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Disseminated Melioidosis with Spinal Intraosseous Abscess

Soo KC, Lee KS, Ooi SY, Darwina A, Sannasey S, Lee HG

Med J Malaysia, 2021 03;76(2):251-253.
PMID: 33742639

Melioidosis is endemic in the State of Sabah, Malaysia. We report a case of a 34-year-old man with one-week history of fever and cough, three days history of diarrhoea and vomiting, which was associated with a loss of appetite and loss of weight for one-month. Clinically, he had hepatosplenomegaly and crepitation over his right lower zone of lung. Chest radiograph showed right lower lobe consolidation. Ultrasound abdomen showed liver and splenic abscesses. Ultrasound guided drainage of splenic abscess yielded Burkholderia pseudomallei. Magnetic resonance imaging (MRI) lumbosacral confirmed right sacral intraosseous abscess after he developed back pain a week later. He received 6 weeks of intravenous antibiotics and oral co-trimoxazole, followed by 6 months oral co-trimoxazole and had full recovery.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination
Occurrence and level of emerging organic contaminant in fish and mollusk from Klang River estuary, Malaysia and assessment on human health risk

Omar TFT, Aris AZ, Yusoff FM, Mustafa S

Environ Pollut, 2019 May;248:763-773.
PMID: 30851586 DOI: 10.1016/j.envpol.2019.02.060

The occurrence, level, and distribution of multiclass emerging organic contaminants (EOCs) in fish and mollusks from the Klang River estuary were examined. The targeted EOCs for this assessment were phenolic endocrine disrupting compounds (bisphenol A, 4-OP, and 4-NP), organophosphorous pesticides (quinalphos, chlorpyrifos, and diazinon), estrogenic hormones (E2, E1, and EE2), and pharmaceutically active chemicals (primidone, sulfamethoxazole, dexamethasone, diclofenac, amoxicillin, progesterone, and testosterone). Results from this study showed that the prevalent contamination of the Klang River estuary by EOCs with diclofenac, bisphenol A, progesterone, and amoxicillin were predominantly detected in fish and mollusks. Among the EOCs, diclofenac and progesterone had the highest concentrations in fish and mollusk samples, respectively. The concentrations of diclofenac and progesterone in fish and mollusk samples range from 1.42 ng/g to 10.76 ng/g and from 0.73 ng/g to 9.57 ng/g, respectively. Bisphenol A should also be highlighted because of its significant presence in both fish and mollusks. The concentration of bisphenol A in both matrices range from 0.92 ng/g to 5.79 ng/g. The calculated hazard quotient (HQ) for diclofenac, bisphenol A, and progesterone without consideration to their degradation byproduct were less than one, thus suggesting that the consumption of fish and mollusks from the Klang River estuary will unlikely pose any health risk to consumers on the basis of the current assessment. Nonetheless, this preliminary result is an important finding for pollution studies in Malaysian tropical coastal ecosystems, particularly for organic micropollutant EOCs, and can serve as a baseline database for future reference.

Matched MeSH terms: Sulfamethoxazole
Phenotypic evaluation of ESBL- and carbapenemaseproducing Escherichia coli and Klebsiella pneumoniae from a teaching hospital in the Philippines

Tiongco RE, Arceo E, Dizon D, Navarro A, Rivera N, Salita C, et al.

