exudates and Leukocytosis

A neglected tropical disease, melioidosis is known to have variability in clinical presentations. Here, we described clinical features that should alert the physicians on the possibility of melioidosis. In this review of 86 cases from 2001 to 2011, the common presentations of melioidosis in the Emergency Department (ED), Hospital Universiti Sains Malaysia were; male gender (79.1 %), in working age group (47.8 ± 15.2 year-old), worked in contact with soil (73.3 %), presented with fever (91.9 %), in rainy season (55.8 %), have underlying diabetes mellitus (79.1 %), have leukocytosis (67.4 %) and high blood glucose (62.8 %) during presentation. In 34.9 % of cases, the antimicrobials were initiated at the ED and only 10.5 % include antimelioid drugs. Thirty-one patients (36.0 %) died due to melioidosis and 51.6 % of this were within 48 h of admission. Despite high mortality rate, the clinical awareness on the possibility of melioidosis among emergency physicians is still low and need to be strengthened.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Diabetes Mellitus; Emergency Service, Hospital; Farmers; Female; Humans; Hyperglycemia; Leukocytosis; Malaysia; Male; Melioidosis; Middle Aged; Retrospective Studies; Seasons; Young Adult

The Twin-Barred Tree Snake, Chrysopelea pelias, is a colubrine that, like other members of the genus Chrysopelea, is able to glide in the arboreal strata. Little is known about the effects of its bite. This report is the first clinically documented bite by this relatively uncommon rear-fanged species.. The patient was a 19-year-old female who arrived at the Emergency Department (ED) of an urban teaching hospital 6 h after being bitten by a snake that was later provisionally identified as a C. pelias. Noted on presentation were bite marks on the right middle toe with minimal inflammation and tenderness. There was slight numbness over the dorsum of the right foot and discomforting sensation radiating up the thigh that persisted for several days. There was mild pyrexia, but no evidence of any systemic effects. The full blood count did show neutrophil leucocytosis, and transient hemoglobinuria was noted in an initial urine analysis.. The properties of Duvernoy's secretion of C. pelias remain uncharacterized. In this case, the clinical course featured only the local effects noted above. However, the significant local pain reported by the patient suggests that bites by C. pelias are not necessarily trivial and do require full evaluation and observation in a medical facility. Discussed also is the importance of the establishment of a national registry for animal bites and stings in Malaysia.. Such a facility could expedite safe and appropriate management of envenomed patients.

Topics: Animals; Colubridae; Emergency Service, Hospital; Female; Hemoglobinuria; Hospitals, Teaching; Humans; Leukocytosis; Malaysia; Neutrophils; Snake Bites; Snake Venoms; Young Adult

Topics: Africa, Central; Africa, Eastern; Africa, Western; Altitude; Animals; Burkitt Lymphoma; Canada; Child; Child, Preschool; Colombia; Culture Techniques; Herpesviridae; Humans; Humidity; Infant; Insect Vectors; Leukocytes; Leukocytosis; Malaysia; Mass Screening; Mice; New Guinea; Reoviridae; Vaccinia virus