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@#The HACEK organisms consist of the non-influenzae Haemophilus sp., Aggregatibacter sp., Cardiobacterium sp., Eikenella corrodens and Kingella sp. are responsible for a sizable percentage of infective endocarditis cases worldwide with the mortality rate of 18%. Amongst them, Aggregatibacter actinomycetemcomitans is the most common pathogen strongly associated with infective endocarditis. A. actinomycetemcomitans forms part of the oral microbiota and is also the etiological agent of periodontitis. Here, we present a case of a 37-year-old man with underlying obstructive uropathy, that sought treatment for postural hypotension and symptomatic anaemia with fever. Later, he had developed decompensated congestive cardiac failure with aortic regurgitation. A cardiac echocardiogram revealed the presence of vegetation on the aortic valve. Blood culture grew A. actinomycetemcomitans, and he was treated with furosemide and ceftriaxone. A further dental examination showed the patient is having chronic periodontitis, which could be the possible source of A. actinomycetemcomitans causing infective endocarditis. The patient was then transferred to the National Heart Centre for the first time for further management after completion of 4 weeks of intravenous antibiotics. As the pathogen is fastidious, rapid and newer technology like MALDI-TOF mass spectrometry provides rapid and accurate identification for appropriate patient clinical management.
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@#Introduction: Musical-based education has been linked with improved students’ academic performance and mental wellbeing. This study aimed to evaluate a musical-based anatomy learning module using the combination of music, choreographed movements and 3D anatomy illustrations on muscles of the hand. Methods: A 5-minute duration video on muscles of the hand was developed through series of discussions with expert panels to incorporate the three stated components, emphasizing on the use of catchy music and simple terms to assist memorization skills. A single arm quasi-experimental pilot study was conducted with pre- and post-intervention measurement of knowledge, perception, stress and happy index related to learning anatomy. A total of 157 medical students were recruited and exposed to a total of 20 minutes video duration over three days. The effectiveness of the intervention was investigated using paired t-test and was interpreted based on the pre- and post-measured exposure mean differences. Results: The newly developed musical-based anatomy learning module had effectively improved knowledge and happy index related to learning anatomy, with significant mean differences were observed on the total mean scores for knowledge (MD= 2.707, p< 0.001) and happy index (MD=3.256, p< 0.001), as well as significant reduction of the mean scores for the negative items for perceptions and stress. Conclusion: The improved knowledge and happy index related to learning anatomy reflecting the positive impact of music used in combination choreographed movements and 3D illustrations to strengthen memorizing skills of medical students as well as instilling positive mood.
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@#Cardiobacterium hominis is part of HACEK group and an atypical cause of infective endocarditis. It may cause similar clinical presentation to other cause of endocarditis. Establishing the diagnosis is challenging as it is a fastidious organism which rarely affects individual without previous cardiac lesion and requires advanced diagnostic tools for identification of species. A 23-year-old previously healthy man presented with intermittent fever for two months associated with palpitations and lethargy. He had undergone a dental procedure four months before the presenting symptoms. Physical examination revealed a pansystolic murmur best heard over the apex. Three aerobic blood culture bottles were positive and Gram stain consistently showed pleomorphic Gram-negative rods. The organism grew as tiny pin-point opaque colonies on sheep blood agar and chocolate agar after 48 hours of incubation but no growth was seen on MacConkey agar. Unsuccessful identification with VITEK 2 NH and VITEK 2 GN was later confirmed by polymerase chain reaction as C. hominis. He was treated with a six-week course of antibiotics.
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@#Introduction: Music has been widely used in teaching and learning due to its observed positive effects. This review aimed to identify the beneficial impacts of music utilization in medical education. Methods: Using four established databases; Scopus, ScienceDirect, JSTOR and PubMed, exhaustive searched of related articles were performed for articles published between January 2010 and January 2020 using combination of keywords. Screening of titles and abstracts were conducted, with removal of duplicates. Results: Five full text articles were finally reviewed, of which one cross-sectional, three intervention and a qualitative studies. Consensus between authors had successfully identified three themes, which were positive effect of music on the well-being and performance of the medical students, as well as improved patient-doctor communication skills. Conclusion: The findings of the review confirmed the positive effects of music utilization on the well-being and performance of medical students, as well as on patient-doctor communication skills.