Trop Biomed, 2018 Dec 01;35(4):1064-1074.
PMID: 33601853

Antimicrobial resistance is a worldwide public health concern. Rise in the number of antimicrobial resistant organisms, such as extended spectrum β-lactamase- (ESBL) and carbapenemase-producing Escherichia coli and Klebsiella pneumoniae, continue to burden millions of people worldwide. E. coli and K. pneumoniae were isolated and collected for four months from a teaching hospital in the Philippines. All isolates were subjected to ESBL and carbapenemase testing using the double disk synergy test and modified Hodge test, respectively. Their pattern of resistance among different classes of antimicrobial agents was also investigated using the Kirby-Bauer disk diffusion test. Among the 32 clinical isolates tested, 28.1% were positive for ESBL production and 6.3% were positive for carbapenemase production. Species-specific classification showed that E. coli (44.4%) has the highest rate of ESBL production whereas both E. coli (5.6%) and K. pneumoniae (7.1%) showed almost similar rates of carbapenemase production. Antimicrobial resistance pattern of drug resistant isolates showed that all organisms were resistant to ampicillin, and majority showed resistance towards ciprofloxacin, cefotaxime, ceftriaxone, and sulfamethoxazole/trimethoprim. ESBL production is seen highest among E. coli isolates while similar rates of carbapenemase production was observed to both E. coli and K. pneumoniae isolates. Overall, antimicrobial resistance continues to rise and poses a huge threat in public health worldwide. Efforts should be made in developing rapid tests for antimicrobial resistance and to search for effective treatment from infections caused by multidrug resistant organisms.

Matched MeSH terms: Sulfamethoxazole
Fulltext Antibiotic resistance and plasmid profile of Escherichia coli isolated from ducks in Penang, Malaysia

Adzitey F., Ali, G.R.R., Huda, N., Ting, S.L.

International Food Research Journal, 2013;20(3):1473-1478.
MyJurnal

Fifty five (n=55) isolates of Escherichia coli isolated from ducks in Penang, Malaysia were examined for their susceptibility to eleven different antibiotics and assayed for the presence of plasmid DNAs. All the 55 Escherichia coli isolates were resistant (100%) to vancomycin. Higher resistance (= 60) occurred for tetracycline 51 (92.7%), ampicillin 40 (72.7%), streptomycin 37 (67.3%), and sulfamethoxazole-trimethophrim 37 (67.3%). No and low resistance was observed for nitrofurantoin (0%) and gentamicin (1.8%), respectively. The isolates also showed some intermediate resistances to all antibiotics examined except for vancomycin. The 55 Escherichia coli isolates exhibited 23 different antibiotic resistant patterns with MAR index ranging from 0.09-0.82. Majority of the Escherichia coli isolates exhibited resistant pattern of VA-C-OFX-SXT-TE-AMP-NA-KF and VA-S-C-OFX-SXT-TE-AMP-NA-KF with MAR index of 0.73 and 0.82, respectively. The smallest plasmid DNA size was 1.2 kb and the largest plasmid DNA size was 81.5 kb. 51 (93%) of the duck Escherichia coli isolates harbored plasmids. The was no direct correlation between plasmid DNA sizes and antibiotic resistant among the duck Escherichia coli isolates. Thus, the antibiotic resistant of the Escherichia coli isolates could mostly be mediated by chromosomes instead of plasmids. This study also suggests that the use of antibiotics in duck farming in Penang, Malaysia needs to be controlled to prevent the spread of multiple antibiotic resistant Escherichia coli isolates.

Matched MeSH terms: Sulfamethoxazole
Fulltext The man with bilateral nipple pain

Hong HC, Koh KC

Malays Fam Physician, 2013;8(3):43-45.
PMID: 25893059 MyJurnal

Figure 1 is a picture of a 48-year-old male patient who presents with progressive painful enlargement of the areolae of 10 months’ duration. There was no bleeding or nipple discharge. He was diagnosed with human immunodeficiency virus (HIV) infection 16 months ago and was initiated on antiretroviral therapy (ARV), which consisted of zidovudine, lamivudine and efavirenz. As his CD4 cell count at diagnosis was less than 200 cells/mm3, he was prescribed trimethoprim-sulphamethoxazole (Bactrim) for prophylaxis against pneumonia due to pneumocystis jirovecii. Physical examination was unremarkable except for bilateral breast enlargement and right-sided old shingles scar in the T4 dermatome distribution.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination
Fulltext Fatal melioidosis in a captive elephant trunk snake (Acrochordus javanicus) in Kuala Lumpur, Malaysia

Sadiq, M.A., Zakaria, Z., Saharee, A.A., Abba, Y., Hassan, L.

