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Fulltext A Rare Presentation of Tubercular Meningitis as Persistent Neutrophilic Meningitis

Ralot T, Bafna C, Singh S, Sharma S

Malays J Med Sci, 2017 Dec;24(6):103-106.
PMID: 29379393 DOI: 10.21315/mjms2017.24.6.13

Persistent neutrophilic meningitis is an atypical form of chronic meningitis defined as clinical meningitis with a cerebrospinal fluid (CSF) analysis suggestive of neutrophilic pleocytosis that persists for more than one week despite giving empirical antimicrobial therapy. The predominant presentation of tubercular meningitis is with CSF lymphocytic pleocytosis and even if early phase of the disease presents with neutrophilic pleocytosis, no persistence is usually observed for more than one week. We hereby report the case of an immunocompetent man aged 25 years with tubercular meningitis manifesting as persistent neutrophilic meningitis which is very rare as an entity in tubercular meningitis (TBM). Patient was started on anti-tubercular therapy based on the granulomas in magnetic resonance imaging (MRI) of the brain after which there was a reduction in total cell count in CSF but persisting neutrophilic predominance. Patient improved clinically and was given a full course of anti-tubercular treatment (ATT) thereafter.

Matched MeSH terms: Anti-Bacterial Agents
Antimicrobial Susceptibility Patterns of an Emerging Multidrug Resistant Nosocomial Pathogen: Acinetobacter baumannii

Tewari R, Chopra D, Wazahat R, Dhingra S, Dudeja M

Malays J Med Sci, 2018 May;25(3):129-134.
PMID: 30899194 DOI: 10.21315/mjms2018.25.3.13

Multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii) bacterium, a nosocomial pathogen associated with a high mortality rate and limited therapeutic options have emerged as a serious problem throughout the world. The present study aimed to assess the current levels of antibiotic susceptibility among the isolates of Acinetobacter species. The sensitivity patterns were analysed from various clinical specimens obtained from both in-patients and outpatients of a teaching hospital. Isolation was performed on 5% sheep blood agar and MacConkey agar. Urine samples were inoculated into CLED agar. Antibiotic susceptibility was performed by the disc diffusion method. A total of 16,452 samples were collected. The total number of samples positive for Acinetobacter species was 67 (0.4%). The highest number of isolates 26 (38.8%) were obtained from urine. Majority 80.3% of the isolates exhibited resistance to three or more classes of antibiotics. All isolates were susceptible to colistin (100%). The susceptibility rate of A. baumannii isolates was 80% for tigecycline and 53.3% for carbapenem. Combination therapies including colistin and tigecycline seem to be the rational treatment for MDR A. baumannii until new alternatives come forward.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Knowledge and attitudes concerning antibiotic use and resistance among the public in Pulau Pinang, Malaysia

Halim NAAA, Chang CT, Chan HK, Hassali MA, Nouri A

Malays J Med Sci, 2018 Nov;25(6):141-147.
PMID: 30914888 MyJurnal DOI: 10.21315/mjms2018.25.6.15

The aim of this cross-sectional study was to evaluate the knowledge and attitudes concerning antibiotic use and resistance among members of the local community in Pulau Pinang, Malaysia. The study was conducted among 326 residents of the Jelutong district, Pulau Pinang state, from August to October 2013. A self-administered five-part questionnaire was used for the data collection. The respondents exhibited inadequate knowledge of antibiotics in general. Approximately 80% of them did not know the indications for antibiotic use, while 76% believed that antibiotics were useful in terms of resolving viral fever. Additionally, 52.6% believed that antibiotics could be used to treat all types of infections. Inadequate knowledge of antibiotic resistance was also evident among the respondents, since 72.9% of them did not agree that resistant bacteria can spread from human or animal to human, while 32% were unaware that bacteria can develop resistance to antibiotics. More than 60% of respondents admitted that they took antibiotics in order to accelerate their recovery from illness, while 34.8% claimed that they only stopped taking antibiotics when they felt better. The findings hence indicate that most respondents had poor knowledge and attitudes concerning antibiotic use and resistance, which suggests the need for more community-based educational campaigns designed to improve the public's knowledge and attitudes regarding antibiotics.
Study site: General public, Jelutong district, Pulau Pinang, Malaysia

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Antimicrobial activities of green synthesized gums-stabilized nanoparticles loaded with flavonoids

Anwar A, Masri A, Rao K, Rajendran K, Khan NA, Shah MR, et al.

