Cryptococcal osteomyelitis of the femur: A case report and review of literature

Fungal osteomyelitis is a rare opportunistic infection. It exhibits some clinical and radiological similarities to several other bone pathologies. A diagnostic delay may result in significant increase in morbidity. We report a case of a 37-year-old man with underlying hypogammaglobulinaemia presented with isolated cryptococcal osteomyelitis of the femur

Mikrorganisma penyebab jangkitan kulat kuku dalam kalangan pesakit kencing manis

Pesakit kencing manis lebih mudah mendapat jangkitan disebabkan oleh sistem imun yang lemah. Antara jangkitan yang dialami adalah infeksi kulat kuku yang lebih dikenali sebagai onikomikosis. Satu kajian keratan rentas telah dijalankan di Pusat Perubatan Primer, Universiti Kebangsaan Malaysia untuk mengenalpasti prevalen onikomikosis dan patogen penyebab utama onikomikosis dalam kalangan pesakit kencing manis. Kajian ini dijalankan sepanjang bulan Oktober 2010 hingga bulan Mei 2011. Keratan kuku diambil dari kuku kaki yang tidak normal. Sekiranya kuku adalah normal, sampel diambil daripada ibu jari kaki kanan. Sampel kuku diketip selepas dibersihkan dengan 70% alkohol, dimasukkan ke dalam sampul kertas dan diproses dalam masa dua jam. Sebahagian sampel diproses dengan larutan kalium hidroksida (20%) (KOH) dan sebahagian lagi dikultur pada plat media agar Sabouraud dekstros. Seramai 78 (51.7%) pesakit perempuan dan 73 (48.3%) pesakit lelaki telah menyertai kajian ini. Purata umur pesakit adalah 60.7 ± 9.1 tahun. Kebanyakan pesakit terdiri daripada etnik Melayu (60.3%, n=91), diikuti oleh Cina (24.5%, n=37), India (13.9%, n=21) dan lain-lain (1.3% n=2). Prevalen jangkitan kulat kuku dalam kalangan subjek adalah 81.5%. Kebanyakan spesies kulat yang dikesan adalah kulapuk selain dermatofit (39.7%, n=60), terutamanya Aspergillus (12.6%, n=19) diikuti dengan yis (20.5%, n=31) dan dermatofit (0.7%, n=1). Keputusan kajian ini berbeza daripada kajian-kajian negara barat kerana spesies dermatofit dan yis lebih kerap ditemui. Kesimpulannya, prevalen jangkitan kulat kuku dalam kalangan pesakit kencing manis dalam kajian ini adalah tinggi. Jangkitan ini perlu dikesan dengan lebih awal dan seterusnya dirawat untuk mengelak daripada komplikasi diabetes pada kaki berlaku. Organisma penyebab utama onikomikosis dalam kalangan pesakit kencing manis dalam kajian ini adalah kulat selain dermatofit dan ini adalah sama dalam kalangan pesakit diabetes dan populasi umum

Risk factors for candidaemia in a Malaysian tertiary hospital

Candidaemia carries high morbidity and mortality, but its conventional diagnosis is time consuming and insensitive. Clinical risk factors may identify suitable candidates for prophylactic or pre-emptive antifungal therapy and may be modified or controlled to prevent candidaemia. Therefore, this study aimed to identify the independent risk factors for candidaemia. The study was a retrospective, case-control study involving 54 patients with candidaemia and 54 patients without candidaemia as controls. The patient’s data were collected from the medical records and the risk factors for candidaemia were analyzed in both groups. Candida species isolated from blood were C. tropicalis (n=19, 35.2%), C. albicans (n=18, 33.3%), C. parapsilosis (n=11, 20.4%) and one isolate each (1.9%) of C. famata, C. glabrata, C. krusei, C. melibiosica, C. pelliculosa and C. sake. Multivariate analysis showed that renal insufficiency, prior antibacterial therapy, prior antifungal therapy, steroid therapy and urinary catheterization were independent risk factors for candidaemia. Central venous catheter, prolonged hospital stay, intensive care unit stay, mechanical ventilation, surgery and parenteral nutrition occurred more commonly among the candidaemia group but were not independently significant. Controlling, limiting or modifying these risk factors may reduce the incidence of candidaemia

Common microorganisms causing onychomycosis in tropical climate

Onychomycosis is the infection of nail apparatus by dermatophytes, yeasts or non-dermatophyte moulds and is responsible for 50% of all nail disorders. A five year retrospective study was conducted at Universiti Kebangsaan Malaysia to identify the common pathogens responsible for onychomycosis and to describe the epidemiology of the affected patients. A total of 278 abnormal nails were cultured, out of which 231 were positive for fungus. Females constituted 50.2% (n=116) while males 49.8% (n=115). The majority (51.9%, n=120) were between ages 50-69 years. The Malay ethnic group was most commonly affected (44.2%, n=102) followed by Chinese (33.8%, n=78), Indians (18.2%, n=42) and other ethnic groups (3.8%, n=9). The most common fungal element isolated was non-dermatophyte moulds (45.4%, n=105) followed by yeast (34.6%, n=80) and dermatophytes (1.3%, n=3). Aspergillus spp. was the commonest (59.8%,n=81) non-dermatophyte mould, while Candida spp. was the commonest yeast (74.3%, n=89) isolated. In this study, non-dermatophyte moulds are the most common microorganisms implicated to cause onychomysosis. Treatment for non-dermatophyte mould is challenging as the current available antifungal agents are more effective against dermatophytes and yeasts

Dermatomycoses in Kuala Lumpur, Malaysia

Prevalence of dermatomycoses varies from one centre to another due to many factors. Knowledge of local prevalence is useful to aid clinical diagnosis and treatment. Due to lack of data in Malaysia, this study aimed to look at the causes of dermatomycoses in Kuala Lumpur, Malaysia. Dermatological specimens including skin scrapings, hair and nail clippings were collected carefully from clinically suspected cases of dermatomycoses between 2008 and 2010. All cultures of skin, hair and nails that yielded positive fungal growth were included. Any fungal growth outside the streaking area, duplicate and incomplete data were excluded from the study. Three-hundred-fifty-eight patients were included. Male patients were slightly more than females with a ratio of 1.2:1. The median age was 53 years old with interquartile range of 38-64 years. More than half (53.6%) belonged to 20-60 years age group. Rates of culture isolation were 89.0% for nails, 56.2% for hair and 55.6% for skin. Five-hundred-twenty-two fungi were isolated from 358 clinical specimens. Non-dermatophyte moulds (NDMs) represented the largest group (50.5%; mainly Aspergillus species 18.7%), followed by yeasts (41.6%; mainly Candida species 26.8%) and dermatophytes (7.9%; mainly Trichophyton species 7.7%). In conclusion, NDMs and yeasts were more commonly isolated than dermatophytes from dermatological specimens in this centre. Current treatment regime that focuses on dermatophytes may be ineffective to treat dermatomycoses caused by NDMs or yeasts. Antifungal susceptibility study may be needed to guide therapy in recalcitrant cases