Jurnal Veterinar Malaysia, 2016;28(1):20-26.
MyJurnal

An adult female Elephant Trunk Snake (Acrochordus javanicus) was reported to have been weak and inappetent for five days. The following morning the snake found dead, while in the process of shedding its skin. On post mortem examination, there were multiple circumscribed caseous nodules of various sizes distributed all over the liver, along the respiratory tract and on the lungs. Bacteriological analysis of the lungs and liver swab samples yielded Burkholderia pseudomallei, which was confirmed by PCR amplification of specific 16S rRNA. The condition was diagnosed as melioidosis and the organism was genotypically characterized as sequence type 51, a genotype that has been previously characterized in humans in Malaysia. Antibiotic susceptibility by both Disc diffusion or Kirby Bauer and E-test minimum inhibitory concentration (MIC) showed that the organism exhibited susceptibility to meropenem, imipenem, ceftazidime, cotrimoxazole and co-amoxyclav; the antibiotics recommended in the treatment of melioidosis.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination
Fulltext Typing of Erwinia chrysanthemi isolated from josapine pineapple in Malaysia using antimicrobial susceptibility, plasmid profiles, ERIC-PCR and RFLP analysis

Sahilah, A.M., Rozeita, L., Umi Kalsum, M.S., Son, R.

International Food Research Journal, 2008;15(3):273-280.
MyJurnal

Ninety one leaf samples of Josapine pineapple cultivar (Kelantan, n=8; Pahang, n=20; Perak, n=11; Sabah, n=15; Johor, n=37) showing symptoms of heart rot disease were collected to determine the incidence of Erwinia chrysanthemi. Sixteen strains of E. chrysanthemi were isolated from 13 leaf samples from Pahang (n=4), Sabah (n=2) and Johor (n=7). All of the E. chrysanthemi strains displayed resistance to bacitracin with two strains showing resistance to sulfamethoxazole. None of the E. chrysanthemi strains were resistant toward ampicillin, carbenicillin, cephalothin, ceftriaxone, cefuroxime, gentamicin, kanamycin, nalidixic acid, penicillin G, streptomycin and tetracycline. All of the E. chrysanthemi strains were plasmidless. The dendrogram generated from the ERIC-PCR fingerprinting showed that the E. chrysanthemi strains formed 4 clusters and 7 single isolates at 80% similarity level. The restriction fragment length polymorphism (RFLP) analysis for 16 strains of E. chrysanthemi with HinfI and HaeIII endonuclease, 2 and 4 restriction profiles were obtained, respectively. The combinations of the four techniques were able to differentiate the 16 E. chrysanthemi strains into 14 genome types, suggesting a wide diversity of strains examined. ERICPCR fingerprinting method is found to be more discriminating and useful for the determination of the E. chrysanthemi strains relatedness.

Matched MeSH terms: Sulfamethoxazole
Evaluation of reported adverse drug reactions in antibiotic usage: a retrospective study from a tertiary care hospital, Malaysia

Arulappen AL, Danial M, Sulaiman SAS

Front Pharmacol, 2018;9:809.
PMID: 30177879 DOI: 10.3389/fphar.2018.00809

Adverse drug reaction (ADR) primarily caused by many drugs including antibiotics. At present, the incidence and pattern of ADR caused by antibiotics have remained as neglected area in Malaysia. This study was conducted to determine the incidence and analyze the pattern of ADR caused by antibiotics among patients in a tertiary care hospital. It is a 2-year retrospective observational study conducted at Hospital Pulau Pinang, Malaysia. All eligible patients who had antibiotic prescribed belonging to any age group either from outpatient or inpatient that had experienced ADR was included in this study. The outcomes were measured with the aid of Naranjo's and Hartwig's scales. The incidence of the ADRs among patients prescribed with antibiotics in Hospital Pulau Pinang is about 1.1%. Vancomycin and Trimethoprim/Sulfamethoxazole both are considered to be the major contributors to ADR incidences. The skin was the most affected organ by ADRs followed by gastrointestinal system. Most of the severe ADRs were caused by Penicillin. The causality relationship of all the severe reactions was mostly probable. General Medicine unit had reported the highest number of ADRs caused by antibiotics. The common manifestations of ADRs are acute kidney injury and exanthem. In addition, majority of the ADRs caused by antibiotics were reversible. A large multicenter study is suggested to confirm the present findings.

