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  1. Molecular characterization of Vibrio cholerae O1 outbreak strains in Miri, Sarawak (Malaysia)
    Radu S, Vincent M, Apun K, Abdul-Rahim R, Benjamin PG, Yuherman, et al.
    Acta Trop, 2002 Aug;83(2):169-76.
    PMID: 12088858
    Bacterial resistance to various antimicrobial agents is common in area with high usage of antibiotics. In this study, the data on antimicrobial susceptibility patterns of Vibrio cholerae O1 from patients during an outbreak period was found to be high but variable rates of multidrug resistance. Thirty-two of 33 V. cholerae isolates harboured the tcp, ctx, zot and ace genes, suggesting their possible roles in the outbreak cases. We analyzed the molecular diversity of a total of 33 strains of V. cholerae O1 isolated from 33 patients between November 1997 and April 1998 using random amplified polymorphic DNA (RAPD) analysis. The 30 typable isolates could be separated into four major clusters containing 5, 17, 2 and 6 isolates, respectively. However, no particular RAPD pattern was predictive of a particular pattern of antibiotic susceptibility. The findings of this study showed that multiple clones seemed to be responsible for cases in the outbreaks in the study area.
    Matched MeSH terms: Cholera/epidemiology*
  2. An ambient temperature stable and ready-to-use loop-mediated isothermal amplification assay for detection of toxigenic Vibrio cholerae in outbreak settings
    Engku Nur Syafirah EAR, Nurul Najian AB, Foo PC, Mohd Ali MR, Mohamed M, Yean CY
    Acta Trop, 2018 Jun;182:223-231.
    PMID: 29545156 DOI: 10.1016/j.actatropica.2018.03.004
    Cholera, caused by Vibrio cholerae is a foodborne disease that frequently reported in food and water related outbreak. Rapid diagnosis of cholera infection is important to avoid potential spread of disease. Among available diagnostic platforms, loop-mediated isothermal amplification (LAMP) is regarded as a potential diagnostic tool due to its rapidity, high sensitivity and specificity and independent of sophisticated thermalcycler. However, the current LAMP often requires multiple pipetting steps, hence is susceptible to cross contamination. Besides, the strict requirement of cold-chain during transportation and storage make its application in low resource settings to be inconvenient. To overcome these problems, the present study is aimed to develop an ambient-temperature-stable and ready-to-use LAMP assay for the detection of toxigenic Vibrio cholerae in low resource settings. A set of specific LAMP primers were designed and tested against 155 V. cholerae and non-V. cholerae strains. Analytical specifity showed that the developed LAMP assay detected 100% of pathogenic V. cholerae and did not amplified other tested bacterial strains. Upon testing against stool samples spiked with toxigenic V. cholerae outbreak isolates, the LAMP assay detected all of the spiked samples (n = 76/76, 100%), in contrast to the conventional PCR which amplified 77.6% (n = 59/76) of the tested specimens. In term of sensitivity, the LAMP assay was 100-fold more sensitive as compared to the conventional PCR method, with LOD of 10 fg per μL and 10 CFU per mL. Following lyophilisation with addition of lyoprotectants, the dry-reagent LAMP mix has an estimated shelf-life of 90.75 days at room temperature.
    Matched MeSH terms: Cholera/epidemiology
  3. Phenotypic and genotypic characteristics and epidemiological significance of ctx+ strains of Vibrio cholerae isolated from seafood in Malaysia
    Chen CH, Shimada T, Elhadi N, Radu S, Nishibuchi M
    Appl Environ Microbiol, 2004 Apr;70(4):1964-72.
    PMID: 15066786
    Of 97 strains of Vibrio cholerae isolated from various seafoods in Malaysia in 1998 and 1999, 20 strains carried the ctx gene and produced cholera toxin. Fourteen, one, and five of these toxigenic strains belonged to the O139, O1 Ogawa, and rough serotypes, respectively. The rough strains had the rfb gene of the O1 serotype. The toxigenic strains varied in their biochemical characteristics, the amount of cholera toxin produced, their antibiograms, and the presence or absence of the pTLC plasmid sequence. DNA fingerprinting analysis by arbitrarily primed PCR, ribotyping, and a pulsed-field gel electrophoresis method classified the toxigenic strains into 3, 7, and 10 types, respectively. The relatedness of these toxigenic strains to clinical strains isolated in other countries and from international travelers was examined by using a dendrogram constructed from the pulsed-field gel electrophoresis profiles. The results of the examination of the antibiogram and the possession of the toxin-linked cryptic plasmid were consistent with the dendrogram-based relatedness: the O139 strains isolated from Malaysian seafoods could be separated into two groups that appear to have been introduced from the Bengal area independently. The rough strains of Malaysian seafood origin formed one group and belonged to a cluster unique to the Thailand-Malaysia-Laos region, and this group may have persisted in this area for a long period. The single O1 Ogawa strain detected in Malaysian seafood appears to have an origin and route of introduction different from those of the O139 and the rough strains.
