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.
The organisation of the radiological services in Malaysia is described and those diseases in which radiology plays an important part in diagnosis are discussed. As radiology embraces all specialities a pattern of diseases emerges which is different from that seen in the West. The control of infectious diseases, the general improvement in health care and the more sophisticated radiological investigations now available mean that in future radiology will play a much more important part in diagnosis and management of patients.
A reported practice of live beetle ingestion in Southeast Asia was investigated among urban Chinese in Kuala Lumpur, Malaysia. Results of four casefindings are: (1) this practice may not be confined to West Malaysia, (2) it occurs among Chinese and Malays, (3) the original use of the beetles as an aphrodisiac has been modified to include treatment of a wide variety of ailments and diseases and (4) the practice is relatively uncommon among urban Chinese. It was also found through experimental studies that ingestion of the live beetles (Palembus dermestoides) represented a potential public health hazard in that the beetles were able to serve as a host for the human-infecting tapeworm Hymenolepis diminuta (Sullivan et al., 1977).
Serum levels were determined in urban Chinese, Malays and Indians and in the forest-residing Orang Asli of age group 11 to 50. There was no difference in the IgM levels in the Chinese, Indians and Malays, but the serum IgG was elevated (p less than 0.05) in the Malays and the serum IgA level (p less than 0.01) in the Indians, when compared to the other two races. In contrast to the three other races there was a significant elevation of all three immunoglobulins in the Orang Asli. The mean immunoglobulin levels of the urban Malaysians are comparable to those reported for Caucasians residing in temperate countries. However, in the Orang Asli, the immunoglobulin levels were higher than observed for populations of the temperate regions but are comparable to the levels reported for several other populations of the tropical regions. Females had higher IgM levels than males in the Chinese, Indian and Malays but in the Orang Asli there was no sex difference in the immunoglobulin levels.
Filarial infections in 447 cats and 68 dogs from six endemic areas of human filariasis in Peninsular Malaysia were studied as part of the study on the zoonotic transmission of subperiodic Brugia malayi infection. 20.6% of cats and 57.4% of dogs had filarial infections. Cats were infected with subperiodic B. malayi, B. pahangi, Dirofilaria repens and D. immitis. Dogs were infected with B. pahangi and D. immitis. 6.9% of the cats had subperiodic B. malayi infection. The zoonotic implications of these infections and their impact on the filariasis control programme in Peninsular Malaysia were discussed.
A survey of 4.112 primary school children living in and around Kuala Lumpur, Malaysia, revealed that 12.9% of the children were infested with Pediculus humanus capitis. Indians (28.3%) and Malays (18.9%) have a higher prevalence than Chinese (4.6%). The higher prevalence among Indians and Malays correlates well with their lower socio-economic status in the community; long hair also contributes to the higher rates of pediculosis among them. The prevalence rate was found to be related to socio-economic status, length of hair, family size, age, crowding and personal hygiene. Treatment with 0.2% and 0.5% malathion in coconut oil gave cure rates of 93% and 100%. Treatment with gammexane and actellic at 0.5% concentration gave a cure rate of 100% against adults and nymphs of Pediculus humanus capitis.
In Malysia, the proportion of children fully immunized againest diphtheria is generally low (20%). On the other hand, the Schick conversion rate rises with age and reaches 90% by 11 years of age. It is noted that asymptomatic carriers are an important epidemiological factor in diphtheria and that carrier rates for school children are high (prevalence of 7.5% while the rate of coloization with C. diphtheriae over a period of one year was 30%). Although immunization protects against clinical diphtheria, it does not prevent the carrier state. Thus, for the control of diphtheria, one should aim for 100% compliance. Some suggestions as to how higher levels of immunity may be achieved are described.
