No abstract

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient’s hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient’s condition worsened, and she succumbed to death on day 7 of hospitalization.

Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P < 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey. C. difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

Conclusion: This is a rare clinical manifestation of Tuberculous meningitis that demonstrates the importance of recognising and initiating the treatment early to reduce disabilities and improve clinical outcome.

Background The recent epidemic of dengue fever (DF) in Malaysia was alarming. The treatment of DF remains supportive as there is no anti-viral agent or vaccine available as yet. Traditional and complementary medicine (T&CM) provides an alternative option for the treatment of DF but there is limited evidence with regard to its usage. The aim of this study was to determine the prevalence, types and predictor factors of T&CM usage among DF patients in the northeast region of Peninsular Malaysia. Methodology This was a cross-sectional study of DF patients in the northeast region of Peninsular Malaysia who had been admitted to a tertiary centre from January 2014 until December 2015. Serologically-confirmed DF patients aged 18 years and above were randomly selected. Phone interviews were conducted to obtain information regarding the use of T&CM during hospitalisation. Notes were made regarding the prevalence and type of T&CM used. Binary logistic regressions were used to identify the predictor factors of T&CM usage. Results A total of 241 DF patients with a mean age of 36.62 (SD = 14.62) years were included. The estimated prevalence of T&CM usage was 84.6% (95%CI: 80.1%, 89.2%). The most common T&CM used were crab soup (85.3%), papaya leaf extract (64.2%) and isotonic drinks (61.8%). The significant predictors for T&CM usage were age [adjusted odds ratio (AOR) 0.97; 95%CI: 0.94, 0.99], tertiary education (AOR 3.86; 95%CI: 1.21, 12.32) and unemployment (AOR 2.55; 95%CI: 1.02, 6.42). Conclusion The prevalence of T&CM usage in our population is high. Age, tertiary education and unemployment influence the use of T&CM.