    Matched MeSH terms: Cholera/epidemiology
  4. The burden of cholera
    Murugaiah C
    Crit Rev Microbiol, 2011 Nov;37(4):337-48.
    PMID: 21823927 DOI: 10.3109/1040841X.2011.603288
    Cholera is an acute secretory diarrheal disease that is perceived by World Health Organization (WHO) to be a highly contagious threat. Firstly discovered by an Italian physician, Filippo Pacini, the disease gains a reputation as the most feared epidemic diarrheal disease encountered in developing countries. Despite effort taken by WHO to reduce the incidence rate, cholera-endemic prevail in certain regions. Factors that contribute to the disease transmission and ongoing spreading in cholera-prone areas remain as elusive. Should an awareness and knowledge of cholera be developed, it is the residents of developing nation that stand to benefit the most. This review gives insight into the disease prevalence, pandemic, epidemiology, pathogenesis, disease transmission, major strategies and steps to be pursued toward controlling cholera.
    Matched MeSH terms: Cholera/epidemiology*
  5. Fulltext Outbreak-associated Vibrio cholerae genotypes with identical pulsotypes, Malaysia, 2009
    Teh CS, Suhaili Z, Lim KT, Khamaruddin MA, Yahya F, Sajili MH, et al.
    Emerg Infect Dis, 2012 Jul;18(7):1177-9.
    PMID: 22709679 DOI: 10.3201/eid1807.111656
    A cholera outbreak in Terengganu, Malaysia, in November 2009 was caused by 2 El Tor Vibrio cholerae variants resistant to typical antimicrobial drugs. Evidence of replacement of treatable V. cholerae infection in the region with antimicrobial-resistant strains calls for increased surveillance and prevention measures.
    Matched MeSH terms: Cholera/epidemiology*
  6. Detection of virulence associated genes, haemolysin and protease amongst Vibrio cholerae isolated in Malaysia
    Iyer L, Vadivelu J, Puthucheary SD
    Epidemiol Infect, 2000 Aug;125(1):27-34.
    PMID: 11057956
    Eighty-four strains of Vibrio cholerae O1, O139 and non-O1/non-O139 from clinical and environmental sources were investigated for the presence of the toxin co-regulated pilus gene, tcpA, the virulence cassette genes ctxA, zot, ace and cep and also for their ability to elaborate haemolysin and protease. The ctxA and zot genes were detected using DNA-DNA hybridization while the ace, cep and tcpA genes were detected using PCR. Production of haemolysin and protease was detected using mammalian erythrocytes and an agar diffusion assay respectively. Analysis of their virulence profiles showed six different groups designated Type I to Type VI and the major distinguishing factor among these profiles was in the in vitro production of haemolysin and/or protease. Clinical O1, O139 and environmental O1 strains were similar with regard to presence of the virulence cassette genes. All environmental O1 strains with the exception of one were found to possess ctxA, zot and ace giving rise to the probability that these strains may actually be of clinical origin. One strain which had only cep but none of the toxin genes may be a true environmental isolate. The virulence cassette and colonization factor genes were absent in all non-O1/non-O139 environmental strains but production of both the haemolysin and protease was present, indicating that these may be putative virulence factors. These findings suggest that with regard to its pathogenic potential, only strains of the O1 and O139 serogroup that possess the tcpA gene which encodes the phage receptor, have the potential to acquire the CTX genetic element and become choleragenic.
    Matched MeSH terms: Cholera/epidemiology
  7. Molecular evidence of clonality amongst Vibrio cholerae O1 biotype El Tor during an outbreak in Malaysia
    Vadivelu J, Iyer L, Kshatriya BM, Puthucheary SD
    Epidemiol Infect, 2000 Feb;124(1):25-30.