Sci Rep, 2019 02 28;9(1):3122.
PMID: 30816269 DOI: 10.1038/s41598-019-39528-0

Herein, we report green synthesized nanoparticles based on stabilization by plant gums, loaded with citrus fruits flavonoids Hesperidin (HDN) and Naringin (NRG) as novel antimicrobial agents against brain-eating amoebae and multi-drug resistant bacteria. Nanoparticles were thoroughly characterized by using zetasizer, zeta potential, atomic force microscopy, ultravoilet-visible and Fourier transform-infrared spectroscopic techniques. The size of these spherical nanoparticles was found to be in the range of 100-225 nm. The antiamoebic effects of these green synthesized Silver and Gold nanoparticles loaded with HDN and NRG were tested against Acanthamoeba castellanii and Naegleria fowleri, while antibacterial effects were evaluated against methicillin-resistant Staphylococcus aureus (MRSA) and neuropathogenic Escherichia coli K1. Amoebicidal assays revealed that HDN loaded Silver nanoparticles stabilized by gum acacia (GA-AgNPs-HDN) quantitatively abolished amoeba viability by 100%, while NRG loaded Gold nanoparticles stabilized by gum tragacanth (GT-AuNPs-NRG) significantly reduced the viability of A. castellanii and N. fowleri at 50 µg per mL. Furthermore, these nanoparticles inhibited the encystation and excystation by more than 85%, as well as GA-AgNPs-HDN only completely obliterated amoeba-mediated host cells cytopathogenicity. Whereas, GA-AgNPs-HDN exhibited significant bactericidal effects against MRSA and E. coli K1 and reduced bacterial-mediated host cells cytotoxicity. Notably, when tested against human cells, these nanoparticles showed minimal (23%) cytotoxicity at even higher concentration of 100 µg per mL as compared to 50 µg per mL used for antimicrobial assays. Hence, these novel nanoparticles formulations hold potential as therapeutic agents against infections caused by brain-eating amoebae, as well as multi-drug resistant bacteria, and recommend a step forward in drug development.

Matched MeSH terms: Anti-Bacterial Agents/administration & dosage*; Anti-Bacterial Agents/pharmacology; Anti-Bacterial Agents/chemistry
Fulltext Endophytic bacteria as a source of novel antibiotics: An overview

Christina A, Christapher V, Bhore SJ

Pharmacogn Rev, 2013 Jan;7(13):11-6.
PMID: 23922451 DOI: 10.4103/0973-7847.112833

World human population is increasing with an alarming rate; and a variety of new types of health issues are popping up. For instance, increase in number of drug-resistant bacteria is a cause of concern. Research on antibiotics and other microbial natural products is pivotal in the global fight against the growing problem of antibiotic resistance. It is necessary to find new antibiotics to tackle this problem. The use of therapeutic plant species in traditional medicine is as old as mankind; and currently, it is strongly believed that all types of plant species across the plant kingdom do harbour endophytic bacteria (EB). The natural therapeutic compounds produced by EB do have several potential applications in pharmaceutical industry. The EB derived natural products such as Ecomycins, Pseudomycins, Munumbicins and Xiamycins are antibacterial, antimycotic and antiplasmodial. Some of these natural products have been reported to possess even antiviral (including Human Immunodeficiency Virus (HIV)) properties. Therefore, to deal with increasing number of drug-resistant pathogens EB could serve as a potential source of novel antibiotics.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Antibiotics in surgical wards: use or misuse? A newly industrialized country's perspective

Lim MK, Lai PSM, Ponnampalavanar SS, Syed Omar SF, Taib NA, Yusof MY, et al.

J Infect Dev Ctries, 2015 Nov 30;9(11):1264-71.
PMID: 26623636 DOI: 10.3855/jidc.6731

