A previously well 13-year-old boy presented with a short history of fever and altered mental status. His mother was admitted for dengue fever and there had been a recent dengue outbreak in their neighbourhood. He was diagnosed with dengue encephalitis as both his dengue non-structural protein 1 (NS-1) antigen and cerebrospinal fluid (CSF) dengue polymerase chain reaction (PCR) were positive. He did not have haemoconcentration, thrombocytopenia or any warning signs associated with severe dengue. He recovered fully with supportive treatment. This case highlights the importance of considering the diagnosis of dengue encephalitis in patients from dengue endemic areas presenting with an acute febrile illness and neurological symptoms.
Dengue

Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis.
Dengue

The incidence of renal abscesses is not common. Patients usually have risk factors like diabetes mellitus or an underlying condition which predisposes to urinary tract infections. We report a case of a previously healthy young girl with multiple bilateral renal abscesses. Ultrasonography revealed multiple renal abscesses with a possible differential diagnosis of polycystic kidney disease with infected cysts. No renal calculi were seen. CT-scan of kidneys confirmed the diagnosis. Blood and urine cultures were repeatedly negative. She was treated with two weeks of intravenous antibiotics followed by another four weeks of oral Ciprofloxacin. No surgical intervention was carried out. Repeated ultrasound at six months showed complete resolution of all the renal abscesses.

Diesel is commonly used as fuel for engines and is distilled from petroleum. Diesel has toxic potential and can affect multiple organs. Exposure can occur after ingestion, inhalation or through the dermal route. The practice of siphoning diesel using a rubber tubing and the mouth is common in rural communities. This can lead to accidental ingestion and aspiration. Here we report a case of a patient who accidentally ingested diesel during siphoning, which caused extensive erosion of the oral cavity and oesophagus leading to pneumomediastinum and severe chemical lung injury. The patient responded well initially to steroids and supportive care but required prolonged hospitalisation. He developed complications of nosocomial infection and succumbed 23 days after admission.
Mediastinal Emphysema ; Lung Injury

Introduction: COVID-19 is a highly transmissible respiratory virus that has affected millions of people worldwide in the span of months. The burden of disease among healthcare workers (HCW) has not been well studied despite reports of infectivity and transmission around the world. Two HCW in Hospital Teluk Intan (HTI) contracted COVID-19 while attending a social event. They were in close proximity with colleagues upon returning to work, resulting in the spread of infection among other HCW in HTI.

Reverse transcriptase polymerase chain reaction (RT-PCR) assays for coronavirus disease 2019 (COVID-19) should be interpreted with clinical, epidemiological history and exposure risk to avoid misdiagnosis. We report a cruise-ship worker with significant travelling history, presented with acute respiratory symptoms and radiographic evidence of viral pneumonia. Initial RNA-dependent RNA polymerase (RdRp) gene confirmatory assay was negative. Use of a more robust RT-PCR assay detected ORF1ab, N and S genes for COVID-19, and the diagnosis was supported by an IgM and IgG positive COVID-19 serology. Subsequent follow up samples which reported inconsistencies in detecting RdRp gene also raise the concern of reliability of RdRp gene as the confirmatory assay for diagnosis of COVID-19. Patient later had prolonged viral shedding beyond serological recovery, with a negative viral culture reflecting non-infectivity.
SARS-CoV-2 ; COVID-19 ; Reverse Transcriptase Polymerase Chain Reaction ;