A comparison is made between atebrin-musonate and quinine bihydrochloride in the treatment of acute malaria. 286 cases of acute malaria due to Malayan strains of P. falciparum, P. vivax, and P. malariae, were treated in alternating sequence with one or other of these drugs. The rates at which the atebrin-musonate and the quinine case groups became trophozoite-free and fever-free are contrasted in a series of graphs. It is shown that there was a tendency for trophozoites to disappear from the peripheral blood and for temperatures to fall to normal somewhat earlier among cases treated with atebrin-musonate. No toxic effects of any importance were observed (but see footnote p. 657). Evidence is recorded which suggests that the minimal effective daily dose for an adult is 0·375 gramme (= atebrin 0·3 gramme). This dose when given either intramuscularly or intravenously on two successive days effected a rapid disappearance of parasites and fever. Intramuscular administration is regarded as the method of choice. It is noted that absorption of the drug from the muscles is very rapid, and that atebrin may be demonstrated in the urine within 10 minutes of an intramuscular injection of 0·3 gramme. A method of testing for the presence of atebrin in the urine which is sensitive to over one in a million is described. It was not possible to obtain precise data regarding the permanency of cure but an analysis of cases returning to hospital within 10 weeks of discharge suggests that relapses after atebrin-musonate treatment are probably fairly common.
An ecologic study on Paragonimus in Malaysia was attempted from May to September 1967. Seven streams located in various directions and distances from Kuala Lumpur were surveyed for the study of intermediate hosts, snail and crab. One Malayan village and one aborigine village where infected crabs were found, and two tuberculosis hospitals in K.L. were surveyed for the study of human population. Intradermal tests along with sputum or stool examination to detect human infection by Paragonimus were employed. Wild animals, only a few, were shot in the vicinity of the aborigine village and several domestic cats from the Malayan village were bought. These animals were autopsied and examined for adult Paragonimus. Among five species of crab collected from the study areas, only two species, Potamon jahorenes and Parathelphusa maculata were found to be infected with Paragonimus. P. maculata seemed to be better crab host for the Paragonimus because this species had higher infection rate and metacercarial density than the other in the very same area. Three out of seven streams had infected crabs and the infection rate as well as the infection intensity varied from one stream to another. Only avilable snail in the streams was identified as Brotia costula. The infection rate of the snail was very low, six snails out of 11,898, which is about the same rate reported from other countries. Infected snail, however, had thousands of rediae uncountable containing about twelve microcercocercariae in each redia, sufficient enough to maintain the life cycle of the parasite even with only a few infected snail, the amplifier. This is the first confirmed report on the snail host of Paragonimus from Malaysia where the existence of Paragonimus had been reported in 1923. The first trial to study human population by means of intradermal test, sputum and/or stool examinations in Malaysia showed no evidence of human infection of Paragonimus. The number of animals, wild and domestic, examined for natural infection was too small to draw any statement. These examined animals were all negative for adult Paragonimus. Even though more extensive studies on wild animals and human population may be necessary for the definite conclusion, the facts that infected crabs from jungle stream where human contacts are extreamely rare, and also highly infected crabs from the area where none of humans or domestic animals were infected, strongly suggest the life cycle of Paragonimus in this area may be maintained by wild animal hosts rather than by human host. The morphology of all stages of the parasite, the pattern of penetrating glands, flame cells and excretroy bladder of cercaria, lancet shaped single cuticular spines and 6 branched ovary of adult worm obtained from experimentally infected cat, and the shape of egg including all measurements agree well with the characteristics of Paragonimus westermani.
Malaria is still a very real threat to health in S.E. Asia including Malaysia. While there has been a dramatic fall in the number of cases and also the number of deaths from the disease in Malaysia cases are still occurring and there has actually been a rise in the number of deaths in the past year. Parts of Perak and the East Coast states are still high risk areas in Peninsular Malaysia. While 95 percent of the population of Peninsular Malaysia is now malaria-free there has also been a concomitant loss of herd immunity which means that if a non-immune person contracts falciparum malaria he stands a greater chance of a fatal outcome. Doctors and other health personnel should be more malaria conscious and make a practice of making blood films of all cases of fever. This is especially important in the rural areas and Estate Hospital Assistants must be encouraged to look for malaria parasites in their fever patients. The younger generation of EHAs have little experience of malaria and a definite policy of education to bring them up to date in antimalarial work and microscopic detection of the parasite should be under taken by the industry. Some problems of chemotherapy and drug resistance are discussed.
A myopathy associated with elongated intramuscular protozoan schizonts of uncertain classification was observed in chickens in commercial farms. Of 152 affected fowls originating from 21 flocks in 12 farms, 149 were 24 weeks of age or older and 136 were broiler breeder birds. Both sexes were affected. The disease was only observed during the months of October, November and December, 1976 and 1977. The monthly mortality rate in affected adult flocks rose by 0.5% to 4% and the egg production declined by 5% to 15% during this period. Most affected birds were in good body condition or overweight. Gross lesions were usually present in all skeletal muscles and the cardiac muscle. They resembled nutritional myopathy, sarcosporidiosis, leucocytozoonosis or haemorrhagic syndrome. Microscopically visible elongated schizonts were demonstrated in skeletal muscles and the cardiac muscle in 49 of 55 birds examined histologically. The possible aetiology with respect to known parasites of muscles in fowls is discussed.
