METHODS: A cohort study was conducted among laboratory-confirmed dengue patients aged >18 y in the central region of Peninsular Malaysia from May 2016 to November 2017. We collected demographic, clinical history, physical examination and laboratory examination information using a standardized form. Dengue severity (DS) was defined as either dengue with warning signs or severe dengue. Participants underwent daily follow-up, during which we recorded their vital signs, warning signs and full blood count results. Incidence of DS was modeled using mixed-effects logistic regression. Changes in platelet count and hematocrit were modeled using mixed-effects linear regression. The final multivariable models were adjusted for age, gender, ethnicity and previous dengue infection.
RESULTS: A total of 173 patients were enrolled and followed up. The mean body mass index (BMI) was 37.4±13.75 kg/m2. The majority of patients were Malay (65.9%), followed by Chinese (17.3%), Indian (12.7%) and other ethnic groups (4.1%). A total of 90 patients (52.0%) were male while 36 patients (20.8%) had a previous history of dengue infection. BMI was significantly associated with DS (adjusted OR=1.17; 95% CI 1.04 to 1.34) and hematocrit (%) (aβ=0.09; 95% CI 0.01 to 0.16), but not with platelet count (x103/µL) (aβ=-0.01; 95% CI -0.84 to 0.81). In the dose response analysis, we found that as BMI increases, the odds of DS, hematocrit levels and platelet levels increase during the first phase of dengue fever.
CONCLUSION: Higher BMI and higher hematocrit levels were associated with higher odds of DS. Among those with high BMI, the development of DS was observed during phase one of dengue fever instead of during phase two. These novel results could be used by clinicians to help them risk-stratify dengue patients for closer monitoring and subsequent prevention of severe dengue complications.
METHODS: Eligible adults >18 y of age in seven endemic villages in Tangkarason, Beluran, Sabah, were interviewed and tested for LF antibody using the Brugia Rapid kit. Multivariable logistic regression was employed to analyse the associated factors.
RESULTS: A total of 244 respondents were included in this study. Their median age was 40 y (interquartile range 30-53). The antibody prevalence of brugian filariasis in the study population was 31.1% (95% confidence interval [CI] 25.7 to 37.2). Older age (adjusted odds ratio [aOR] 1.04 [95% CI 1.02 to 1.06]) and outdoor jobs (aOR 2.26 [95% CI 1.05 to 4.85]) were identified as independent risk factors for positive LF antibody. Participating in the MDA program previously (aOR 0.24 [95% CI 0.10 to 0.57]) was found to be a protective factor for LF infection.
CONCLUSIONS: A high prevalence of microfilariae was confirmed in all the study sites, which was above the target of <1%. Important factors associated with positive LF antibody were identified, which could be used as a guide for program managers to design more focused control measures in LF-endemic areas.
METHODS: This study examined the immunological binding and neutralization capacity of PCAV against the two cobra venoms using WHO-recommended protocols.
RESULTS: In mice, both venoms were highly neurotoxic and lethal with a median lethal dose of 0.18 and 0.20 µg/g, respectively. PCAV exhibited strong and comparable immunoreactivity toward the venoms, indicating conserved venom antigenicity between the two allopatric species. In in vivo assay, PCAV was only moderately effective in neutralizing the toxicity of both venoms. Its potency was even lower against the hetero-specific N. samarensis venom by approximately two-fold compared with its potency against N. philippinensis venom.
CONCLUSION: The results indicated that PCAV could be used to treat N. samarensis envenomation but at a higher dose, which might increase the risk of hypersensitivity and worsen the shortage of antivenom supply in the field. Antivenom manufacturing should be improved by developing a low-dose, high-efficacy product against cobra envenomation.