Asrul Abdul wahab

• MPath (Medical Microbiology)
• Faculty of Medicine Universiti Kebangsaan Malaysia (UKM)

Introduction Early diagnosis of Severe Combined Immunodeficiency (SCID) increases survival outcomes and quality of life while significantly minimizing healthcare burden and costs. Despite growing evidence supporting the benefits and cost-effectiveness of SCID detection through newborn screening (NBS), it has yet to be implemented in Malaysia. This...

Introduction: Anti-nuclear antibody (ANA) testing is among the most common immunological test requested in the diagnostic immunology laboratory. The main purpose of this test is to screen for the underlying systemic autoimmune rheumatic diseases (SARDs). The gold standard laboratory method for ANA detection is by the indirect immunofluorescence (I...

Objectives Rotavirus (RoV) infections have emerged as a significant public health concern around the world. Understanding the relationship between climatic conditions and hospitalisations due to RoV infections can help engage effective prevention strategies. This study aims to investigate the potential associations between meteorological variabilit...

Introduction Respiratory syncytial virus (RSV) is one of the leading causes of hospitalization and mortality among children with respiratory tract infections. The non-pharmaceutical preventive measures against severe acute respiratory syndrome coronavirus (COVID-19) may have reduced the transmission of RSV, altering its tropical epidemiological sea...

Background: Candida tropicalis is a globally distributed yeast that has been popping up in the medical literature lately, albeit for unenviable reasons. C. tropicalis is associated with substantial morbidity, mortality as well as drug resistance. The aims of this study were to ascertain the antifungal susceptibility profile and the biofilm-produci...

Anti-nuclear antibody test (ANA) is the test commonly requested for the working diagnosis of systemic autoimmune rheumatic diseases (SARDs) particularly in ANA-associated rheumatic diseases (AARDs) such as SLE, systemic sclerosis, Sjogren syndrome, mixed connective tissue diseases, and dermatomyositis. Dense fine speckled (DFS) pattern is an ANA fl...

Immunoglobulin (Ig) G4 accounts for 4–6% of the total IgG in a healthy human. Several evidence-based studies have suggested that the level of IgG4 is significantly elevated in autoimmune diseases, including rheumatoid arthritis (RA). The clinical significance of IgG4 in RA with regard to disease activity, severity, and treatment response remains el...

Vibrio cholerae is a gram-negative bacterium synonymous with its namesake disease, cholera. Thus, gastrointestinal symptoms are the norm and V. cholerae is very rarely associated with skin and soft tissue infections. We describe a case of a 63-year-old Chinese woman with multiple medical comorbidities on corticosteroid therapy who developed fever a...

Background SLE is a complex inflammatory multiorgan disease that leads to multiple comorbidities and mortality. Probiotics were shown to be successful in lowering the pro-inflammatory cytokines in animal SLE models. Objectives This study looked at probiotics’ effect on disease activity and pro-inflammatory cytokine interleukin-6 (IL-6) among SLE p...

Anti-nuclear antibody (ANA) is an example of autoantibodies that precedes the development of autoimmune diseases particularly systemic autoimmune rheumatic diseases. Thus, ANA is one of the most common laboratory tests requested by the clinician when there is suspicious of underlying autoimmune disease in a patient. There are various laboratory met...

Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated...

Respiratory syncytial virus (RSV) is the most common pathogen causing viral respiratory tract infections among younger children worldwide. The influence of meteorological factors on RSV seasonal activity is well-established for temperate countries; however, in subtropical countries such as Malaysia, relatively stable temperate climates do not clear...

Toxoplasma infectionduring pregnancy is an important condition to be recognized as it can result in significant morbidity to the fetus. This case described a 23-year-old lady in her first pregnancy was diagnosed with toxoplasmosis when her serology test was positive for Toxoplasma gondii specific IgM and IgG antibodies. She was asymptomatic at the...

