Background: Co-infection by human immunodeficiency and hepatitis C viruses (HIV/HCV) is common and results in significant morbidity and mortality despite effective antiretroviral therapies (ART). Method: A retrospective and prospective evaluation of the efficacy and safety of pegylated interferon alfa 2a/2b plus ribavirin (PEG-IFN/RBV) in consecutive HIV/HCV co-infected patients treated in real life clinical practice in Malaysia. Results: Forty-five HIV/HCV co-infected patients with a median age (interquartile range, IQR) of 41 years (37; 47) were assessed for treatment with PEG-IFN/RBV. All except one are of male gender and the most common risk behaviour was injecting drug use. At baseline 75.5% was on ART and the median (IQR) CD4 count was 492 cells/µl (376; 621). The HCV genotypes (GT) were 73 % GT3 and 27% GT1. Liver biopsies in forty patients showed 10% had liver cirrhosis and another 50% had significant liver fibrosis. The treatment completion rate was 79.5% with 15.9% dropped out of treatment due to adverse effects (AE) or default and 4.6% due to lack of early virological response. The AE causing premature discontinuations were neuropsychiatric and haematological. The overall sustained virological response (SVR) was 63.6% with a trend towards higher SVR in GT3 compared with GT1 (71.9% vs. 41.7%; p=0.064). In patients with bridging fibrosis plus occasional nodules or cirrhosis on liver biopsy, the SVR was significantly lower at 20% (p=0.030) compared to those with milder fibrosis. Conclusion: HIV/HCV co-infected patients can be successfully and safely treated with PEG-IFN/RBV achieving high rates of SVR except in cirrhotic patients.
HIV ; Hepacivirus

Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.

A 61-year-old male presented with community-onsetpneumonia not responding to treatment despite givenappropriate antibiotics. Computed tomography scan of thethorax showed large multiloculated pleural effusion withmultiple cavitating foci within collapsed segments; lesionswhich were suggestive of necrotising pneumonia. Drainageof the effusion and culture revealed methicillin-resistantStaphylococcus aureus, which had the same antibioticprofile with the blood isolate and PVL gene positive.

INTRODUCTIONIt has been noted that SARS transmission is characterised by a few super-spreading events (SSEs) giving rise to a disproportionate number of secondary cases. Clinical and environmental features surrounding the index cases involved were compared with cases in non- SSEs.

MATERIALS AND METHODSData on 231 cases of probable SARS admitted to Tan Tock Seng Hospital (TTSH) were used. Index cases directly causing 10 or more secondary cases were classified as having been involved in SSEs; all others were defined as non-SSEs.

RESULTSOnly 5 cases were involved in SSEs; all 5 were isolated on day 5 of illness or later, and spent at least a brief period in a non-isolation ward; in contrast, amongst the 226 non-SSE cases, only 40.7% and 4.0% were isolated late and admitted to non-isolation wards respectively, and only 3.1% had both these environmental features present; the differences were highly significant (P = 0.012, P <0.001 and P <0.001 by Fisher's Exact test). When compared to 7 non-SSE cases with delayed isolation and an admission to non-isolation wards, SSEs were more likely to have co-morbid disease or require ICU care at time of isolation (P = 0.045 for both factors).

CONCLUSIONSSEs were likely due to a conglomeration of environmental factors of delayed isolation and admission to a non-isolation ward, coupled with severe disease stage at time of isolation.

Adult ; Female ; Humans ; Male ; Middle Aged ; Severe Acute Respiratory Syndrome ; epidemiology ; transmission ; Singapore ; epidemiology

Introduction: The outbreak of coronavirus disease (COVID-19) in December 2019 called for a rapid solution, leading to repurposing of existing drugs. Due to its immunomodulatory effect and antiviral properties, hydroxychloroquine (HCQ) has been used in early 2020 for treatment of COVID-19 patients. This study was conducted to evaluate the treatment outcome of HCQ monotherapy in Malaysia. Methods: A retrospective cohort study was conducted in COVID-19 ward in Hospital Kuala Lumpur (HKL), from March to April 2020. A total of 446 COVID-19 patients were recruited, only 325 patients were finally included for analysis. Statistical analysis was done using SPSS, with a significant value set at p<0.05. Results: The mean age of the patients were 38.5 ±15.5. They were majority male, (n=210, 64.6%) Malaysian (n=239, 73.5%) and Malay ethnicity (n=204, 62.8%). Ninety-one (28%) patients received HCQ monotherapy. HCQ monotherapy was associated with worse outcome (OR: 10.29, 95% CI 1.17-90.80). There was a significant difference in mean length of stay between those with and without HCQ treatment (t323=5.868, p<0.001, 95% CI, 2.56-5.31). The average length of stay for HCQ treated group was 3.84 days longer than those without treatment. 6.6% of the patient receiving HCQ monotherapy encountered adverse drug effects. Conclusion: Similar to study reported worldwide, our study demonstrated that HCQ did not improve length of stay and the outcome of COVID-19 patients.

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) is increasingly reported worldwide causing serious threats to healthcare. This study aimed to identify the common organisms associated with CRE, the clinical characteristics and risk factors for acquiring CRE infection and colonisation among hospitalised patients. Methods: This is a matched, case-control study. Patients aged 18 years and above whom were hospitalised from January 2019 to December 2019 and had CRE isolated from clinical specimens were matched with carbapenem-susceptible controls (CSE), based on gender and age. Univariate and multivariate statistical analysis was performed. Results: Among 184 patients, Klebsiella pneumoniae was the most common organism causing CRE infection and colonisation. Chronic kidney disease (p=0.025, OR:3.12, 95% CI:1.15-8.41), urinary catheterisation (p=0.005, OR:3.67, 95% CI:1.49- 9.00), prior use of cephalosporin (p<0.001, OR:4.69, 95% CI:1.96–11.22) and beta-lactam combination agent (p<0.001, OR:7.18, 95% CI:2.98-17.26) were identified as the independent risk factors. Conclusion: Chronic kidney disease, urinary catheterisation, prior use of cephalosporin and beta-lactam combination agents were independently associated with CRE infection and colonisation. These findings enable targeting potential CRE cohorts, hence, necessitate early undertaking of prevention measures to delay the onset of CRE. A rigorous effort by antibiotic stewardship an infection control team are pivotal.