A 38-year-old diabetic woman presented with fever and jaundice for 4 days. On arrival, she was alert and hemodynamically stable. Physical examination revealed hepatomegaly. An abdominal computed tomography showed a large multiloculated abscess in the right liver lobe without biliary system dilatation ( Fig. 1a). There was no evidence of pneumonia, endophthalmitis or central nervous system involvement. Klebsiella pneumoniae was isolated from the blood culture, which was susceptible to amoxicillin-clavulanic acid and ceftriaxone. String tests on colonies from culture media yielded positive results with strings measuring 7 mm in length ( Fig. 1b). The diagnosis of hypervirulent K. pneumoniae (HvKP) was established following the detection of iuca, rmpA and peg344 gene.

Background: Melioidosis is a potentially life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Melioidosis is difficult to diagnose due to its diverse clinical manifestations, which often delays administration of appropriate antibiotic therapy. Case presentation: Melioidosis is uncommon in pregnancy but both spontaneous abortion and neonatal melioidosis have been reported. We report a case of bacteraemic melioidosis in a young woman with a subsequent spontaneous abortion, with B. pseudomallei cultured from a high vaginal swab as well as blood. Conclusion: It remains unclear in this and previously reported cases as to whether the maternal melioidosis was sexually transmitted.

Melioidosis is an infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Melioidosis can affect any organ and result in a broad spectrum of diseases. Ocular involvement in melioidosis is rare but can potentially lead to devastating outcomes. We describe ocular manifestations in 3 patients diagnosed with culture-confirmed melioidosis in Kapit, Sarawak, Malaysian Borneo. Melioidosis affecting the eye can present as periorbital cellulitis and eyelid abscess. High clinical suspicion and early empirical treatment were crucial to a successful outcome. Surgical drainage of the abscess was an important part of management beyond standard antimicrobial therapy.

Plasmodium knowlesi, a malaria parasite typically found in long-tailed and pig-tailed macaques, is the most common cause of human malaria in Malaysian Borneo. Infections in humans result in a spectrum of disease, including fatal outcomes. Spontaneous splenic rupture is a rare, but severe complication of malaria and has not been reported previously for knowlesi malaria. A 46-year-old man presented with fever and acute surgical abdomen with concomitant P. knowlesi malaria infection at Kapit Hospital. He was in compensated shock upon arrival to the hospital. He had generalized abdominal tenderness, maximal at the epigastric region. Bedside focused abdominal ultrasonography revealed free fluid in the abdomen. He underwent emergency exploratory laparotomy in view of haemodynamic instability and worsening peritonism. Intraoperatively, haemoperitoneum and bleeding from the spleen was noted. Splenectomy was performed. Histopathological examination findings were suggestive of splenic rupture and presence of malarial pigment. Analysis of his blood sample by nested PCR assays confirmed P. knowlesi infection. The patient completed a course of anti-malarial treatment and recovered well post-operation. Spontaneous splenic rupture is a rare complication of malaria. This is the first reported case of splenic rupture in P. knowlesi malaria infection. Detection of such a complication requires high index of clinical suspicion and is extremely challenging in hospitals with limited resources.

Cryptococcosis is a systemic fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii. Cryptococcus causes a wide range of diseases, ranging from asymptomatic pulmonary lesions to disseminated disease involving the central nervous system, particularly meningoencephalitis. C. gattii infection has rarely been reported in Malaysia. We present a case of C. gattii meningitis with pulmonary cryptococcosis complicated by immune reconstitution inflammatory syndrome in an apparently immunocompetent person with no prior travel history.

Infective endocarditis can result in potentially fatal complications such as heart failure, systemic embolization, mycotic aneurysm and neurological complications. Staphylococci and streptococci are the most common causative agents of infective endocarditis, with Streptococcus gordonii being a rare cause. We present a case of infective endocarditis in a young patient who presented with an acute abdomen 2 months after being diagnosed with cerebrovascular accident. An abdominal computed tomography revealed superior mesenteric artery thrombosis, and infarct in the right kidney and spleen as a result of systemic septic embolism. Echocardiography showed numerous vegetations at the aortic and mitral valves. Infective endocarditis was diagnosed based on echocardiographic findings and positive blood cultures for S. gordonii. He was treated with intravenous benzylpenicillin and was also referred for surgical intervention.