False positive blood culture from automated microbial detection system in severe malaria – a case report

Automated microbial detection system (AMDs) are design to detect early growth of bacterial and fungal. We herein report a rare case of false positive blood culture by AMDs in Plasmodium falciparum infection. A 41-year-old previously healthy lady, with recent history of travelling to Lagos, Nigeria had presented to the casualty with history of fever and lethargy for three days. There was no malaria prophylaxis taken prior to the travelling history. Peripheral blood smear confirmed the presence of young trophozoite of Plasmodium falciparum with parasitemia of 7%. Concurrent blood culture sent was positive, however all subcultures were negative for any growth. She was treated with intravenous artesunate however succumbed to death on the day of admission due to severe falciparum infection complicated with multiorgan failure and shock. The aim of this report is to highlight, the circumstances that can trigger the false positive AMDs detection and the possible underlying mechanism

Melioidotic septic arthritis: report of two cases

Osteomyelitis caused by Burkholderia pseudomallei is an uncommon presentation of melioidosis. The clinical diagnosis of melioidosis is difficult as the signs and symptoms are non-specific and the duration of symptoms varies widely. We present two cases of melioidotic septic arthritis, one associated with tibial osteomyelitis and another involving the femur

A fatal case of rhinocerebral mucormycosis

Rhinocerebral mucormycosis is a potentially fatal and progressive angioinvasive fungal infection. It is classically described in patients with uncontrolled diabetes mellitus and hematological malignancies. This report describes a case of progressive rhinocerebral mucormycosis in a patient with poorly controlled diabetes who was on prolonged prednisolone therapy for autoimmune kidney disease. The patient, who was a female, presented to hospital with headache, orbital pain and nasal bridge swelling. Black eschar on nasal mucosae was present on admission. Later, she was started on intravenous fluconazole for the diagnosis of fungal sinusitis. Subsequently, she developed intra-cerebral haemorrhage complicated with transtentorial herniation. Diagnosis of rhinocerebral mucormycosis was later observed by a laboratory finding and the treatment was changed to intravenous amphotericin B. However, the patient succumbed to her illness on the 6th day of hospitalisation. This report discusses the risk factors associated with rhinocerebral mucormycosis as well as the underlying pathogenesis. This report will also highlight the importance of early diagnosis and appropriate treatment for mucormycosis to improve prognosis in patients

Hyaluronatelyase production by Streptococcus pneumoniae isolated from patients and carriers

Hyaluronatelyase produced by various microorganisms are capable of degrading hyaluronic acid in connective tissues and initiating the spread of infection by opening an access for the pathogen into host tissues. The present study attempts to determine the distribution of hyaluronatelyase-producing Streptococcus pneumoniae among invasive, non invasive and carriage isolates, and correlate it with the clinical sources, year of isolation, colonial morphology and their serotypes. A total of 100 isolates from various clinical samples were selected and screened for hyaluronatelyase production and presence of the encoding SpnHyl gene. All isolates possessed SpnHyl gene. Ninety-six isolates including 34 carriage isolates were positive for production of hyaluronatelyase. Four hyaluronatelyase-negative isolates were from blood (2 isolates) and sputum (2 isolates). No significant association was detected among hyaluronatelyase production and bacterial characteristics except for colonial morphology (p = 0.040). High percentages of hyaluronatelyase production in these isolates suggest their possible role as human pathogens

Hymenolepis nana in a renal transplant recipient : to treat or not to treat?

A case of hymenolepiasis in a renal transplant recipient. Issues discussed include the benefit of anti-parasitic agents as well as the preventive measures

Multiple ambler class A ESBL genes among Klebsiella pneumoniae isolates in a Malaysian district hospital

Detailed reports regarding the distribution and activity of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are currently not widely available in the Malaysian setting. This study was conducted to determine the ESBL genes distribution rate, phenotypic detection, and antimicrobial susceptibility patterns among beta-lactam resistant Klebsiella pneumoniae isolated from a Malaysian district hospital. K. pneumoniae isolates were collected from a microbiology laboratory at Hospital Pakar Sultanah Fatimah, Malaysia. Following exclusion and inclusion criteria, 141 isolates were selected for this study. K. pneumoniae was identified by phenotypic method, whilst antibiotics' susceptibility patterns were determined by the Kirby-Bauer method, as described in Clinical Laboratory Standard Institute (CLSI) guidelines (Oxoid, UK; Becton-Dickenson, USA). Detection of Ambler Group A ESBL gene (blaSHV, blaTEM, blaCTX-M-1, blaCTX-M-2, blaCTX-M-8, blaCTX-M-9, and blaCTX-M-25) was done using polymerase chain reaction (PCR). ESBL genes were found in 85.8% of K. pneumoniae (121 of 141) isolates. Only blaSHV, blaTEM, blaCTX-M-1, and blaCTX-M-9 were detected among K. pneumoniae isolates with distribution rates of 75.2% (106 of 141), 41.1% (58 of 141), 44% (62 of 141), and 0.7% (1 of 141), respectively. There was no blaCTX-M-2, blaCTX-M-8, or blaCTX-M-25 detected from any isolates in this study. Sequencing of representative amplicons revealed blaSHV as SHV-12, blaTEM as TEM-1, blaCTX-M-1 as CTX-M-15, and blaCTX-M-9 as CTX-M-18. The phenotypic detection rate of ESBL was 71.6% (101 of 141), whilst 9.2% (13 of 141) were positive for carbapenemase. AmpC beta-lactamase was detected in 22% (31 of 141) of all isolates. Antibiotic resistance was between 44.6% (netilmicin) and 97.2% (cefotaxime). Based on ESBL genes distribution, blaSHV was a predominant gene found in one of Malaysian district hospitals, notwithstanding having blaTEM, blaCTX-M-1, and blaCTX-M-9. Despite carrying multiple ESBL genes, some strains were positive for carbapenemase or AmpC beta-lactamase, which resulted in high antimicrobial resistance rates

