Chromobacterium violaceum is a gram negative, facultative anaerobic coccobacillus. Human infections are rare and usually occur after exposure to contaminated soil or water. Infections can present with fulminant septicemia, multiple abscesses and rapidly spreading soft tissue infections. Here we present a fatal case of pulmonary Chromobacterium violaceum infection following aspiration of drain water. Treatment with fluroquinolones in combination with either co-trimoxazole or amikacin has been described in successfully treated cases.
Typhoid fever being a systemic infection can present in a multitude of ways, involving various systems. Here we describe a case of typhoid fever presenting with acute cerebellar ataxia and marked thrombocytopenia. This atypical presentation is not common in typhoid fever and can lead to misdiagnosis as well as a delay in the initiation of appropriate therapy. Prompt clinical improvement and the return of platelet counts to normal were noted after the patient was started on IV Ceftriaxone.
A previously well 13-year-old boy presented with a short history of fever and altered mental status. His mother was admitted for dengue fever and there had been a recent dengue outbreak in their neighbourhood. He was diagnosed with dengue encephalitis as both his dengue non-structural protein 1 (NS-1) antigen and cerebrospinal fluid (CSF) dengue polymerase chain reaction (PCR) were positive. He did not have haemoconcentration, thrombocytopenia or any warning signs associated with severe dengue. He recovered fully with supportive treatment. This case highlights the importance of considering the diagnosis of dengue encephalitis in patients from dengue endemic areas presenting with an acute febrile illness and neurological symptoms.
We report a case of a diabetic patient with an infected leg wound leading to septicemia and abscess formation in the contra-lateral leg due to Streptococcus canis. This organism belongs to the Lancefield group G and is more commonly found in dogs. It is often mistaken for Streptococcus dysgalactiae which is a human strain of streptococci. Infections in humans are not common and usually involve infected wounds or ulcers and the surrounding soft tissue. In most reported cases, patients had close contact with domestic dogs and a pre-existing wound as a portal of entry. Our patient recovered after surgical debridement and drainage of abscess together with antibiotics. This organism is sensitive to common antibiotics like penicillin, amoxycillin, cephalosporins and erythromycin. The incidence of infections due to Streptococcus canis may be under-reported as laboratories may just report an isolate as group G streptococcus. Susceptible patients with wounds or ulcers should be counselled on proper wound care and advised to avoid or minimise contact with the family dog.
Study site: Hospital Raja Permaisuri Bainun, Ipoh, Perak
Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis.
The incidence of renal abscesses is not common. Patients usually have risk factors like diabetes mellitus or an underlying condition which predisposes to urinary tract infections. We report a case of a previously healthy young girl with multiple bilateral renal abscesses. Ultrasonography revealed multiple renal abscesses with a possible differential diagnosis of polycystic kidney disease with infected cysts. No renal calculi were seen. CT-scan of kidneys confirmed the diagnosis. Blood and urine cultures were repeatedly negative. She was treated with two weeks of intravenous antibiotics followed by another four weeks of oral Ciprofloxacin. No surgical intervention was carried out. Repeated ultrasound at six months showed complete resolution of all the renal abscesses.
Diesel is commonly used as fuel for engines and is distilled from petroleum. Diesel has toxic potential and can affect multiple organs. Exposure can occur after ingestion, inhalation or through the dermal route. The practice of siphoning diesel using a rubber tubing and the mouth is common in rural communities. This can lead to accidental ingestion and aspiration. Here we report a case of a patient who accidentally ingested diesel during siphoning, which caused extensive erosion of the oral cavity and oesophagus leading to pneumomediastinum and severe chemical lung injury. The patient responded well initially to steroids and supportive care but required prolonged hospitalisation. He developed complications of nosocomial infection and succumbed 23 days after admission.
A graphene nanoplatelet (GNP) coating is utilized as a functionalized surface in enhancing the evaporation rate of micro-spray cooling for light-emitting diodes (LEDs). In micro-spray cooling, water is atomized into micro-sized droplets to reduce the surface energy and to increase the surface area for evaporation. The GNP coating facilitates the effective filmwise evaporation through the attribute of fast water permeation. The oxygenated functional groups of GNPs provide the driving force that initiates the intercalation of water molecules through the carbon nanostructure. The water molecules slip through the frictionless passages between the hydrophobic carbon walls, resulting an effective filmwise evaporation. The enhancement of evaporation leads to an enormous temperature reduction of 61.3 °C. The performance of the LED is greatly enhanced: a maximum increase in illuminance of 25% and an extension of power rating from 9 W to 12 W can be achieved. With the application of GNP coating, the high-temperature region is eliminated while maintaining the LED surface temperature for optimal operation. This study paves the way for employing the effective hybrid spray-evaporation-nanostructure technique in the development of a compact, low-power-consumption cooling system.