    PMID: 10722126
    Forty-three clinical strains of V. cholerae O1 biotype E1 Tor were isolated between 3 May and 10 June 1998 during an outbreak in the metropolitan area of Kuala Lumpur and its suburbs. With the exception of three Inaba strains that were restricted to three members of a family, all the others belonged to the Ogawa serotype. The strains were analysed for clonality using ribotyping and pulsed-field gel electrophoresis (PFGE). Two ribotypes, V/B21a and B27, were identified among 40 Ogawa isolates using BglI restriction endonuclease. Ribotype V/B21a has been described previously from Taiwan and Colombia and several Asian countries while B27 has been reported among isolates from Senegal. The three Inaba strains belonged to one ribotype, designated type A, not previously reported. PFGE analysis using NotI revealed that all isolates within a ribotype had identical profiles demonstrating clonality amongst the strains. Dice coefficient analysis of the two Ogawa genotypes revealed 89% similarity on ribotype patterns and 91.3% on PFGE profiles. Ribotype V/B21a isolates were associated with cases from dispersed areas of Kuala Lumpur and its suburbs while ribotype B27 was restricted to cases from one particular area suggesting a common-source outbreak.
    Matched MeSH terms: Cholera/epidemiology
  8. Molecular characterization of Vibrio cholerae O1 and non-O1 from human and environmental sources in Malaysia
    Radu S, Ho YK, Lihan S, Yuherman, Rusul G, Yasin RM, et al.
    Epidemiol Infect, 1999 Oct;123(2):225-32.
    PMID: 10579441
    A total of 31 strains of Vibrio cholerae O1 (10 from outbreak cases and 7 from surface water) and non-O1 (4 from clinical and 10 from surface water sources) isolated between 1993 and 1997 were examined with respect to presence of cholera enterotoxin (CT) gene by PCR-based assays, resistance to antibiotics, plasmid profiles and random amplified polymorphic DNA (RAPD) analysis. All were resistant to 9 or more of the 17 antibiotics tested. Identical antibiotic resistance patterns of the isolates may indicate that they share a common mode of developing antibiotic resistance. Furthermore, the multiple antibiotic resistance indexing showed that all strains tested originated from high risk contamination. Plasmid profile analysis by agarose gel electrophoresis showed the presence of small plasmids in 12 (7 non-O1 and 5 O1 serotypes) with sizes ranging 1.3-4.6 MDa. The CT gene was detected in all clinical isolates but was present in only 14 (6 O1 serotype and 8 non-O1 serotype) isolates from environmental waters. The genetic relatedness of the clinical and environmental Vibrio cholerae O1 and non-O1 strains was investigated by RAPD fingerprinting with four primers. The four primers generated polymorphisms in all 31 strains of Vibrio cholerae tested, producing bands ranging from < 250 to 4500 bp. The RAPD profiles revealed a wide variability and no correlation with the source of isolation. This study provides evidence that Vibrio cholerae O1 and non-O1 have significant public health implications.
    Matched MeSH terms: Cholera/epidemiology*
  9. Fulltext Cholera outbreak by Sea Gypsies in Sabah, Malaysia: A challenge in North Borneo
    Jikal M, Riduan T, Aarifin R, Jeffree MS, Ahmed K
    Int J Infect Dis, 2019 Jun;83:83-85.
    PMID: 30986543 DOI: 10.1016/j.ijid.2019.04.008
    OBJECTIVES: In this study we investigated an outbreak of Vibrio cholera O1 Ogawa serotype, occurred during December 2014 in Kudat district, situated in Sabah state of the Malaysian part of Borneo.

    METHODS: Active case detection and contact tracing were done at respective localities by house to house survey. Passive case detection was done among acute gastroenteritis patients attended at various health facilities. To determine the source, samples from food, water and environment were taken. A case control study was also done to determine the risk factors.

    RESULTS: A total of 44 symptomatic and 34 asymptomatic cases from 19 localities were investigated. 39 cases were detected through passive case detection. Median age of cases was 23 years. All cases belonged to serogroup O1 and Ogawa serotype. The epidemiological investigation of time, place, and person identified that V. cholerae cross-transmission might have occurred in two fish markets and the fish-loading port. Circumstantial evidences indicated that cholera was possibly transmitted through contaminated sea foods.

    CONCLUSIONS: We concluded that the life-style of Sea Gypsies is a challenge in cholera control; therefore vaccination might be an effective way to mitigate cholera in an outbreak prone area like Kudat.

    Matched MeSH terms: Cholera/epidemiology*
  10. Molecular epidemiologic analysis of Vibrio cholerae O1 isolates by pulsed-field gel electrophoresis
    Mahalingam S, Cheong YM, Kan S, Yassin RM, Vadivelu J, Pang T
    J Clin Microbiol, 1994 Dec;32(12):2975-9.
