This is a report of a case of vulvovaginitis due to Shigella flexneri in a three-year-old child. This is probably the first documented case of shigella vulvovaginitis In Malaysia. The patient was successfully treated with cotrimoxazole. Extraintestinal infections by Shigella are rare and are briefly reviewed in this article.
The usefulness of counterimmunoelectrophoresis (CIEP) and coagglutination (COAG) methods in the diagnosis of bacterial meningitis was evaluated. Out of the 31 cerebrospinal fluid (CSF) specimens which had a cell count of >5 x10^6 wbc/l and were negative on gram stain and culture, pneumococcal antigens were detected in four specimens and Haemophilus influenzae type b antigen was detected in one specimen by both the methods. No false positives were detected in 10 specimens obtained from cases of febrile fits whose CSF showed no evidence of meningitis. One CSF sample, from which Klebsiella spp. was isolated, cross reacted with the meningococcal polyvalent group A-D antiserum in the CIEP test. From this study we found that these methods are rapid, simple and useful adjunctive tests In the diagnosis of bacterial meningitis, especially in the partially treated cases.
The current drugs recommended for treatment of melioidosis are tetracycline, chloramphenicol and cotrimoxazole. Unfortunately these drugs are not the drug of choice in an acutely ill patient with septicaemia prior to the availability of laboratory results. With the discovery of the new cephalosporins which have a broad spectrum of activity clinicians are using them either alone or in combination with other antibiotics in such critical situations. Hence, an in-vitro study was carried out on the susceptibility of 41 strains of P. pseudomallei isolated in Malaysia, to these new cephalosporins and a new quinolone. The results showed that all the cephalosporins tested had some activity on the strains tested, with ceftazidime being the most active drug. Pefloxacin had very poor activity. However, further clinical studies are required to determine the duration, dosage and in-vivo activity of the antibiotics.
Thirty six clinical isolates of Cryptococcus neoformans were tested for their susceptibility to 5-fluorocytosine and amphotericin B by the determination of minimum inhibitory concentrations and minimum fungicidal concentrations. 22.2% of the isolates were resistant to 5-fluorocytosine and 36.1% indicated 5-fluorocytosine tolerance. All strains were sensitive to amphotericin B.
The prevalence of Enterotoxigenic Escherichia coli (ETEC) in 433 stool samples from diarrhoeal cases of all ages was studied using two commercially available test kits for the detection of heat labile toxin (LT) and the infant mouse assay for the heat stable toxin (ST). 16 samples (3.7%) were positive for ETEC, of which nine were producing ST alone, six LT alone and only one was producing both LT and ST. Although the percentage of isolation rate was low, its occurrence was almost as common as the Shigella spp and Salmonella spp in the same study. Of the two test kits examined, the Phadebact ETEC-LT Test 50 (Pharmacia Diagnostics, Uppsala, Sweden) was found to be more suitable for use in a routine diagnostic laboratory. Ten out of 12 (83%) of the strains tested were resistant to one or more antibiotics.
Between January and August, 1989, 36 men and 28 women with uncomplicated lower genital tract infections by Neisseria gonorrhoeae were given single intramuscular injections of sulbactam (500 mg)/ampicillin (1000 mg) together with 1 g oral probenecid. Cure rates that were obtained were 100% for women, 97.2% for men, 100% for patients with penicillinase-producing Neisseria gonorrhoeae (PPNG), and 98.4% for patients with non-PPNG. No serious side effects were encountered, and patient acceptance of the drug was good. A high proportion of patients had concurrent chlamydial infection. Sulbactam/ampicillin was found to be effective against gonococcal urethritis and cervicitis by both PPNG and non-PPNG but have little effect on concomitant chlamydial infections, especially in women.
The microbial aetiology of genital ulcers was studied in 249 patients (241 men and 8 women) attending a Sexually Transmitted Disease Clinic in Kuala Lumpur, Malaysia. Herpes simplex virus type 2 was isolated in 48 (19.2%) patients, Haemophilus ducreyi from 22 (8.8%), Neisseria gonorrhoeae from seven (2.8%) and Chlamydia trachomatis from four (1.6%). Syphilis was diagnosed in 18 (7.2%) patients on the basis of dark field microscopy. Two (0.8%) patients were found to have both chancroid and syphilis and one (0.5%) had both gonorrhoea and syphilis. No organism was isolated in the remaining 151 (61.5%) patients. Overall, the accuracy of clinical diagnosis was 58% for single infection, 67% for herpes, 63% for syphilis, 47% for chancroid and 0% for lymphogranuloma venereum. Therefore, our study confirms the need for laboratory tests to diagnose accurately the aetiology of genital ulcer disease.