Here, we described a fatal case of a 37-year-old returning traveller from Burkina Faso, West Africa, who presented with an acute fitting episode later diagnosed as cerebral malaria induced by Plasmodium falciparum based on microscopic examination and Plasmodium mitochondrial cytochrome c oxidase III (cox3) gene PCR target. Unfortunately, the patien...

Parengyodontium album is a very rarely encountered opportunistic fungal pathogen. A severely neutropenic 11-year-old boy with acute T-cell lymphoblastic leukemia/lymphoma was febrile and lethargic during his admission for elective chemotherapy. No cutaneous lesion or obvious source of infection was noted, and clinical examination was otherwise unre...

Background: Neutrophil plays a defense role against bacteria and fungi specifically by the neutrophil phagoburst activity. The nitroblue tetrazolium (NBT) test is the gold standard method to measure this but the flow cytometry assays also have been developed. The aim of the study was to evaluate the performance of flow cytometry using Dihydrorhodam...

Immunoglobulin (Ig)G4 is a unique protein molecule and its role in autoimmune diseases remains elusive and controversial. Accumulating evidence suggests a pathogenic role of IgG4 in rheumatoid arthritis (RA). Rheumatoid factors (RF) in RA can recognize the Fc domains of IgG4 to form RF-IgG4 immune complexes that may activate the complement system l...

Background: Pseudomonas aeruginosa is a notorious gram-negative bacterium that has become a globalpublic health concern owing to the emergence of multi- and pandrug-resistant strains. This study sought todetermine the antibiotic susceptibility profile of P. aeruginosa in a tertiary medical center from Malaysia. Materials and Methods: Each isolate’s...

The second wave of the COVID-19 pandemic in India had brought with it a surge of ‘black fungus’ co-infection, which is a misnomer for mucormycosis. The present case illustrates the ‘real black fungus’ infection in a 50-year old male patient with COVID-19 pneumonia, who otherwise had no significant previous medical history. He was admitted on day 8...

We report a clinical and laboratory observation in a boy with X-linked agammaglobulinemia (XLA) who underwent an immunoglobulin replacement therapy (IRT) via the subcutaneous route (IGSC) seven years after his IRT via intravenous route (IGIV). He was free of invasive infections when on IGIV but not the troublesome coughs a week before the next infu...

Acute infectious gastroenteritis (AGE) is among the leading causes of mortality in children less than 5 years of age worldwide. There are many causative agents that lead to this infection, with rotavirus being the commonest pathogen in the past decade. However, this trend is now being progressively replaced by another agent, which is the norovirus....

Background A retrospective review of clinical manifestations and demographic pattern of patients diagnosed as chronic granulomatous disease (CGD) from 7 hospitals in Malaysia. An analysis of the available database would establish clinical characteristics, diagnoses and outcome including microbiologic pattern. Studying the demography allows us to do...

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement...

Introduction: Tuberculosis is a disease of public health concern. It can be treated effectively with good knowledge about the disease and complete adherence to the recommended treatment regime. This study is intended to assess the level of knowledge and perception of treatment among tuberculosis patients attending primary care clinics. Methodolog...

Salmonella intracranial infection is infrequently encountered in clinical practice. However, with prompt intervention and appropriate antimicrobial therapy, the outcome is usually favourable. A 56-year-old gentleman who worked as an organic fertilizer production supervisor underwent tumour resection for meningioma located at the left frontal tempor...

Nasopharyngeal diphtheria is an acute infectious upper respiratory tract disease caused by toxigenic strains of Corynebacterium diphtheriae. We report a case of a young adult who presented to us with a short history of fever, sore throat, hoarseness of voice and neck swelling. He claimed to have received all his childhood vaccinations and had no kn...

Background: Beta-hemolytic streptococci remained the important cause of acute bacterial pharyngitis. This study aims to determine the prevalence of beta-hemolytic Streptococcal pharyngitis and the correlation of positive throat culture with the clinical parameters. Materials and Methods: A prospective cross-sectional study was conducted involving 9...