    PMID: 7883885
    Isolates of Vibrio cholerae O1 El Tor from two well-defined cholera outbreaks in Malaysia were analyzed by using pulsed-field gel electrophoresis (PFGE). Isolates from sporadic cases occurring during the same time period were also studied. Digestion of chromosomal DNA from these isolates of V. cholerae O1 with restriction endonucleases NotI (5'-GCGGCCGC-3') and SfiI (5'-GGCCNNNN-3'), followed by PFGE, produced restriction endonuclease analysis (REA) patterns consisting of 13 to 24 bands (ranging in size from 46 to 398 kbp). Analysis of the REA patterns generated by PFGE after digestion with NotI and SfiI suggested the clonal nature and close genetic identity of the isolates obtained during each of the two outbreaks (Dice coefficient, 0.93 to 1.0). Although they had very similar REA patterns, the two outbreak clones were not identical. Isolates of V. cholerae O1 from sporadic cases, on the other hand, appeared to be much more heterogeneous (five different REA patterns detected in the five isolates tested; Dice coefficient, 0.31 to 0.81) than those obtained during the two outbreaks. We conclude that PFGE of V. cholerae O1 chromosomal DNA digested with infrequently cutting restriction endonucleases is a useful method for molecular typing of V. cholerae isolates for epidemiological purposes.
    Matched MeSH terms: Cholera/epidemiology
  11. Fulltext Molecular evidence of cholera outbreak caused by a toxigenic Vibrio cholerae O1 El tor variant strain in Kelantan, Malaysia
    Ang GY, Yu CY, Balqis K, Elina HT, Azura H, Hani MH, et al.
    J Clin Microbiol, 2010 Nov;48(11):3963-9.
    PMID: 20826646 DOI: 10.1128/JCM.01086-10
    A total of 20 Vibrio cholerae isolates were recovered for investigation from a cholera outbreak in Kelantan, Malaysia, that occurred between November and December 2009. All isolates were biochemically characterized as V. cholerae serogroup O1 Ogawa of the El Tor biotype. They were found to be resistant to multiple antibiotics, including tetracycline, erythromycin, sulfamethoxazole-trimethoprim, streptomycin, penicillin G, and polymyxin B, with 35% of the isolates being resistant to ampicillin. All isolates were sensitive to ciprofloxacin, norfloxacin, chloramphenicol, gentamicin, and kanamycin. Multiplex PCR analysis confirmed the biochemical identification and revealed the presence of virulence genes, viz., ace, zot, and ctxA, in all of the isolates. Interestingly, the sequencing of the ctxB gene showed that the outbreak strain harbored the classical cholera toxin gene and therefore belongs to the newly assigned El Tor variant biotype. Clonal analysis by pulsed-field gel electrophoresis demonstrated that a single clone of a V. cholerae strain was responsible for this outbreak. Thus, we present the first molecular evidence that the toxigenic V. cholerae O1 El Tor variant has invaded Malaysia, highlighting the need for continuous monitoring to facilitate early interventions against any potential epidemic by this biotype.
    Matched MeSH terms: Cholera/epidemiology
  12. A review of potential factors contributing to epidemic cholera in Yemen
    Al-Gheethi A, Noman E, Jeremiah David B, Mohamed R, Abdullah AH, Nagapan S, et al.
    J Water Health, 2018 Oct;16(5):667-680.
    PMID: 30285950 DOI: 10.2166/wh.2018.113
    The menace of cholera epidemic occurrence in Yemen was reported in early 2017. Recent reports revealed that an estimated 500,000 people are infected with cholera whereas 2,000 deaths have been reported in Yemen. Cholera is transmitted through contaminated water and food. Yemen is the least developed country among the Middle East countries in terms of wastewater and solid waste management. The population of Yemen is about 24.5 million and generates about 70-100 million m3 of sewage. An estimated 7% of the population has sewerage systems. It has been revealed that 31.2 million m3 of untreated sewage is used for irrigation purposes especially for vegetables and Khat trees. In addition, more than 70% of the population in Yemen has no potable water. They depend on water wells as a water source which are located close to sewage disposal sites. The present review focuses on the current status of water, wastewater as well as solid waste management in Yemen and their roles in the outbreak of cholera. Future prospects for waste management have been proposed.
    Matched MeSH terms: Cholera/epidemiology*
  13. Comparative PCR-based fingerprinting of Vibrio cholerae isolated in Malaysia
    Shuan Ju Teh C, Thong KL, Osawa R, Heng Chua K
    J Gen Appl Microbiol, 2011;57(1):19-26.