INTRODUCTION: Studies exploring the appropriateness of therapeutic antibiotic use among surgical patients are limited, particularly in developing countries. Therefore, the aim of our study was to determine the appropriateness of antibiotics prescribed in a surgical setting in Malaysia.
METHODOLOGY: A prospective observational study was conducted in two surgical wards at a tertiary hospital in Malaysia from November 2012-July 2013. Data was collected using a case report form. The appropriateness of antibiotic therapy was based on compliance with either the Malaysian National Antibiotic Guidelines 2008 or International Clinical Practice Guidelines and determined by an expert panel (consisting of two infectious disease consultants and a pharmacist).
RESULTS: Over the study period, a total of 593 antibiotic courses were prescribed for 129 patients (4.6±3.4 antibiotics/patient). Only 34 (26.4%) patients received appropriate antibiotic therapy, whilst 95 (73.6%) patients received at least one course of inappropriate antibiotic therapy. The prevalence of inappropriate antibiotic use was 214 (66.3%) and 55 (42.0%) for prophylactic and therapeutic purposes, respectively. The most common causes of inappropriate prophylactic antibiotics were inappropriate timing 20 (36.4%) and inappropriate duration of prophylaxis 19 (34.5%). In cases of inappropriate timing, 9 (45%) were administered too late while 6 (30%) were too early. In contrast, inappropriate choice of antibiotics (42.1%) and inappropriate indication (40.7%) were the most common reasons encountered for inappropriate therapeutic antibiotics.
CONCLUSION: Our study suggests considerable inappropriate use of both prophylactic and therapeutic antibiotics in the surgical wards; highlighting an urgent need for antibiotic stewardship initiatives in this setting.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
Fulltext Cutaneous melioidosis in a healthy Danish man after travelling to South-East Asia

Bodilsen J, Langgaard H, Nielsen HL

BMJ Case Rep, 2015 Jan 16;2015.
PMID: 25596295 DOI: 10.1136/bcr-2014-207340

A healthy Danish man presented with infected prepatellar bursitis 8 months after being involved in a car accident in Malaysia resulting in exposure of a laceration of his knee to stagnant water. Tissue samples grew Burkholderia pseudomallei and diagnostic work up revealed no secondary foci. The patient was successfully treated with surgical debridement and 3 months of oral trimethoprim-sulfamethoxazole. At 6 months follow-up the patient was without relapse.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use
Fulltext Efficacy of azithromycin in the treatment of bronchiectasis

Lourdesamy Anthony AI, Muthukumaru U

Respirology, 2014 Nov;19(8):1178-82.
PMID: 25183304 DOI: 10.1111/resp.12375

We evaluated the efficacy of a 12-week oral treatment with azithromycin in adult patients with bronchiectasis. The objectives were to demonstrate that this treatment reduces sputum volume, improves quality of life and to assess the lengths of effects after cessation of therapy.

Matched MeSH terms: Anti-Bacterial Agents/administration & dosage
Should all children admitted with community acquired pneumonia have blood cultures taken?

Lai EM, Nathan AM, de Bruyne JA, Chan LL

Indian J Pediatr, 2015 May;82(5):439-44.
PMID: 25179241 DOI: 10.1007/s12098-014-1565-6

OBJECTIVE: To evaluate the yield of blood cultures and the impact of blood culture results on the adjustment of empiric antibiotic treatment in children hospitalised with community acquired pneumonia (CAP).
METHODS: This was a prospective study conducted at a tertiary hospital in Malaysia, from 1st August 2010 until 31st July 2011. Children aged between 1 mo and 12 y who were admitted for CAP and had blood cultures performed before starting intravenous antibiotics were recruited. Children with congenital pneumonia, immunodeficiency, chronic cardiac or respiratory disorders, nosocomial pneumonia or those on corticosteroids, were excluded. Decision for admission was made by the attending Accident and Emergency physician.
RESULTS: One hundred and seventy-one children were enrolled. The median age was 13 mo (range: 38 d-10 y 3 mo) and 59 % were males. Blood cultures were positive in 1.2 % (2/171) of patients while the contamination rate was 1.8 % (3/171). Doctors altered antibiotics based on blood culture results in only one patient.
CONCLUSIONS: Both the yield and the impact of blood culture results on the adjustment of empiric antibiotic treatment were very small. There was a high contamination rate. The recommended practice of performing blood cultures in all children admitted with CAP should be reviewed.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use
Directed assembly of bifunctional silica-iron oxide nanocomposite with open shell structure

Che HX, Yeap SP, Osman MS, Ahmad AL, Lim J

ACS Appl Mater Interfaces, 2014 Oct 8;6(19):16508-18.
PMID: 25198872 DOI: 10.1021/am5050949

The synthesis of nanocomposite with controlled surface morphology plays a key role for pollutant removal from aqueous environments. The influence of the molecular size of the polyelectrolyte in synthesizing silica-iron oxide core-shell nanocomposite with open shell structure was investigated by using dynamic light scattering, atomic force microscopy, and quartz crystal microbalance with dissipation (QCM-D). Here, poly(diallydimethylammonium chloride) (PDDA) was used to promote the attachment of iron oxide nanoparticles (IONPs) onto the silica surface to assemble a nanocomposite with magnetic and catalytic bifunctionality. High molecular weight PDDA tended to adsorb on silica colloid, forming a more extended conformation layer than low molecular weight PDDA. Subsequent attachment of IONPs onto this extended PDDA layer was more randomly distributed, forming isolated islands with open space between them. By taking amoxicillin, an antibiotic commonly found in pharmaceutical waste, as the model system, better removal was observed for silica-iron oxide nanocomposite with a more extended open shell structure.

