Symmetrical Flexural and Intertriginous Exanthema: A Rare Manifestation Associated with COVID-19 Infection

Summary@#Cutaneous manifestations of Coronavirus disease (COVID-19) are variable. We present a case of non-drug related symmetrical flexural and intertriginous exanthema in a patient with COVID-19 infection. A 58-year-old Chinese male who was diagnosed to have COVID-19 infection, developed maculopapular erythematous rashes at bilateral axillary and inguinal folds on the fourth day of illness. He was treated symptomatically with anti-histamine and topical corticosteroid. The skin condition improved and he was discharged well on tenth day of illness. Although symmetrical flexural intertriginous exanthema isclassically caused by drug reaction, this case demonstrated the possibility of the rash being directly associated with COVID-19 infection. More cohorts should be evaluated to fully describe the full spectrum of dermatological manifestation in COVID-19.

Pulmonary actinomycosis masquerading as lung cancer: A case report

Pulmonary actinomycosis is a rare yet important and challenging diagnosis to make. It is commonly confused with other lung diseases, such as tuberculosis and bronchogenic carcinoma, leading to delay diagnosis or misdiagnosis. A 49-year-old man presented with a chronic cough, hemoptysis, and pleuritic chest pain. His initial imaging studies including computed tomography (CT) was suggestive of bronchogenic carcinoma. A subsequent CTguided biopsy was consistent with pulmonary actinomycosis and excluded the possibility of bronchogenic carcinoma. He was treated with antibiotic therapy and achieved remission with complete radiological resolution upon follow-up.

Antimicrobial stewardship program in a Malaysian District Hospital: First Year experience

Backgrounds and Objective: Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program [ASP] is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital

Methods: An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above

Results: Recommendations were provided for 60% of cases [110 patients] with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy [30.3%], and the most common audited antimicrobials was Piperacillin/ Tazobactam [25.5%], followed by Meropenem [11.82%], Amoxicillin/Clavulanate and Vancomycin [8.18%] respectively

The concordance rate towards authorization policy was increased in 2015 [71.59% of cases] as compared before the implementation of ASP in 2014 [60.6% of cases]

Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy [p-value: 0.004]

Conclusion: ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures