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  1. Vaccine preventable meningitis in Malaysia: epidemiology and management
    McNeil HC, Jefferies JM, Clarke SC
    Expert Rev Anti Infect Ther, 2015 06;13(6):705-14.
    PMID: 25962101 DOI: 10.1586/14787210.2015.1033401
    Worldwide bacterial meningitis accounts for more than one million cases and 135,000 deaths annually. Profound, lasting neurological complications occur in 9-25% of cases. This review confirms the greatest risk from bacterial meningitis is in early life in Malaysia. Much of the disease burden can be avoided by immunization, particularly against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. Despite inclusion of the Hib vaccine in the National Immunisation Programme and the licensure of pneumococcal vaccines, these two species are the main contributors to bacterial meningitis in Malaysia, with Neisseria meningitidis and Mycobacterium tuberculosis, causing a smaller proportion of disease. The high Hib prevalence may partly be due to dated, small-scale studies limiting the understanding of the current epidemiological situation. This highlights the need for larger, better quality surveillance from Malaysia to evaluate the success of Hib immunization and to help guide immunization policy for vaccines against S. pneumoniae and N. meningitidis.
    Matched MeSH terms: Streptococcus pneumoniae
  2. Fulltext Transcriptome analysis of Streptococcus pneumoniae treated with the designed antimicrobial peptides, DM3
    Le CF, Gudimella R, Razali R, Manikam R, Sekaran SD
    Sci Rep, 2016 05 26;6:26828.
    PMID: 27225022 DOI: 10.1038/srep26828
    In our previous studies, we generated a short 13 amino acid antimicrobial peptide (AMP), DM3, showing potent antipneumococcal activity in vitro and in vivo. Here we analyse the underlying mechanisms of action using Next-Generation transcriptome sequencing of penicillin (PEN)-resistant and PEN-susceptible pneumococci treated with DM3, PEN, and combination of DM3 and PEN (DM3PEN). DM3 induced differential expression in cell wall and cell membrane structural and transmembrane processes. Notably, DM3 altered the expression of competence-induction pathways by upregulating CelA, CelB, and CglA while downregulating Ccs16, ComF, and Ccs4 proteins. Capsular polysaccharide subunits were downregulated in DM3-treated cells, however, it was upregulated in PEN- and DM3PEN-treated groups. Additionally, DM3 altered the amino acids biosynthesis pathways, particularly targeting ribosomal rRNA subunits. Downregulation of cationic AMPs resistance pathway suggests that DM3 treatment could autoenhance pneumococci susceptibility to DM3. Gene enrichment analysis showed that unlike PEN and DM3PEN, DM3 treatment exerted no effect on DNA-binding RNA polymerase activity but observed downregulation of RpoD and RNA polymerase sigma factor. In contrast to DM3, DM3PEN altered the regulation of multiple purine/pyrimidine biosynthesis and metabolic pathways. Future studies based on in vitro experiments are proposed to investigate the key pathways leading to pneumococcal cell death caused by DM3.
    Matched MeSH terms: Streptococcus pneumoniae
  3. Fulltext Thermostable Heptaplex PCR Assay for the Detection of Six Respiratory Bacterial Pathogens
    Nik Zuraina NMN, Goni MD, Amalina KN, Hasan H, Mohamad S, Suraiya S
    Diagnostics (Basel), 2021 Apr 22;11(5).
    PMID: 33922299 DOI: 10.3390/diagnostics11050753
    A thermostabilized, multiplex polymerase chain reaction (mPCR) assay was developed in this study for the detection of six respiratory bacterial pathogens. Specific primers were designed for an internal amplification control (IAC) and six target sequences from Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Mycobacterium tuberculosis, and Haemophilus influenzae. The resultant seven-band positive amplification control (PAC) of this heptaplex PCR assay corresponded to 105 base pairs (bp) of IAC, 202 bp of K. pneumoniae, 293 bp of S. aureus, 349 bp of S. pneumoniae, 444 bp of P. aeruginosa, 505 bp of M. tuberculosis, and 582 bp of H. influenzae. Results found that 6% (w/v) of the stabilizer was optimum to preserve the functional conformation of Taq DNA polymerase enzyme. This assay was stable at ambient temperature for at least 6 months. The sensitivity and specificity of this assay were both 100% when testing on the intended target organisms (n = 119) and non-intended species (n = 57). The mPCR assay developed in this study enabled accurate, rapid, and simple detection of six respiratory bacteria.