Cryptococcus is a basidiomycetous yeast responsible for considerable HIV-related morbidity and mortality. A cachectic 26-year-old HIV-positive man with a CD4 count of 103 cells/μl presented with fever, breathlessness, and bilateral lower limb weakness. A brain computed tomography scan could not elucidate the neurological deficit. His blood was sent...

Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune blistering condition. A 10-year-old boy presented with generalized vesiculobullous skin eruptions and was initially diagnosed with bullous disease of childhood. Indirect immunofluorescence testing for antinuclear antibodies (ANA) was positive, with a homogeneous pattern and a titre of...

Candida dubliniensis is a pathogenic yeast which is rarely encountered in clinical practice. An 83-year-old HIV-negative woman with numerous medical co-morbidities presented with a dental abscess which was preceded by a long-standing toothache. The right side of her face was swollen from the preauricular to the malar and submandibular regions. A co...

Introduction: Rifampicin is a key first-line antimycobacterial agent employed for the treatment of pulmonary tuberculosis (PTB). This study sought to obtain prevalence data on rifampicin-resistant Mycobacterium tuberculosis among smear-positive PTB patients in the Klang District of Malaysia. Materials and methods: A total of 103 patients from th...

Background: The Malaysian Breastfeeding Peer Counselor Association (MBfPCA) is a pioneer non-governmental organization (NGO) of trained breastfeeding peer counselors in Malaysia. We explored the effect of peer counseling support on breastfeeding outcomes among postnatal mothers who delivered at a national tertiary teaching hospital and their satisf...

Septic arthritis usually represents a direct invasion of joint space by various microorganisms, most commonly caused by bacteria. Most of the time, it is caused by Staphylococci spp. or Streptococci spp. This is a case of a 70-year-old Chinese man with underlying end stage renal failure on regular hemodialysis who presented with recurrent right sho...

Primary prostatic melioidosis is a rare presentation of melioidosis even in melioidosis endemic areas. We report a case of a 58-year-old man with underlying diabetes mellitus who presented with a 5-day history of high-grade fever associated with lower urinary tract symptoms. Suprapubic tenderness and tender prostatomegaly were noted on examination....

Trichosporon asahii is a yeast-like fungus that is emerging as an important cause of invasive infections in tertiary medical centres. A 58-year-old Chinese man with no known medical illnesses presented with liver lacerations and multiple fractures following an alleged 12-foot fall at a construction site. The gravity of his injuries and poor haemody...

Background Systemic Lupus Erythematosus (SLE) commonly affects young women in their reproductive age group. However, there is an increase prevalence of late-onset SLE, parallel to the higher life expectancies among general populations worldwide. It has been reported that up to 25% SLE populations have a later onset of disease and their disease expr...

Primary biliary cholangitis (PBC) is an autoimmune disease that is increasingly recognized as an important cause of chronic liver disease. Incidental diagnoses are not uncommon. We report a case of a middle-aged female with persistently elevated ALP activity. During the investigation of cholestasis, anti-mitochondrial antibodies (AMA) were detected...

Kidney dysfunction, a deleterious effect of obesity, is now recognized as a relevant health risk. Chemokine (C-C Motif) Ligand 2 (CCL2) is one of the critical chemokines that play a vital role in the development of obesity-related metabolic disease. We aim to measure the changes in urinary CCL2 in our patients before and after their bariatric proce...

Background: Bronchiectasis is a chronic condition which can result in significant physical and social morbidity. The exact prevalence in Malaysia is unknown although several studies have shown a higher prevalence in the Asian population. Several causative factors have been identified but there are many patients with unknown aetiologies. This study...

Sporotrichosis is a globally prevalent subcutaneous mycosis commonly acquired through traumatic inoculation. A 66-year-old woman with underlying systemic lupus erythematosus (SLE) presented initially with a painful non-healing nodule on her right thumb. There was no history of traumatic contact with soil, plants or animals. She was started on an an...

