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 case of dengue and COVID-19 co-infection in a young man from Malaysia

As Malaysia is highly endemic to both dengue and SARS-CoV-2 infection, it is expected that co-infection can arise. Therefore, we describe a case of a young gentleman with dengue and SARS-CoV-2 co-infection

Red cell antibody screening: a single centre experience

The Transfusion Unit of International Islamic University Medical Centre (IIUM MC) performs screening for red cell antibodies for all patients who are to be or might be transfused with red cell components. There are two types of red cell antibodies, the alloantibodies and autoantibodies. While the red cell autoantibodies are produced against self-antigen, the alloantibodies are the results of sensitization through transfusion or pregnancies. These antibodies are implicated in haemolytic transfusion reactions. This retrospective study examines the prevalence of red cell antibodies among patients of IIUM MC. Materials and Methods: All group cross matching and group screen and hold testing performed in IIUM MC from January 2017 to June 2018 were reviewed. Results: In total, samples of 3,712 patients were subjected to antibody screening using gel card. Twelve patients (0.32%) had positive antibody screening tests. The age ranged from 17 to 77 years. Nine (75%) patients were females. Four patients had positivity with Screening Cell I, one patient with Screening Cell II and III respectively. In the remaining patients (6/12) the antibody screening was positive for both Screening Cell I and II. In nine patients (0.24%) alloantibodies were identified, with six exhibiting multiple antibodies. The alloantibodies identified include anti-Le(a), anti-Le(b), anti-Kp(a), anti-C, anti-c, anti-E and anti-e. In three patients autoantibodies with no specificities were detected. Conclusion: Although the prevalence of red cell antibodies, specifically the alloantibodies is lower compared to other studies, the finding further reiterates the need to screen for unexpected red cell antibodies prior to red cell transfusion

Uncovering the uncommon: a primary pyomyositis of vastus muscle by Streptococcus pyogenes in an immunocompetent child

Pyomyositis is a condition where a primary muscle abscess forms within the striated muscle. "Tropical pyomyositis" refers to the disease's prevalence in tropical countries with high temperatures and humidity. Staphylococcus aureus is the most common organism involved, followed by other organisms such as Group A Streptococcus, Streptococcus Groups B, C, and G, pneumococcus, Neisseria sp., Haemophilus sp., Aeromonas sp., Pseudomonas sp., Klebsiella sp., and Escherichia coli. This case report describes a rare case of primary pyomyositis of the vastus muscle caused by Streptococcus pyogenes in an immunocompetent 12-year-old boy. The patient presented with severe right thigh pain and fever following a fall during a football game. The initial diagnosis was viral myositis. However, subsequent imaging revealed an avulsion fracture of the right lesser trochanter apophysis complicated with an infected hematoma. The patient was treated with antibiotics. He underwent ultrasound-guided drainage of the hematoma. Bacterial culture and sensitivity testing identified Streptococcus pyogenes. The patient recovered fully after a two-week hospital stay and continued oral antibiotics for another four weeks. This case highlights a rare presentation of pyomyositis of the vastus medialis muscle, which can mimic other conditions. A proper diagnosis can be established by aspiration of pus from the muscle or muscle biopsy with culture and tissue staining in cases of absent macroabscesses. Tropical pyomyositis should be considered in the differential diagnosis of any patient presenting with muscle pain, fever, and/or leucocytosis

Agreement between TST and QuantiFERON-TB gold plus in diagnosing latent tuberculosis infection among exposed health care workers at a Malaysian teaching hospital

Incidence rates of tuberculosis (TB) infection among health care workers (HCWs) were always higher compared to the general population. The tuberculin skin test (TST), which was used to screen tuberculosis contact among HCWs has low specificity due to cross reaction with Bacille Calmette-Guerin (BCG) vaccination or nontuberculosis mycobacterium infection. QuantiFERON-TB Gold Plus (QFT-Plus) offered higher specificity since it used specific antigens to stimulate the production of interferon-gamma in the serum. QFT-Plus could help narrow down the treatment group for latent tuberculosis infection among HCWs. To determine the agreement between TST and QFT-Plus in diagnosing latent tuberculosis infection among exposed health care workers in Hospital Canselor Tuanku Muhriz. Between January and December 2020, 417 HCWs were screened for TB close contact, 157 had positive TST and 260 had negative TST results. HCWs from both TST groups were selected using a convenient sampling method, and QFT-Plus testing was performed on 107 consented HCWs. From 107 consented HCWs, 21 (19.6%) had positive QFT-Plus. Among the positive QFT-Plus participants, 14 (66.7%) had positive TST, and 7 (33.3%) had negative TST. Meanwhile, among 86 (80.4%) HCWs had negative QFT-Plus, 35 (40.7%) had positive TST, and 51 (59.3%) had negative TST. There was poor agreement between the tests (kappa = 0.163). Poor agreement between TST and QFT-Plus in diagnosing latent tuberculosis infection among exposed HCWs