Enterobius worms or their eggs, or both, are present in preserved tissue sections or tissue specimens of 259 patients whose medical records are on file at the Armed Forces Institute of Pathology, Washington D.C., U.S.A. The most common site of infection (86.5%) was found to be the lumen of the appendix, where the worms provoke no reaction. Of the 259 patients 11 (4.2%) had worms and/or eggs in granulomas of the abdominal and pelvic peritoneum, and an equal number had granulomas on the peritoneum of the salphinx or on the surface of the ovary. There were also ectopic worms and/or eggs in granulomas on the peritoneum of the small and large intestines (2.7%). These Enterobius granulomas form around degenerating adult worms, around discrete eggs, around clusters of eggs, and, we believe, also around the tracks of migrating worms. Three patients (1.2%) had worms in perianal abscesses. A necrotic granuloma, removed from the lung of one patient, surrounded a degenerating adult worm. This suggests that the worm, carried to the lung as an embolus, impacted in a pulmonary arteriole. A stool specimen of one patient contains eggs of Enterobius, and that of another patient contains an adult Enterobius. This is the largest recorded histopathological study of enterobiasis in man.
Zygomycosis is an uncommon polymorphic fungal disease. One clinical subtype, nasofacial zygomycosis, is caused by infectious exposure to the organism Conidiobolus coronatus. A case affecting the nose and lips of a 42-year-old Malay man is reported here. The clinicopathologic features and management of this disease are described, and its differential diagnosis is discussed.
MeSH terms: Adult; Humans; Lip Diseases/drug therapy; Lip Diseases/microbiology; Lip Diseases/pathology*; Male; Mucorales/isolation & purification; Mucormycosis/drug therapy; Mucormycosis/microbiology; Mucormycosis/pathology*; Nose Diseases/drug therapy; Nose Diseases/microbiology; Nose Diseases/pathology*; Potassium Iodide/therapeutic use
A consecutive series of 24 patients with clinical features of primary dengue infection and 22 controls (14 patients with viral fever of unknown origin and 8 healthy subjects) were assayed for serum levels of tumour necrosis factor (TNF). The acute sera of the 24 patients with clinical dengue infection were positive for dengue virus-specific IgM antibody. Clinically, 8 had dengue fever (DF), 14 dengue haemorrhagic fever (DHF) and 2 dengue shock syndrome (DSS). All 16 patients with DHF/DSS had significantly elevated serum TNF levels but the 8 DF patients had TNF levels equivalent to that in the 22 controls. A case is made for augmented TNF production having a role for the pathophysiological changes observed in DHF/DSS and mediator modulation as a possible therapeutic approach to treatment.
A nitrocellulose membrane strip dotted with a specific 50 kDa outer membrane protein of Salmonella typhi was applied for the serodiagnosis of typhoid fever. Using horseradish peroxidase conjugated IgM and IgG antibodies with 4-chloronaphthol as substrate, antibodies in typhoid patients were clearly visualised as bluish purple dots while sera from patients with non-typhoid fevers gave negative results. The detection of specific IgM and IgG antibodies in typhoid patients suggest either recent or current infection. Combined with the high specificity, reliability and rapidity of the test, the dot EIA technique provides a simple and useful method for the serodiagnosis of typhoid using a single serum specimen.
Various studies on toxoplasmosis in Malaysia have shown that specific antibodies to Toxoplasma gondii are common among Malaysians. Among the ethnic groups, the Malays have the highest prevalence rate followed by Indians, Orang Aslis (aborigines) and Chinese. Antibody is acquired early in life and increases with age. There is no significant difference in the prevalence rate between males and females. The disease is apparently more prevalent among rural dwellers and those in the lower socioeconomic group. It appears that the prevalence rate is also influenced by environmental conditions, occupation, diet and cultural habits. Studies with animals have shown the presence of antibody to T. gondii, but this does not seem to be the source of infection since Malaysians normally cook their meat well.
Thirty in vitro serial passages of Toxoplasman gondii cultures in Vero cell line performed once in every five days had a mean increase in parasite count of 74.4 +/- 14.8 times from that of initial counts. Long term cultures in Vero cell line did not alter the virulence of the parasite. The good correlation (r = 0.99) between the IFA titer and ELISA OD values using the parasite antigens from in vitro sources indicates that long term maintenance of T. gondii in culture does not affect significantly the ability to recognize antibodies to surface and soluble antigens. The results also show that soluble antigens containing host cells can be directly used for immunodiagnostic purposes without purification. The in vitro maintenance of T. gondii is safer and cheaper when compared to the in vivo method.
