Helmi Sulaiman

Severe Plasmodium falciparum infection mimicking acute myocardial infarction

This case report describes a case of presumed acute myocardial infarction in a returned traveler who was later diagnosed to have severe malaria. Emergency coronary angiography was normal and subsequent peripheral blood film was positive for Plasmodium falciparum.

Cervical abscesses due to co-infection with Burkholderia pseudomallei, Salmonella enterica serovar Stanley and Mycobacterium tuberculosis in a patient with diabetes mellitus

BackgroundInfections due to Mycobacterium tuberculosis, Burkholderia pseudomallei and non-typhoidal Salmonella cause significant morbidity and mortality throughout the world. These intracellular pathogens share some common predisposing factors and clinical features. Co-infection with two of these organisms has been reported previously but, to our knowledge, this is the first time that infection with all three has been reported in one person.Case presentationIn September 2010, a 58-year-old diabetic Malaysian male presented with fever and a fluctuant mass on the right side of his neck. B. pseudomallei was isolated from an aspirate of this lesion and there was radiological evidence of disseminated infection in the liver and spleen. The recurrence of clinical symptoms over ensuing months prompted further aspiration and biopsy of a cervical abscess and underlying lymph nodes. Salmonella enterica serovar Stanley and then M. tuberculosis were identified from these specimens by culture and molecular methods. The patient responded to targeted medical management of each of these infections.ConclusionIn endemic settings, a high index of suspicion and adequate tissue sampling are imperative in identifying these pathogenic organisms. Diabetes was identified as a predisposing factor in this case while our understanding of other potential risk factors is evolving.

Pharmacokinetic/pharmacodynamics-optimized antimicrobial therapy in patients with hospital-acquired pneumonia/ventilator-associated pneumonia

Abstract Hospital‐acquired pneumonia and ventilator‐associated pneumonia continue to cause significant morbidity and mortality. With increasing rates of antimicrobial resistance, the importance of optimizing antibiotic treatment is key to maximize treatment outcomes. This is especially important in critically ill patients in intensive care units, in whom the infection is usually caused by less susceptible organisms. In addition, the marked physiological changes that can occur in these patients can cause serious changes in antibiotic pharmacokinetics which in turn alter the attainment of therapeutic drug exposures. This article reviews the various aspects of the pharmacokinetic changes that can occur in the critically ill patients, the barriers to achieving therapeutic drug exposures in pneumonia for systemically delivered antibiotics, the optimization for commonly used antibiotics in hospital‐ and ventilator‐associated pneumonia, the agents that should be avoided in the treatment regimen, as well as the use of adjunctive therapy in the form of nebulized antibiotics.

Human papillomavirus 16 (HPV16) and HPV52 E6-specific immunity in HIV-infected adults on combination antiretroviral therapy.

Human papillomavirus (HPV)‐associated cancers disproportionately affect those infected with HIV despite effective combination antiretroviral therapy (cART). The primary aim of this study was to quantify HPV16 and HPV52 E6‐specific interferon (IFN)‐γ enzyme‐linked immunospot (ELISPOT) T‐cell responses, a correlate of protective immunity, in the first year following cART initiation and subsequently in those patients with suboptimal (sIR) and optimal (oIR) immune reconstitution.

Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients?

Tenofovir disoproxil fumarate (TDF) is the recommended first‐line nucleoside reverse transcriptase inhibitor (NRTI) in the management of human immunodeficiency virus (HIV); however, its use is associated with nephrotoxicity.

First report of cervicofacial lymphadenitis due to Mycobacterium haemophilum in an immunocompromised adult patient.

We report the first case of an immunocompromised adult patient presenting with cervicofacial lymphadenitis due to Mycobacterium haemophilum, confirmed using hsp65 gene sequencing and line-probe assays. In resource-limited settings, especially in developing countries, appropriate culture methods and rapid molecular diagnostic tools such as hsp65 gene sequencing for identification of this organism may not be readily available. This may cause M. haemophilum infections to go unrecognised or lead to delays in diagnosis. Lack of heightened awareness about the potential for this mycobacterial species to cause infections may also contribute to possible underestimation of M. haemophilum cases in the developing world.

Photo quiz. A painful and disfiguring lesion on the face.

A 37-year-old Nigerian man presented to us with a disfiguring lesion on his upper lip, which was described as painful and nonpruritic for 6 months’ duration. The lesion began on the skin above the right upper lip, and gradually increased in size to involve the right upper lip and nasal cavities. The lesion was tender and resulted in dysphagia, odynophagia, and dysphonia. The patient was anorexic and reported a 20-kg weight loss. He denied fever, cough, nausea, diarrhea, and other skin lesions. Prior to presenting to us, the patient had been evaluated and treated without improvement by several local general practitioners and ear, nose, and throat consultants. Treatment included analgesics and oral antibacterial and antiviral agents. Examination at University Malaya Medical Centre revealed an extremely tender ulcerating mass involving the patient’s right upper lip and extending into both nostrils (Figure 1A). There was serous discharge with overlying crust formation, with encroachment and Figure 1. A, Appearance of the lesion at time of presentation. B, Hematoxylin and eosin stain of the biopsy of the lesion (magnification ×400). C, Gomori methenamine silver stain of the biopsy of the lesion (magnification ×400).