Background: Rheumatoid arthritis (RA) is a destructive chronic inflammatory disease with intra- and extra-articular manifestations. It is associated with accelerated formation of arteriosclerosis. The aim of this study was to ascertain the correlation between endothelial dysfunction using carotid intima–media thickness (cIMT) and tumor necrosis fac...

Introduction: Rheumatoid arthritis is diagnosed based on the 2010 Rheumatoid Arthritis Classification Criteria whereby rheumatoid factor and anti-citrullinated protein antibody are the serological markers included in these criteria. Anti-RA33 antibody has the potential to provide additional diagnostic value in rheumatoid arthritis. The aim of this...

Shewanella spp. are infrequently implicated in human infections but they are emerging pathogens with particular significance in regions with warm climates, such as Southeast Asia. This is a case of a middle-aged diabetic and hypertensive man who presented with worsening congestive heart failure symptoms associated with fever and a painful right leg...

Objectives This study examined the correlations of both serum and urine interleukin‐17A (IL‐17A) levels with disease activity in systemic lupus erythematosus (SLE). This study was also aimed at determining their sensitivity and specificity as biomarkers of disease activity in SLE. Methods A cross‐sectional study was performed involving SLE patient...

Background Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with an unpredictable course of disease. The severity and outcomes of SLE vary across different ethnicities. Objectives This study is aimed to determine the pattern of development and progression of organ damage in a cohort of multi-ethnic SLE patients followed for at le...

Ocular syphilis is one of the clinical presentation or complication of syphilis. Uveitis is the most common ocular diagnosis of the condition but any component of the eyes can be affected. Serology test that include both treponemal and non-treponemal antibody detections play an important role for supporting the diagnosis. This condition is consider...

INTRODUCTION: Infant hepatitis B vaccination was introduced into the Expanded Programme on Immunisation (EPI) in Malaysia in 1989. This study aimed to investigate seroprevalence of hepatitis B among UKM pre-clinical medical students, born between 1991 and 1995, and had their infant vaccination more than 20 years ago. MATERIALS AND METHODS: A prospe...

Background Systemic lupus erythematosus (SLE) is an autoimmune disease which predominantly affects females. The disease characteristics in male SLE patients are reported to be distinct and may vary across ethnicities and geographical regions. Objective To determine and compare the clinical phenotype and organ damage between male and female patient...

Catheter-related bloodstream infections caused by Kodamaea ohmeri are generally not considered due to the relative scarcity of reported cases. This is a case of an 85-year-old man with poorly controlled diabetes mellitus who was initially admitted to our hospital for diabetic ketoacidosis. An internal jugular catheter was inserted as part of the in...

Children with Down syndrome are known to have intellectual disability, developmental milestone delay and may also have associated medical conditions. Having a child with Down syndrome could be physically and emotionally challenging to the affected family members. The impact on a family can be multifaceted which can alter the family dynamics and har...

Background Pyridinoline (Pyd) is a 3-hydroxypyridinium derivative which is an intermolecular cross-link compound of type I and II collagen.¹ It is a marker of bone resorption based on bone biopsy and radioisotope kinetics studies.²In rheumatoid arthritis (RA), destruction of bones may contribute to increased levels of serum Pyd. Objectives The pur...

p> Background: Syphilis is common and resurgences predominantly occurs among men who have sex with men (MSM ). Objective: The aim of the study was to describe the epidemiology, clinical and serological aspects of patients with syphilis diagnosed at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Methods: A retrospective study was conducte...

The aim of the study is to investigate the correlation of serum cartilage oligomeric matrix protein (COMP) levels with articular cartilage damage based on sonographic knee cartilage thickness (KCT) and disease activity in rheumatoid arthritis (RA). A total of 61 RA patients and 27 healthy controls were recruited in this study. Serum samples were ob...

p>Human infection by Pasteurella multocida is commonly associated with cat or dog bite. This is the case report of a 57-year-old lady with chronic diabetes mellitus and hypertension presented with non-healing left leg ulcer for three weeks duration. A Pasteurella multocida bacterium was isolated in the Microbiology Laboratory from her blood specime...

