This study describes the prevalence of Clostridium difficile toxin (CDT) in loose stool samples from inpatients aged more than two years of a tertiary hospital. A total of 175 samples that had been examined were from stool samples that were sent to the Medical Microbiology & Parasitology Laboratory for various clinical indications. The toxin was detected by a commercial immunochromatograhic test, and the patients’ demography, clinical features, treatment and outcomes were analyzed from their medical records. Clostridium difficile toxin was positive in 24 (13.7%) of the stool samples. Male and female were 11 (45.8 %) and 13 (54.2 %) respectively, with the majority of them aged more than 50 years. Most were from medical wards (n=21, 87.5%), with the rest from surgical wards (n=2, 8.3%) and intensive care units (n=1, 3.4%). All the CDT positive patients had history of prior antibiotic usage within 6 weeks before the detection of the toxin. The mean duration of antibiotics usage was 17.75 (±13.75) days, while the mean duration of diarrhea was 5.21((± 5.85) days. Eighteen patients had underlying medical illnesses that were diabetes mellitus, chronic renal disease, hypertension, ischaemic heart disease, cerebrovascular disease and malignancy; with seven of them being CDT positive while on chemotherapy. Stool occult blood test was positive in 15 patients whereas presence of pus cells in the CD positive stool samples were detected in 21 patients. The duration of hospitalization among the patients was 27.96 (± 23.22) days.

Background: Foot infection is a major complication of diabetes mellitus (DM) and its agents are usually polymicrobial. This study aims to describe the agent and determine the association between polymicrobial infections and the severity of diabetic foot infections (DFI) and their outcomes. Methods: This retrospective cohort study was conducted during one year and it involved 104 patients. Their records were reviewed and assessed. The causative agents and its sensitivity pattern were noted. The results were presented as descriptive statistic and analysed. Results: A total of 133 microorganisms were isolated with 1.28 microorganisms per lesion. The microorganism isolated were 62% (n = 83) GN (Gram-negative) and 38% (n = 50) GP (Grampositive). GN microorganisms include Pseudomonas spp (28%), Proteus spp (11%), Klebsiella spp (8%) and E. coli (4%). Staphylococcus aureus (54%) was predominant among GP, followed by Group B Streptococci (26%) and Enterococcus spp (6%). Thirty patients (28.8%) had polymicrobial infections. The association between the quantity of microorganisms and severity of DFI was significant. Among severe DFI cases, 77.8% with polymicrobial microorganisms underwent amputation compared to 33.3% with monomicrobial infection. Conclusion: GN microorganisms were predominantly isolated from DFIs and remained sensitive to widely used agents. Polymicrobial infections were associated with DFI severity.

Introduction: HIV is the leading cause of mortality and morbidity worldwide. There are two types of HIV, HIV-1, and HIV-2, which are geographically different in epidemiology and determinants. Objective: To determine the epidemiology and determinants of HIV-1 and HIV-1&2 in the three tertiary hospitals of Eastern Peninsular Malaysia. Method: A cross-sectional study of confirmed serologically HIV-1 and HIV-1&2 from January 2016 until December 2018. SPSS analysed all collected data, descriptive statistics for sociodemographic data and Pearson chi-square for the association between type of HIV with HCV, HBV, syphilis, and tuberculosis. In identifying the risk factor associated with HIV-1&2, several variables were tested by the Multiple Logistic Regression Model. A P-value of <0.05 was considered statistically significant. Results: Out of 519 serologically diagnosed HIV, 344 (66.28%) were HIV-1, and 175 (33.72%) were HIV-1&2. HIV positive were highly distributed in Malay male in both groups. Most HIV-1 patients were single, unemployed, and presented with tuberculosis. HIV-1&2 were single and employed, mostly asymptomatic at diagnosis. The commonest mode of transmission for HIV-1 was by sexual contact (31.87%), whereas IVDU (13.63%) in HIV-1&2. Co-infection with tuberculosis (P=0.005) and HCV (P<0.001) were significantly higher in HIV-1 as compared to HIV-1&2. IVDU was a significant determinant to develop HIV-1&2 (Adjusted OR: 3.5, 95% CI=1.875-5.227, P<0.001). Conclusion: HIV-1&2 was high in this study. Patients with HIV-1&2 present in less severe symptoms compared to the patient with HIV-1. A further molecular diagnostic study should be tested to confirm the type of HIV.