Displaying publications 1 - 20 of 132 in total

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  1. Fulltext A curriculum in medical ethics and medical humanities
    Puthucheary SD
    Med J Malaysia, 1980 Sep;35(1):86-95.
    PMID: 7254006
    The code of ethics derived from the Hippocratic Oath needs to be supplemented by a formal curriculum in Medical Ethics and Medical Humanities in our Medical schools. The need and justification for it, a review of the medical ethics curricula in American. European. British and Australian Universities, together with an outline of the proposed curriculum is described.
  2. A simple adherence test for detection of IgM antibodies in typhoid
    Ong LY, Pang T, Lim SH, Tan EL, Puthucheary SD
    J Med Microbiol, 1989 Jul;29(3):195-8.
    PMID: 2473209
    A simple adherence test to detect IgM antibodies in patients with typhoid is described. The test utilises the IgM-"capture" approach, in which the test serum is applied to microtitration plate wells previously coated with anti-human IgM, followed by application of a stained Salmonella typhi antigen suspension which shows adherence in positive cases. By this test, 58 (95%) of 61 sera from confirmed cases of typhoid possessed IgM antibodies to the H or O or both antigens of S. typhi. In patients for whom a diagnosis of typhoid was based only on a significant Widal-test titre, 31 (41%) of 76 sera had IgM antibodies to the H or O or both antigens of S. typhi. Some cross-reactivity of the IgM antibodies was detected, especially with the O antigens of S. paratyphi A and B. A total of 82 sera from non-typhoidal fevers (leptospirosis, typhus, dengue fever) showed no reactivity in this test. In normal sera there was no detectable IgM to the O antigen of S. typhi and only a small number (3.9%) had low levels of IgM to the H antigen. The significance and potential importance of this simple, sensitive, specific and economical test is discussed.
  3. Fulltext Acute gastroenteritis in Malaysian children: aetiological and therapeutic considerations
    Iyngkaran N, Abidin Z, Lam SK, Puthucheary SD
    Med J Malaysia, 1980 Jun;34(4):403-8.
    PMID: 7219272
    In a prospective study of 300 infants with acute gastroenteritis 150 infants had enteropathogens in the stools, 58 being due to rotavirus, 130 to adenovirus, 32 to Sahnonella, 18 Shigella and 29 E. coli. Hypernatraemic dehydration was present in 11% and acquired carbohydrate intolerance in 30% of the infants. Protracted diarrhoea was observed in 8% of infants and was commoner in the bacterial than viral group. The study shows that clinical features and simple blood tests cannot be used as reliable indices of predicting the aetiology of AGE. Despite the diverse aetiology of acute gastroenteritis, rehydration by the oral or intravenous route remained the mainstay of therapy.
    Keywords: Kuala Lumpur, university hospital,
  4. Fulltext Acute respiratory failure in melioidosis
    Puthucheary SD, Vadivelu J, Wong KT, Ong GS
    Singapore Med J, 2001 Mar;42(3):117-21.
    PMID: 11405563
    In melioidosis caused by Burkholderia pseudomallei, although every organ in the body may be involved, the highest mortality of 73% occurs when the respiratory system is affected. These patients invariably die of acute respiratory failure. Most of them also have underlying predisposing factors like diabetes mellitus.
  5. Acute septicaemic melioidosis: a report of seven cases
    Puthucheary SD, Lin HP, Yap PK
    Trop Geogr Med, 1981 Mar;33(1):19-22.
    PMID: 7245336
    A report is presented of seven patients with acute septicaemic melioidosis seen at the University Hospital, Kuala Lumpur, Malaysia, during 1976-1979. All had associated disorders which rendered them more susceptible to infection. As prognosis depends on early diagnosis it is important that this disease be considered in the differential diagnosis of a septicaemic illness in such patients from endemic areas. The treatment of choice is a combination of tetracyclines and chloramphenicol, initially used in massive doses, and continued for at least six month to prevent relapses.
  6. Acute septicemic melioidosis occurring in a child with acute lymphoblastic leukemia
    Lin HP, Puthucheary SD, Sinniah D
    Clin Pediatr (Phila), 1980 Oct;19(10):697-9.
    PMID: 6931670
    A 13-year old boy with acute lymphoblastic leukemia on chemotherapy developed neutropenia and acute cellulitis progressing to fulminating septicemia due to Pseudomonas pseudomallei. Septicemic melioidosis should be considered in the differential diagnosis of a febrile illness in children who are susceptible to infections.