Study site: Hospital Pulau Pinang

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination
Fulltext Frequency and molecular epidemiology of Panton-Valentine leukocidin gene in Staphylococcus aureus colonising HIV-infected patients

Mohd-Zain Z, Mohd-Nawi SFA, Adnan A, Kumar S

Malays J Pathol, 2017 Aug;39(2):115-122.
PMID: 28866692 MyJurnal

BACKGROUND: HIV-infected patients pose a high risk of contracting skin and soft tissue infections caused by Staphylococcus aureus. Those who are colonized with methicillin-resistant S. aureus (MRSA) that carry Panton-Valentine leukocidin (PVL) are predisposed to severe infections that could lead to necrotic skin infections. However the association of S. aureus specifically methicillin sensitive S. aureus carrying PVL gene in HIV patients has not been widely reported. Here, we study the prevalence and the molecular epidemiology of PVL-producing S. aureus in HIV-infected patients.
METHODS: Swabs from four body sites of 129 HIV-infected patients were cultured for S. aureus and identified by standard microbiological procedures. The isolates were subjected to antimicrobial susceptibility testing by disk diffusion against penicillin, erythromycin, clindamycin, and cotrimoxazole. PCR was used to detect the PVL gene and genetic relationship between the isolates was determined by using pulse field gel electrophoresis.
RESULTS: A total of 51 isolates of S. aureus were obtained from 40 (31%) of the patients. The majority (43.1%) of the isolates were obtained from the anterior nares. Thirteen (25.5%) of all the isolates were resistant to more than one category of antibiotics, with one isolate identified as MRSA. Thirty-eight (74.5%) isolates (including the MRSA isolate) carried PVL gene where the majority (44.7%) of these isolates were from the anterior nares. A dendogram revealed that the isolates were genetically diverse with 37 distinct pulsotypes clustered in 11 groups.
CONCLUSION: S. aureus obtained from multiple sites of the HIV patients were genetically diverse without any clonality observed.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination
Genetic relatedness, antimicrobial resistance and biofilm formation of Salmonella isolated from naturally contaminated poultry and their processing environment in northern Malaysia

Chuah LO, Shamila Syuhada AK, Mohamad Suhaimi I, Farah Hanim T, Rusul G

Food Res Int, 2018 03;105:743-751.
PMID: 29433269 DOI: 10.1016/j.foodres.2017.11.066

We investigated the genetic relatedness, antibiotic resistance and biofilm-producing ability of 114 strains of Salmonella, belonged to three serotypes (Corvallis, Brancaster and Albany), isolated from naturally contaminated poultry and their environment in wet markets and smale-scale processing plant from northern Malaysia. Pulsed-field gel electrophoresis revealed that Salmonella strains isolated from various wet markets were clonally related, suggesting the widespread dissemination of these three serotypes in northern Malaysia. All except one strain of Salmonella were resistant to more than two classes of antibiotics, hence regarded as multidrug resistant (MDR). Resistance to sulphonamide (96.5%), ampicillin (89.5%), tetracycline (85.1%), chloramphenicol (75.4%), trimethoprim (68.4%), trimethoprim-sulfamethoxazole (67.5%), streptomycin (58.8%) and nalidixic acid (44.4%) were observed. Resistance determinants, floR, cmlA, tetA, tetB, tetG, temB, blaPSE-1, sul1, sul2, qnrA, qnrS, strA and aadA were detected by PCR among MDR Salmonella strains. Seventy-six strains (66.7%) harboured class-I integrons. The gene cassettes identified were dfrA1, dfrA12, aadA2 and an open reading frame orfC with unknown function. All Salmonella strains produced biofilm and 69.3% of them were strong biofilm-producers. Our findings suggested that most likely, persistent Salmonella colonises various sites in the processing environment by producing biofilm, which leads to their widespread dissemination in wet markets located in northern Malaysia.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination
Isolation of Moraxella catarrhalis from sputum specimens of Malaysian patients

