The emergence of azole-resistant Candida tropicalis poses a significant threat in healthcare settings. It contributed to high morbidity and mortality, particularly in those undergoing chemotherapy for haematological diseases. In this study, we investigated a suspected outbreak in the haematology ward of Hospital Sultanah Bahiyah involving three patients, using whole genome sequencing. Azole-resistant C. tropicalis was isolated from all patients during episodes of neutropenic sepsis following chemotherapy. The index patient developed breakthrough candidemia while receiving fluconazole prophylaxis. Subsequently, the second and third patients developed candidemia occurring four days apart. Consequently, phylogenetic analysis confirmed that these isolates formed a clade closely related to other C. tropicalis strains, indicating a clonal nosocomial transmission. Further analysis demonstrated that, among key azole resistance genes, mutations were specifically identified in ERG11. Our findings underscore the critical role of genomic surveillance in uncovering transmission chains of multidrug-resistant fungal pathogens and highlight an urgent need for reinforced infection control measures to contain the spread of this clone.
Saccular cysts are extremely rare, but they can pose a significant risk to the airway of a newborn. We describe a case of saccular cyst in a term infant born via emergency Caesarean section for fetal distress, who immediately presented with respiratory difficulties. Multiple provisional diagnoses were made before the definite diagnosis of saccular cyst was confirmed using direct laryngoscopy and surgically treated with marsupialisation. Postoperatively, the infant's condition steadily improved, and was discharged home well. This case highlights the importance of quick recognition and timely intervention in newborns with airway obstruction.
Pleomorphic adenoma is the most common benign tumour of the major salivary glands, but it may also arise in the minor salivary glands, particularly those located in the hard and soft palate. Its occurrence in the nasal cavity is rare, with approximately 80% of intranasal cases originating from the nasal septum and the remainder from the lateral wall or turbinates. We report the case of a 49-year-old woman who experienced left-sided epistaxis for one year, along with progressive nasal obstruction and a painless swelling over the left lateral alar region for six months. Rigid nasoendoscopy revealed a large polypoid mass occupying the left anterior nasal cavity. Histopathological examination of a biopsy specimen suggested pleomorphic adenoma. Computed tomography of the paranasal sinuses demonstrated an enhancing soft tissue lesion at the proximal left nasal meatus. The mass was excised endoscopically, and the patient has remained disease-free on follow-up. This case underscores the importance of recognising intranasal pleomorphic adenoma as a rare differential diagnosis and highlights the value of early identification and surgical intervention.