    Matched MeSH terms: Streptococcus pneumoniae
  4. Fulltext The upper respiratory tract microbiome of indigenous Orang Asli in north-eastern Peninsular Malaysia
    Cleary DW, Morris DE, Anderson RA, Jones J, Alattraqchi AG, A Rahman NI, et al.
    NPJ Biofilms Microbiomes, 2021 01 05;7(1):1.
    PMID: 33402693 DOI: 10.1038/s41522-020-00173-5
    Much microbiome research has focused on populations that are predominantly of European descent, and from narrow demographics that do not capture the socio-economic and lifestyle differences which impact human health. Here we examined the airway microbiomes of the Orang Asli, the indigenous peoples of Malaysia. A total of 130 participants were recruited from two sites in the north-eastern state of Terengganu in Peninsular Malaysia. Using 16S rRNA sequencing, the nasal microbiome was significantly more diverse in those aged 5-17 years compared to 50+ years (p = 0.023) and clustered by age (PERMANOVA analysis of the Bray-Curtis distance, p = 0.001). Hierarchical clustering of Bray-Curtis dissimilarity scores revealed six microbiome clusters. The largest cluster (n = 28; 35.4%) had a marked abundance of Corynebacterium. In the oral microbiomes Streptococcus, Neisseria and Haemophilus were dominant. Using conventional microbiology, high levels of Staphylococcus aureus carriage were observed, particularly in the 18-65 age group (n = 17/36; 47.2% 95% CI: 30.9-63.5). The highest carriage of pneumococci was in the <5 and 5 to 17 year olds, with 57.1% (4/7) and 49.2% (30/61), respectively. Sixteen pneumococcal serotypes were identified, the most common being the nonvaccine-type 23A (14.6%) and the vaccine-type 6B (9.8%). The prevalence of pneumococcal serotypes covered by pneumococcal conjugate vaccines support introduction into a Malaysian national immunisation schedule. In addition, the dominance of Corynebacterium in the airway microbiomes is intriguing given their role as a potentially protective commensal with respect to acute infection and respiratory health.
    Matched MeSH terms: Streptococcus pneumoniae/classification; Streptococcus pneumoniae/drug effects; Streptococcus pneumoniae/genetics; Streptococcus pneumoniae/isolation & purification
  5. Fulltext The role of interspecies recombination in the evolution of antibiotic-resistant pneumococci
    D'Aeth JC, van der Linden MP, McGee L, de Lencastre H, Turner P, Song JH, et al.
    Elife, 2021 Jul 14;10.
    PMID: 34259624 DOI: 10.7554/eLife.67113
    Multidrug-resistant Streptococcus pneumoniae emerge through the modification of core genome loci by interspecies homologous recombinations, and acquisition of gene cassettes. Both occurred in the otherwise contrasting histories of the antibiotic-resistant S. pneumoniae lineages PMEN3 and PMEN9. A single PMEN3 clade spread globally, evading vaccine-induced immunity through frequent serotype switching, whereas locally circulating PMEN9 clades independently gained resistance. Both lineages repeatedly integrated Tn916-type and Tn1207.1-type elements, conferring tetracycline and macrolide resistance, respectively, through homologous recombination importing sequences originating in other species. A species-wide dataset found over 100 instances of such interspecific acquisitions of resistance cassettes and flanking homologous arms. Phylodynamic analysis of the most commonly sampled Tn1207.1-type insertion in PMEN9, originating from a commensal and disrupting a competence gene, suggested its expansion across Germany was driven by a high ratio of macrolide-to-β-lactam consumption. Hence, selection from antibiotic consumption was sufficient for these atypically large recombinations to overcome species boundaries across the pneumococcal chromosome.
    Matched MeSH terms: Streptococcus pneumoniae/drug effects; Streptococcus pneumoniae/genetics
