1.Pericardial abscess: The corollary of disseminated Methicillin-resistant Staphylococcus aureus following diabetic foot ulcer infection
Thai Lun Tan ; Soon Hooi Lim ; Mohd Ruslan Mustapa ; Ganeswary Ramaloo
The Medical Journal of Malaysia 2020;75(6):742-744
Methicillin-resistant Staphylococcus aureus (MRSA)
purulent pericarditis, characterised by frank pus collection
or microscopic pyogenic effusion in the pericardium
represents the most serious form of pericardial infection.
The route of MRSA acquisition in pericardial abscess
commonly occurs via the blood stream infection and it is
more commonly observed among immunocompromised
individuals. To date, diabetic foot ulcer infection rarely
disseminates and becomes a nidus for pericardial infection.
Herein, we report an unusual case of MRSA pericardial
abscess in a 44-year-old man who presented at Hospital Seri
Manjung, Malaysia with cardiac tamponade. Past medical
history indicated that he was recently treated for infected
diabetic foot ulcer with MRSA bacteraemia one week earlier.
Despite adequate pericardial drainage and extended
parenteral vancomycin therapy, this case ended in fatality on
day 42 of admission due to nosocomial infection. It is hoped
that this report serves to increase the vigilance among
clinicians that diabetic foot ulcer infections have the
potential to progress to pericardial abscess in the presence
of MRSA bacteraemia, although they may appear seemingly
innocuous at presentation. Systemic vancomycin must be
instituted promptly when MRSA bacteraemia is confirmed in
order to circumvent the propagation of MRSA.
3.A 5-year retrospective study of melioidosis cases treated in a district specialist hospital
Ray Yank Tang ; Soon Hooi Lim ; Jo Ee Lam ; Nurasykin Salim ; Su-Sian Eileen Toh ; Yen Wen Chan
The Medical Journal of Malaysia 2019;74(6):472-476
INTRODUCTION: Melioidosis is caused by Burkholderia
pseudomallei, a gram-negative aerobic bacillus, found in the
soil and surface water. Treating melioidosis has been a
challenge in district hospitals due to high usage of broad
spectrum antibiotics and prolonged hospitalisation. This
study is to review the patients’ demography, clinical
presentations and microbiological data.
METHODS: A 5-year retrospective study was carried out on
patients admitted with culture positive for melioidosis from
year 2013 to 2017 in Hospital Teluk Intan, Perak.
RESULTS: There were a total of 46 confirmed cases of
melioidosis. Majority of the patients were working in the
agricultural and farming (28.6%), and factories (25.7%).
Thirty-one patients had diabetes mellitus (71.1%).
Presentations of patients with melioidosis included
pneumonia (54.3%), skin and soft tissue infection (19.6%),
deep abscesses (15.2%) and bone and joint infections (13%).
An average of 5.8 days was needed to confirm the diagnosis
of melioidosis via positive culture. However, only 39.4% of
these patients were started on ceftazidime or carbapenem
as the empirical therapy. The intensive care unit (ICU)
admission rate for melioidosis was 46% and the mortality
rate was 52%. Our microbial cultures showed good
sensitivity towards cotrimoxazole (97.1%), ceftazidime
(100%) and carbapenem (100%).
CONCLUSION: Melioidosis carries high mortality rate,
especially with lung involvement and bacteremia.
Physicians should have high clinical suspicion for
melioidosis cases to give appropriate antimelioidosis
therapy early
4.Percutaneous transcatheter aortic valve implantation for degenerated surgical bioprostheses: the first case series in Asia with one-year follow-up.
Paul Toon-Lim CHIAM ; See-Hooi EWE ; Jia-Lin SOON ; Kay-Woon HO ; Yong-Koong SIN ; Swee-Yaw TAN ; Soo-Teik LIM ; Tian-Hai KOH ; Yeow-Leng CHUA
Singapore medical journal 2016;57(7):401-405
INTRODUCTIONPercutaneous transcatheter aortic valve implantation (TAVI) has become an established therapy for inoperable and high-surgical-risk patients with severe aortic stenosis. Although TAVI in patients with degenerated surgical aortic bioprostheses (i.e. valve-in-valve TAVI) is increasingly reported in Western studies, such data is lacking in Asian patients. We describe the initial experience of valve-in-valve TAVI in Asia.
METHODSEight patients who underwent valve-in-valve TAVI due to degenerated aortic bioprostheses were enrolled. The mechanism of bioprosthetic valve failure was stenotic, regurgitation or mixed. All procedures were performed via transfemoral arterial access, using the self-expanding CoreValve prosthesis or balloon-expandable SAPIEN XT prosthesis.
RESULTSThe mean age of the patients was 71.6 ± 13.2 years and five were male. Mean duration to surgical bioprosthesis degeneration was 10.2 ± 4.1 years. Valve-in-valve TAVI was successfully performed in all patients. CoreValve and SAPIEN XT prostheses were used in six and two patients, respectively. There were no deaths, strokes or permanent pacemaker requirement at 30 days, with one noncardiac mortality at one year. All patients experienced New York Heart Association functional class improvement. Post-procedure mean pressure gradients were 20 ± 11 mmHg and 22 ± 8 mmHg at 30 days and one year, respectively. Residual aortic regurgitation (AR) of more than mild severity occurred in one patient at 30 days. At one year, only one patient had mild residual AR.
CONCLUSIONIn our experience of valve-in-valve TAVI, procedural success was achieved in all patients without adverse events at 30 days. Good clinical and haemodynamic outcomes were sustained at one year.
Aged ; Aged, 80 and over ; Aortic Valve ; surgery ; Aortic Valve Insufficiency ; surgery ; Aortic Valve Stenosis ; surgery ; Arteries ; Bioprosthesis ; Cardiac Catheterization ; methods ; Female ; Fluoroscopy ; Follow-Up Studies ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Hemodynamics ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial ; Prosthesis Failure ; Severity of Illness Index ; Transcatheter Aortic Valve Replacement