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Wahab AA, Nurazizah SMA, Ding CH, Muttaqillah NAS, Nordashima AS, Kori N, Periyasamy P. Non-bacteremia liver abscess caused by Burkholderia pseudomallei from a tertiary teaching hospital in Malaysia: a case report and literature review. Trop Biomed 2023; 40:290-294. [PMID: 37897160 DOI: 10.47665/tb.40.3.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Melioidosis is endemic in Southeast Asia, including Malaysia. Liver abscess is not uncommon in melioidosis, but it is usually associated with bacteremia. We presented a case of a 55-year-old gentleman with underlying end-stage renal failure who presented with non-specific abdominal pain for three months. Initial blood investigations showed leukocytosis and increased C-reactive protein. Computed tomography (CT) of the abdomen revealed multiple hypodense lesions in the liver and spleen. The culture of the liver specimen obtained through the ultrasound-guided isolated Burkholderia pseudomallei. He was given an adjusted dose of intravenous ceftazidime due to underlying renal failure. Melioidosis serology also returned positive for IgM with titer >1:1280. His blood cultures were reported negative three times. Despite on antibiotics for five weeks, there was no significant improvement of the liver abscesses was observed. He was unfortunately infected with the SARS-CoV-2 virus during his admission and passed away due to severe COVID-19 pneumonia.
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Affiliation(s)
- A A Wahab
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - S M A Nurazizah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - C H Ding
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N A S Muttaqillah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - A S Nordashima
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Kori
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
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Wahab AA, Mohamed N, Ding CH, Muttaqillah NAS, Rosli N, Mohammed F. Salmonella enteritidis abdominal aorta mycotic aneurysm presented with acute cholestatic jaundice: A case report and literature review. Trop Biomed 2023; 40:23-28. [PMID: 37356000 DOI: 10.47665/tb.40.1.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated with mild jaundice. The initial laboratory investigations suggested features of obstructive jaundice and urinary tract infection. The contrast enhancing computed tomography of the abdomen revealed the presence of saccular mycotic aneurysm located at the infrarenal abdominal aorta. The blood culture grew Salmonella Enteritidis which was susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, ampicillin, and amoxicillin-clavulanic acid. Intravenous ceftriaxone was initiated, and he underwent open surgery and artery repair at day 8 of admission. He responded well to the treatment given and subsequently discharged home after completed three weeks of intravenous ceftriaxone.
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Affiliation(s)
- A A Wahab
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Mohamed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - C H Ding
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N A S Muttaqillah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - N Rosli
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - F Mohammed
- Department of Pathology, Faculty of Medicine, Hospital Canselor Taunku Muhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia
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Mokhtar NA, Abdul Samat Muttaqillah N, Hussin S, Tuan Soh TS, Abdul Wahab Z, Jahit MS. Helicobacter pylori Infection: Prevalence, Demographic Characteristics, Clarithromycin Resistance and Evaluation of the In-House Rapid Urease Test in Sungai Buloh Hospital, Malaysia. SAINS MALAYS 2019. [DOI: 10.17576/jsm-2019-4812-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ding CH, Wahab AA, Muttaqillah NAS, Kamarudin N, Saarah WR. Cellulitis due to Shewanella algae: Crucial diagnostic clues from basic microbiological tests. Trop Biomed 2019; 36:883-887. [PMID: 33597461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- C H Ding
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Kuala Lumpur, Malaysia
| | - A A Wahab
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Kuala Lumpur, Malaysia
| | - N A S Muttaqillah
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Kuala Lumpur, Malaysia
| | - N Kamarudin
- Department of Pathology and Laboratory Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - W R Saarah
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, 55100 Kuala Lumpur, Malaysia
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Ding CH, Yusoff H, Muttaqillah NAS, Tang YL, Tan TL, Periyasamy P, Ban AYL. The crucial role of molecular testing to facilitate the diagnosis of pneumocystis pneumonia during pregnancy. Malays J Pathol 2018; 40:69-72. [PMID: 29704387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pneumocystis pneumonia is an important human immunodeficiency virus (HIV)-associated opportunistic infection, and especially so in pregnant HIV-positive patients. We report a case of a 40-year-old woman in her first trimester of pregnancy who initially presented with acute gastroenteritis symptoms but due to a history of high-risk behaviour and the observation of oral thrush, she was worked up for HIV infection. Her retroviral status was positive and her CD4+ T cell count was only 8 cells/µL. She was also worked up for pneumocystis pneumonia due to the presence of mild resting tachypnoea and a notable drop in oxygen saturation (from 100% to 88%) following brief ambulation. Her chest radiograph revealed bilaterally symmetrical lower zone reticular opacities and Giemsa staining of her bronchoalveolar lavage (BAL) was negative for Pneumocystis jirovecii cysts. However, real-time P. jirovecii polymerase chain reaction (PCR) testing on the same BAL specimen revealed the presence of the organism. A course of oral co-trimoxazole plus prednisolone was commenced and her clinical condition improved.
