1.Thrombotic thrombocytopenic purpura-like syndrome associated with arcanobacterium pyogenes endocarditis in a post-transplant patient: A case report
The Medical Journal of Malaysia 2018;73(5):344-346
Systemic Arcanobacterium pyogenes is a rare bacterial
infection in humans.1The diagnosis of thrombotic
thrombocytopenic purpura (TTP)-like syndrome and
infective endocarditis (IE) is often elusive. We report a case
of TTP-like syndrome associated with A. pyogenes
endocarditis in a post-allogenic transplant patient.
2.Subcutaneous mycosis presenting as a non- healing left calf ulcer in an immunocompromised patient
Andy Tang Sing Ong ; Dr Yong Kar Ying ; Dr Jacqueline Wong Oy Leng ; Chua Hock Hin ; Chew Lee Ping
The Medical Journal of Malaysia 2017;72(2):122-123
This is a case report of subcutaneous mycosis presenting
as a non-healing left calf ulcer in an immunocompromised
patient. Traumatic inoculation of the causative agent is the
most likely route of infection. The diagnosis requires a
detailed history and high clinical suspicion, confirmed by
histopathological examination. The management requires a
multidisciplinary team approach involving surgeon,
pathologist, physician sub-specialised in infectious disease,
wound care nursing team as well as social support services.
The literature review recommended that the treatment of
choice for such infection is surgical debridement in addition
to optimal antifungal therapy.
Mycoses
3.Demographics and outcome of patients with congenital haemophilia in Sarawak, Malaysia
Andy Tang Sing Ong ; Wong Qi Ying ; Tan Yee Yen ; Chieng Chae Hee ; Ko Ching Tiong ; Ong Gek Bee ; Chew Lee Ping
The Medical Journal of Malaysia 2021;76(1):51-55
Introduction: Sarawak has a population that is
geographically and characteristically widely varied. This
study aimed to determine the demographic profile of
patients in Sarawak, Malaysia.
Materials and Methods – A cross-sectional study was
conducted in 2019 at four major haemophilia treatment
centres in Kuching, Sibu, Bintulu and Miri Hospitals,
Sarawak. Demographic and clinical data were collected with
consents from patients.
Results and Discussion: Ninety-six haemophilia patients
were identified - 79(82.3%) haemophilia A(HA) and 17(17.7%)
haemophilia B(HB). Severe haemophilia patients were noted
in 45.6% (36/79) of HA and 64.7% (11/17) of HB. In all 44.3%
of the HA and 52.9% of the HB population had no identifiable
family history of haemophilia. Two-thirds of the patients with
severe HA were on prophylaxis [24/36 (66.7%)] and only onethird [4/11 (36.4%)] in severe HB. Inhibitors developed in 9/79
(11.4%) of the HA population [3/79 (3.8%) high responders].
The median inhibitor titre was not significantly different
between the different treatment groups – on demand versus
prophylaxis (1.0BU versus 2.0BU; z statistic -1.043, p-value
0.297, Mann-Whitney test). None of the patients developed
inhibitory alloantibodies to factor IX. Four HA patients (5.1%)
underwent immune tolerance induction where one case had
a successful outcome. Three severe HA patients received
emicizumab prophylaxis and showed remarkable reduction
in bleeding events with no thromboembolic events being
reported. One female moderate HA patient received
PEGylated recombinant anti-haemophilic factor. Eleven
patients underwent radiosynovectomy. One mild HB patient
succumbed to traumatic intracranial bleeding. Our data
reported a prevalence (per 100,000 males) of 5.40 cases for
all severities of HA, 2.46 cases for severe HA; 1.16 cases for
all severities of HB, and 0.75 cases for severe HB. The
overall incidence of HA and HB was 1 in 11,500 and 1 in
46,000, respectively.
Conclusion: This study outlines the Sarawakian haemophilia
landscape and offers objective standards for forward
planning. Shared responsibilities among all parties are of
utmost importance to improve the care of our haemophilia
population.
4.Demographic characteristics and outcomes of continuous ambulatory peritoneal dialysis related peritonitis in Miri General Hospital, Malaysia
Andy Sing Ong Tang ; Carolisna Yanti Incham ; Sakura Doris ; Diplo Nurs ; Siaw Tze Yeo ; Keng Hee Koh
The Medical Journal of Malaysia 2019;74(4):270-274
Introduction: Sarawak has a population that is
geographically and characteristically widely varied. In this
study we aimed to determine the demographic
characteristics of our patient population who undergo
continuous ambulatory peritoneal dialysis (CAPD) and to
study the incidence, the microbiology and the outcome of
CAPD peritonitis.
Methods: A retrospective record review of all CAPD patients
on follow-up at the Miri Hospital, Sarawak, Malaysia from
2014 until 2017 was done.
Results and Discussion: During the 4-year period, the
overall peritonitis rate was 0.184 episodes per patient-year.
Gram-positive and gram-negative bacteria each constituted
one-third of the peritonitis; fungi (2.6%), Mycobacterium
tuberculosis (MTB) (5.3%), polymicrobial (2.6%) and sterile
culture (26.3%). The most commonly isolated gram-positive
bacteria were coagulase-negative Staphylococcus. Our
peritonitis rate is comparable to that of other centres i.e.,
Japan 0.195 and Indonesia 0.25. In comparison, countries
like India (0.41), Korea (0.40) and Singapore (0.59) had
relatively higher rate of PD-associated peritonitis. Two
tuberculosis peritonitis patients died. The rate of catheter
removal was approximately 20%. Gram-negative bacteria
and MTB have a higher risk of catheter loss. About one-fifth
used rainwater to clean their CAPD exit site. Out of this
group, 33% did not boil the rainwater prior to usage.
Conclusion: Patient’s characteristics and microbial
susceptibility vary in different places of practice. The high
rates of culture-negative peritonitis and high mortality risks
associated with TB peritonitis warrant special attention. In
patients with refractory peritonitis, early catheter removal is
warranted in order to reduce mortality and minimize damage
to peritoneal membrane.