exudates and Opportunistic-Infections

Persistent superficial skin infection caused by multiple fungi is rarely reported. Recently, a number of fungi, both opportunistic and persistent in nature were isolated from the foot skin of a 24-year old male in Malaysia. The fungi were identified as Candida parapsilosis, Rhodotorula mucilaginosa, Phoma spp., Debaryomyces hansenii, Acremonium spp., Aureobasidium pullulans and Aspergillus spp., This is the first report on these opportunistic strains were co-isolated from a healthy individual who suffered from persistent foot skin infection which was diagnosed as athlete's foot for more than 12 years. Among the isolated fungi, C. parapsilosis has been an increasingly common cause of skin infections. R. mucilaginosa and D. hansenii were rarely reported in cases of skin infection. A. pullulans, an emerging fungal pathogen was also being isolated in this case. Interestingly, it was noted that C. parapsilosis, R. mucilaginosa, D. hansenii and A. pullulans are among the common halophiles and this suggests the association of halotolerant fungi in causing persistent superficial skin infection. This discovery will shed light on future research to explore on effective treatment for inhibition of pathogenic halophiles as well as to understand the interaction of multiple fungi in the progress of skin infection.

Topics: Adult; Diagnosis, Differential; Diagnostic Errors; Foot Dermatoses; Fungi; Humans; Malaysia; Male; Opportunistic Infections; Skin; Tinea Pedis; Young Adult

Chemotherapy can cause immunosuppression, which may trigger latent intestinal parasitic infections in stools to emerge. This study investigated whether intestinal parasites can emerge as opportunistic infections in breast and colorectal cancer patients (n=46 and n=15, respectively) undergoing chemotherapy treatment. Breast cancer patients were receiving a 5-fluorouracil/epirubicin/cyclophosphamide (FEC) regimen (6 chemotherapy cycles), and colorectal cancer patients were receiving either an oxaliplatin/5-fluorouracil/folinic acid (FOLFOX) regimen (12 cycles) or a 5-fluorouracil/folinic acid (Mayo) regimen (6 cycles). Patients had Blastocystis hominis and microsporidia infections that were only present during the intermediate chemotherapy cycles. Thus, cancer patients undergoing chemotherapy should be screened repeatedly for intestinal parasites, namely B. hominis and microsporidia, as they may reduce the efficacy of chemotherapy treatments.

Topics: Animals; Antineoplastic Combined Chemotherapy Protocols; Blastocystis hominis; Breast Neoplasms; Colorectal Neoplasms; Cyclophosphamide; Epirubicin; Feces; Female; Fluorouracil; Humans; Leucovorin; Life Style; Malaysia; Male; Microsporidia; Middle Aged; Opportunistic Infections; Organoplatinum Compounds; Oxaliplatin; Surveys and Questionnaires

An observational study was carried out to establish the existence of intestinal microsporidiosis among patients with and without gastrointestinal symptoms in Hospital Universiti Kebangsaan Malaysia, Malaysia. A total of 893 faecal specimens from hospitalized patients were examined for microsporidia using a modification of the usual Gram-chromotrope stain technique. One hundred and sixteen (13.0%) patients were positive for microsporidia: 84 (72.4%), 27 (23.3%) and 5 (4.3%) were low, moderate and high excreters of microsporidia spores, respectively. Of the 91 patients with available medical records, microsporidiosis was commonly observed in children aged 0-6 years (26.4%) and adults aged >or=31 years (57.2%). About one-third of this infection was observed in immunocompetent individuals. Among the immunosuppressive group, microsporidia were observed to be more prevalent in patients with haematological malignancy or a combination of malignancy and diabetes mellitus. About 74% of the patients who had microsporidia in their faeces had gastrointestinal symptoms, which could be related to infections or induced by immunosuppressive therapy. The role of microsporidia in causing gastrointestinal symptoms in this population is as yet unclear.

Topics: Adolescent; Adult; Child; Child, Preschool; Feces; Female; Humans; Infant; Intestinal Diseases; Malaysia; Male; Microsporidia; Microsporidiosis; Middle Aged; Opportunistic Infections; Prevalence; Young Adult

Rhodococcus equi, a recognized pathogen in horses, is emerging as a human opportunistic pathogen, especially in immunocompromized hosts. We describe four immunocompromized patients who had serious R. equi infections with an overall mortality of 75%. The natural habitat of R. equi is soil, particularly soil contaminated with animal manure. Necrotizing pneumonia is the commonest form of infection but extrapulmonary infections, such as wound infections and subcutaneous abscess, have also been described in humans. R. equi is cultured easily in ordinary non-selective media. Large, smooth, irregular colonies appear within 48 hours. It is a facultative, intracellular, nonmotile, non-spore forming, gram-positive coccobacillus, which is weakly acid-fast staining and bears a similarity to diphtheroids. It forms a salmon-colored pigment usually after 48 hours incubation. A particular characteristic of this organism is that it undergoes synergistic hemolysis with some bacteria on sheep blood agar. R. equi may be misidentified as diphtheroids, Mycobacterium species, or Nocardia. In vitro R. equi is usually susceptible to erythromycin, ciprofloxacin, vancomycin, aminoglycosides, rifampin, imipenem and meropenem. The organism can be difficult to eradicate, making treatment challenging. Increased awareness of the infection may help with early diagnosis and timely treatment.

Topics: Actinomycetales Infections; Adolescent; Adult; Anti-Bacterial Agents; Fatal Outcome; Female; Humans; Immunocompromised Host; Malaysia; Male; Middle Aged; Opportunistic Infections; Rhodococcus equi

The 1st case of acquired immunodeficiency syndrome (AIDS) in Malaysia was detected in 1987, 1 year after the Ministry of Health established a national AIDS task force. The patient was a 45-year-old Chinese man of Malaysian origin who had been living overseas for the past 30 years. The patient denied any homosexual relationships, blood transfusions, of intravenous drug use; however, he reported multiple sexual partners 10 years prior to developing AIDS. At hospital admission, the patient was in acute respiratory distress and Pneumocystis carinii was isolated from his sputum. The enzyme-linked immunosorbent assay and Western blot tests revealed antibodies to human immunodeficiency virus (HIV). The T- helper/T-suppressor cell ratio was inverted, 16:51%. There were no antibodies to cytomegalovirus or toxoplasmosis. The patient showed rapid clinical improvement after treatment with co-trimoxazole and was released from the hospital 2 weeks after admission. Although this is the 1st case of full-blown AIDS in Malaysia, individuals with antibodies to HIV have been identified.

Topics: Acquired Immunodeficiency Syndrome; Humans; Malaysia; Male; Middle Aged; Opportunistic Infections; Pneumonia, Pneumocystis