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  1. Mohan A, Yeong LC, Kumarasamy G, Manan K
    J Infect Dev Ctries, 2023 Jun 30;17(6):886-890.
    PMID: 37406064 DOI: 10.3855/jidc.17821
    A 12-year-old boy was admitted after 11 days of fever and 2 days of nasal obstruction as well as swelling of a right cervical lymph node. Nasal endoscopy and computed tomography of the neck showed a nasopharyngeal mass occupying the entire nasopharynx, extending into the nasal cavity, and obliterating the fossa of Rosenmuller. Abdominal ultrasonography revealed a small solitary splenic abscess. Although a nasopharyngeal tumor or malignancy was initially considered, biopsy of the mass showed only suppurative granulomatous inflammation, and bacterial culture from the enlarged cervical lymph node yielded Burkholderia pseudomallei. The symptoms, nasopharyngeal mass, and cervical lymph node enlargement resolved with melioidosis-directed antibiotic therapy. Although rarely reported, the nasopharynx may be an important primary site of infection in melioidosis patients, especially in pediatric patients.
  2. Sritharan S, Lau PS, Manan K, Mohan A
    Front Pediatr, 2023;11:1214551.
    PMID: 37520056 DOI: 10.3389/fped.2023.1214551
    BACKGROUND: Systemic lupus erythematosus (SLE) can involve any organ system and cause a wide range of manifestations. Noninfectious inflammatory lesions termed aseptic abscesses have been reported in some autoimmune and autoinflammatory conditions but not in childhood-onset SLE. In this report, we highlight the unusual finding of occult splenic abscesses in two children diagnosed with SLE who had no evidence of concomitant infection.

    CASE PRESENTATION: An 8-year-old and an 11-year-old were admitted separately to the hospital with fever for 7 and 14 days, respectively. In the younger child, a generalized rash preceded the fever. Both had been well, with no significant past medical history prior to the onset of the illness. In both girls, abdominal ultrasonography showed multiple small hypoechoic lesions suggestive of abscesses scattered throughout the spleen. Their C-reactive protein and blood cultures were negative, and symptoms persisted despite intravenous antibiotics. Fulfilling the clinical and immunologic criteria for diagnosis, both were ultimately diagnosed with childhood-onset SLE. Rapid recovery of symptoms and complete resolution of the abscesses ensued with corticosteroids and immunosuppressive therapy.

    CONCLUSIONS: These two cases suggest that aseptic splenic abscesses may occur in childhood-onset SLE. Autoimmune conditions such as SLE should be included in the differential diagnosis of children with occult splenic abscesses.

  3. Md Dom S, Abdul Razak HR, Ahmad Zaiki FW, Saat NH, Abd Manan K, Che Isa IN, et al.
    Quant Imaging Med Surg, 2013 Feb;3(1):49-53.
    PMID: 23483040 DOI: 10.3978/j.issn.2223-4292.2013.02.06
    The aim of this study was to investigate the changes in parathyroid hormone (PTH) level of rabbit foetal bodies exposed to ultrasound at different gestational stages. A total of 9 pregnant rabbits (Oryctolagus cuniculus) were insonated for 60 minutes at the middle of 1(st), 2(nd) and 3(rd) gestational stages for group A (n=14 newborns), group B (n=7 newborns) and group C (n=24 newborns) respectively. Seven pregnant rabbits with 41 newborns severed as negative control group. Blood samples were withdrawn from each newborn rabbits for Parathyroid Hormone-Intact (PTH-I) test. Results of the independent samples t-test implied statistically significant differences (P<0.05) between the control group and the 1(st) stage (P=0.001), the 2(nd) stage (P<0.001) and the 3(rd) stage group (P<0.001). This in-vivo study revealed diagnostic ultrasound heating has the potential of affecting foetal PTH level. This study observed significantly low PTH level for all the treated groups. A further study should be instituted to determine whether this finding in rabbit may also occur in human by means of clinical trials.
  4. Mohan A, Manan K, Tan LS, Tan YC, Chin ST, Ahmad R, et al.
    Int J Infect Dis, 2020 Sep;98:59-66.
    PMID: 32535300 DOI: 10.1016/j.ijid.2020.06.025
    OBJECTIVES: Melioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children.

    METHODS: We conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018.

    RESULTS: Fifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy.

    CONCLUSIONS: A large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.

  5. Mohan A, Podin Y, Liew DW, Mahendra Kumar J, Lau PS, Tan YY, et al.
    BMC Infect Dis, 2021 Oct 15;21(1):1069.
    PMID: 34654392 DOI: 10.1186/s12879-021-06754-9
    BACKGROUND: Melioidosis, the infection caused by Burkholderia pseudomallei, is associated with a high case fatality rate, due in part to difficulties in clinical recognition and diagnostic confirmation of the disease. Although head and neck involvement is common in children, specific disease manifestations differ between geographic regions. The aim of this study was to provide a detailed description of melioidosis of the head and neck among children in Sarawak, Malaysia, and determine if fine-needle aspiration of suspected head or neck lesions could improve melioidosis diagnosis.

    METHODS: We conducted a retrospective descriptive study of all children aged

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