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Affiliation(s)
- C H Ding
- Universiti Kebangsaan Malaysia Medical Centre, Department of Medical Microbiology & Immunology, Kuala Lumpur, Malaysia.
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Abidin NZZ, Sulong A, Alfizah H, Ding CH, Muttaqillah NAS, Rahman MM. Screening for New Delhi metallo-β-lactamase-1 in Enterobacteriaceae: Is there a role for the modified Hodge test? Pak J Med Sci 2016; 31:1340-3. [PMID: 26870093 PMCID: PMC4744278 DOI: 10.12669/pjms.316.8159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The New Delhi metallo-β-lactamase-1 (NDM-1) enzyme is a plasmid-encoded enzyme that inactivates carbapenem antibiotics. This study aims to ascertain if the modified Hodge test (MHT) has a role in screening for NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility. METHODS Over a period of one year, all Enterobacteriaceae isolates from all clinical specimens with reduced susceptibility to at least one carbapenem were subjected to MHT and conventional polymerase chain reaction (PCR) detection of the NDM-1 gene. RESULTS A total of 13,098 Enterobacteriaceae isolates were screened and 63 (0.48%) had reduced susceptibility to at least one carbapenem. Out of the 63 isolates, 45 (71.4%) were MHT-positive. The NDM-1 gene was detected in 18 of the 63 isolates (28.6%). All 18 PCR-positive isolates were also MHT-positive. Thus, the sensitivity and specificity of the MHT in detecting NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility are 100% and 40%, respectively. CONCLUSION The MHT is a useful test to screen for the presence of NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility. However, due to its rather low specificity, all MHT-positive isolates should be subjected to alternative tests (e.g. PCR) for confirmation, especially if other types of carbapenemases (e.g. KPC) are prevalent.
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Affiliation(s)
- Nor Zanariah Zainol Abidin
- Nor Zanariah Zainol Abidin, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Anita Sulong
- Anita Sulong, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hanafiah Alfizah
- Hanafiah Alfizah, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Chuan Hun Ding
- Chuan Hun Ding, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Najihan Abdul Samat Muttaqillah
- Najihan Abdul Samat Muttaqillah, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Md Mostafizur Rahman
- Md Mostafizur Rahman. Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Zainol Abidin NZ, Sulong A, Alfizah H, Muttaqillah NAS, Ding CH. Molecular detection of the New Delhi metallo-β-lactamase-1 gene in Enterobacteriaceae isolates in a tertiary medical centre. Malays J Pathol 2015; 37:227-232. [PMID: 26712667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND New Delhi metallo-β-lactamase-1 (NDM-1) is a relatively recent carbapenemase enzyme that inactivates all β-lactam antibiotics with the exception of aztreonam. This study aims to ascertain the baseline prevalence and antibiotic susceptibility patterns of NDM-1-producing Enterobacteriaceae in a tertiary medical center in Malaysia. METHODS Over a period of one year, all Enterobacteriaceae isolates from all clinical specimens with reduced susceptibility to at least one carbapenem and resistance to at least one third generation cephalosporin were subjected to antibiotic susceptibility testing by disk diffusion and molecular detection of the NDM-1 gene by single-target PCR followed by gel electrophoresis. RESULTS A total of 13,098 Enterobacteriaceae isolates were screened and 63 (0.48%) had reduced susceptibility to at least one carbapenem. Of this 63, 18 (29%) were NDM-1-positive. Of this 18, 16 (89.0%) were Klebsiella pneumoniae, one (5.5%) was Escherichia coli and one (5.5%) was Klebsiella ornithinolytica. Reduced susceptibility to at least one aminoglycoside was seen in 17 (94%) of the NDM-1-positive isolates. All 18 (100%) had reduced susceptibility to ertapenem and were resistant to all the second and third generation cephalosporin antibiotics tested. CONCLUSION The prevalence of NDM-1-producing Enterobacteriaceae among all the Enterobacteriaceae isolates in our institution is low (0.14%) and screening for the NDM-1 gene is best performed using ertapenem-impregnated disks.