  6. The epidemiology of pneumococcal carriage and infections in Malaysia
    Le CF, Jefferies JM, Yusof MY, Sekaran SD, Clarke SC
    Expert Rev Anti Infect Ther, 2012 Jun;10(6):707-19.
    PMID: 22734960 DOI: 10.1586/eri.12.54
    In Malaysia, various aspects of the epidemiology of pneumococcal carriage and disease remain largely unclear due to the lack of supporting data. Although a number of relevant studies have been documented, their individual discrete findings are not sufficient to inform experts on pneumococcal epidemiology at a national level. Therefore, in this review we aim to bring together and systematically evaluate the key information regarding pneumococcal disease epidemiology in Malaysia and provide a comprehensive overview of the data. Major aspects discussed include pneumococcal carriage, disease incidence and prevalence, age factors, invasiveness of pneumococci, serotypes, molecular epidemiology and antibiotic susceptibility. Penicillin resistance is increasingly prevalent and studies suggest that the majority of pneumococcal serotypes causing pneumococcal disease in Malaysia are covered by currently available conjugate vaccines. Continued surveillance is needed to provide a better understanding of pneumococcal epidemiology in Malaysia.
    Matched MeSH terms: Streptococcus pneumoniae/genetics*
  7. Fulltext The Streptococcus pneumoniaeyefM-yoeB and relBE Toxin-Antitoxin Operons Participate in Oxidative Stress and Biofilm Formation
    Chan WT, Domenech M, Moreno-Córdoba I, Navarro-Martínez V, Nieto C, Moscoso M, et al.
    Toxins (Basel), 2018 09 18;10(9).
    PMID: 30231554 DOI: 10.3390/toxins10090378
    Type II (proteic) toxin-antitoxin systems (TAs) are widely distributed among bacteria and archaea. They are generally organized as operons integrated by two genes, the first encoding the antitoxin that binds to its cognate toxin to generate a harmless protein⁻protein complex. Under stress conditions, the unstable antitoxin is degraded by host proteases, releasing the toxin to achieve its toxic effect. In the Gram-positive pathogen Streptococcus pneumoniae we have characterized four TAs: pezAT, relBE, yefM-yoeB, and phD-doc, although the latter is missing in strain R6. We have assessed the role of the two yefM-yoeB and relBE systems encoded by S. pneumoniae R6 by construction of isogenic strains lacking one or two of the operons, and by complementation assays. We have analyzed the phenotypes of the wild type and mutants in terms of cell growth, response to environmental stress, and ability to generate biofilms. Compared to the wild-type, the mutants exhibited lower resistance to oxidative stress. Further, strains deleted in yefM-yoeB and the double mutant lacking yefM-yoeB and relBE exhibited a significant reduction in their ability for biofilm formation. Complementation assays showed that defective phenotypes were restored to wild type levels. We conclude that these two loci may play a relevant role in these aspects of the S. pneumoniae lifestyle and contribute to the bacterial colonization of new niches.
    Matched MeSH terms: Streptococcus pneumoniae/physiology*
  8. Fulltext Synergistic effects of Persicaria odorata (daun kesom) leaf extracts with standard antibiotics on pathogenic bacteria
    Ridzuan, P.M., Hairul Aini Hamzah, Anis Shah, Norazian Mohd Hassan, Baharudin Roesnita
    International Medical Journal Malaysia, 2017;16(2):27-32.
    MyJurnal
    Antibacterial activity of different types of P. odorata leaf extracts was evaluated in combination with
    standard antibiotics. Persicaria. odorata leaves were extracted with n-hexane (n-hex), dichloromethane
    (DCM) and methanol (MeOH). Each extract was applied on vancomycin (30µg), erythromycin (15µg) and
    gentamicin (10µg) discs, respectively. Disk diffusion method was used to evaluate the synergistic activity of
    each combination on Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes,
    Streptococcus pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, and Escherichia coli. Minimum
    inhibitory concentration (MIC) and gas chromatography mass spectrometry (GCMS) analysis was performed on
