1.Frequency and molecular epidemiology of Panton-Valentine leukocidin gene in Staphylococcus aureus colonising HIV-infected patients
Zaini Mohd-Zain ; Siti Farah Alwani Mohd-Nawi ; Ariza Adnan ; Suresh Kumar
The Malaysian Journal of Pathology 2017;39(2):115-122
Background: HIV-infected patients pose a high risk of contracting skin and soft tissue infections
caused by Staphylococcus aureus. Those who are colonized with methicillin-resistant S. aureus
(MRSA) that carry Panton-Valentine leukocidin (PVL) are predisposed to severe infections that
could lead to necrotic skin infections. However the association of S. aureus specifically methicillin
sensitive S. aureus carrying PVL gene in HIV patients has not been widely reported. Here, we
study the prevalence and the molecular epidemiology of PVL-producing S. aureus in HIV-infected
patients. Methods: Swabs from four body sites of 129 HIV-infected patients were cultured for
S. aureus and identified by standard microbiological procedures. The isolates were subjected to
antimicrobial susceptibility testing by disk diffusion against penicillin, erythromycin, clindamycin,
and cotrimoxazole. PCR was used to detect the PVL gene and genetic relationship between the
isolates was determined by using pulse field gel electrophoresis. Results: A total of 51 isolates of
S. aureus were obtained from 40 (31%) of the patients. The majority (43.1%) of the isolates were
obtained from the anterior nares. Thirteen (25.5%) of all the isolates were resistant to more than
one category of antibiotics, with one isolate identified as MRSA. Thirty-eight (74.5%) isolates
(including the MRSA isolate) carried PVL gene where the majority (44.7%) of these isolates were
from the anterior nares. A dendogram revealed that the isolates were genetically diverse with 37
distinct pulsotypes clustered in 11 groups. Conclusion: S. aureus obtained from multiple sites of
the HIV patients were genetically diverse without any clonality observed.
2.A sudden paediatric death due to hand, foot and mouth disease:the importance of vigilance
Razuin Rahimi ; Effat Omar ; Tuan Suhaila Tuan Soh ; Siti Farah Alwani Mohd Nawi ; Shahidan Md Noor
The Malaysian Journal of Pathology 2017;39(2):167-170
Background: Hand, foot and mouth disease (HFMD) is caused by enteroviruses such as Coxsackie
virus A16 (CVA16) and Enterovirus 71 (EV71). The diagnostic hallmarks are oral ulcers and
maculo-papular or vesicular rash on the hands and feet. Severe form of this disease can lead to
death due to neurological and cardiopulmonary complications. This case report aims to describe a
fatal case of HFMD with minimal oral and skin manifestations. Case report: A four-year-old girl
was brought to a hospital after suddenly becoming unresponsive at home. She had a history of
fever and lethargy for three days prior to her demise. The patient, and five other children in her
neighbourhood had been diagnosed to have HFMD at a local health clinic; the other children had
recovered without complications. Results: Autopsy revealed a few punctate, sub-epidermal vesicles
measuring 1 to 2 mm on the palm of her right hand and sole of the right foot, visible only with a
magnifying glass. Internal examination revealed prominent nodularity at the oro- and hypopharynxes.
The lungs were markedly congested and oedematous. Histopathology of the lung showed marked
oedema and haemorrhage with mild pneumonic changes. Oedema with increase in macroglia
and astrocytic proliferation were seen in the cerebral tissue, but no lymphocytic infiltration was
evident. Enterovirus EV71 was detected by polymerase chain reaction in samples from the lung,
cerebrospinal fluid and serum. The cause of death was given as HFMD complicated by pneumonia.
Conclusion: Fatal HFMD may have minimal signs. A complete history, careful physical examination
and relevant investigations lead to a diagnosis at post mortem examination. Awareness of the subtle
signs and rapid deterioration associated with a fatal case of HFMD is a challenge to clinicians who
encounter these cases.
3.High Prevalence of Methicillin-resistant Staphylococcus haemolyticus Isolated From Commensals in Healthy Adults
Farhan Haziq Azharollah ; Mohd Faiz Foong Abdullah ; Siti Farah Alwani Mohd Nawi ; Aziyah Abdul-Aziz
Malaysian Journal of Medicine and Health Sciences 2021;17(No.1):145-152
Introduction: S. haemolyticus is known to be commensals residing on human skin. However, their ability to develop
as pathogens among the healthy community has becoming increasingly vital. Methods: In this study, a total of 49
non-duplicated samples of S. haemolyticus was isolated from the skin of healthy adults and confirmed via sodA gene
sequencing method. Cefoxitin (30μg) disc diffusion test was performed to determine methicillin resistance among
the S. haemolyticus isolates. The isolates were then subjected to mecA amplification and Staphylococcus Cassette
Chromosome (SCCmec) typing of I, II, III, IV and V. Results: Interestingly, 59.2% of the S. haemolyticus commensal
isolates were found to be methicillin-resistant (MRSH) while the remaining 40.8% was methicillin-sensitive (MSSH).
Amplification of mecA gene showed that 43 isolates (87.8%) were positive while only six isolates were negative for
the gene. A majority of the positive mecA isolates (90.7%) were discovered to harbour SCCmec Type II while the remaining 44.2% were Type V followed by 23.3% of Type I and 18.6% of Type IV. Only one of the isolates was found
to be SCCmec Type III while another isolate, T187 was non-typeable. Conclusion: The data indicates the acquisition
of SCCmec typing circulated among the commensal strains which could be a potential route of pathogenicity among
the isolates.