Cryptosporidium is an intestinal protozoan parasite which causes diarrhoea in animals and has recently been reported to cause similar symptoms in man. Cryptosporidiosis is a zoonotic infection and the first human case was reported in 1976.2 Since then the number of cases has increased by the hundreds especially among patients with acquired immuno-deficiency syndrome (AIDS), as a result of the severe symptoms that they cause in the im-munosuppressed patients and also due to the better screening techniques which have been developed resulting in the detection of cases.3 To date 20 species of Cryptosporidium have been reported but these cannot be differentiated morphologically. The differences are based mainly on the host from which the parasites were recovered. The species responsible for causing infection in man is Cryptosporidium parvum.4 Of the 20 species reported several are invalid because the oocysts of some of them were found to be the same as the sporocyst of Sarcocystis. It is now concluded that there are only two species that infect mammals (C. Muris and C. parvum). (Copied from article).
Lymphatic filariasis is endemic in Asia. The infections persist as a major cause of clinical morbidity and a significant impediment to socioeconomic development. Its prevalence is increasing world wide, largely because of rapid unplanned urbanization in many endemic areas. It is estimated that at least 120 million people are infected. In our study on foreign workers, a total of 241 day time blood samples were collected. The countries represented were Bangladesh (134), Indonesia (103), Pakistan (3) and Myanmar(1). The tests conducted on blood samples were thick blood film for microfilaria and thin blood film for malaria and quantitation of eosinophiles using the Giemsa stain. Out of the 241 blood samples tested, one was positive for Wuchereria bancrofti and one other was positive for malaria (Plasmodium falciparum) each from Bangladesh and Indonesia respectively. As for the blood eosinophiles, 39 (16.18%) blood samples showed high eosinophilia. Fifteen (6.22%) were from Banglandesh and 24 (9.96%) were from Indonesia. The Bangladeshi male who was positive for Witcherrria bamuofti also showed eosinophilia of 22%. We believe that some of these cases with high eosinophilia, may be positive for microfilaria. We may have missed some cases because of the methodology we chose. Lymphatic filariasis is endemic in Bangladesh and Indonesia. In Malaysia W. brancrofti, especially in the cities have been eliminated. However their vectors for the transmission of W. bancrofti is rampant in the cities. With the influx of immigrants with W. bancrofti and in relation to their occupational nature, W. bancrofti may eventually be introduced into the community and change the whole facet of the disease in Malaysia.
One hundred seventy three stool samples were obtained from workers from Indonesia, Bangladesh, Myanmar, Pakistan and others. The stool samples were examined for Ascaris, Trichuris, Hookworm, Schistosomes, trematodes and cestodes. The protozaon parasites included Bnlantidiirrir coli, Blastocystis honlinis, Cyclospora cryptosporidium, Microsporidiirin, Entamoeeba histolytica, Giardia lamblia, lodamoeba butschilli. Of these 21.9%, 17% and 1% of the population studied had hookworm, Trichuris trichiura and Ascaris lumbricoides infections respectively. There was only one Indonesian reported to have Hymenolepis nana infections. The most common protozoan seen in the faecal sample is Blastocystis hominis (36%) followed by Giardia lamblia (4%). Most of the stools positive with these faecal pathogens were semisolid especially the ones positive for the protozoan. We have also shown Blastocystis from the Indonesian workers show very small forms almost 3-5 in size compared to the normal size of 10-15 pm in the other nationalities. These forms show a distinct growth profile in cultures and appears to be more resistant to temperature changes than Blastocystis seen in the other two nationalities. The high incidence of Hookworm and Trichuris infections is suggestive that if these workers are left unheated their productivity will be hampered by other possible serious complications such as anaemia, weight loss, abdominal pain with diarrhoea1 stools and nausea. There are increasing reports that Blastocystis hominis is pathogenic. Flatulence, abdominal discomfort and the increase in the frequency of the passing watery stool has been noted in patients infected with the parasite. Since most of the workers are generally housed in crowded rooms it is highly likely that this will facilitate transmission through the faecal-oral route of both Giardia and Blastocystis possibly increasing the incidences of these infections among workers.
We have recently reported that a dipstick colloidal dye immunoassay (DIA) that detect parasite antigens in human serum is sensitive and specific for the diagnosis of active infection of lymphatic filariasis. Rabbit polyclonal antibodies (RbBmCAg) labelled with a commercial dye, palanil navy blue was used to detect filarial antigenemia among Indonesian and Bangladeshi immigrant workers (N= 630) at oil palm estates at Hulu Trengganu District, Peninsular Malaysia. Microfilaremia with Brugia malayi were detected in 51 (8.10 %) individuals, of which 42 (6.67 %) were among the Indonesians and 9 (1.98 %) among the Bangladeshis. Microfilaremia with Wuchereria bancrofti were detected in 33 (5.24 %) individuals of which 15 (2.38 %) were among the Indonesians and 18 (2.86 %) among the Bangladeshis workers. The DIA detected 96 (15.24 %) antigenemic cases which comprise of all the microfilaremic cases and 15 (2.38 %) amicrofilaremic cases. The amicrofilaremic cases with filarial antigenemia consisted of 9 (1. 43 %) Indonesians and 6 (0.95%) Bangladeshis. We have used 6 ul of the RbBmCAg and diluted (1:10) patients' sera per dipstick which make the DIA reagent conservative. The DIA is a rapid test and can be read in approximate 2 hours.. Additionally, coloured dots developed in the DIA can be qualitatively assessed visually for intensity. The DIA does not require sophisticated equipment or radioactivity, and therefore suitable for field application.