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@#A case of a toxigenic strain of Corynebacterium diphtheriae in an immunocompetent adult is presented, with the possibility of the adult acquiring the infection from her unvaccinated child. The abovementioned adult is a 29-year-old housewife who was previously immunised with diphtheria, tetanus, and pertussis (DTaP) vaccination in childhood, who presented fever, cough, sore throat, hoarseness of voice, odynophagia, and bilaterally enlarged tonsils. A throat swab confirmed the presence of toxigenic Corynebacterium diphtheriae. The patient was given 80,000 international units (IU) dose of diphtheria antitoxin (DAT) and treated with 2.4 million units (MU) QID intravenous penicillin and oral erythromycin 800 mg twice daily for two weeks. The patient responded well to the treatment and recovered with no cardiovascular or neurotoxicity.
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@#Introduction: Coagulase-negative staphylococci (CoNS) is often considered as a culture contaminants but it can potentially be pathogenic to patients with risk factors. A combination of species identification and clinical criteria has been suggested in determining true CoNS bacteraemia. Objectives: To identify the species distribution, antibiotic susceptibility patterns and clinical profiles of CoNS isolated from blood cultures among paediatric patients in Hospital Kuala Lumpur (HKL). Methods: This study involved CoNS isolation from blood cultures of paediatric in-patients of the Paediatric Institute HKL. Isolates were identified to species level using Analytical Profile Index Staph identification strips and antimicrobial susceptibility pattern following Kirby-Bauer Disc Diffusion method. The clinical profiles of patients were obtained from their medical records. Results: Eleven CoNS species were identified from 148 isolates. Staphylococcus epidermidis was the most frequent species isolated (67.6%). The majority of the isolates showed resistance to penicillin (85.8%); while 70.3% were methicillin-resistant (MR) CoNS, which demonstrated a significant association with true infection (p=0.021). Predictors for significant CoNS infection included thrombocytopaenia, presence of predisposing factors, nosocomial infection, blood collected from peripheral vein, and CoNS isolated from two consecutive blood cultures. The most common predisposing factors for the isolation of CoNS were the presence of peripheral (54.1%) and central venous catheters (35.1%). Conclusion: CoNS can cause significant bloodstream infections. The isolation of CoNS from blood cultures should be carefully interpreted by considering the predictive factors. Local data regarding predictive factors of patients with culture-positive CoNS, species distribution and antimicrobial susceptibility pattern are useful to determine the significance of blood culture results and care management of patients
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@#We report a rare case of Ochrobactrum anthropi bacteremia in a previously healthy young man who was admitted for severe dengue. O. anthropi is a rarely encountered Gram negative organism which is resistant to commonly used beta-lactam antibiotics. This organism is usually interpreted as a contaminant as it is ubiquitous in the environment. Isolation of this organism upon admission suggested a community-acquired infection. He had persistent bacteremia and had to be treated with a prolonged course of meropenem and ciprofloxacin. This case report highlights the importance of early diagnosis and prompt treatment of this otherwise contaminant as previous reports showed this organism can be an opportunistic pathogen which may lead to severe infection.
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@#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 intracerebral 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.
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@#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.
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Coagulase-negative staphylococci (CoNS) are considered low pathogenic organisms. However, they are progressively causing more serious infections with time because they have adapted well to various antibiotics owing to their ability to form biofilms. Few studies have been conducted on CoNS in both, hospital and community-acquired settings, especially in Malaysia. Thus, it is important to study their species and gene distributions. A mobile genetic element, staphylococcal cassette chromosome mec (SCCmec), plays an important role in staphylococci pathogenesis. Among CoNS, SCCmec has been studied less frequently than Staphylococcus aureus (coagulase-positive staphylococci). A recent study (8) conducted in Malaysia successfully detected SCCmec type I to VIII as well as several new combination patterns in CoNS species, particularly Staphylococcus epidermidis. However, data are still limited, and further research is warranted. This paper provides a review on SCCmec types among CoNS species.