The HACEK organisms consist of the non-influenzae Haemophilus sp., Aggregatibacter sp., Cardiobacterium sp., Eikenella corrodens and Kingella sp. are responsible for a sizable percentage of infective endocarditis cases worldwide with the mortality rate of 18%. Amongst them, Aggregatibacter actinomycetemcomitans is the most common pathogen strongly associated with infective endocarditis. A. actinomycetemcomitans forms part of the oral microbiota and is also the etiological agent of periodontitis. Here, we present a case of a 37-year-old man with underlying obstructive uropathy, that sought treatment for postural hypotension and symptomatic anaemia with fever. Later, he had developed decompensated congestive cardiac failure with aortic regurgitation. A cardiac echocardiogram revealed the presence of vegetation on the aortic valve. Blood culture grew A. actinomycetemcomitans, and he was treated with furosemide and ceftriaxone. A further dental examination showed the patient is having chronic periodontitis, which could be the possible source of A. actinomycetemcomitans causing infective endocarditis. The patient was then transferred to the National Heart Centre for the first time for further management after completion of 4 weeks of intravenous antibiotics. As the pathogen is fastidious, rapid and newer technology like MALDI-TOF mass spectrometry provides rapid and accurate identification for appropriate patient clinical management.

Introduction: The emergence of a novel Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic. Rapid and accurate diagnosis method is crucial to reduce the disease burden and to improve early diagnosis approaches to control of the disease. Real time Reverse transcriptase PCR (qRT-PCR) has been identified by the World Health Organization as the most sensitive and specific method of detection. However, the success of this assay relies on the quantity and quality of the extracted viral RNA. Methods: Various methods have been developed for nucleic acid extraction however, the methods have not been assessed. RNA extraction was performed from 24 nasopharyngeal swab samples using a manual extraction kit (GF-1) and an automated extraction kit (Genolution). The concentration and purity of the extracted RNA samples were measured, and its performance were tested using qRT-PCR. Results: The average concentration and purity of the RNA samples extracted using GF-1 kit was higher compared to Genolution. Similarly, the qRT-PCR assay using the RNA samples extracted using manual extraction was better compared to automated kit. Conclusion: Both the manual and automated extraction kits have its advantages and disadvantages in terms of yield and purity. However, with proper optimization, both methods may be used for routine molecular diagnostic of COVID-19 in laboratories.

Group B Streptococcus (GBS) is a predominant causative pathogen of neonatal meningitis that is associated with a high rate of mortality and morbidity. The establishment of antenatal screening and intrapartum chemoprophylaxis has led to a significant reduction in the incidence rate of invasive GBS disease in developed countries. However, these strategies are not routinely practiced in most developing countries. To ensure good recovery of infants affected with GBS, a prompt diagnostic strategy and appropriate therapy are essential. We highlight here the case of a preterm male infant diagnosed with early-onset of GBS meningitis diagnosed by using polymerase chain reaction (PCR) method on the cerebrospinal fluid (CSF) of the infant. Initially the pathogen was not isolated in both blood and CSF cultures as sampling was performed after the administration of antibiotics. Hence, PCR was a crucial diagnostic test in facilitating the detection of the pathogen in CSF. We believe that PCR is a potentially fast and precise diagnostic method for infection in a newborn.

Introduction: Hajj is a unique religious mass gathering among Muslims hosted by Kingdom of Saudi Arabia (KSA) annually. It is a fifth pillar that is compulsory to be carried among muslim. Infections due to Neisseria meningitidis, Streptococcus Pneumoniae and Influenza virus are very high among Hajj pilgrims in KSA. Study shows knowledge and attitude towards vaccine preventable disease and vaccination which is very important for the prevention of these infectious diseases. This study aims to determine knowledge and attitude among the prospective Malaysian hajj pilgrims on vaccine preventable disease and vaccination. Method: A cross sectional study was conducted among prospective hajj pilgrims in June 2019. Self-administered questionnaires were given to the respondents through simple random sampling. The socio-demographic characteristics were described using descriptive analysis. Chi-square test was used to analyse the association between the socio-demographic and Malaysian hajj pilgrims’ knowledge and attitude towards the vaccine preventable diseases and vaccination. Results: A total of 135 respondents were recruited in the study. There were statistically significant associations between the knowledge and the highest education level (p=0.01), and also between the knowledge and the occupation (p=0.02) on vaccine preventable disease and vaccination. Conclusion: There is a lack of knowledge among the Malaysian hajj pilgrims about these vaccine preventable diseases and vaccination, especially those who have lower education level and also unemployed. Tabung Haji are highly advised to focus on these group and prepare a special course that focused on these vaccine preventable diseases so that Malaysian Hajj pilgrims will be protected.