    the active extract. Synergistic effects seen were mainly from the n-hex+antibiotics combinations, mainly on
    the Gram-positive bacteria (7 additive, 5 antagonistic), with MIC range from 50 µg/ml to 100 µg/ml, as well
    as Gram-negative bacteria (2 additive, 2 indifferent, 5 antagonistic). In particular, synergism showed by the
    combination of n-hex+van were all additive against the susceptible bacteria. DCM extract combination
    showed synergistic effects on three Gram-positive species (S. aureus, S. epidermidis, S. pyogenes).
    Meanwhile, MeOH+antibiotics combination showed significant additive synergistic effects (p
    Matched MeSH terms: Streptococcus pneumoniae
  9. Susceptibility pattern of Streptococcus pneumoniae among pre-school children in Kota Bharu, Malaysia
    Malik AS, Ismail A, Pennie RA, Naidu JV
    J Trop Pediatr, 1998 02;44(1):10-4.
    PMID: 9538599 DOI: 10.1093/tropej/44.1.10
    Streptococcus pneumoniae (S. pneumoniae) is the most common bacterial cause of pneumonia, meningitis, and otitis media, with the highest incidence among young children and the elderly. S. pneumoniae was once routinely susceptible to penicillin, but since the mid-1980s the incidence of resistance to penicillin and other antimicrobial agents has been increasing all over the world. To optimize empirical regimens and initial therapy for S. pneumoniae infections, clinical healthcare providers must be informed about the prevalence and pattern of drug resistance among the isolates in their communities. No such data are available for the Malaysian population. Therefore, this study was designed to determine the antibiotic susceptibility pattern of S. pneumoniae among colonized pre-school children in Kota Bharu, Malaysia. Pharyngeal swabs were collected from children 1 month to 6 years of age. S. pneumoniae isolates were identified according to the standard and tested for penicillin resistance with a 1-microgram oxacillin disk by the Kirby-Bauer disk diffusion methods. Of 355 nasopharyngeal specimens obtained from kindergarten students, in-patients and pediatric clinics over a period of 1 year, S. pneumoniae was isolated from 36 (10 per cent). All isolates, except one, were susceptible to penicillin. The resistant isolates was susceptible to erythromycin, chloramphenicol and cephalosporins.
    Study site: kindergarten, schools, pediatric outpatients clinics, and in-patient wards of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.
    Matched MeSH terms: Streptococcus pneumoniae/drug effects*
  10. Fulltext Streptococcus pneumoniae Meningitis and Intracranial Vasculopathy: Clinical Correlation with Improving Transcranial Doppler Hemodynamics
    Idris MI, Tai SML, Tan CT, Tan KS
    Case Rep Neurol, 2020 12 14;12(Suppl 1):106-109.
    PMID: 33505281 DOI: 10.1159/000500950
    Streptococcus pneumoniae are Gram-positive bacteria that are responsible for many types of illnesses including pneumonia, sinus infections, and community-acquired meningitis. One important complication of bacterial meningitis is intracranial vasculopathy. Possible etiologies include vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. We present a case report of S. pneumoniae meningitis treated with antibiotics in which clinical improvement correlated with serial transcranial Doppler ultrasonography (TCD) improvement, suggesting vasospasm or vasculitis as a possible mechanism for intracranial vasculopathy.
    Matched MeSH terms: Streptococcus pneumoniae
  11. Status of the effectiveness of contact lens disinfectants in Malaysia against keratitis-causing pathogens
    Abjani F, Khan NA, Jung SY, Siddiqui R
    Exp Parasitol, 2017 Dec;183:187-193.
    PMID: 28919333 DOI: 10.1016/j.exppara.2017.09.007
