The introduction of diphtheria immunisation into the Expanded Program of Immunisation in the 1970s has markedly reduced the incidence of diphtheria diseases. We report a case of fatal diphtheria in a 2 year-old girl whose immunisation status was not known. She had presented with acute exudative tonsillitis and was treated with intravenous amoxicillin-clavulanate but showed progressive signs of upper airway obstruction; stridor, drooling of saliva and bull-neck appearance, with bilateral facial swelling around the parotid region that extended to submental and submandibular regions. Initial cultures from blood, throat, nasal and oral cavity revealed no significant organisms. Corynebacterium diphtheriae subspecies gravis which was resistant to penicillin, was isolated from pus specimen a day after her demise. Clinical suspicion is important to aid diagnosis, microbiological confirmation and management of diphtheria, as the disease is rare in the era of successful immunisation programs. Microbiological vigilance plays an important role in early detection of infection as well as outbreaks. Early institution of diphtheria antitoxin may save lives, while delay in diagnosis may increase mortality and the risk of transmission. This case reaffirms the vital role of immunisation and the importance of efforts to ensure a high uptake of the scheduled immunisations.

Objectives: Hepatitis C virus (HCV) genotyping is important for treatment and epidemiological purposes. The objective was to determine HCV genotype and their associations with certain risk factors at University Kebangsaan Malaysia Medical Centre (UKMMC). Methods: A total of 89 samples were collected from December 2009 to January 2011. Demographic data of patients were collected from medical record. Reverse Transcriptase Polymerase chain reaction (RT PCR) was performed and sixty-four samples yielded positive for HCV. Sequencing was performed and analyzed based on sequence information in GenBank. Statistical analysis were done using SPSS version 15. Results: HCV genotype 3 (73%) was the most frequent genotype, followed by genotype 1(27%). The distribution of HCV genotype/ subtype was as follows: 3a (64.8%), 1a (13.5%), 1 (10.8%), 3 (8.1%) and 1b (2.7%). Conclusions: HCV subtypes 3a, 1a, and 1b were identified in patients at UKMMC, Malaysia with subtype 3a being the most prevalent. No significant association was found between HCV genotypes and patients' demographic data.

Background: Hepatitis C virus (HCV) genotyping is important for treatment and epidemiological purposes. The objective of this study was to evaluate the performance of AmpliSens® HCV-1/2/3-FRT kit in comparison to sequencing method for genotyping. Methods: A total of 17 samples collected from December 2009 to January 2011 were analyzed. Reverse transcriptase polymerase chain reaction (PCR) was performed, followed by sequencing technique. Results were analyzed based on sequence information in GenBank. A second genotyping method (AmpliSens® HCV-1/2/3-FRT) was done, which differentiates HCV genotypes by means of real-time hybridization-fluorescence detection. Results: From 17 samples, four were untypeable by AmpliSens® HCV-1/2/3-FRT. Eleven of 13 (84.6%) results showed concordant genotypes. A specimen that was determined as genotype 3a by sequencing was genotype 1 by the AmpliSens® HCV-1/2/3-FRT. Another specimen that was genotype 1 by sequencing was identified as genotype 3 by AmpliSens® HCV-1/2/3-FRT. Conclusion: HCV genotyping with AmpliSens® HCV-1/2/3-FRT using real-time PCR method provides a much simpler and more feasible workflow with shorter time compared to sequencing method. There was good concordance compared to sequencing method. However, more evaluation studies would be required to show statistical significance, and to troubleshoot discordant results. AmpliSens® HCV-1/2/3-FRT does differentiate between genotype but not until subtype level.

Objective: Influenza is considered as an emerging disease until today. The present study was undertaken to determine the prevalent genotypes of Influenza A virus in Malaysia. Methods: Influenza A virus was identified from respiratory specimens by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). Phylogenetic analysis of the identified isolates was performed and genotypes were detected. Results: A total number of 505 throat swabs and nasopharyngeal aspirates were examined by rRT-PCR at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in which 65(12.87%) were positive for influenza A. The identified isolates were successfully genotyped by phylogenetic analysis. The identified influenza A genotypes were: H1N1 (42), H3N2 (20) and H5N1 (3). Conclusion: The findings indicated that 3 genotypes were circulating in Malaysia during 2011 in which H1N1 was the predominant. Results added new genotype (H5N1) identification record in Malaysia that may be added in data base of WHO and CDC.

Objectives: Streptococcus pneumoniae causes acute otitis media, pneumonia, meningitis and bacteraemia. This study aimed to determine the prevalence of Streptococcus pneumoniae oropharyngeal carriage in healthy children and the antimicrobial susceptibility in a daycare nursery and a government-managed orphanage in Kuala Lumpur during 2010.Methods: Throat swabs were obtained from 36 children of daycare nursery (open community) and from 84 orphans from orphanage (closed community) those did not receive any pneumococcal vaccine. Children were between births to 6 years of age. Antibiotic susceptibility of isolated strains was determined using disk diffusion method and Etest� (minimum inhibitory concentration). Results: Overall prevalence of Streptococcus pneumoniae of the children was 1.7% (2 out of 120). Prevalence of the bacteria in open community was 5.6% (2 out of 36) and no positive cases were recorded in orphanage (closed community, (p=0.161). Prevalence was 15.4% (2 out of 13) in children aged below 2 years in the open community. There was no association was found to exist between Streptococcus pneumoniae carriage with age (p=0.432) and gender (p=0.418). Serotyping showed serotype 11F for one isolate, while the other was non-typable. Both isolates were susceptible to penicillin, azithromycin, ceftriaxone and vancomycin. The serotype 11F isolate was susceptible while the non-typable isolate was resistant to erythromycin.Conclusions: The results demonstrated low prevalence of Streptococcus pneumoniae in healthy children. These findings may complement other studies to explore further risk factors for colonisation, antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae to help for the planning of immunization strategies.

Human respiratory syncytial virus (RSV) is an important cause of acute respiratory tract infection in infants and young children. Phylogenetic analysis for RSV in Malaysia has not been reported before. We investigated the genetic features of RSV in respiratory specimens from March to August 2011 with molecular methods. From a total of 130 throat swab and nasopharyngeal aspirate specimens, 54 (41.5%) were positive with RSV, identified by in-house real-time reverse transcriptase polymerase chain reaction (rRT-PCR) assay. Thirty-four out of 54 (63.0%) RSV positive patients were children below two years old and two (1.4%) were adults. Phylogenetic analysis showed 39 isolates were genotype GA5, 13 genotypes GA2, one genotype GA1 and one genotype GA7. The findings indicated four genotypes of RSV circulating in the country and the predominant genotype is GA5.