Introduction: Chlamydia trachomatis is the most prevalent sexually transmitted infection world wide caused by the bacterial agent named Chlamydia trachomatis. Long term chlamydial infection has a negative impact on the female reproductive system and often leads to infertility. We determined the prevalence of Chlamydia trachomatis and its associated factors among subfertile couples attending the Lembaga Penduduk dan Pembangunan Keluarga Negara (LPPKN) Subfertility Clinic. Method: Blood samples were collected from 95 couples (190 respondents) for Chlamydia trachomatis IgG antibody testing. The Enzyme-Linked Immunosorbent Assay (ELISA) technique was used to detect outer membrane protein complexes of Chlamydia trachomatis in the assay. Results: Chlamydia trachomatis IgG antibody seropositivity was detected in 14 husbands (14.7%) and 17 wives (17.9%). The prevalence of Chlamydia trachomatis among these couples was 22.1%. Our findings found no significant association between Chlamydia trachomatis and its associated factors, but the prevalence rate among the studied population is of concern. Conclusion: The screening of Chlamydia trachomatis among couples is recommended for integration in the subfertility investigation procedure. It is crucial, particularly for women with tubal factor infertility (TFI).

Sporotrichosis is a relatively uncommon fungal infection in human as compared to other fungal infectiction such as tinea corporis or cruris. The fungus can be found in the environment and on plant matter. Sporotrichosis usually results from trauma to the skin followed by exposure to the fungus. It can also be spread by cat scratch or bite. Sporotrichosis usually presents as multiple skin nodules arranged in a linear fashion over the limbs, often with associated lymphadenopathy. This calls for importance of full physical examination and a high index of suspicion in order to diagnose this infection that can either involve the skin or the lymphatic channel or both. If misdiagnosed, treatment can be delayed and lead to prolonged suffering of the patient. This is an interesting case report about a 43-year-old woman who presented with left axillary swelling and decreased range of movement of the corresponding shoulder which was feared initially to be linked to breast cancer. However, good clinal acumen lead to the actual diagnosis of sporotrichosis.

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.

Pneumonia is a common lung infection. Common bacterial cause of this serious lung infection includes Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. Haemophilus parahaemolyticus pneumonia is an uncommon cause of bacterial pneumonia, occurring mainly as an opportunistic pathogen in immunocompromised patients as in this case, diabetes mellitus. Therefore, this case report will look at a case of 49-year-old man who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics. This case report will look at a case of 49 years old who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics.

The aim of this study was to study the genotype of a hospital collection of Group B Streptococcus (GBS) from invasive and non-invasive sites. Fifty-one pre-characterised human of GBS were re-identified and further analysed by multilocus sequence typing (MLST) in relation to previously published serotypes. Fifteen sequence types (ST) were found with ST1 being the most predominant. ST1 was also associated with majority of the invasive isolates. The genotypic distribution patterns of GBS in this study were largely in agreement with previous reports from other countries indicating the tendency of certain genotypes to prevail in human infection settings.

Introduction: Challenge arises for medical undergraduates as the subject of medicine is intricate and extensive. Although students come from the same pool of excellent academic background, the medical undergraduates are still prone to failure in exams, resulting in them repeating the year of study or even having the thought of changing to other courses. In order to cope with the programme, students may adopt learning approaches that would help them to go through the programme.Therefore, it would be interesting to explore the learning approaches of medical students in Universiti Putra Malaysia. Methods: The purposes of this study were to determine the learning approach of medical undergraduates of Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (FMHS, UPM) together with its associated factors, which were socio-demographic characteristics and learning environment. This research was a cross-sectional study where the sample size calculated was 554. Self-administered questionnaires were given to the respondents chosen by simple random sampling. The socio-demographic characteristics were analysed using descriptive statistics such as frequency and percentage. Chi-square test was used to analyse the association between the variables. Results: The response rate was 83% (460 respondents agreed to participate). The majority of the respondents were females (73.7%), Malay (67%), and in their clinical years of study (58.7%). Overall, most students preferred deep approach (DA) of learning (49.6%), followed by strategic approach (29.1%) and surface apathetic approach (21.3%) of learning. There were statistically significant associations between learning approach and gender (p=0.005), as well as between learning approach and year of study (p=0.037). Conclusion:Our study showed an association between learning approaches and year of study and gender. DA of learning was the preferred learning approach in medical students at FMHS, UPM. This approach of learning, where students learn to understand the subject matter, may result in students become effective learners. Their understanding about the subject matter will be applicable to their clinical practice in the future.