    The aim of this study was (i) to assess the antimicrobial effects of contact lens disinfecting solutions marketed in Malaysia against common bacterial eye pathogens and as well as eye parasite, Acanthamoeba castellanii, and (ii) to determine whether targeting cyst wall would improve the efficacy of contact lens disinfectants. Using ISO 14729 Stand-Alone Test for disinfecting solutions, bactericidal and amoebicidal assays of six different contact lens solutions including Oxysept®, AO SEPT PLUS, OPTI-FREE® pure moist®, Renu® fresh™, FreshKon® CLEAR and COMPLETE RevitaLens™ were performed using Manufacturers Minimum recommended disinfection time (MRDT). The efficacy of contact lens solutions was determined against keratitis-causing microbes, namely: Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Acanthamoeba castellanii. In addition, using chlorhexidine as an antiamoebic compound and cellulase enzyme to disrupt cyst wall structure, we determined whether combination of both agents can enhance efficacy of marketed contact lens disinfectants against A. castellanii trophozoites and cysts, in vitro. The results revealed that all contact lens disinfectants tested showed potent bactericidal effects exhibiting 100% kill against all bacterial species tested. In contrast, none of the contact lens disinfectants had potent effects against Acanthamoeba cysts viability. When tested against trophozoites, two disinfectants, Oxysept Multipurpose and AO-sept Multipurpose showed partial amoebicidal effects. Using chlorhexidine as an antiamoebic compound and cellulase enzyme to disrupt cyst wall structure, the findings revealed that combination of both agents in contact lens disinfectants abolished viability of A. castellanii cysts and trophozoites. Given the inefficacy of contact lens disinfectants tested in this study, these findings present a significant concern to public health. These findings revealed that targeting cyst wall by using cyst wall degrading molecules in contact lens disinfecting solutions will enhance their efficacy against this devastating eye infection.
    Matched MeSH terms: Streptococcus pneumoniae/drug effects
  12. Spread of drug-resistant Streptococcus pneumoniae in Asian countries: Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study
    Song JH, Lee NY, Ichiyama S, Yoshida R, Hirakata Y, Fu W, et al.
    Clin Infect Dis, 1999 Jun;28(6):1206-11.
    PMID: 10451154
    Antimicrobial susceptibility of 996 isolates of Streptococcus pneumoniae from clinical specimens was investigated in 11 Asian countries from September 1996 to June 1997. Korea had the greatest frequency of nonsusceptible strains to penicillin with 79.7%, followed by Japan (65.3%), Vietnam (60.8%), Thailand (57.9%), Sri Lanka (41.2%), Taiwan (38.7%), Singapore (23.1%), Indonesia (21.0%), China (9.8%), Malaysia (9.0%), and India (3.8%). Serotypes 23F and 19F were the most common. Pulsed-field gel electrophoresis (PFGE) of 154 isolates from Asian countries showed several major PFGE patterns. The serotype 23F Spanish clone shared the same PFGE pattern with strains from Korea, Japan, Singapore, Taiwan, Thailand, and Malaysia. Fingerprinting analysis of pbp1a, pbp2x, and pbp2b genes of 12 strains from six countries also showed identical fingerprints of penicillin-binding protein genes in most strains. These data suggest the possible introduction and spread of international epidemic clones into Asian countries and the increasing problems of pneumococcal drug resistance in Asian countries for the first time.
    Matched MeSH terms: Streptococcus pneumoniae/classification; Streptococcus pneumoniae/drug effects*
  13. Serotyping of Brunei pneumococcal clinical strains and the investigation of their capability to adhere and invade a brain endothelium model
    Rahman NA, Sharudin A, Diah S, Muharram SH
    Microb Pathog, 2017 Sep;110:352-358.
    PMID: 28711510 DOI: 10.1016/j.micpath.2017.07.021
    INTRODUCTION: Pneumococcal infections have caused morbidity and mortality globally. Streptococcus pneumoniae (pneumococci) are commensal bacteria that colonize the nasopharynx, asymptomatically. From there, pneumococci can spread in the lungs causing pneumonia and disseminate in the bloodstream causing bacteremia (sepsis) and reach the brain leading to meningitis. Endothelial cells are one of the most important components of the blood-brain barrier that separates the blood from the brain and plays the first protective role against pneumococcal entry. Thus this study aimed to investigate on the ability of non-meningitis pneumococcal clinical strains to adhere and invade a brain endothelium model.