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Affiliation(s)
- Nor Zanariah Zainol Abidin
- Universiti Kebangsaan Malaysia Medical Centre, Department of Medical Microbiology & Immunology, 16th Floor, Pre-clinical Building, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
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Muttaqillah NAS, Abdul Wahab A, Ding CH, Mohammad M, Biswas S, Rahman MM. Presence of anti-mitochondrial antibodies and elevated serum immunoglobulin G levels: is this primary biliary cirrhosis-autoimmune hepatitis overlap syndrome? EXCLI J 2015; 14:175-8. [PMID: 26648811 PMCID: PMC4665353 DOI: 10.17179/excli2014-660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/11/2014] [Indexed: 11/17/2022]
Abstract
Primary biliary cirrhosis in combination with autoimmune hepatitis has been termed "overlap syndrome", but its diagnosis is challenging. We report a case of a 43-year-old lady who presented with a six-month history of jaundice and pruritus. She subsequently developed gum bleeds. Laboratory investigations revealed hypochromic microcytic anemia, abnormal coagulation profiles, elevated serum alanine transferase and alkaline phosphatase levels, and raised serum IgG and IgM levels. Her serum was also positive for anti-nuclear and anti-mitochondrial antibodies. The findings from her abdominal CT scan were suggestive of early liver cirrhosis and the histopathological examination results of her liver biopsy were consistent with primary biliary cirrhosis. The patient was treated with ursodeoxycholic acid and her liver function test parameters normalized after six months.
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Affiliation(s)
- Najihan Abdul Samat Muttaqillah
- Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia
| | - Asrul Abdul Wahab
- Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia,*To whom correspondence should be addressed: Asrul Abdul Wahab, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia, E-mail:
| | - Chuan Hun Ding
- Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia
| | - Marlyn Mohammad
- Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia
| | - Suvra Biswas
- Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia
| | - Md. Mostafizur Rahman
- Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia
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Ding CH, Wahab AA, Muttaqillah NAS, Tzar MN. Prevalence of albicans and non-albicans candiduria in a Malaysian medical centre. J PAK MED ASSOC 2014; 64:1375-1379. [PMID: 25842581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine the proportion of albicans and non-albicans candiduria in a hospital setting and to ascertain if fluconazole is still suitable as empirical antifungal therapy based on antifungal susceptibility patterns of Candida species. METHODS The cross-sectional study was conducted between December 2010 and December 2011 at UKM Medical Centre, Kuala Lumpur, Malaysia and comprised 64 urine samples from patients who were either suspected or confirmed to have urinary tract infections. Yeasts were speciated using ID 32 C and subjected to antifungal susceptibility testing using Sensititre® YeastOne YO8. RESULTS Candida albicans accounted for 38(59.4%) of the isolates, Candida tropicalis 18(28.1%), Candida glabrata 6(9.4%) and Candida parapsilosis 2(3.1%). Overall, the isolates were susceptible to both amphotericin B (MIC90 1 μg/ml) and to 5-flucytosine (MIC90 0.25 μg/ml), but susceptible-dose dependent towards fluconazole (MIC90 16 μg/ml). Individually, Candida albicans was susceptible to fluconazole (MIC90 2 μg/ml), amphotericin B (MIC90 0.5 μg/ml) and 5-flucytosine (MIC90 0.25 μg/ml). Candida tropicalis was also susceptible to fluconazole (MIC90 4 μg/ml), amphotericin B (MIC90 1 μg/ml) and 5-flucytosine (MIC90 0.125 μg/ml). Candida glabrata was resistant to fluconazole (MIC90 64 μg/ml), but susceptible to amphotericin B (MIC90 1 μg/ml) and 5-flucytosine (MIC90 0.125 μg/ml). Lastly, Candida parapsilosis was resistant to fluconazole (MIC90 256 μg/ml), but susceptible to amphotericin B (MIC90 0.5 μg/ml) and 5-flucytosine (MIC90 0.5 μg/ml). CONCLUSION The commonest yeast associated with candiduria at the study site was Candida albicans, and fluconazole can still be used for empirical therapy of candiduria.
