1.Adult Diphteria: Possible Transmission of Corynebacterium diphtheriae from Unvaccinated Child?
Thenmalar Kandasamy ; Fatimahtuz Zahrah Muhamad Damanhuri ; Adillahtul Bushro Zaini ; Siti Zulaikha Zakariah ; Rosni Ibrahim
Malaysian Journal of Medicine and Health Sciences 2021;17(No.3):311-314
A case of a toxigenic strain of Corynebacterium diphtheriae in an immunocompetent adult is presented, with the possibility of the adult acquiring the infection from her unvaccinated child. The abovementioned adult is a 29-year-old
housewife who was previously immunised with diphtheria, tetanus, and pertussis (DTaP) vaccination in childhood,
who presented fever, cough, sore throat, hoarseness of voice, odynophagia, and bilaterally enlarged tonsils. A throat
swab confirmed the presence of toxigenic Corynebacterium diphtheriae. The patient was given 80,000 international
units (IU) dose of diphtheria antitoxin (DAT) and treated with 2.4 million units (MU) QID intravenous penicillin and
oral erythromycin 800 mg twice daily for two weeks. The patient responded well to the treatment and recovered with
no cardiovascular or neurotoxicity.
2.Suppurative BCG Lymphadenitis and the Importance of Microbiology Investigations – A Case Report
Fatimahtuz Zahrah Muhamad Damanhuri ; Hasni Mahayidin ; Thenmalar Kandasamy ; Adilahtul Bushro Zaini ; Siti Norbaya Masri ; Syafinaz Amin Nordin
Malaysian Journal of Medicine and Health Sciences 2020;16(SP 1, September):38-40
Suppurative BCG lymphadenitis can easily be overlooked, as it mimics other diseases such as tuberculous
lymphadenitis. A case of a three-month old female infant who received the BCG vaccination at birth presented
with isolated left axillary mass at two months of age. She was initially treated as lymph node abscess but
was referred to the hospital due to the increasing size of the swelling. Needle aspiration was done and
the microbiology analysis came out positive for acid-fast bacilli. She was planned for syrup isoniazid;
however, the management team withheld treatment until they were certain of the identity of the bacteria.
The bacteria was confirmed by the molecular method to be Mycobacterium bovis BCG strain.
The case report highlights the importance of the microbiology investigations for appropriate management in this case.
3.Serotype 15C Streptococcus pneumoniae with Third Cranial Nerve Palsy: Unusual Serotype and Presentation
Fatimahtuz Zahrah Muhamad Damanhuri ; Evelyn Aun ; Revathy Arushothy ; Thenmalar Kandasamy ; Adillahtul Bushro Zaini ; Siti Zulaikha Zakariah ; Siti Norbaya Masri
Malaysian Journal of Medicine and Health Sciences 2020;16(No.4):442-444
We present a unique case of pneumococcal meningitis caused by serotype 15C, a non-vaccine serotype, which is
long thought to be non-virulent. Our patient is a young lady with a known case of plaque psoriasis, presented with
sudden onset of left oculomotor nerve palsy and severe headache two days prior to admission. The clinical features
were initially mimicking of brain tumour and brain aneurysm. The diagnosis of pneumococcal meningitis was confirmed by the bacterial antigen test and genome detection using multiplex PCR from the CSF. The blood culture also
grew Streptococcus pneumoniae. Serotyping was performed on the isolate using Neufeld's Quellung method and it
was identified as serotype 15C. Psoriatic skin disease was identified as a potential source of this invasive infection.