  7. Aeromonas aquariorum clinical isolates: antimicrobial profiles, plasmids and genetic determinants
    Puah SM, Puthucheary SD, Liew FY, Chua KH
    Int J Antimicrob Agents, 2013 Mar;41(3):281-4.
    PMID: 23312608 DOI: 10.1016/j.ijantimicag.2012.11.012
    The objective of this study was to investigate the antimicrobial resistance patterns of 47 clinical isolates of Aeromonas aquariorum and to identify the presence of plasmids and the relevant antibiotic resistance genes (ARGs). Antibiotic susceptibilities were determined by the standard disc diffusion method. The presence of plasmids and ARGs was detected by gel electrophoresis and monoplex PCR. Resistance to amoxicillin/clavulanic acid (98%), amoxicillin (91%), gentamicin (13%), trimethoprim/sulfamethoxazole (11%) and kanamycin (6%) was observed, whilst no ciprofloxacin- or amikacin-resistant strains were detected. All isolates harboured plasmids with sizes ranging from ca. 2 kb to 10 kb. PCR revealed that A. aquariorum carried three β-lactam resistance genes (bla(TEM), bla(MOX) and bla(PSE)) and two sulphonamide resistance genes (sul1 and sul2). This study provides further understanding of the phenotypic and genotypic characteristics of multiresistant A. aquariorum clinical isolates.
  8. An electronmicroscopic study of the interaction of Burkholderia pseudomallei and human macrophages
    Nathan SA, Puthucheary SD
    Malays J Pathol, 2005 Jun;27(1):3-7.
    PMID: 16676686
    B. pseudomallei has been shown to persist intracellularly in melioidosis patients until reactivated by decreasing immunocompetence. We have shown by transmission electron microscopy the internalization of B. pseudomallei by human macrophages via conventional phagocytosis enclosed within membrane-bound vacuoles or phagosomes. Ferritin labeled lysosomes provided evidence of phagosome-lysosome fusion. Ingested bacilli were designated as "intact" or "damaged" on the basis of their ultrastructural features. An intact bacterium was seen with low electron opaque central nuclear region surrounded by dense bacterial cytoplasm, bounded externally by bacterial plasma membrane and cell wall. In contrast, B. pseudomallei were considered damaged when seen with cavitation within the central nuclear region, separation of bacterial cytoplasm from the cell wall, herniation of cytoplasmic contents and lamination of bacterial cell wall and its surrounding electron transparent zone. Our observations indicate that the microbicidal mechanism(s) in B. pseudomallei-infected macrophages failed to ensure complete clearance of the organism and this failure probably facilitates intracellular persistence and proliferation, and this may be one of the survival strategies adopted by this organism.
  9. An immunohistochemical method for the diagnosis of melioidosis
    Wong KT, Vadivelu J, Puthucheary SD, Tan KL
    Pathology, 1996 May;28(2):188-91.
    PMID: 8743829
    In order to assess the usefulness of immunohistochemistry in the diagnosis of melioidosis, an infection by Burkholderia pseudomallei, polyclonal antibodies were applied to tissues from known cases of melioidosis and to other infected tissues. Formalin-fixed, paraffin-embedded tissues were stained by a modified immunoperoxidase technique. In autopsy tissues with inflammatory lesions of melioidosis, the cytoplasm of phagocytes and intact bacilli, both intra- and extracellular, were stained very strongly positive. Relatively more focal positive staining was observed in some but not all surgical biopsies from proven cases of melioidosis. In granulomas staining was mainly found in the central necrotic areas, with little staining of peripheral phagocytes. All control materials stained negative. Immunohistochemistry appears to be a useful diagnostic tool in melioidosis.
  10. Analysis of fliC variation among clinical isolates of Burkholderia cepacia
    Winstanley C, Hales BA, Morgan JAW, Gallagher MJ, Puthucheary SD, CISSé MF, et al.
    J Med Microbiol, 1999 Jul;48(7):657-662.
    PMID: 10403416 DOI: 10.1099/00222615-48-7-657
    PCR and restriction fragment length polymorphism (RFLP) typing of flagellin genes (fliC) from 57 clinical isolates of Burkholderia cepacia indicated that only type 11 flagellins were present. Twenty-two isolates previously identified as the epidemic UK cystic fibrosis strain were indistinguishable by this method, as were 11 isolates from a pseudo-outbreak in Senegal. Other clinical isolates, including 19 from disparate sources in Malaysia, were separated into nine fliC RFLP groups, exhibiting a large degree of divergence. When isolates were indistinguishable by fliC genotyping, their similarity was confirmed by whole genome macro-restriction analysis with pulsed-field gel electrophoresis following XbaI digestion. The variation in fliC sequences of B. cepacia was far greater than that with B. pseudomallei, supporting the view that 'B. cepacia', as currently defined, may comprise several different genomic species.