Ahmad N, Cheong YM, Tahir HM

Malays J Pathol, 1994 Jun;16(1):63-7.
PMID: 16329578

Moraxella catarrhalis has gained reputation as a pathogen in the lower respiratory tract especially in patients with underlying chronic lung diseases. It is considered significant when isolated from sputum specimens of adults with respiratory tract infections. A study was carried out to determine the prevalence of Moraxella catarrhalis isolated in sputum specimens and beta-lactamase production of these isolates. Sputum specimens sent to the Bacteriology division, Institute for Medical Research from April 1990 until April 1993 were screened for Moraxella catarrhalis. A total of 1678 sputum specimens were processed and Moraxella catarrhalis was isolated from 15 (0.89%) of the sputum specimens. Six out of 15 (40%) were isolated from patients with chronic lung disease. Eight out of 15 (47%) were beta-lactamase producers. Moraxella catarrhalis isolated in good-quality sputum must not be disregarded and should be looked for especially in patients with chronic obstructive pulmonary disease. Beta-lactamase production should be tested on all isolates so that appropriate treatment can be given. All the isolates in this study were sensitive to cotrimoxazole.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology
Fulltext Antibiotic susceptibility profile of Haemophilus influenzae and transfer of co-trimoxazole resistance determinants

Mohd-Zain Z, Kamsani NH, Ismail IS, Ahmad N

Trop Biomed, 2012 Sep;29(3):372-80.
PMID: 23018500 MyJurnal

Prior to the implementation of Haemophilus influenzae type b vaccination worldwide, H. influenzae has been one of the main causative agents of community acquired pneumonia and meningitis in children. Due to the lack of information on the characteristics of the H. influenzae isolates that have previously been collected in Malaysia, the H. influenzae were assessed of their microbial susceptibility to commonly used antibiotics. Emphasis was made on strains that were resistance to co-trimoxazole (SXT) and their mode of transfer of the antibiotic resistance determinants were examined. A collection of 34 H. influenzae isolates was serotyped and antimicrobial susceptibility tests were performed to 11 antibiotics. To the isolates that were found to be resistant to co-trimoxazole, minimum inhibition concentration (MIC) to SXT was performed using Etest while agar dilution method was used to measure the individual MICs of trimethoprim (TMP) and sulfamethoxazole (SUL). These isolates were also examined for presence of plasmid by PCR and isolation method. Conjugal transfers of SXT-resistant genes to SXT-susceptible hosts were performed to determine their rate of transfer. Result showed that 20.6% of the total number of isolates was serotype B while the remaining was non-typeable. Antimicrobial susceptibility profile of all the isolates revealed that 58.8% was resistant to at least one antibiotic. Majority of these isolates were equally resistant to ampicillin and tetracycline (29.4% each), followed by resistance to SXT (26.5%). From nine isolates that were found to be SXT-resistant, five contained plasmid/s. Conjugal transfer experiment showed that these five isolates with plasmid transferred SXT-resistance determinants at a higher frequency than those without. From these observations, it is postulated that plasmid is not involved in the transfer of SXT-resistance genes but presence of plasmid facilitates their transfer. The information obtained from this study provides some basic knowledge on the antimicrobial susceptibility pattern of the H. influenzae isolates and their mode of transfer of SXT-resistance genes.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology*
Dissemination of Trimethoprim-Sulfamethoxazole Drug Resistance Genes Associated with Class 1 and Class 2 Integrons Among Gram-Negative Bacteria from HIV Patients in South India

Ramesh Kumar MR, Arunagirinathan N, Srivani S, Dhanasezhian A, Vijaykanth N, Manikandan N, et al.

