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Introduction This study was conducted to assess the efficacy of point-of-care (POC) procalcitonin (PCT) serial measurement in determining the antibiotic treatment duration in patients with ventilator-associated pneumonia (VAP). Material and methods One hundred patients were randomly recruited and then further randomly divided into two groups of 50 patients each. The first group used the POC PCT test along with the standard sepsis parameter monitoring, while the second group had the standard monitoring only (C-reactive protein [CRP] level, total white count, temperature and tracheal aspirate culture). Serial PCT test results and CRP levels were monitored on days 1, 3, 7 and 9. The patients were followed up for 28-day mortality. Results Eighty-five patients completed the trial, of whom 43 were in the PCT group and 42 were in the control group. The PCT group had a significantly lower mean (SD) antibiotic treatment duration (10.28 [2.68] days) than the control group (11.52 [3.06]). The mean (SD) difference was -1.25 (95% confidence interval [CI], -2.48 to 0.01; t-statistic [df] = -1.997 [83]; P = 0.049). The PCT group also had a higher number of antibiotic-free days alive during the 28 days after VAP onset than the control group (mean [SD], 10.79 [7.61] vs. 8.72 [6.41]). The Sequential Organ Failure Assessment score was the sole factor for the decrease in duration after VAP onset (regression coefficient β [95% CI], -0.70 [-1.19 to -0.20]; P = 0.006). Conclusions The POC procalcitonin test can reduce the antibiotic treatment duration in patients with VAP.

Acute hepatitis is an unusual manifestation of listeriosis. Most patients with listeriosis present with fever, flu-like illness and gastroenteritis symptoms due to consumption of contaminated food. Pregnancy-associated Listeria monocytogenes infection commonly occurs during the third trimester of pregnancy compared to early trimesters. We report a case of listeriosis in the first trimester of pregnancy, which presented with the acute onset of jaundice and was successfully treated with ampicillin.

Melioidosis can happen in humans and animals. It has a wide range of clinical presentations that include asymptomatic infection, ulcers or abscesses of the skin, pneumonia, and multiple internal organ abscesses that may lead to fulminant septic shock. The organism presence in soil and surface of the water. We present a case of a non-diabetic chronic kidney disease patient presented with multiple carbuncles and respiratory melioidosis in which we are able to isolate B. pseudomallei after prolonging the plate incubation for 48-hours. We also suggested available tests in most diagnostic microbiology laboratory for identification of the organism. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.456-458

Cytomegalovirus (CMV) is a virus under the Herpesviridae family. We describe two case reports on different manifestations of infants with CMV infection presented with neonatal jaundice, small for gestational age (SGA) and congenital cataract. Congenital CMV (cCMV) was diagnosed in a neonate presented with jaundice and SGA. cCMV cannot be excluded in another case as no CMV PCR done within 3 weeks of life. Only one cCMV infection was treated with 6 weeks of ganciclovir anti-viral therapy, which presented with neonatal jaundice, SGA with a very high CMV viral load. All cases were under multidisciplinary follow[1]up, including pediatric for developmental assessments, audiologist for hearing assessment, and ophthalmology for vision assessment. These case reports describe the importance of thorough clinical examination and early screening of CMV infection in infants to rule out cCMV as CMV is the commonest congenital treatable viral infection in Malaysia. Early treatment and intervention can be planned for child wellbeing.

We present an atypical presentation of melioidosis, which was an appendicular abscess in a man with newly diagnosed Type 2 diabetes mellitus, which has never been reported before worldwide.

Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section. Keywords: Tinea versicolor, Spinal anaesthesia, Caesarean section