Over the past two decades there has been numerous new associations between chronic diseases traditionally considered non-infectious with infectious agents. This list of diseases include peptic ulcer, coronary heart disease, neuropsychiatric disorders, haematological disorders and malignancies. These associations have been made possible through improvements in diagnostic tests based on molecular biology techniques. The discovery of these associations is important as it opens up exciting opportunities for the prevention and treatment of many diseases hitherto considered incurable.
Gentamicin is an aminoglycoside antibiotic which is commonly used in the treatment of serious Gram-negative infections. However, gentamicin like other aminoglycosides, has a narrow therapeutic index and is potentially ototoxic and nephrotoxic. Blood levels following administration of gentamicin has been shown to be highly unpredictable and monitoring of gentamicin levels is necessary to ensure effective therapeutic levels as well as to avoid toxicity. The Department of Microbiology, Universiti Kebangsaan Malaysia offers such a monitoring service. This paper analyses the results of 135 such estimations performed between August 1979 and May 1981. It is shown that a significant proportion of patients were receiving either too much or too little gentamicin. Empirical determinations of dosages is unsatisfactory and as the microbiological assay method of determining gentamicin levels is both easy to perform and inexpensive, such a service should be offered by all general hospitals in Malaysia.
Nonfermentative Gram-negative bacilli were commonly isolated from clinical material in a Malaysian hospital over a two year period of study. Pseudomonas aeruginosa, Acinetobacter sp and other Pseudomonas were the most common organisms seen. Although these bacteria occurred regularly in clinical specimens their pathogenetic role could be established in only a small proportion of cases. Most 01 these organism were either contaminants or
commensals 01 the normal bacterial flora. It is important to interpret the isolation of a nonfermentative Gram-negative bacillus with caution, and in the light of clinical findings. Failure to do so may result in the unnecessary use of antibiotics.
The in vitro activity of sulperazon (cefoperazone/sulbactam) was tested against 94 ceftazidime-resistant strains of bacteria isolated from mostly seriously ill patients in critical care units. Acinetobacter baumanii, Pseudomonas aeruginosa and Klebsiella pneumoniae made up 80% of the pathogens studied; 90% of the Klebsiella strains were producers of extended-spectrum beta-lactamases (ESBL). The MIC90 of sulperazon for Klebsiella was 12 mg/l (range 1.5-16 mg/l), indicating that this drug may be a useful alternative for the treatment of ceftazidime-resistant, ESBL-producing Klebsiella.
A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.
One hundred and eight consecutive previously untreated males with gonococcal urethritis were treated with single-dose oral ampicillin under supervision. A high failure-rate of 41.5 percent was obtained. The main cause of failure was the high incidence of penicillinase-producing Neisseria gonorrhoeae - an overall incidence of 37.2 percent was obtained.
One hundred and thirty-eight male patients presented unth. a total of 146 episodes of urethritis at a Kuala Lumpur STD clinic over a period of six months. Gonorrhoea accounted for almost 4 out of 5 cases of male urethritis. The incidence of betalactamase producing strains of Neisseria gonorrhoeae was 36 percent. Furthermore nearly 3 out of 10 cases of gonococcal urethritis developed post-gonococcal urethritis.
A case of neonatal meningitis caused by an unusual organism, Acinetobacter calcoaceticus var anitratus is reported. The source of the meningitis is probably a scalp abscess caused by the same organism. This patient was successfully treated with cotrimoxazole. Infections caused by Acinetobacter are rare and are briefly reviewed in this article
31 cases of ocular toxoplasmosis were seen at the Ophthalmology Clinic, Uniuersiti Kebangsaan Malaysia, Kuala Lumpur during a one-and-a-half year period. All these cases were diagnosed as congenital ocular toxoplasmosis. As this condition appears not to be uncommon in. Malaysia, greater effort should be made towards its prevention especially among pregnant women.
Study site: Ophthalmology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Forty-two previously untreated male patients with uncomplicated gonococcal urethritis were treated with a single dose oral regimen comprising 3 gm ofamoxycillin and 125 mg of clavulanic acid. Thirty-five patients returned for follow-up and the cure rate among them was 89 percent. The cure rate for patients infected with penicillinase producing Neisseria gonorrhoeae (PPNG) was 73 percent. Further work is required to establish the optimum dosage for this particular regimen.
Study site: Sexually Transmitted Diseases (STD) clinic at the Faculty of Medicine,
Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)