Community-acquired necrotising pneumonia caused by Panton-Valentine leucocidin-producing methicillinresistant Staphylococcus aureus

A 61-year-old male presented with community-onsetpneumonia not responding to treatment despite givenappropriate antibiotics. Computed tomography scan of thethorax showed large multiloculated pleural effusion withmultiple cavitating foci within collapsed segments; lesionswhich were suggestive of necrotising pneumonia. Drainageof the effusion and culture revealed methicillin-resistantStaphylococcus aureus, which had the same antibioticprofile with the blood isolate and PVL gene positive.

Prevalence Study of Candidiasis by Conventional Pap Smear at Sarawak General Hospital, Malaysia / Jurnal Sains Kesihatan Malaysia

This study was conducted to determine the prevalence of candidiasis among women of 20 to 59 years of age at Sarawak General Hospital by examining the conventional Pap smear. The prevalence of this infection was studied among the five main ethnic groups comprising of Iban, Chinese, Malay, Bidayuh and Orang Ulu. Microscopic screening of 300 conventional Pap smears which had been processed and stained with the Papanicolaou staining method was conducted. Based on the information provided in the Pap smear screening form, the clinical manifestations were observed which may provide some indications on the type of infection. The details of the clinical manifestations were very important because in an infection or inflammation, Pap smears would usually demonstrate the cyto-morphological changes of the epithelial cells. The age factor among the different ethnics also plays important role in the assessment of the infection frequency. Candida sp. was detected in 12.7% of the specimens. The infection occurred in all ethnic groups as well as in all age groups. All cases presented with clinical signs and symptoms. The results of this study revealed the importance of undergoing Pap smear screening for candidiasis detection besides screening for the early detection of cervical cancer

The Presence of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus (heteroVISA) in a Major MalaysianHospital

This study was conducted to detect the presence of heterogenous vancomycin-intermediate Staphylococcus aureus (heteroVISA) among MRSA isolates in a major hospital. Forty-three MRSA isolates with vancomycin MIC 2 μg/ml collected in 2009 was screened for heteroVISA using Etest Glycopeptide Resistance Detection (GRD) and confirmed by population analysis profile-area under curve method. The genetic relatedness of heteroVISA strains with other MRSA was examined by pulsed-field gel electrophoresis (PFGE) method. Two isolates were shown to be heteroVISA and derived from the same clone. This showed that heteroVISA strains were already present among our local strains since 2009 and were genetically related to other susceptible strains.

The discrimination of d-tartrate positive and d-tartrate negative S. enterica subsp. enterica serovar Paratyphi B isolated in Malaysia by phenotypic and genotypic methods

Serotyping is not suffi cient to differentiate between Salmonella species that cause paratyphoid fever from the strains that cause milder gastroenteritis as these organisms share the same serotype Salmonella Paratyphi B (S. Paratyphi B). Strains causing paratyphoid fever do not ferment d-tartrate and this key feature was used in this study to determine the prevalence of these strains among the collection of S. Paratyphi B strains isolated from patients in Malaysia. A total of 105 isolates of S. Paratyphi B were discriminated into d-tartrate positive (dT+) and d-tartrate negative (dT-) variants by two lead acetate test protocols and multiplex PCR. The lead acetate test protocol 1 differed from protocol 2 by a lower inoculum size and different incubation conditions while the multiplex PCR utilized 2 sets of primers targeting the ATG start codon of the gene STM3356. Lead acetate protocol 1 discriminated 97.1% of the isolates as S. Paratyphi B dT+ and 2.9% as dT- while test protocol 2 discriminated all the isolates as S. Paratyphi B dT+. The multiplex PCR test identifi ed all 105 isolates as S. Paratyphi B dT+ strains. The concordance of the lead acetate test relative to that of multiplex PCR was 97.7% and 100% for protocol 1 and 2 respectively. This study showed that S. Paratyphi B dT+ is a common causative agent of gastroenteritis in Malaysia while paratyphoid fever appears to be relatively uncommon. Multiplex PCR was shown to be a simpler, more rapid and reliable method to discriminate S. Paratyphi B than the phenotypic lead acetate test.

Occurrence of virulent genes among environmental isolates of Legionella pneumophila serogroup 1 strains from various parts of peninsular Malaysia

Legionella pneumophila are intracellular pathogens, associated with human disease, attributed to the presence and absence of certain virulent genes. In this study, virulent gene loci (lvh and rtxA regions) associated with human disease were determined. Thirty-three cooling tower water isolates, isolated between 2004 to 2006, were analyzed for the presence of these genes by PCR method. Results showed that 19 of 33 (57.5%) of the L. pneumophila serogroup 1 isolates have both the genes. Six (18.2%) of the isolates have only the lvh gene and 2 (6.1%) of the isolates have only the rtxA gene. However, both genes were absent in 6 (18.2%) of the L. pneumophila isolates. The result of our study provides some insight into the presence of the disease causing L. pneumophila serogroup 1 in the environment. Molecular epidemiological studies will provide better understanding of the prevalence of the disease in Malaysia.