOCCEMIA IN A PATIENT WITH HODGKIN'S LYMPHOMA

Cryptococcemia attributed to non-neoformans cryptococci has not received much attention due to the relative scarcity of reported cases. The primary aim of this case report is to highlight several notable characteristics of Cryptococcus laurentii. A 35-year-old woman presented with a right supraclavicular mass and a history of low-grade fever. A yeast was isolated from her blood. It formed cream-colored colonies which turned yellowish after 72 h of incubation and had a microscopic morphology of elongated budding yeast cells. Its identity was confirmed to be C. laurentii through carbohydrate assimilation testing (ID 32 C). The patient responded clinically to fluconazole and cleared the cryptococcemia. She was subsequently diagnosed with Hodgkin's lymphoma through histopathological examination of the supraclavicular mass

THE PITFALL OF RELYING ON A SPHYGMOMANOMETER DURING A HYPERTENSIVE CRISIS

Hypertensive crises can be life-threatening if undiagnosed due to the risk of acute target organ damage. This is a case of a middle-aged woman with poorly controlled hypertension who presented with a 3-day history of dyspnea, orthopnea, and cough productive of frothy sputum. Repeated attempts to measure her blood pressure (BP) using both a mercury and an electronic sphygmomanometer were unsuccessful. However, when an arterial catheterization of the right radial artery was performed, her mean BP was 358/151 mm Hg. A chest X-ray revealed cardiomegaly with plethoric lung fields. Following a diagnosis of hypertensive emergency with acute pulmonary edema, a glyceryl trinitrate infusion at a dose of 20 mg/min was commenced and titrated in an escalating manner. She was also given a single dose of intravenous frusemide 40 mg. Her BP was successfully reduced by 25% within 3 h of presentation

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

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A case series of Shewanella algae bacteremia with different outcomes

Shewanella spp. is increasingly recognized as an emerging pathogen causing skin and soft tissue infection (SSTI). They are found ubiquitously in soil and the aquatic environment, particularly in warmer geographical climates. Here, we present 2 cases of Shewanella algae infection

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

Asymptomatic primary biliary cholangitis in a young patient: an incidental finding

Primary biliary cholangitis (PBC) is an autoimmune disease that is increasingly recognized as an important cause of chronic liver disease. Incidental diagnoses are not uncommon. We report a case of a middle-aged female with persistently elevated ALP activity. During the investigation of cholestasis, anti-mitochondrial antibodies (AMA) were detected in her serum. Ductular reaction with cholestasis was observed in the liver biopsy sample. Based on these findings, a diagnosis of PBC was established and ursodeoxycholic acid therapy was commenced. After several weeks of treatment, biochemical improvement was noted

Disseminated sporotrichosis in an immunocompetent patient: an unusual presentation

Systemic sporotrichosis with cutaneous and pulmonary involvement in an immunocompetent patient is rare. We herein report a case of a 50-year-old man who presented with fever and multiple painful nodules for 1-month duration. On examination, there were hyperpigmented fluctuant subcutaneous nodules with hemorrhagic crusts on the face, trunk and extremities. Skin biopsy revealed acute suppurative granulomatous inflammation and panniculitis with budding yeasts. Chest X-ray demonstrated multiple centrilobular lung nodules at right upper lung zone and CT scan of the thorax showed consolidation over the peribronchovascular of right upper lobe, irregularity of the apical branch of right upper lobe bronchus and right hilar lymphadenopathy. Fungal culture from the skin nodule and bronchoalveolar lavage yielded Sporothrix schenckii. All investigations for immunocompromised state were negative. He was commenced on oral itraconazole which resulted in improvement of his symptoms. This case report highlights the rarity of sporotrichosis affecting the skin and lung simultaneously in an individual with a competent immune response