RESUMEN
Intro: Kodamaea ohmeri, previously known as Pichia ohmeri, is an ascomycetous yeast that has emerged as an important cause of fungemia in immunocompromised patients. During the anamorphic stage this organism is also known as Candida guillermondii var. membranaefaciens. Method(s): We report five cases of Kodamaea ohmeri encountered from multicenter in Malaysia. Antifungal agent of choice will be discussed based on literature review. Finding(s): The cases were: (1) a contaminated peritoneal fluid in an adult patient on peritoneal dialysis;(2) a 60-year-old man with infected diabetic foot isolated K. ohmeri from a bone sample. Both cases discharged well without active antifungal fungal therapy. We observed fatality cases involving (3) an old man with underlying gastric adenocarcinoma who complicated with catheter- related bloodstream infection caused by K. ohmeri;(4) a patient with ventilator- associated pneumonia and septicaemic shock secondary to perforated terminal ileum;(5) and a severely ill COVID-19 stage 5b patient who passed away due to systemic fungaemia caused by K. ohmeri. Discussion(s): All three fatal cases received either amphotericin B or caspofungin as active antifungal agent. Literature evidence has shown that 40% of patient met demise despite on active antifungal agent, suggesting that currently no definitive antifungal agent proven to be a superior treatment option for K. ohmeri infection. Removal of indwelling medical device combined with antifungal therapy has favorable clinical outcome. Conclusion(s): Therefore, K. ohmeri infection in severely ill patients should be considered as a critical condition. Potential of alternative antifungal combinations need to be explored for an effective treatment option.Copyright © 2023
RESUMEN
Intro: Leptospirosis is an emerging zoonosis with a global health concern. In Malaysia, leptospirosis incidence remains significant, since its first gazettement as a compulsorily notifiable disease in 2010. However, the prevalence of this disease among local forensic cases is unknown. Therefore, the present study aimed to determine the frequency of human leptospirosis among post-mortem specimens. Method(s): Archived forensic specimens referred to the Institute for Medical Research (IMR), Malaysia between January 2020 and December 2021 were retrieved. DNA from the specimens were extracted using an automated MagNA Pure 96 instrument and subjected to in-house qPCR targeting LipL32 gene and 16S rRNA gene of the pathogenic group of Leptospira spp. Amplification of RNaseP gene was included as internal amplification control (IAC). Finding(s): A total of 408 forensic specimens from 365 patients were received during the study period. Majority of the specimens were blood (n = 195, 47.8%), followed by tissue (n = 136, 33.3%) and liver (n = 59, 14.5%). Of the tested specimens, 2.2% (n = 9) were positive for leptospiral DNA. These positive specimens belonged to 9 different patients, of which the vast majority were male (n = 8, 88.9%), with an average age of 37.5 years. Conclusion(s): Albeit low detection of leptospiral DNA among forensic specimens in Malaysia, this study highlighted that majority of the positive patients were males of productive age.Copyright © 2023
RESUMEN
This study aimed to show the incidence, presentation, management, and outcome of acute limb ischemia (ALI) in patients diagnosed with COVID-19 pneumonia, and prove the association between them. A multi-centre retrospective cohort study in the middle and south of Iraq, comparing 400 patients admitted to the isolation hospitals for COVID-19 pneumonia with a matched control group at period from 1stJune 2020 to 1stAugust 2020. A total of 21/400 cases of ALI in COVID-19 pneumonia and only 4/400 cases in the non-COVID-19 group. Relative Risk (Risk Ratio= 5.25, 95%CI=1.818-15.157, P = 0.001). There were 291 (72.7%) males and 109 (27.2%) females. The average time from diagnosis of COVID-19 to the onset of ALI was (9.4±6.4 days). The mean ischemic time was (22.05 ±18.8 hours) in the COVID-19 group, while it was (11.75±8.7 hours) in the non-COVID-19 group. The mean D-dimer level for the patient with COVID-19 pneumonia without ALI is (1705±1256 μg/L), while it is (3730±2373 μg/L) for the patient with COVID-19 pneumonia. The embolectomy done in 14 patients (66.6%) of the COVID-19 pneumonia group, and it was successful in 10 patients (71.4%). In comparison, it was done in 3 patients (75%) of the control group and was successful in 2 (66.6%). Amputation was done in 4 patients (19%) of the COVID-19 pneumonia group, while only one patient (25%) in the control group had amputation. The association between COVID-19 pneumonia and ALI incidence;the D-dimer level is also associated with ALI in COVID-19 pneumonia cases. The anticoagulants, antiplatelet, vasodilators, and embolectomy had a management success rate. © 2021. All Rights Reserved.