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Ding CH, Tzar MN, Rahman MM, Muttaqillah NAS, Redzuan SRM, Periyasamy P. Paecilomyces lilacinus fungaemia in an AIDS patient: the importance of mycological diagnosis. Pak J Med Sci 2014; 30:914-6. [PMID: 25097544 PMCID: PMC4121725 DOI: 10.12669/pjms.304.4937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/02/2014] [Accepted: 04/12/2014] [Indexed: 11/15/2022] Open
Abstract
Fungaemia due to Paecilomyces lilacinus is generally not considered in AIDS patients because this condition is not categorised as an AIDS-indicator illness. We report a case of a 25-year-old lady who presented to our hospital with Guillain-Barré Syndrome, with the subsequent development of refractory fungaemia, multi-organ failure and disseminated intravascular coagulopathy. Amphotericin B was given as empirical antifungal therapy. HIV screening was reactive and Paecilomyces lilacinus was isolated from her blood. The fungaemia did not resolve after one week of amphotericin B treatment. The addition of itraconazole was also unsuccessful in clearing the fungaemia. Accurate mycological diagnosis is important in the care of AIDS patients with fungaemia because of the risk of treatment failure with empirical therapy.
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Affiliation(s)
- Chuan Hun Ding
- Chuan Hun Ding, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Mohd Nizam Tzar
- Mohd Nizam Tzar, Department of Medical Microbiology & Immunology, v Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Md Mostafizur Rahman
- Md Mostafizur Rahman, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Najihan Abdul Samat Muttaqillah
- Najihan Abdul Samat Muttaqillah, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Shazatul Reza Mohd Redzuan
- Shazatul Reza Mohd Redzuan, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Petrick Periyasamy, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
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Ding CH, Muttaqillah NAS, Rahman MM, Abidin NZZ, Biswas S, Tzar MN. Scedosporium apiospermum fungaemia: the ramification of broad-spectrum antimicrobial treatments. Bangladesh J Med Sci 2014. [DOI: 10.3329/bjms.v13i3.19154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Scedosporium apiospermum is a cosmopolitan mycotic agent with unique characteristics. This is a case of a 65-year-old immunocompetent patient who presented with shortness of breath and fever. Consolidation was observed in both lung fields on chest X-ray. A diagnosis of aspiration pneumonia was made. Extended-spectrum ?-lactamase (ESBL)-producing Klebsiella pneumoniae was identified from his tracheal aspirate and imipenem was administered. Initial blood cultures were negative but after 10 days on imipenem, Candida glabrata was isolated. Amphotericin B was added to the treatment regimen, but after a week on this antifungal, Scedosporium apiospermum was cultured from the blood. The patient succumbed to illness before a change in the antifungal regimen. The case highlights the unwelcome consequence of using a broad spectrum antibiotic and later a broad spectrum antifungal agent. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19154 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.326-328Note: updated with minor changes on 20th June 2014. Last author added.
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