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.

Intrauterine infection has emerged to be the main and frequent cause of premature delivery and foetal demise. Microorganisms gain entry into the amniotic cavity via ascending route, haematogenous dissemination, retrograde seeding from peritoneal cavity and accidental introduction during invasive procedures. This is a case of foetal loss in utero from a twin pregnancy due to intrauterine sepsis diagnosed through placenta examination. Both maternal and foetal evidences of inflammatory response were demonstrated in the placenta on histology. Microscopically, there were acute chorioamnionitis and villitis as well as abundant gram positive cocci in the foetal blood within placental villous capillaries. The presence of intravascular bacterial organism provides evidence for a conclusive diagnosis of intrauterine sepsis, particularly where the placenta or foetal blood microbiological cultures results are not available or equivocal. More attention should therefore be given when sampling, as pathological evidences of underlying foetal compromise or death could be provided by well-represented placental tissue samples.

Introduction: Sudden unexpected death of infancy (SUDI) refers to when the occurrence of death is sudden and not expected in previously healthy child. Infection is recognized as one of the leading identifiable causes of SUDI, and a significant proportion of currently unexplained infant deaths may be infection related, possibly mediated by abnormal systemic immune responses. We would like to share some of these cases and highlight the importance of microbiological investigations as part of investigations of SUDI. Case Reports: Case 1: A 2-month-old female, was found unresponsive on bed by the mother. Autopsy tissue histopathological examination showed acute stress changes in thymus and features of early pneumonic changes. Microbiology investigations isolated pure cultures of E. coli from blood, lungs and spleen tissue cultures. Case 2: A 2-monthold female, was found unresponsive by the father. There were history of vomiting and shortness of breath post-feeding the day before. Postmortem investigations concluded Klebsiella pneumoniae infection as primary cause of death. Additionally, there were features to suggest misalignment of pulmonary vein with pulmonary hypertension, enlarged heart with pleural effusions and chronic stress changes in thymus. Case 3: A 3-month-old female, with 2-week history of NICU admission after birth following meconium aspiration syndrome, was found unresponsive by the caretaker. Autopsy findings revealed lung changes in keeping with previous pneumonitis and Group B streptococcal sepsis. Learning Points: The postmortem microbiological investigations remain a critical value in investigations of SUDI. Moreover, these microbiological investigations will identify unexpected infections in cases with absence of histologically identifiable focus of infection. Appropriate and correct technique of postmortem microbiology sampling will increase the likelihood in identifying infection-related cause.