Plasmodium knowlesi is an emerging zoonotic malaria species and a leading cause of malaria in Malaysia. Although severe disease is increasingly recognised, cerebral malaria remains uncommon and is traditionally associated with Plasmodium falciparum. We report a fatal case of cerebral malaria caused by P. knowlesi in a previously healthy 61-year-old woman with a history of frequent orchard visits for peridomestic agricultural activities. She presented with rapid neurological deterioration and circulatory shock, complicated by an acute pontine infarction. Peripheral blood smear and polymerase chain reaction confirmed P. knowlesi infection with a parasite density of approximately 35,000 parasites/ µL. The patient met World Health Organization criteria for severe malaria and was treated promptly with intravenous artesunate in accordance with international guidelines, alongside intensive supportive care for septic shock and multiorgan failure. Despite a rapid reduction in parasitaemia, her condition deteriorated, and she died within 24 hours of presentation. This case highlights the potential for P. knowlesi to cause rapidly progressive and fatal cerebral malaria. Clinicians in endemic regions should maintain a high index of suspicion for zoonotic malaria in patients presenting with acute neurological deterioration.

Typhoid is an acute febrile illness primarily caused by Salmonella enterica serotype typhi (S. Typhi) which could be challenging to diagnose in children, owing to its non-specific clinical signs and symptoms which may resemble other febrile illnesses. Here, we present a case of typhoid which was atypically presented as fever of unknown origin (FUO) in a two-year-old boy with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency. This child was initially diagnosed and managed as acute tonsillopharyngitis, however remained febrile despite medications. A series of investigations were performed and S. Typhi was isolated from the bone marrow culture after almost a month of admission. The antibiotic was started based on antibiotic susceptibility testing and he recovered well. Our case underscores the challenges of diagnosis establishment and clinical management of typhoid in paediatric patients who has underlying disease and emphasizes the importance of having high index of clinical suspicion to ascertain timely and proper diagnosis.

Research, development, and production of vaccines are still highly dependent on the use of animal models in the various evaluation steps. Despite this fact, there are strong interests and ongoing efforts to reduce the use of animals in vaccine development. Tuberculosis vaccine development is one important example of the complexities involved in the use of animal models for the production of new vaccines. This review summarises some of the general aspects related with the use of animals in vaccine research and production, as well as achievements and challenges towards the rational use of animals, particularly in the case of tuberculosis vaccine development.