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

The prevalence of Cytomegalovirus (CMV) infection among infants and correlation between CMV PCR with clinical outcomes in a tertiary teaching hospital in Malaysia

Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of congenital hearing loss and neurodevelopmental disability. This study aimed to describe the prevalence and clinical manifestations of infants age 12 months and below with CMV infection in Hospital Universiti Sains Malaysia (Hospital USM) and to determine the correlation between CMV PCR with clinical outcomes. A total of 648 hospitalized infants with clinically suspected cases of cytomegalovirus infection admitted to Hospital USM from January 2018 to December 2018 were tested for anti-CMV IgM and IgG by electrochemiluminescence immunoassay method. The results suggestive of CMV infection were requested for the second serum sample at 2-4 weeks’ interval together with plasma samples for CMV DNA viral load quantification by real-time PCR and maternal sample for serological analysis. Correlation of CMV viral load with clinical outcomes was analyzed using the point- biserial correlation. The results showed that the prevalence of acute CMV infection was 6.48 % (42/648) and cCMV infection was 0.3% (n=2/648). The findings were as follows: acute CMV infection (n = 42), passive immunity (n = 113) and inconclusive (n =41).) CMV hepatitis (p-value= 0.018), rash (p-value= 0.043), presumed sepsis (p-value=0.044) and abnormal hearing (p-value 0.031) were significantly associated with CMV status. Significant moderate correlation between CMV viral load and abnormal hearing assessment was observed. As a conclusion, CMV hepatitis, presumed sepsis, rash, and abnormal hearing were associated with the infant’s CMV status. A significant correlation was found between CMV viral load and abnormal hearing

Evaluation of toxicity and antibacterial activities of Andrographis paniculata herbal mouthwash against oral pathogens

Andrographis paniculata (AP) is an ancient herb known for its medicinal and therapeutic values. In this study, we aimed to evaluate the antibacterial activity and cytotoxicity of AP herbal mouthwash. Aqueous extract of AP was used to prepare the herbal mouthwash. The product was tested against selected oral pathogens namely Actinomyeces viscosus, Staphylococcus aureus, Streptococcus mutans, Streptococcus sobrinus, and Porphyromonas gingivalis for its antibacterial activity using the agar well diffusion method. Toxicity analysis was carried out and subjected to cytotoxicity screening using 3-(4,5-dimethylthiazol-2- yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, in vivo study using brine shrimp lethality bioassay, and detection of heavy metals using atomic absorption spectroscopy (AAS). Five AP herbal mouthwash concentrations (62.5, 125, 250, 500, 1000 mg/mL) were developed. AP herbal mouthwash exhibited the strongest antibacterial activity against A. viscosus. AP herbal mouthwash (125 to 1000 mg/mL) showed inhibition against P. gingivalis, S. mutans and S. sobrinus, except for S. aureus which did not reflect any sign of antibacterial activity. In brine shrimp lethality bioassay, AP herbal mouthwash has LC50 3255.064 µg/ mL. In vitro cytotoxic evaluation was done on L929 mouse fibroblast cell lines using MTT assay with IC50 43.55 mg/mL denotes the mouthwash is non-toxic. Heavy metals content in AP herbal mouthwash falls within the permissible range of plumbum (2.50 ppm) followed by arsenic (1.875 ppm), mercury (0.15 ppm), and cadmium (0.06 ppm). Thus, verifying AP herbal mouthwash is effective in common oral pathogens and has a non-toxic effect

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

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

A case report: community-acquired Pseudomonas aeruginosa necrotizing fasciitis in a morbidly obese diabetic young man can be fatal

We present a case study of a 26-year-old morbidly obese man with a three-day history of right leg pain and swelling. The swelling was associated with low grade fever. He was alert and conscious upon presentation to the hospital. His physical examination showed gross swelling of the entire right lower limb with no systemic manifestations. There was no discharge and bullae from the swelling area of the leg. He had high blood sugar and was newly diagnosed with type 2 diabetes mellitus. He was diagnosed with necrotizing fasciitis. An intravenous imipenem-cilastatin 500 mg every 6 h together with clindamycin 900 mg every 8 h was started empirically. Extensive wound debridement was performed. The swab culture obtained intraoperatively grew\ua0Pseudomonas aeruginosa.\ua0He required an above knee amputation due to worsening infection despite wound debridement. Post-operatively, he developed acute kidney injury with severe metabolic acidosis, which required daily hemodialysis. However, the patient deteriorated due to septic shock with multi-organ failure, resulting in his death

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