  11. Antimicrobial susceptibility and distribution of non-typhoidal Salmonella serovars isolated in Malaysian children
    Lee WS, Puthucheary SD, Parasakthi N, Choo KE
    J Trop Pediatr, 2003 Feb;49(1):37-41.
    PMID: 12630719
    There is widespread resistance of Salmonella species to commonly prescribed antimicrobials the world over. We aimed to determine the antimicrobial susceptibility and serovar distribution of non-typhoidal Salmonella (NTS) isolated from blood cultures of Malaysian children. Positive isolates of NTS from blood cultures obtained from children admitted to the pediatric wards of University of Malaya Medical Center (UMMC), a large urban hospital from Kuala Lumpur (1991-2001), and Hospital Kota Bharu (HKB), from the predominantly rural state of Kelantan (1991-1999), Malaysia, were reviewed retrospectively. Serovar distribution and antimicrobial susceptibility were ascertained. A total of 64 and 55 isolates of NTS were obtained from blood cultures of children admitted to UMMC and HKB, respectively. The commonest serovar isolated was Salmonella enteritidis in both centers. The NTS isolated were highly sensitive to the antimicrobials tested: ampicillin 98 per cent, chloramphenicol 98 per cent, gentamicin 97 per cent, trimethoprim-sulfamethoxazole (TMP-SMX) 98 per cent, and ceftriaxone 100 per cent in UMMC; ampicillin 100 per cent, chloramphenicol 87 per cent, kanamycin 100 per cent, streptomycin 96 per cent, TMP-SMX 93 per cent, and tetracycline 89 per cent in HKB. There were only one and five multi-resistant isolates in UMMC and HKB, respectively. In conclusion, NTS isolated from blood cultures of Malaysian children from Kuala Lumpur and Kota Bharu were highly sensitive to commonly prescribed antibiotics. We speculate that this is due to the restriction of sales of antimicrobials in Malaysia except by prescription. Continuing vigilance and frequent antmicrobial surveillance is necessary.
  12. Fulltext Antimicrobial susceptibility and virulence genes of clinical and environmental isolates of Pseudomonas aeruginosa
    Liew SM, Rajasekaram G, Puthucheary SA, Chua KH
    PeerJ, 2019;7:e6217.
    PMID: 30697478 DOI: 10.7717/peerj.6217
    Background: Pseudomonas aeruginosa is ubiquitous, has intrinsic antibiotic resistance mechanisms, and is associated with serious hospital-associated infections. It has evolved from being a burn wound infection into a major nosocomial threat. In this study, we compared and correlated the antimicrobial resistance, virulence traits and clonal relatedness between clinical and fresh water environmental isolates of P. aeruginosa.

    Methods: 219 P. aeruginosa isolates were studied: (a) 105 clinical isolates from 1977 to 1985 (n = 52) and 2015 (n = 53), and (b) 114 environmental isolates from different fresh water sources. All isolates were subjected to ERIC-PCR typing, antimicrobial susceptibility testing and virulence factor genes screening.

    Results: Clinical and environmental isolates of P. aeruginosa were genetically heterogenous, with only four clinical isolates showing 100% identical ERIC-PCR patterns to seven environmental isolates. Most of the clinical and environmental isolates were sensitive to almost all of the antipseudomonal drugs, except for ticarcillin/clavulanic acid. Increased resistant isolates was seen in 2015 compared to that of the archived isolates; four MDR strains were detected and all were retrieved in 2015. All clinical isolates retrieved from 1977 to 1985 were susceptible to ceftazidime and ciprofloxacin; but in comparison, the clinical isolates recovered in 2015 exhibited 9.4% resistance to ceftazidime and 5.7% to ciprofloxacin; a rise in resistance to imipenem (3.8% to 7.5%), piperacillin (9.6% to 11.3%) and amikacin (1.9% to 5.7%) and a slight drop in resistance rates to piperacillin/tazobactam (7.7% to 7.5%), ticarcillin/clavulanic acid (19.2% to 18.9%), meropenem (15.4% to 7.5%), doripenem (11.5% to 7.5%), gentamicin (7.7% to 7.5%) and netilmicin (7.7% to 7.5%). Environmental isolates were resistant to piperacillin/tazobactam (1.8%), ciprofloxacin (1.8%), piperacillin (4.4%) and carbapenems (doripenem 11.4%, meropenem 8.8% and imipenem 2.6%). Both clinical and environmental isolates showed high prevalence of virulence factor genes, but none were detected in 10 (9.5%) clinical and 18 (15.8%) environmental isolates. The exoT gene was not detected in any of the clinical isolates. Resistance to carbapenems (meropenem, doripenem and imipenem), β-lactamase inhibitors (ticarcillin/clavulanic acid and piperacillin/tazobactam), piperacillin, ceftazidime and ciprofloxacin was observed in some of the isolates without virulence factor genes. Five virulence-negative isolates were susceptible to all of the antimicrobials. Only one MDR strain harbored none of the virulence factor genes.

