Fungaemia due to
Paecilomyces lilacinus
is generally not considered in AIDS patients because this condition is not categorised as an AIDS-indicator illness. We report a case of a 25-year-old lady who presented to our hospital with Guillain-Barré Syndrome, with the subsequent development of refractory fungaemia, multi-organ failure and disseminated intravascular coagulopathy. Amphotericin B was given as empirical antifungal therapy. HIV screening was reactive and
Paecilomyces lilacinus
was isolated from her blood. The fungaemia did not resolve after one week of amphotericin B treatment. The addition of itraconazole was also unsuccessful in clearing the fungaemia. Accurate mycological diagnosis is important in the care of AIDS patients with fungaemia because of the risk of treatment failure with empirical therapy.
Helicobacter pylori infection remains an essential global research focus, and increasing clarithromycin resistance was reported to impact the efficacy of clarithromycin-based treatment regiments. The study objectives sought to understand the prevalence of H. pylori infection amongst patients from Sungai Buloh Hospital, Malaysia, its association with demographic factors, and the clarithromycin resistance rate. The in-house rapid urease test (IRUT) was also evaluated and compared to the Campylobacter-like organism (CLO) test using culture or histopathological testing as the gold standard for diagnosis. The gastric corpus biopsies of 352 patients were included, as well as their age group, gender and ethnicity. Clarithromycin susceptibility was measured using the E-test method. The overall prevalence of H. pylori infection was 15.1% (53/352). There was no significant association between the age groups, gender and ethnicity with regards to H. pylori infection. Four of the 13 viable isolates (30.8%) were clarithromycin-resistant. Although IRUT had a slightly lower specificity (94.9%) than that of the CLO test (95.9%), both tests had the same sensitivity values (81.1%). IRUT had a lower positive predictive value (74.1%) than the CLO test (78.2%) but showed a similar negative predictive value (96.5%) compared to the CLO test (96.6%). Both tests displayed a very good agreement (κ = 0.97). In conclusion, the overall prevalence of H. pylori infection in our study was generally low. The high proportion of clarithromycinresistant isolates may not reflect the exact resistance rate due to the small number of positive cultures. Our IRUT is an acceptable alternative to the CLO test for the rapid diagnosis of H. pylori infections based on its comparable performance.
Objective:The New Delhi metallo-β-lactamase-1 (NDM-1) enzyme is a plasmid-encoded enzyme that inactivates carbapenem antibiotics. This study aims to ascertain if the modified Hodge test (MHT) has a role in screening for NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility.Methods:Over a period of one year, all Enterobacteriaceae isolates from all clinical specimens with reduced susceptibility to at least one carbapenem were subjected to MHT and conventional polymerase chain reaction (PCR) detection of the NDM-1 gene.Results:A total of 13,098 Enterobacteriaceae isolates were screened and 63 (0.48%) had reduced susceptibility to at least one carbapenem. Out of the 63 isolates, 45 (71.4%) were MHT-positive. The NDM-1 gene was detected in 18 of the 63 isolates (28.6%). All 18 PCR-positive isolates were also MHT-positive. Thus, the sensitivity and specificity of the MHT in detecting NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility are 100% and 40%, respectively.Conclusion:The MHT is a useful test to screen for the presence of NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility. However, due to its rather low specificity, all MHT-positive isolates should be subjected to alternative tests (e.g. PCR) for confirmation, especially if other types of carbapenemases (e.g. KPC) are prevalent.
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