    PMID: 21478644
    Vibrio cholerae, the causative agent of cholera, is endemic in many parts of the world, especially in countries poor in resources. Molecular subtyping of V. cholerae is useful to trace the regional spread of a clone or multidrug-resistant strains during outbreaks of cholera. Current available PCR-based fingerprinting methods such as Random Amplified Polymorphic DNA (RAPD)-PCR, Enterobacterial Repetitive Intergenic Consensus Sequence (ERIC)-PCR, and Repetitive Extragenic Palindromic (REP)-PCR were used to subtype V. cholerae. However, there are problems for inter-laboratory comparison as these PCR methods have their own limitations especially when different PCR methods have been used for molecular typing. In this study, a Vibrio cholerae Repeats-PCR (VCR-PCR) approach which targets the genetic polymorphism of the integron island of Vibrios was used and compared with other PCR-based fingerprinting methods in subtyping. Forty-three V. cholerae of different serogroups from various sources were tested. The PCR-fingerprinting approaches were evaluated on typeability, reproducibility, stability and discriminatory power. Overall, Malaysian non-O1/non-O139 V. cholerae were more diverse than O1 strains. Four non-O1/non-O139 strains were closely related with O1 strains. The O139 strain in this study shared similarity with strains of both O1 and non-O1/non-O139 serogroups. ERIC-PCR was the most discriminative approach (D value = 0.996). VCR-PCR was useful in discriminating non-O1/non-O139 strains. RAPD-PCR and REP-PCR were less suitable for efficient subtyping purposes as they were not reproducible and lacked stability. The combination of the ERIC-PCR and VCR-PCR may overcome the inadequacy of any one approach and hence provide more informative data.
    Matched MeSH terms: Cholera/epidemiology*
  14. An appraisal of El Tor carrier state in Kelantan
    Dutt AK, Tan Hock Joo
    Med J Malaya, 1971 Mar;25(3):205-7.
    PMID: 4253247
    Matched MeSH terms: Cholera/epidemiology*
  15. A cholera epidemic without a hospital death
    Hart PL
    Med J Malaya, 1966 Jun;20(4):281-3.
    PMID: 4224335
    Matched MeSH terms: Cholera/epidemiology*
  16. Cholera in the Kedah River area
    Chen PC
    Med J Malaya, 1970 Jun;24(4):247-56.
    PMID: 4248344
    Matched MeSH terms: Cholera/epidemiology*
  17. Cholera epidemic in the State of Kedah (1963-1964) with administrative, preventive measures, treatment and laboratory investigations
    Subrahmanyam C
    Med J Malaya, 1966 Sep;21(1):41-8.
    PMID: 4224877
    Matched MeSH terms: Cholera/epidemiology*
  18. Fulltext Review of the trends and causes of food borne outbreaks in Malaysia from 1988 to 1997
    Meftahuddin T
    Med J Malaysia, 2002 Mar;57(1):70-9.
    PMID: 14569721 MyJurnal
    This paper examines the trend and possible contributing factors for the occurrence of the food borne diseases outbreaks in Malaysia. These diseases mainly are cholera, typhoid fever, hepatitis A, dysentery and food poisoning. The outbreaks still occur sporadically in certain high risk areas throughout the country. The incidence rate of all the other three major food borne diseases steadily declined from the year 1988 to 1997 except for food poisoning and cholera. Statistic of food poisoning from the year 1996 to 1997 showed that 66.5% of the outbreak occurred in schools whereas only 0.4% originated from the contaminated food sold at various public food outlets. The school age group is always more affected than the general population. Amongst the contributing factors identified are related to unhygienic food handling practices followed by inadequate safe water supply and poor environmental sanitation. A multisectoral approach between Ministry of Health and other government agencies or private agents needs to be undertaken in the management of the food borne diseases in order to curb the incidences of food borne diseases in Malaysia.
    Matched MeSH terms: Cholera/epidemiology*
  19. Fulltext Cholera: a re-emerging infection
    Lim VKE
    Med J Malaysia, 2001 Mar;56(1):1-3.
    PMID: 11503284
    Matched MeSH terms: Cholera/epidemiology*
  20. Fulltext Cholera--still a major health problem
    Lim VKE
    Med J Malaysia, 1993 Mar;48(1):1-2.
    PMID: 8341166
    Matched MeSH terms: Cholera/epidemiology*
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