Matched MeSH terms: Anti-Bacterial Agents/isolation & purification
Exploring antibiotic use and practices in a Malaysian community

Fatokun O

Int J Clin Pharm, 2014 Jun;36(3):564-9.
PMID: 24700341 DOI: 10.1007/s11096-014-9937-6

BACKGROUND: In Malaysia, antibacterial agents are among the most utilized drugs. There has been an increase in their use in recent years, contributing to an increase of antimicrobial resistance (AMR).
OBJECTIVES: This study explores the pattern of antibiotic use and practices in a Malaysian community and identifies the variables associated with a likelihood of non-compliance with a course of antibiotic treatment.
SETTING: The study was conducted in Cheras, a community located to the south-east of Kuala Lumpur, the capital city of Malaysia.
METHOD: A cross-sectional survey was conducted with 250 individuals, using an interviewer-administered questionnaire in Cheras, Kuala Lumpur, Malaysia.
MAIN OUTCOME MEASURES: Frequency of antibiotic use, sources of antibiotics, use of antibiotics without prescription, discontinuation of antibiotic treatment, antibiotic resistance awareness, handling of unused antibiotics, and association between respondents characteristics and compliance with a course of antibiotic treatment.
RESULTS: Approximately 36 % of the participants (n = 91) had taken antibiotics in the year of the study. The majority (66.8 %) obtained antibiotics from clinics. Almost 80 % of the participants had never obtained antibiotics without a doctor's prescription. Nearly 55 % discontinued the course of antibiotics once symptoms disappeared. The most common method of disposing leftover antibiotics was throwing them into the household rubbish bin (78.8 %). Only 6.4 % of participants returned leftover antibiotics to the pharmacist or doctor. Univariate analysis revealed that male gender (p = 0.04), lack of knowledge of antibiotic functions (p < 0.0001), and lack of awareness of antibiotic resistance (p < 0.0001) were all significantly associated with a greater likelihood of non-compliance with a full course of prescribed antibiotic treatment.
CONCLUSION: Most individuals in the Malaysian community obtained antibiotics through prescription. Non-completion of a course of antibiotic treatment and improper disposal of unused antibiotics need to be addressed to prevent AMR. Male gender, lack of knowledge and awareness of antibiotics and resistance were significantly associated with a greater likelihood of non-compliance with a full course of prescribed antibiotic treatment. Therefore, patient education and counselling about antibiotics and antibacterial resistance is very important to enhance compliance to antibiotic therapy.

Matched MeSH terms: Anti-Bacterial Agents/administration & dosage*
Enterobacteriaceae resistant to third-generation cephalosporins and quinolones in fresh culinary herbs imported from Southeast Asia

Veldman K, Kant A, Dierikx C, van Essen-Zandbergen A, Wit B, Mevius D

Int J Food Microbiol, 2014 May 2;177:72-7.
PMID: 24607424 DOI: 10.1016/j.ijfoodmicro.2014.02.014

Since multidrug resistant bacteria are frequently reported from Southeast Asia, our study focused on the occurrence of ESBL-producing Enterobacteriaceae in fresh imported herbs from Thailand, Vietnam and Malaysia. Samples were collected from fresh culinary herbs imported from Southeast Asia in which ESBL-suspected isolates were obtained by selective culturing. Analysis included identification by MALDI-TOF mass spectrometry, susceptibility testing, XbaI-PFGE, microarray, PCR and sequencing of specific ESBL genes, PCR based replicon typing (PBRT) of plasmids and Southern blot hybridization. In addition, the quinolone resistance genotype was characterized by screening for plasmid mediated quinolone resistance (PMQR) genes and mutations in the quinolone resistance determining region (QRDR) of gyrA and parC. The study encompassed fifty samples of ten batches of culinary herbs (5 samples per batch) comprising nine different herb variants. The herbs originated from Thailand (Water morning glory, Acacia and Betel leaf), Vietnam (Parsley, Asian pennywort, Houttuynia leaf and Mint) and Malaysia (Holy basil and Parsley). By selective culturing 21 cefotaxime resistant Enterobacteriaceae were retrieved. Array analysis revealed 18 isolates with ESBL genes and one isolate with solely non-ESBL beta-lactamase genes. Mutations in the ampC promoter region were determined in two isolates with PCR and sequencing. The isolates were identified as Klebsiella pneumoniae (n=9), Escherichia coli (n=6), Enterobacter cloacae complex (n=5) and Enterobacter spp. (n=1). All isolates tested were multidrug resistant. Variants of CTX-M enzymes were predominantly found followed by SHV enzymes. PMQR genes (including aac(6')-1b-cr, qnrB and qnrS) were also frequently detected. In almost all cases ESBL and quinolone resistance genes were located on the same plasmid. Imported fresh culinary herbs from Southeast Asia are a potential source for contamination of food with multidrug resistant bacteria. Because these herbs are consumed without appropriate heating, transfer to human bacteria cannot be excluded.