    METHODS: Two pneumococcal Brunei clinical strains were serotyped by multiplex PCR method using oligonucleotide sequences derived from Centers for Disease Control and Prevention. A validated immortalised mouse brain endothelial cell line (bEnd.3) was used as a brain endothelium model for the study of the pneumococcal breach of the blood-brain barrier using an adherence and invasion assay.

    RESULTS: Both of the pneumococcal clinical strains were found to be serotype 19F, a common circulating serotype in Southeast Asia and globally and possess the ability to adhere and invade the brain endothelial cells.

    CONCLUSION: In addition, this is the first report on the serotype identification of pneumococci in Brunei Darussalam and their application on a brain endothelium model. Further studies are required to understand the virulence capabilities of the clinical strains.

    Matched MeSH terms: Streptococcus pneumoniae/genetics*; Streptococcus pneumoniae/metabolism; Streptococcus pneumoniae/pathogenicity
  14. Fulltext Serotypes & penicillin susceptibility of Streptococcus pneumoniae isolated from children admitted to a tertiary teaching hospital in Malaysia
    Subramaniam P, Jabar KA, Kee BP, Chong CW, Nathan AM, de Bruyne J, et al.
    Indian J Med Res, 2018 Aug;148(2):225-231.
    PMID: 30381546 DOI: 10.4103/ijmr.IJMR_1987_16
    Background & objectives: Streptococcus pneumoniae: (pneumococcus) is a highly invasive extracellular pathogen that causes diseases such as pneumonia, otitis media and meningitis. This study was undertaken to determine the serotype diversity and penicillin susceptibility of S. pneumoniae isolated from paediatric patients in a tertiary teaching hospital in Malaysia.

