Abiotrophia defectiva is a gram-¬‐positive coccobacilli that specifically grown in chocolate blood agar and Brucella agar. Infectious diseases caused by A. defectiva are extremely rare, and identification of this pathogen is important, as its bacterial characteristics require proper attention. An 8-¬‐year-¬‐old Chinese girl who is a known case of small perimembranous ventricular septal defect (PMVSD) presented with recurrent high grade fever, cough and poor oral intake for a week. The organism isolated from bloodspecimens from the patient was identified as A. defectiva. Her echocardiogram showed there was large vegetation at pulmonary valve extending on to the main pulmonary artery and right ventricular cavity. Due to detection of vegetations during her follow-¬‐up, she was readmitted for further management. Her conditions improved after antibiotics therapy, and she was on routine follow-¬‐up every 2 weeks. Clinically it is important to diagnose early so that the treatment can be started as soon as possible and improved the patient’s condition.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) is a pathogen recognized to be distinct in both phenotype and genotype from hospital-acquired MRSA. We have identified CA-MRSA cases in Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, including their antibiotic susceptibility patterns and genotypic characteristics. Cases were identified during January to December 2009 from routine clinical specimens, where culture and antibiotic susceptibility results yielded pauci-resistant MRSA isolates suspected as being CA-MRSA. The patients clinical data were collected and their specimens were sent for molecular confirmation and analysis. Five cases of CAMRSA were identified, which had a multi-sensitive pattern on antibiotic susceptibility tests and were resistant to only penicillin and oxacillin. All cases were skin and soft-tissue infections, including diabetic foot with gangrene, infected scalp hematoma, philtrum abscess in a healthcare worker, thrombophlebitis complicated with abscess and infected bedsore. All five cases were confirmed MRSA by detection of mecA. SCCmec typing (ccr and mec complex) revealed SCCmec type IV for all cases except the infected bedsore case. Panton-Valentine leukocidin gene was positive in all isolates. As clinical features among methicillin-sensitive Staphylococcus aureus, CA-MRSA and nosocomial CA-MRSA are indistinct, early recognition is necessary in order to initiate appropriate antibiotics and infection control measures. Continual surveillance of pauci-resistant MRSA and molecular analysis are necessary in order to identify emerging strains as well as their epidemiology and transmission, both in the community and in healthcare setting.