Background Cartilage Oligomeric Matrix Protein (COMP) is an extracellular protein which is primarily found in the cartilage and to a lesser extent in ligaments, meniscus, tendons and synovium. Experimental models of rheumatoid arthritis (RA) and osteoarthritis have pointed out that serum COMP levels are reflective of the cartilage turnover rate. O...

Background and aims Prolactin has been found to be associated with immune regulation in SLE. The aim of this study is to determine the correlation between high prolactin level in comparison with IL – 6 with lupus nephritis disease activity in UKMMC. Methods In this cross-sectional study, the analysis was conducted in SLE patients who attended Neph...

Background Rheumatoid Arthritis (RA) patients are at risk of cardiovascular disease (CVD) and carotid intima media thickness (cIMT) is an excellent marker of subclinical atherosclerosis. However, cIMT and the CVD biomarkers among RA patients with low disease activity and remission are not well studied. Objectives To assess the carotid intima media...

Multilocus sequence typing (MLST) has been used to characterise methicillin-resistant Staphylococcus aureus (MRSA) isolates into sequence types (STs) and together with SCCmec typing, form the clonal nomenclature for MRSA. MLST was conducted as per the standard protocol on ten out of 236 isolates collected previously from January to December 2009 re...

Syphilis in pregnancy remains an important medical condition due to its consequences. We present two cases of young pregnant women who were diagnosed syphilis during their antenatal visit. The first case was a 29-year-old Malay lady diagnosed with syphilis during the first trimester of pregnancy, while the second case was a 21-year-old Chinese lady...

Primary biliary cirrhosis in combination with autoimmune hepatitis has been termed “overlap syndrome”, but its diagnosis is challenging. We report a case of a 43-year-old lady who presented with a six-month history of jaundice and pruritus. She subsequently developed gum bleeds. Laboratory investigations revealed hypochromic microcytic anemia, abno...

Primary biliary cirrhosis in combination with autoimmune hepatitis has been termed “overlap syndrome”, but its diagnosis is challenging. We report a case of a 43-year-old lady who presented with a six-month history of jaundice and pruritus. She subsequently developed gum bleeds. Laboratory investigations revealed hypochromic microcytic anemia, abno...

To determine the proportion of albicans and non-albicans candiduria in a hospital setting and to ascertain if fluconazole is still suitable as empirical antifungal therapy based on antifungal susceptibility patterns of Candida species. The cross-sectional study was conducted between December 2010 and December 2011 at UKM Medical Centre, Kuala Lumpu...

AimThe main objective of this study is to elucidate the role of immunoglobulin A (IgA) rheumatoid factor (RF) in predicting the clinical response to tumour necrosis factor inhibitors (TNFi) among patients with rheumatoid arthritis (RA).Method We recruited all patients with RA who were ever on TNFi for a minimum duration of 3 months at our centre. B...

The purpose of this study was to compare the serum interleukin (IL)-23 levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of IL-23 levels with disease activity, joint damage and functional disability in RA. Serum samples were obtained from 45 patients with RA and 45 healthy controls. The enzyme-l...

Pseudomonas aeruginosa is a gram-negative bacillus that causes wide spectrum clinical infections. However, it is most frequently associated with hospital-acquired infection. In this case a 58-year-old male with underlying hypertension and dyslipidaemia was admitted for acute right leg cellulitis. Pseudomonas aeruginosa was identified from the case,...

Syphilis and HIV co-infection are indeed dangerous combinations. The present communication describes three different cases of syphilis and HIV co-infection in young men. The first case is a 25-year-old medical graduate with a primary and secondary syphilis lesions at time of presentation. The second case is a 24-year-old government officer with rig...

Objectives: Anti-cyclic citrullinated peptide (CCP) antibody has recently been used in the classification of rheumatoid arthritis (RA). This antibody is more specific than rheumatoid factor (RF) for the diagnosis of RA. The study objectives were to determine the sensitivity, specificity, positive and negative predictive values of anti-CCP in RA dia...