    Methods: A total of 125 clinical isolates collected from January 2013 to May 2015 were serotyped using seven sequential multiplex polymerase chain reactions. The susceptibility of these isolates to penicillin was also investigated.

    Results: Serotypes detected among the isolates were serotypes 3, 6A/B, 6C, 11/A/D/F, 15A/F, 19A, 19F, 23A, 23F, 34. Serotypes 19F and 6A/B were the most prevalent serotypes detected. Most of the S. pneumoniae were isolated from nasopharyngeal samples of children below five years of age. Majority of the isolates were penicillin susceptible. Only 5.6 per cent of the isolates were non-susceptible to penicillin, mostly of serotype 19F.

    Interpretation & conclusions: Our study revealed the distribution of various serotypes in S. pneumoniae isolates obtained from children in a teaching hospital at Kuala Lumpur, Malaysia and decreasing rates of penicillin resistance among them. The shifts in serotypes and susceptibility to penicillin from time to time have been observed. Continuous monitoring and surveillance are pivotal for better infection control and management of pneumococcal infections among children.

    Matched MeSH terms: Streptococcus pneumoniae/pathogenicity
  15. Fulltext Serotype prevalence of Streptococcus pneumoniae in Malaysia - the need for carriage studies
    McNeil HC, Clarke SC
    Med J Malaysia, 2016 Jun;71(3):134-8.
    PMID: 27495888
    Pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, is a major burden to global health. Although the World Health Organisation (WHO) strongly recommends the inclusion of pneumococcal conjugate vaccines in national immunisation programmes (NIP's) worldwide, this has not occurred in many countries in the WHO South East Asia and Western Pacific regions - particularly longstanding middle-income countries. It is widely accepted that carriage of S. pneumoniae is a precursor to developing any pneumococcal disease. The reduction in pneumococcal disease from vaccine serotypes (VT) following widespread implementation of the pneumococcal conjugate vaccine (PCV) is believed to be through the direct immunogenic protective effect of immunised individuals as well as indirectly through herd immunity diminishing the incidence of disease in nonimmunised individuals. In Malaysia, pneumococcal disease is not included in national surveillance programmes and although PCVs have been licensed, they have not been included in the NIP. Hence, the vaccine is only available privately and the majority of the population is not able to afford it. There is an urgent need to develop surveillance programmes in Malaysia to include pneumococcal serotype data from carriage and invasive disease so that it may help guide national vaccine policy prior to a decision being taken on the inclusion of PCVs in the NIP.
    Matched MeSH terms: Streptococcus pneumoniae*
  16. Fulltext Serotype distribution of invasive, non-invasive and carried Streptococcus pneumoniae in Malaysia: a meta-analysis
    Lister AJJ, Le CF, Cheah ESG, Desa MNM, Cleary DW, Clarke SC
    Pneumonia (Nathan), 2021 May 25;13(1):9.
    PMID: 34030731 DOI: 10.1186/s41479-021-00086-7
    BACKGROUND: Pneumococcal pneumonia is the leading cause of under-five mortality globally. The surveillance of pneumococcal serotypes is therefore vital for informing pneumococcal vaccination policy and programmes. Pneumococcal conjugate vaccines (PCVs) have been available as an option in the private healthcare setting and beginning December 2020, PCV10 was incorporated as part of routine national immunisation programme (NIP) in Malaysia. We searched existing literature on pneumococcal serotype distribution across Malaysia to provide an overall view of this distribution before the implementation of PCV10.

    METHODS: Online databases (PubMed, Ovid MEDLINE and Scopus), reference lists of articles identified, and grey literature (Malaysian Ministry of Health website, WHO website) were systematically searched for relevant literature on pneumococcal serotype distribution across Malaysia up to 10th November 2020. No lower date limit was set to maximise the number of target reports returned. Results of serotypes were split by age categories, including ≤5 years, > 5 years and unreported for those that did not specify.

    RESULTS: The search returned 18 relevant results, with a total of 2040 isolates. The most common serotypes across all disease types were 19F (n = 313, 15.3% [95%CI: 13.8-17.0]), 23F (n = 166, 8.1% [95%CI: 7.0-9.4]), 14 (n = 166, 8.1% [95%CI: 7.0-9.4]), 6B (n = 163, 8.0% [95%CI: 6.9-9.2]) and 19A (n = 138, 6.8% [95%CI: 5.8-7.9]).

    CONCLUSION: Four of the most common serotypes across all isolate sources in Malaysia are covered by PCV10, while PCV13 provides greater serotype coverage in comparison to PCV10. There is still a need for surveillance studies, particularly those investigating serotypes in children under 5 years of age, to monitor vaccine effectiveness and pneumococcal population dynamic following implementation of PCV10 into routine immunisation.

    Matched MeSH terms: Streptococcus pneumoniae
  17. Fulltext Safety and Efficacy of Pneumococcal Vaccination in Pediatric Nephrotic Syndrome
    Goonewardene ST, Tang C, Tan LT, Chan KG, Lingham P, Lee LH, et al.
    Front Pediatr, 2019;7:339.
    PMID: 31456997 DOI: 10.3389/fped.2019.00339
    Nephrotic syndrome affects both children and adults. Idiopathic nephrotic syndrome is reported to be one of the most frequent renal pathologies in childhood. Nephrotic children are at high risk for severe pneumococcal infections as one of the life-threatening complications of nephrotic syndrome due to involvement of the immunosuppressive regimen and the acquired immune deficiency induced by nephrotic syndrome including decreased plasma IgG and low complement system components. Aiming to prevent pneumococcal infection is of paramount importance especially in this era of ever-increasing pneumococcal resistance to penicillins and cephalosporins. The pneumococcal vaccines currently available are inactivated vaccines-the two main forms in use are polysaccharide vaccines and conjugated vaccines. However, the data supporting the use of these vaccines and to guide the timing and dosage recommendations is still limited for nephrotic children. Thus, this review discusses the evidences of immunogenicity and safety profile of both vaccinations on nephrotic patients as well as the effect of nephrotic syndrome treatment on vaccine seroresponses.
    Matched MeSH terms: Streptococcus pneumoniae
  18. Retrospective database analysis for clinical diagnoses commonly associated with pneumococcal diseases in the Malaysian healthcare system over a 3-year period (2013-2015)
    Sundaramurthy SSR, Allen KE, Fletcher MA, Liew KF, Borhanuddin B, Ali M, et al.
    BMC Infect Dis, 2024 Jan 12;24(1):79.
    PMID: 38216882 DOI: 10.1186/s12879-023-08611-3
    BACKGROUND: Pneumococcal disease caused by Streptococcus pneumoniae is an important cause of morbidity and mortality across all ages, particularly in younger children and older adults. Here, we describe pneumococcal disease hospitalizations at Ministry of Health (MoH) facilities in Malaysia between 2013 and 2015.

