The COVID-19 outbreak, which has its first reported case in Wuhan City, China, has evolved rapidly and was declared as a pandemic by the World Health Organization on 11 March 2020. The novel coronavirus is known officially as SARS-CoV-2. Genomic analysis revealed that SARS-CoV-2 is phylogenetically related to SARS-like bat viruses; therefore, bats could be the possible primary reservoir. Infected individuals have a broad spectrum of manifestations, ranging from asymptomatic and mild symptoms to severe disease with multiorgan involvement. Symptomatic patients commonly presented with fever, cough, shortness of breath and other non-specific symptoms such as muscle ache, headache, confusion and diarrhoea.The implications of COVID-19 infection during pregnancy remain unclear at this moment. Pregnancy is considered high risk as this population remains vulnerable to coronavirus infection. Till date, data regarding SARS-CoV-2 infection amongst pregnant women, their manifestations and outcomes remain limited. Most pregnancies had good outcomes, and transmission of SARS-CoV-2 to infant was uncommon [1].However, the relationship between SARS-CoV-2 infection and risk of miscarriage remains unclear.Sarawak General Hospital is the only tertiary hospital in southern Sarawak, Malaysia, serving a population of around 2.5 million people. We have in total 465 SARS-CoV-2 RT-PCR confirmed COVID-19 cases which were from 12 March 2020 to 25 May 2020. We use nasopharyngeal and oropharyngeal combined swab (NPS/OPS) to collect the samples for SARS-CoV-2 RT-PCR. Seven of these cases were pregnant women, in which at the time of presentation, 2 were in the first trimester, 3 in the second trimester and another 2 in the third trimester of their pregnancies. Two of the cases who were in their first trimester of pregnancies had miscarriages. At the time of writing, the other 5 cases have no reported adverse pregnancy outcomes, in which one of the cases has undergone an uneventful delivery through caesarean section.We would like to highlight 2 cases of first trimester miscarriage in COVID-19 infected pregnant mothers.The first case involves a 34-year-old Malay lady, who was gravida 5, para 4 at a 10-week period of amenorrhea when she was diagnosed to have COVID-19 infection. She first experienced irregular cramping lower abdominal pain, with per vaginal bleeding, associated with blood clots at a 7-week and 1day period of amenorrhea. Three days later, she started to experience non-productive cough and sore throat, which completely resolved after 2 days. She otherwise did not experience any fever, rhinorrhoea, shortness of breath, arthralgia, myalgia, anosmia, dysgeusia or any gastrointestinal symptoms. Her COVID-19 screening was around 2 weeks after a significant contact history with a colleague with COVID-19 infection, and her NPS/OPS for SARS-CoV-2 RT-PCR was positive.Her blood investigations showed absolute lymphocyte count (ALC) 2.4 × 10 3 /μl, with total white cell (TWC) 11.18 × 10 3 /μl, platelet 397 × 10 3 /μl and haemoglobin (Hb) 13.3 g/d...
Background Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections. Methods We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016. Results One-hundred and forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B. pseudomallei. The average annual incidence of melioidosis was 12·3 per 100,000 population, with marked variation between districts ranging from 5·8-29·3 per 100,000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B. pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections. Conclusions Gentamicin-susceptible B. pseudomallei infections are common in Sarawak and dominate in the high incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B. pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B. pseudomallei in Sarawak are clonal and to ascertain their environmental drivers and niches.
Introduction As a causal organism in infective endocarditis, Burkholderia pseudomallei is rare. Burkholderia pseudomallei is intrinsically resistant to aminoglycosides but a gentamicin-susceptible strain was discovered in Sarawak, Malaysian Borneo in 2010. We report the first occurrence of infective endocarditis due to the gentamicin-susceptible strain of B. pseudomallei . Case presentation A 29-year-old man presented with pneumonia and melioidosis septicaemia. His condition was complicated with infective endocarditis and septic emboli to the brain. Despite difficulties in reaching a diagnosis, the patient was successfully treated using intravenous gentamicin and ceftazidime and was discharged well. Discussion The role of gentamicin in the treatment of the gentamicin-susceptible strain of B. pseudomallei remains unclear.
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