Vaginal discharge is a common complaint of women attending gynaecological clinics. The purpose of this study was to compare the occurrence of commonly implicated microorganisms in vaginal discharge amongst women with or without the complaint, attending a gynaecological and family planning clinic. The association of Gardnerella vaginalis with bacterial vaginosis was also studied. It was found that there were no significant differences between the cases and controls in the isolation rate of Gardnerella vaginalis, Torulopsis glabrata, Ureaplasma urealyticum, Mycoplasma ssp and Group B streptococcus (p greater than 0.05). Only the isolation rate of Candida albicans was significantly higher in the cases than controls (p less than 0.01). However, there was a significant association of G. vaginalis with bacterial vaginosis.
A turnaround time study was conducted for bacteriological culture tests in seven Malaysian general hospitals. The turnaround times were determined using a specially designed form that was completed by the ward staff. Doctors at these hospitals were also polled to find out whether they were satisfied with the promptness of bacteriological test reporting in their hospitals. The turnaround times obtained from this survey were found to be satisfactory taking into account the constraints of laboratory methods employed. Nevertheless only about a third of doctors expressed satisfaction with the timeliness of the bacteriological test reporting. Doctors and microbiologists should get together and agree on acceptable standards of turnaround times that are practical and reasonable.
A dot-immunobinding assay (DIBA) was compared with a direct fluorescent antibody technique (DFAT) for the detection of Rickettsia tsutsugamushi infection in Leptotrombidium fletcheri (Womersley & Heaslip). Laboratory colonies of infected and noninfected chiggers were examined. The relative proportions of positive, negative, and indeterminate results were significantly different between DIBA and DFAT for infected but not for noninfected chiggers. DIBA was more sensitive and had a better negative predictive value and a lower false negative percentage than DFAT. It was concluded that DIBA is a suitable alternative to DFAT for detecting scrub typhus infection in chiggers.
Forty-four serum samples of various reactivities to rickettsial antigens demonstrated by the indirect immunoperoxidase technique were tested with INDX Dip-S-Ticks (INDX Integrated Diagnostics Inc., USA) Kit for the detection of tick borne diseases. The kit utilised Rickettsia rickettsii the causative agent of Rocky Mountain spotted fever (RMSF) as antigens. The samples positive for endemic typhus were also tested against R. typhi, the agent for endemic typhus by the same method. The aim of this study was to determine the extent of cross-reactivity of R. rickettsii with rickettsial infections in Malaysia. Nine out of 12 tick typhus, 4 out of 10 scrub typhus and 4 out of 12 endemic typhus samples cross reacted with R. rickettsii. Ten out of 12 endemic samples were positive with R. typhi by the same method. From the study, we concluded that the INDX Dip-S-Ticks Kit can be used as a rapid screening test to detect endemic and tick-borne rickettsial infections in Malaysia but a second serological test is strongly recommended on all weakly reactive cases.
A first case of Chlamydia pneumoniae pneumonia in Malaysia is reported. The diagnosis was made by a significant change in C. pneumoniae antibody titre. The infection responded well to a course of erythromycin.
Binding studies of 160 overlapping, synthetic octapeptides from the hydrophilic regions of the Sta58 major outer membrane protein of Rickettsia tsutsugamushi with sera from patients with scrub typhus revealed 15 immunodominant peptides which are recognized by all the sera tested. Further analysis of the specificity of peptide binding with five of these peptides indicated that the peptides showed significantly stronger binding to scrub typhus patients' sera than they did to sera from patients with other febrile illnesses common in the region, i.e., malaria, dengue fever, typhoid fever, and leptospirosis. The main antibody class binding to these peptides appears to be immunoglobulin M, and there appears to be little correlation between reactivity with peptides and antibody titers measured by the indirect immunoperoxidase test.