During a routine medical examination of 5280 government employees (2736 males, 2544 females; age range 17 to 66 years; 3386 Chinese, 1252 Malays, 508 Indians and 134 other ethnic groups) diabetes was found in 31 (0.59%). The prevalence was higher in males (0.95%) than in females (0.20%). The highest prevalence was in the age-group 50 to 59 years (5.4%); at ages 30 to 66 years, the overall prevalence was 2.18%. The prevalence of diabetes is higher in Indians (2.76%) than in Chinese (0.30%) and Malays (0.48%); the difference is statistically significant, as it also is in the age-group 30 to 66 years (Indians 6.36%, Malays 1.39%, Chinese 0.9%). Of the 31 cases, only four were previously known and only nine were overwieght. The possible reasons for the higher prevalence of diabetes in Indians are discussed.
A survey of the freshwater snails, Pila scutata and Bellamyia ingallsiana, as food consumed by the local population was carried out in Peninsular Malaysia. Of these two species the first is preferred; the sizes favoured are between 25--40 mm. Pila snails were found to be consumed by the three communities, viz. Malay, Chinese and Indian, in different ways. The various methods of preparing the snails for consumption are described. P. scutata is an intermediate host of the rat-lung worm, Angiostrongylus malaysiensis. As this worm presumably is the causative agent of human eosinophilic meningoencephalitis, the eating habits of the three races in consuming the snail in relation to the epidemiology of the disease was also discussed.
The first case report of Yersinia enterocolitica infection in Malaysia is presented. The patient was a 34-year-old Indian woman who had a four day history of fever, abdominal pain and cough and loose stools for 2 days. She was diagnosed and treated as a case, initially of bacillary dysentery, and then of urban typhus. She responded to tetracycline therapy. Bacteriological examination eventually resulted in the isolation and identification of Yersinia enterocolitica, serotype 0:3. This case indicates the presence of the infection in Malaysia although the incidence is probably very low. This appears to be the situation in 'warm' countries.
The present paper reviews the health problems of rural agricultural workers in Malaysia. As is common with most developing countries, the agricultural sector forms the pillar of the national economy in Malaysia, the major products being rubber, palm oil, rice and timber. Most of the agricultural workers, who form the largest occupational group in the country, live in the rural areas under poor socioeconomic and environmental conditions. Their general health problems include large families, substandard housing, overcrowding, lack of piped water supply and sanitary excreta disposal, malnutrition and prevalent diseases such as cholera, typhoid, dysentery and parasitic infections. The specific occupational health problems include infectious diseases, agricultural accidents, pesticide poisonings, physical hazards, keratitis nummularis and snake-bites. The organization of agricultural health services in developing countries is also discussed.
Hereditary haemolytic anaemias have been found to be a significant cause of haemolytic disease in West Malaysia. This paper reports a micromapping study of 916 healthy Malay males from June to August 1983 to determine the distribution of the relevant thalassaemia genes in West Malaysia. Beta thalassaemia trait was found in 2.18%, HbE 3.49% and alpha thal2 (alpha+) trait in 26%. Of the sixteen transfusion dependant Malay thalassaemic patients at the Paediatric Unit, National University of Malaysia, eight patients had HbE beta thalassaemia and the rest are beta thalassaemia major; these patients who are transfusion dependant receive inadequate treatment. Prevention is the only resort.
Three cases of muscular sarcocystosis from West Malaysia are reported. The morphological features of the parasites from these three cases are similar to the eight cases previously reported from this country. A review of this total of eleven cases of muscular sarcocystosis showed that they were all incidental findings, where man acted as intermediate hosts of as yet unknown Sarcocystis spp. These cases of muscular sarcocystosis were probably zoonotic in origin and associated with close contact with definitive hosts (both domestic and wild animals) thus permitting the contamination of food and drink with sporocysts shed by these definitive hosts. These infections were probably acquired locally as most of the subjects were born in Malaysia and none had ever left the country to stay elsewhere. Eight of the eleven cases reported were associated with malignancies, especially of the tongue and nasopharynx.