    Conclusion: Over a period of 30 years, a rise in antipseudomonal drug resistance particularly to ceftazidime and ciprofloxacin was observed in two hospitals in Malaysia. The occurrence of resistant environmental isolates from densely populated areas is relevant and gives rise to collective anxiety to the community at large.

  13. Application of ribosomal RNA gene restriction patterns analysis and pulsed-field gel electrophoresis in distinguishing Salmonella weltevreden isolates in Malaysia
    Goh YL, Puthucheary SD, Thong KL
    Southeast Asian J. Trop. Med. Public Health, 2000 Dec;31(4):697-701.
    PMID: 11414415
    A representative sample of 20 isolates of Salmonella weltevreden strains from stool cultures of patients admitted at the University Hospital, Kuala Lumpur, Malaysia were analyzed. All the strains were susceptible to ampicillin, ceftriaxone, ciprofloxacin, chloramphenicol, tetracycline, trimethoprim, gentamicin and co-trimoxazole. Ribosomal RNA gene restriction pattern analysis of PstI-digested DNA gave three ribotypes while pulsed-field gel electrophoresis (PFGE) analysis of XbaI-digested DNA gave ten distinct profiles. PFGE was more discriminative than ribotyping in distinguishing the strains. The majority of the strains analyzed were very closely related with similarity coefficient values ranging from 0.8 to 1.0. Both PFGE and ribotyping could distinguish one of the strains which was obtained from a patient following a bone marrow transplant for beta-thalassemia major, indicating that this particular strain was unrelated to the rest of the strains from patients with acute gastroenteritis.
  14. Fulltext Bacteraemic enteritis due to Campylobacter jejuni
    Puthucheary SD, Lin HP
    Med J Malaysia, 1982 Dec;37(4):378-80.
    PMID: 7167093
    Campylobacter Jejuni is being increasingly recognised as a cause of bacteraemia enteritis and two infants with this condition are described. Awareness of the organism. as a possible cause of septicaemia is important because it has special growth requirements and delay in the diagnosis can be detrimental in a disease which usually only responds to erythromycin, gentamicin and chloramphenicol.
  15. Fulltext Bacterial enteropathogens isolated in childhood diarrhoea in Kuala Lumpur--the changing trend
    Lee WS, Puthucheary SD
    Med J Malaysia, 2002 Mar;57(1):24-30.
    PMID: 14569714
    A retrospective review of all stool samples obtained from children aged < 16 years with diarrhoea from University of Malaya Medical Centre (UMMC), Kuala Lumpur, from 1978 to 1997 was undertaken to ascertain the pattern of bacterial pathogens causing diarrhoea in children in an urban area in Malaysia. Of 26444 stool samples processed, 2989 (11%) were positive. The five most common bacterial pathogens isolated were non-typhoidal Salmonella (57%), enteropathogenic E. coli (EPEC) (14%), Shigella spp. (11%), Campylobacter spp. (5%) and Aeromonas spp. (4%). There was a significant reduction in the average percentage of positive isolation during the last 5 years of the study period as compared to the first 5 years (15.0% vs. 7.2%; r = -0.92, p = 0.0001). EPEC and Shigella spp. were less commonly isolated in the last five years compared with the first five years of the study (6% vs 21% p < 0.001 for E. coli; 7% vs 22%, p < 0.001 for Shigella spp.). This information is important for public health education in reducing the incidence of childhood diarrhoea further, and in the selection of appropriate antimicrobials in the management of extra-intestinal complications of childhood diarrhoea.
  16. Beta haemolytic streptococcal carriers among normal schoolchildren
    Chen ST, Dugdale AE, Puthucheary SD
    Trop Geogr Med, 1972 Sep;24(3):257-64.
    PMID: 4636100
  17. Burkholderia pseudomallei: in vitro susceptibility to some new and old antimicrobials
    Karunakaran R, Puthucheary SD
    Scand. J. Infect. Dis., 2007;39(10):858-61.