Serotype 15C streptococcus pneumoniae with third cranial nerve palsy: unusual serotype and presentation

We present a unique case of pneumococcal meningitis caused by serotype 15C, a non-vaccine serotype, which islong thought to be non-virulent. Our patient is a young lady with a known case of plaque psoriasis, presented with sudden onset of left oculomotor nerve palsy and severe headache two days prior to admission. The clinical features were initially mimicking of brain tumour and brain aneurysm. The diagnosis of pneumococcal meningitis was confirmed by the bacterial antigen test and genome detection using multiplex PCR from the CSF. The blood culture also grew Streptococcus pneumoniae. Serotyping was performed on the isolate using Neufeld's Quellung method and it was identified as serotype 15C. Psoriatic skin disease was identified as a potential source of this invasive infection

Genotypic characterization of Malaysian human isolates of Streptococcus pneumoniae from carriage and clinical sources

This study characterized carriage and clinical pneumococcal isolates for serotypes, penicillin susceptibility, virulence genes and restriction fragment length polymorphism (RFLP) pattern of penicillin binding protein (PBP) genes. DNA fingerprint of isolates was generated by BOX-PCR. Majority of serotypes were 23F followed by 19F, 19A and 6A. Twenty-four percent of isolates were penicillin non-susceptible (PNSP). All of the targeted virulence genes were detected in all isolates with the exception of pili; 20.6% (n = 22) for PI-1 and 14.0% (n = 15) for PI-2. Of the 13 isolates which carried both PI-1 and PI-2, 10 were of clinical origin. Digested pbp-DNA produced three PBP-RFLP profiles for pbp1a (A1 to A3), six profiles for pbp2b (B1 to B6) and seven for pbp2x (X1 to X7) mostly in PNSPs. Based on BOX-PCR analysis, the majority of isolates were genetically diverse with a small number of potentially related isolates carrying pili genes. No obvious genotypic association was observed pertaining to carriage and clinical origin of isolates

Hyaluronate lyase activity in Malaysian Isolates of Streptococcus pneumoniae

Streptococcus pneumoniae is an important pathogen cause various severe illness in human particularly pneumonia, septicaemia and meningitis. One of its virulence factors is hyaluronate lyase, an enzyme which degrades hyaluronic acid (HA), a major component in extracellular matrix of human connective tissues. Degradation of HA decrease host tissue viscosity and eventually increase tissue permeability to allow migration of pneumococcus or its product into human tissues. The study attempted to screen production of hyaluronate lyase in 100 isolates of S. pneumoniae from various sites and year of isolation, and other bacterial characteristics. Ninety-six isolates (96%) showed positive hyaluronate lyase through hyaluronic acid diffusion agar method. Few positive hyaluronate lyase isolates were selected and proceed to enzymatic activity determination through hyaluronic acid turbidity reduction assay. The study found that non-vaccine serotypes and carriage isolates showed high hyaluronate lyase activity than invasive isolates. This finding suggest that hyaluronate lyase in S. pneumoniae might play more important role in pneumococcal colonization than invasion

Seroprevalence of leptospiral antibodies and knowledge, attitude and practices of leptospirosis to non high risk group in Selangor

Background: Leptospirosis has become an urban public health problem as the rural poor population has moved into the cities. It is not much known about seropositivity among community and factor associated with leptospirosis. This study aims to determine the seroprevalence of leptospiral antibodies and its association between identified risk factors and exposure to rodents as well as to determine knowledge, attitude, and practice (KAP) level among non high risk group in Selangor. Material and methods: A cross sectional study was conducted among 100 healthy individual in Ampang Jaya. Data of personal information of respondents and exposure to rodents were recorded. KAP survey concerning leptospirosis using modified validated questionnaires was carried out. Determinant of seroprevalence was determined through serology test and leptospiral antibodies were detected by MAT. Results: This study found that 27 sera were positive with 9 serogroups were detected. The most prevalent serovar were Sarawak and Terengganu. The most prevalence was in male and age <50 years old. Of the respondents, 2% have good knowledge, 6% have good attitude and 21% have good practice. No significant association between socio-demographic factor, exposure to rodents and knowledge, attitude, practice with seroprevalence were found. Conclusion: The results found that 27% were seropositive and there was also lack on knowledge of leptospirosis among respondents