Microb Drug Resist, 2017 Jul;23(5):602-608.
PMID: 27854149 DOI: 10.1089/mdr.2016.0034

The antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), is generally used for prophylaxis in HIV individuals to protect them from Pneumocystis jiroveci infection. Long-term use of TMP-SMX develops drug resistance among bacteria in HIV patients. The study was aimed to detect the TMP-SMX resistance genes among gram-negative bacteria from HIV patients. TMP-SMX-resistant isolates were detected by the Kirby-Bauer disc diffusion method. While TMP resistance genes such as dfrA1, dfrA5, dfrA7, and dfrA17 and SMX resistance genes such as sul1 and sul2 were detected by multiplex PCR, class 1 and class 2 integrons were detected by standard monoplex PCR. Of the 151 TMP-SMX-resistant bacterial isolates, 3 were positive for sul1 alone, 48 for sul2 alone, 11 for dfrA7 alone, 21 for sul1 and sul2, 1 for sul1 and dfrA7, 23 for sul2 and dfrA7, 2 for sul2 and dfrA5, 41 for sul1, sul2, and dfrA7, and 1 for sul2, dfrA5, and dfrA7. Of 60 TMP-SMX-resistant isolates positive for integrons, 44 had class 1 and 16 had class 2 integrons. It was found that the prevalence of sul genes (n = 202; p

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology*
Fulltext Methicillin-resistant Staphylococcus aureus nosocomial infection trends in Hospital Universiti Sains Malaysia during 2002-2007

Al-Talib HI, Yean CY, Al-Jashamy K, Hasan H

Ann Saudi Med, 2010 Sep-Oct;30(5):358-63.
PMID: 20697171 DOI: 10.4103/0256-4947.67077

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide. The aim of the present study was to assess the burden of MRSA nosocomial infection, its association with factors of interest, and its antimicrobial susceptibility.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology
Fulltext Antimicrobial resistance of Listeria monocytogenes and Salmonella Enteritidis isolated from vegetable farms and retail markets in Malaysia

Kuan, C.H., Rukayadi, Y., Ahmad, S. H., Wan Mohamed Radzi, C.W.J., Kuan, C.S., Yeo, S.K., et al.

International Food Research Journal, 2017;24(4):1831-1839.
MyJurnal

Listeriosis and salmonellosis are the major foodborne illnesses worldwide. Over the last decade,
increasing reports about the antibiotic resistance of Listeria monocytogenes and Salmonella from diverse sources have prompted public health concerns, especially in developing countries with over reliance or misuse of antibiotic drugs in the treatment of humans and animals. In this study, antibiotic susceptibility profiles of 58 L. monocytogenes and 12 Salmonella Enteritidis strains from vegetable farms and retail markets in Malaysia were testedby the standard disk diffusion method. Listeria monocytogenes isolates were found to exhibit 100% resistance to penicillin G. Also, high resistance patterns were observed for meropenem (70.7%) and rifampicin (41.4%). The multiple antibiotic resistance (MAR) index of L. monocytogenes isolates ranged from 0.11 to 0.56. Besides, the antibiogram results revealed that multidrugresistant (MDR) S. Enteritidis were detected and all the S. Enteritidis isolates demonstrated resistance to at least four antibiotics. Ampicillin, amoxicillin, and trimethoprim failed to inhibit all the S. Enteritidis strains. Salmonella Enteritidis isolates also displayed high resistance to nalidixic acid (75.0%), trimethoprim-sulfamethoxazole (75.0%), and chloramphenicol (66.7%). Findings in this study indicated that vegetables could be potential sources of multidrug resistance of L. monocytogenes and S. Enteritidis, which can be a serious issue and a major concern for public health. Thus, there is a great need for surveillance programs in Malaysia to continuously monitor the antibiotic resistance profiles of important pathogens.

Matched MeSH terms: Trimethoprim, Sulfamethoxazole Drug Combination

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