Matched MeSH terms: Anti-Bacterial Agents/pharmacology
In vitro antibacterial effects of Cinnamomum extracts on common bacteria found in wound infections with emphasis on methicillin-resistant Staphylococcus aureus

Buru AS, Pichika MR, Neela V, Mohandas K

J Ethnopharmacol, 2014 May 14;153(3):587-95.
PMID: 24613273 DOI: 10.1016/j.jep.2014.02.044

Cinnamomum species have been widely used in many traditional systems of medicine around the world. In the Malaysian traditional system of medicine, the leaves, stem bark and stem wood of Cinnamomum iners, Cinnamomum porrectum, Cinnamomum altissimum and Cinnamomum impressicostatum have been used to treat wound infections. To study the antibacterial effects of Cinnamomum iners, Cinnamomum porrectum, Cinnamomum altissimum and Cinnamomum impressicostatum against common bacteria found in wound infections with primary focus on methicillin-resistant Staphylococcus aureus (MRSA).

Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
Antimicrobial and in vitro wound healing properties of novel clay based bionanocomposite films

Mishra RK, Ramasamy K, Lim SM, Ismail MF, Majeed AB

J Mater Sci Mater Med, 2014 Aug;25(8):1925-39.
PMID: 24831081 DOI: 10.1007/s10856-014-5228-y

The present study investigates the development of methyl cellulose (MC)-sodium alginate (SA)-montmorillonite (MMT) clay based bionanocomposite films with interesting wound healing properties. The differential scanning calorimetry analysis of the composite films revealed presence of single glass transition temperature (Tg) confirming the miscible nature of the ternary blended films. The increase in MMT ratio in the composite films reduced the mobility of biopolymer chains (MC/SA) which increased the Tg of the film. Thermogravimetric analysis showed that dispersion of clay (MMT) at nano level significantly delayed the weight loss that correlated with higher thermal stability of the composite films. It was observed that the developed films were able to exhibit antimicrobial activity against four typical pathogenic bacteria found in the presence of wound. The developed films were able to significantly inhibit (10 mg/ml) the growth of Enterococcus faecium and Pseudomonas aeruginosa. In vitro scratch assay indicated potential wound closure activities of MC-2-4 bionanocomposite films at their respective highest subtoxic doses. In conclusion, these ternary bionanocomposite films were found to be promising systems for wound healing applications.

Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
Membrane disruption and anti-quorum sensing effects of synergistic interaction between Lavandula angustifolia (lavender oil) in combination with antibiotic against plasmid-conferred multi-drug-resistant Escherichia coli

Yap PS, Krishnan T, Yiap BC, Hu CP, Chan KG, Lim SH

J Appl Microbiol, 2014 May;116(5):1119-28.
PMID: 24779580 DOI: 10.1111/jam.12444

The aim of this study was to investigate the mode of action of the lavender essential oil (LV) on antimicrobial activity against multi-drug-resistant Escherichia coli J53 R1 when used singly and in combination with piperacillin.

Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
Genotypic characterization of Streptococcus pneumoniae serotype 19F in Malaysia

Jeevajothi Nathan J, Mohd Desa MN, Thong KL, Clarke SC, Masri SN, Md Yasin R, et al.