Sarcocystis is a tissue coccidian with an obligatory two-host life cycle. The sexual generations of gametogony and sporogony occur in the lamina propria of the small intestine of definitive hosts which shed infective sporocysts in their stools and present with intestinal sarcocystosis. Asexual multiplication occurs in the skeletal and cardiac muscles of intermediate hosts which harbor Sarcocystis cysts in their muscles and present with muscular sarcocystosis. In Malaysia, Sarcocystis cysts have been reported from many domestic and wild animals, including domestic and field rats, moonrats, bandicoots, slow loris, buffalo, and monkey, and man. The known definitive hosts for some species of Sarcocystis are the domestic cat, dog and the reticulated python. Human muscular sarcocystosis in Malaysia is a zoonotic infection acquired by contamination of food or drink with sporocysts shed by definitive hosts. The cysts reported in human muscle resembled those seen in the moonrat, Echinosorex gymnurus, and the long-tailed monkey, Macaca fascicularis. While human intestinal sarcocystosis has not been reported in Malaysia so far, it can be assumed that such cases may not be infrequent in view of the occurrence of Sarcocystis cysts in meat animals, such as buffalo. The overall seroprevalence of 19.8% reported among the main racial groups in Malaysia indicates that sarcocystosis (both the intestinal and muscular forms) may be emerging as a significant food-borne zoonotic infection in the country.
Twenty-three species of intestinal flukes reported in man in Southeast Asia are assigned to seven families: Echinostomatidae, Fasciolidae, Heterophyidae, Lecithodriidae, Microphallidae, Paramphistomatidae and Plagiorchiidae. The majority of species belongs to the Heterophyidae and Echinostomatidae families. Common species are Fasciolopsis buski, Echinostoma ilocanum, E. malayanum, E. revolutum and Haplorchis yokogawai. The countries where large number of species were reported are Thailand (14 species), Philippines (12 species), Indonesia (8 species) and Malaysia (4 species). Only one species was recognized in Laos, and Vietnam. Several species reported in man in the other regions, were reported in animals in Southeast Asia. It is possible that these are present in humans but have not yet been reported.
Food-borne parasitic zoonoses are emerging as major public health problems in most countries because they are widespread and pose a medical challenge. Not only are they important from an economic standpoint, but they also cause severe sequalae in all those affected. The extent of parasitic zoonoses in Malaysia is considered a "tip of the iceberg" problem. Cases of zoonotic diseases, like porocphaliasis, sarcocystosis, toxoplasmosis, cysticercosis, hydatidosis, echinostomiasis, and gnathostomiasis are traced and documented. An epidemiologic reassessment of methods is suggested to determine the extent of these parasitoses in Malaysia.
Liver fluke disease (fascioliasis) is an important parasitic disease found worldwide affecting sheep, goats, cattle and buffalo, as well as other domestic ruminants. The common causative agents are Fasciola hepatica and F. gigantica which require various species of Lymnaea, fresh water snails, as their intermediate hosts. The epidemiology of the disease and its prevalence in Malaysia is mentioned briefly. The disease causes considerable impact on the economy of the livestock industry. The economic losses consist of costs of anthelmintics, drenches, labor, liver condemnation at meat inspection; and losses in production due to mortality, reduction in meat, milk and wool production; and reduction in growth rate, fertility and draught power. The disease also has public health significance, causing human fascioliasis and "halzoun".
MeSH terms: Animals; Animals, Domestic/parasitology*; Fascioliasis/economics; Fascioliasis/epidemiology*; Humans; Malaysia/epidemiology; Public Health*; Ruminants/parasitology*; Global Health; Prevalence; Food Parasitology*
Although most anatomical pathologists have encountered breast lesions with the composite histological features of fibroadenoma (FA) and fibrocystic change (FC), referred to as fibroadenomatosis or fibroadenomatoid mastopathy (FAM), little is known about its prevalence or clinico-pathological significance. In a retrospective histological review of 400 consecutive breast lesions, among both East and West Malaysians, coded either as FA or FC in the files of the Department of Pathology, University of Malaya, we found 45 (11.3%) cases of FAM. Typically, FAM lesions showed fibroadenomatoid foci in a background of fibrocystic change. The finding of FAM among lesions coded as FC was higher (18.5%) than among FA (4%). The mean age of patients with FAM (32.1 years) was similar to FC (35.1 years) but significantly older than that of FA (26.1 years). The notion that FA and FC are lesions at two ends of a spectrum of growth disorder of breast related to oestrogen-progesterone interplay, and that FAM occupies a position intermediate between the two, may explain its morphological and age patterns, but remains speculative. It is hoped that increasing awareness of this condition will lead to better understanding of breast pathophysiology. Nevertheless, until its biological nature, histogenesis and malignant potential are more clearly understood, defining FAM as a distinct form of breast disease may not be meaningful to patient management.