    PMID: 17852912
    The treatment of melioidosis currently involves the use of antimicrobials such as ceftazidime, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate and doxycycline. Evaluation of other antimicrobials with activity against the organism continues to be pursued, however, as the causative organism, B. pseudomallei, may not always be susceptible to the above antimicrobials. This study aimed to test the susceptibility of Malaysian isolates of B. pseudomallei against imipenem, meropenem, ertapenem, moxifloxacin and azithromycin. 80 previously stocked clinical isolates collected between 1978 and 2003 from the UMMC, Kuala Lumpur were tested for in vitro susceptibility to these antimicrobials using the E-test minimum inhibitory concentration method. 100% of isolates were sensitive to imipenem and meropenem, 97.5% were sensitive to trimethoprim-sulfamethozaxole, 37.5% to moxifloxacin, and only a minority was sensitive to ertapenem (7.5%). Using breakpoints for Staphylococcus and Haemophilus, 5.0%-6.3% of isolates were sensitive to azithromycin. In conclusion, our findings support the in vitro efficacy of imipenem, meropenem and trimethoprim-sulfamethoxazole against B. pseudomallei. Moxifloxacin, ertapenem and azithromycin cannot be recommended for the treatment of melioidosis; however, further studies are needed to test the efficacy of azithromycin in combination with quinolones.
  18. Burkholderia thailandensis whole cell antigen cross-reacts with B. pseudomallei antibodies from patients with melioidosis in an immunofluorescent assay
    Puthucheary SD, Anuar AS, Tee TS
    Southeast Asian J. Trop. Med. Public Health, 2010 Mar;41(2):395-400.
    PMID: 20578523
    An immunofluorescent assay (IFAT) using whole cell antigen derived from Burkholderia thailandensis used for detection of total antibodies to Burkholderia pseudomallei, was found to compare favorably with a previous published report on a B. pseudomallei IFAT assay. At a 1:20 cut-off titer, the assay had high sensitivity (98.9%) and satisfactory specificity (92.3%), when tested against sera from 94 patients suspected of melioidosis. Sera from 12 patients with culture proven melioidosis gave absolute concordance with the 2 test antigens. No sera from 50 blood donors had a titer of > or =20. Cross-reactivity with patients' sera positive for Chlamydia, Mycoplasma, Legionella and typhoid was not observed, except for 3 sera from typhus patients and one from a patient with leptospirosis. The major advantage of this assay is that the cultivation and preparation of B. thailandensis as antigen can be carried out in any laboratory with basic microbiological set-up. The serodiagnosis of melioidosis can be made safe for medical laboratory personnel, particularly in B. pseudomallei endemic regions.
  19. Fulltext Campylobacter enteritis in children: clinical and laboratory findings in 137 cases
    Puthucheary SD, Parasakthi N, Liew ST, Chee YW
    Singapore Med J, 1994 Oct;35(5):453-6.
    PMID: 7701360
    One hundred and thirty-seven children with Campylobacter diarrhoea were reviewed. The predominant species was C. jejuni. Ninety-five percent of the children were below 5 years of age with 61% of these being 2-12 months old. A slight male preponderance was noted. About half the cases presented with fever and bloody diarrhoea; vomiting was seen in 28% and abdominal colic in only 8%. Moderate to severe diarrhoea was present in 48% of the children. Thirty-seven percent had a history of recent or concurrent illness. Other bacterial enteropathogens together with Campylobacter were isolated in 15% of the children. Erythromycin, the most useful drug, when indicated for Campylobacter infections, had an MIC90 of 2 mg/l with 96.2% of the strains being sensitive.
  20. Campylobacter pylori infection: experience in a multiracial population
    Goh KL, Peh SC, Wong NW, Parasakthi N, Puthucheary SD
    J Gastroenterol Hepatol, 1990 5 1;5(3):277-80.
    PMID: 2103410
    Over a 15-month period, 399 patients with dyspepsia were investigated for the presence of Campylobacter pylori infection. Half of the patients (50.6%) had Campylobacter organisms in the antrum of the stomach. C. pylori was found in 96.1% of patients with histological changes of chronic active gastritis in the antrum. Of patients with duodenal and gastric ulcers, 87.8% and 87.5%, respectively, had Campylobacter organisms, as did 39.3% of patients with non-ulcer dyspepsia. C. pylori infection was most commonly found in Chinese and Indians. Although the prevalence of infection appeared to increase with age, there was an equal distribution amongst the sexes.
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