Infect Genet Evol, 2014 Jan;21:391-4.
PMID: 24342879 DOI: 10.1016/j.meegid.2013.11.026

Streptococcus pneumoniae is an epidemiologically important bacterial pathogen. Recently, we reported the antibiotic susceptibility patterns of a limited collection of pneumococcal isolates in Malaysia with a high prevalence of erythromycin resistant strains. In the present study, 55 of the pneumococcal isolates of serotype 19F were further analysed by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The generated genotypic patterns were then correlated with the antibiograms previously reported. Forty-seven different PFGE profiles (PTs) were obtained, showing that the isolates were genetically diverse. MLST identified 16 sequence types (STs) with ST-236 being predominant (58.2%), followed by ST-81 (10.3%). Among the ST-236 isolates, 22 were erythromycin resistant S. pneumoniae (ERSP) and 15 were trimethoprim/sulfamethoxazole (TMP/SMX) resistant, while among ST-81, four isolates were ERSP and two were TMP/SMX resistant. The high prevalence of erythromycin resistant serotype 19F isolates of ST-236 in this study has also been reported in other North and South East Asian countries.

Matched MeSH terms: Anti-Bacterial Agents/pharmacology
Fulltext Antibiotic usage in surgical prophylaxis: a prospective surveillance of surgical wards at a tertiary hospital in Malaysia

Oh AL, Goh LM, Nik Azim NA, Tee CS, Shehab Phung CW

J Infect Dev Ctries, 2014 Feb;8(2):193-201.
PMID: 24518629 DOI: 10.3855/jidc.3076

INTRODUCTION: The widespread and inappropriate use of broad-spectrum antibiotics in surgical prophylaxis has led to reduced treatment efficacy, increased healthcare costs, and antibiotic resistance. This study aimed to explore the adherence of antibiotic usage in surgical prophylaxis to the national antibiotic guideline and the incidences of surgical site infection (SSI).
METHODOLOGY: A three-month prospective observational study has been conducted in the surgical wards of Sarawak General Hospital (SGH) using a standardized surveillance form. Each patient was reviewed for up to 30 days post-operatively to determine the occurrence of SSI.
RESULTS: A total of 87 patients were included within the study period. The majority of the cases were clean-contaminated wounds (60.9%). Most were hepatobiliary cases (37.9%), followed by colorectal cases (19.5%). The most preferred antibiotic used was cefoperazone (63.2%). The choices of antibiotics in 78.2% of the cases were consistent with the guideline. Around 80% of prophylactic antibiotics were given within one hour before operation and 27.6% were omitted from intraoperative re-dosing. Prophylactic antibiotics were discontinued within 24 hours post-operatively in 77% of the cases. Of those continued for > 24 hours, the majority (60%) were administered for unknown reasons. SSI was documented in 13.8% of the total cases studied. However, there was no significant association between choices of antibiotics and timing of surgical prophylaxis with SSI (p = 0.299 and p = 0.258 respectively).
CONCLUSION: Overall guideline adherence rate was more than 70%. Areas of non-concordance to the guideline require further investigation.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use
Neurosyphilis and psychosis

Wahab S, Md Rani SA, Sharis Othman S

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:90-4.
PMID: 23857843 DOI: 10.1111/appy.12050

Neurosyphilis may presents with a range of psychiatric symptoms. This report illustrates a case of neurosyphilis in a man who presented with psychosis and cognitive dysfunction. Clinical findings and investigations done in the present case showed positive results for syphilis. Reduction of symptoms was noted after treatment with antibiotic. This case further highlights the importance of having high index of suspicion for neurosyphilis in patients presenting with psychiatric symptoms.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use
Prevalence of plasmid-mediated qnr determinants and gyrase alteration in Klebsiella pneumoniae isolated from a university teaching hospital in Malaysia

Saiful Anuar AS, Mohd Yusof MY, Tay ST

Eur Rev Med Pharmacol Sci, 2013 Jul;17(13):1744-7.
PMID: 23852897

The ciprofloxacin resistance of Klebsiella (K.) pneumoniae is mediated primarily through alterations in type II topoisomerase (gyrA) gene and plasmid-mediated quinolone resistance-conferring genes (qnr). This study aimed to define the prevalence of plasmid-mediated quinolone resistance-conferring genes (qnr) and type II topoisomerase (gyrA) alterations of a population of ciprofloxacin-resistant (n = 21), intermediate (n = 8), and sensitive (n = 18) K. pneumoniae isolates obtained from a teaching hospital at Kuala Lumpur, Malaysia.

Matched MeSH terms: Anti-Bacterial Agents/pharmacology
Salmonella enteritidis ventriculitis

Johan AJ, Hung LC, Norlijah O

Southeast Asian J. Trop. Med. Public Health, 2013 May;44(3):456-9.
PMID: 24050077

Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

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