MeSH terms: Adenofibroma/epidemiology; Adenofibroma/pathology*; Adolescent; Adult; Aged; Breast Diseases/epidemiology; Breast Diseases/pathology*; Female; Fibrocystic Breast Disease/epidemiology; Fibrocystic Breast Disease/pathology*; Humans; Malaysia/epidemiology; Middle Aged
Seventy-seven patients who had PAP smear cytology and colposcopic examination in a 2-year period between 1988 and 1989 were reviewed. Those with findings indicative or suspicious of malignancy were subjected to biopsy. All 50 patients thus biopsied were confirmed to have preclinical cancer on histological examination. Compared against histology, PAP smear cytology gave an accuracy rate of 90% (5 false negatives) and colposcopy gave an accuracy rate of 94% (3 false negatives). These results demonstrate that the two techniques are useful as screening tests for preclinical cervical cancer. The results are improved if they are used complementarily. However, there was poor specificity in the categorisation of cervical cancer by both methods. This was probably due to the subjectiveness of the two procedures. The study also raised the possibility of a higher incidence of preclinical cervical cancer in the Chinese ethnic group.
An in-house method which utilizes 14C-thymidine as a substrate was used to assay deoxythymidine kinase in serum. The method is sensitive enough to detect normal levels of serum deoxythymidine kinase and the assay procedure also enables rapid handling of multiple samples. With a total reaction volume of 60 ul, the enzyme reaction was found to be linear with concentrations for up to 650 U/L of TK activity. On studying serum deoxythymidine kinase (s-TK) activity with incubation time, there was a proportional increase in activity with the length of incubation time. "Within-batch" precision showed a coefficient of variation (CV) of 4.7% for serum with extremely high s-TK levels and a CV of 8.8% for serum with normal s-TK levels. S-TK showed a CV of less than 16.0% in its activity when stored at -8 degrees C and at -20 degrees C. The normal reference range obtained for s-TK activity was 8.6 +/- 7.5 U/L.
Immunophenotyping of acute leukaemias has become an important diagnostic tool in haematology laboratories as it is now well recognised that the presence of certain surface markers has prognostic significance. In 1988, we experimented with the alkaline phosphatase anti-alkaline phosphatase (APAAP) method for immunophenotyping of leukaemic cells in our laboratory. 48 cases of peroxidase-negative acute leukaemias were studied. Our study showed that 2 peroxidase-negative cases carried myeloid surface markers, 44% were negative for the markers studied and 5% were unclassified due to technical problems. We concluded that the APAAP method is a useful technique for demonstrating cell markers in leukaemic cells as the reaction is reddish and usually intense. We failed to demonstrate surface markers in 44% of the cases probably because of the choice of a limited panel of monoclonal antibodies.
An adult male sustained a number of stab injuries and other injuries including a fatal stab injury to the neck. There was evidence of air embolism which was considered to be a major factor causing death. The discussion is in four parts. Part I is confined to the post mortem examination. Part II relates to the medico-legal aspects of the case. Part III is a general discussion on embolism and its medico-legal significance whilst Part IV is on the medico-legal aspects of air embolism.
MeSH terms: Asia, Southeastern/epidemiology; Humans; Malaysia/epidemiology; Time Factors; Tuberculosis, Pulmonary/epidemiology*; World Health Organization
In a retrospective study of 100 patients with pleural effusion the final diagnosis was tuberculosis in 49, malignancy in 43, malignancy with tuberculosis, bacterial infection, hydrothorax with cirrhosis, reaction to pneumothorax in one each, and unknown in 4. Most of the effusions analysed were exudates (94%). Pleural biopsy was diagnostic in 46% of tuberculous effusions (13/28) and 67% of malignant effusions (20/30). Tuberculosis accounted for 87% of cases in patients aged 40 years and under. In this age group, patients with exudative pleural effusion and a positive tuberculin test are likely to have tuberculosis and early therapeutic trial is justified.
The role of fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis was examined among 74 patients who were suspected of having the disease but had negative sputum smear for acid fast bacilli. Bronchial brushing and washing were routinely performed in all subjects and bronchial biopsy was performed on abnormal mucosa in 7 of them. The diagnosis of pulmonary tuberculosis was confirmed in 44.6% of the patients studied from smear examination, culture, histology or the combination of them. Rapid diagnosis was achieved in 54.5% of the confirmed cases from smear or histology within a few days of examination. Two of the cases had concomitant bronchogenic carcinoma. We conclude that the fiberoptic bronchoscopy is a useful investigation for this group of patients as confirmation of the diagnosis can be made fairly rapidly in a significant proportion of them, hence the treatment can be started confidently.