    METHODS: This was a retrospective databases analysis. Tabular data from the Malaysian Health Data Warehouse (MyHDW) were used to identify microbiologically confirmed, pneumococcal disease hospitalizations and deaths during hospitalization, using hospital-assigned ICD-10 codes (i.e., classified as meningitis, pneumonia, or non-meningitis non-pneumonia). Case counts, mortality counts, and case fatality rates were reported by patient age group and by Malaysian geographic region.

    RESULTS: A total of 683 pneumococcal disease hospitalizations were identified from the analysis: 53 pneumococcal meningitis hospitalizations (5 deaths and 48 discharges), 413 pneumococcal pneumonia hospitalizations (24 deaths and 389 discharges), and 205 non-meningitis non-pneumonia pneumococcal disease hospitalizations (58 deaths and 147 discharges). Most hospitalizations occurred in children aged 

    Matched MeSH terms: Streptococcus pneumoniae
  19. Fulltext Regional epidemiology of invasive pneumococcal disease in Asian adults: epidemiology, disease burden, serotype distribution, and antimicrobial resistance patterns and prevention
    Hung IF, Tantawichien T, Tsai YH, Patil S, Zotomayor R
    Int J Infect Dis, 2013 Jun;17(6):e364-73.
    PMID: 23416209 DOI: 10.1016/j.ijid.2013.01.004
    To summarize published data on the clinical and economic burden, epidemiology, antimicrobial resistance levels, serotype prevalence, and prevention strategies for pneumococcal disease among adults in Asia.
    Matched MeSH terms: Streptococcus pneumoniae/classification; Streptococcus pneumoniae/drug effects
  20. Fulltext Quintuplex PCR to detect antibiotic resistance genes in Streptococcus pneumoniae
    Navindra Kumari Palanisamy, Parasakthi Navaratnam, Shamala Devi Sekaran
    Journal of Clinical and Health Sciences, 2016;1:22-28.
    Introduction: Streptococcus pneumoniae is an important bacterial pathogen, causing respiratory infection. Penicillin resistance in S. pneumoniae is associated with alterations in the penicillin binding proteins, while resistance to macrolides is conferred either by the modification of the ribosomal target site or efflux mechanism. This study aimed to characterize S. pneumoniae and its antibiotic resistance genes using 2 sets of multiplex PCRs. Methods: A quintuplex and triplex PCR was used to characterize the pbp1A, ermB, gyrA, ply, and the mefE genes. Fifty-eight penicillin sensitive strains (PSSP), 36 penicillin intermediate strains (PISP) and 26 penicillin resistance strains (PRSP) were used. Results: Alteration in pbp1A was only observed in PISP and PRSP strains, while PCR amplification of the ermB or mefE was observed only in strains with reduced susceptibility to erythromycin. The assay was found to be sensitive as simulated blood cultures showed the lowest level of detection to be 10cfu. Conclusions: As predicted, the assay was able to differentiate penicillin susceptible from the non-susceptible strains based on the detection of the pbp1A gene, which correlated with the MIC value of the strains.
    Matched MeSH terms: Streptococcus pneumoniae
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