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Emerging and re-emerging diseases in Malaysia

Lam SK

Asia Pac J Public Health, 2002;14(1):6-8.
PMID: 12597511 DOI: 10.1177/101053950201400103

Emerging and re-emerging infectious diseases have become a major global problem. Malaysia appears to be an epicenter for such infections and in recent years, several outbreaks have occurred resulting in loss of lives and economic hardships. In this paper, we discussed the outbreaks of leptospirosis, enterovirus 71 encephalitis, chikungunya polyarthritis and Nipah encephalitis and how a developing country such as Malaysia managed the situation with the help of international agencies and organisations. Many valuable lessons were learned and by sharing our experience, it is hoped that we will be in a better position to handle future outbreaks and prevent their spread to countries in the region.

Matched MeSH terms: Arthritis, Infectious/epidemiology; Arthritis, Infectious/virology
Fulltext Klebsiella pneumoniae sacroiliac septic arthritis: First case report

Chee YC, Lim CH

IDCases, 2018;14:e00459.
PMID: 30386726 DOI: 10.1016/j.idcr.2018.e00459

Infective sacroiliitis is a rare disease with misleading clinical signs that often delay diagnosis. We report a case of pyogenic sacroiliac joint septic arthritis caused by Klebsiella pneumoniae that has not been reported in the literature highlighting it as one of the important etiologies of infective sacroiliitis especially among diabetics.

Matched MeSH terms: Arthritis, Infectious
Fulltext Congenital insensitivity to pain with recurrent septic arthritis of the left knee

Zamzuri Z, Goh KL, Aminuddin CA, Mohamed Azril MA, Shukrimi A

International Medical Journal Malaysia, 2011;10(1):51-52.
MyJurnal

A 15-year–old Malay male with congenital insensitivity to pain presented with recurrent septic arthritis of the left knee complicated by osteomylitis. Repeated arthrotomy and wound debridement was done, however, the condition was not resolved. Amputation was suggested as the best method of treatment to eradicate the infection.

Matched MeSH terms: Arthritis, Infectious
Fulltext Septic arthritis of the knee and necrotizing fasciitis in a young immunocompetent adult: a case report

Miptah HN, Badlishah Sham SF, Lloyd S, Ramli AS

Journal of Clinical and Health Sciences, 2018;3(2):56-61.
MyJurnal

Septic arthritis is uncommon in immunocompetent young adults. It typically presents in individuals with underlying risk factors. Isolation of Group A Streptococcus (GAS) as the causative agent of septic arthritis is usually associated with autoimmune diseases, chronic skin infections or trauma. Here we report a case of a young lady who is immunocompetent without any prior history of trauma, who presented with an abrupt onset of left knee pain and swelling to the emergency department. An initial diagnosis of acute gout was made and she was treated with non-steroidal anti-inflammatory drug (NSAID). She presented again two days later to a primary care clinic with worsening knee pain and severe left calf pain. A clinical diagnosis of septic arthritis was suspected and the patient was urgently referred to the Orthopaedic team. Synovial fluid from the knee joint aspiration showed growth of GAS. A diagnosis of necrotizing fasciitis was also made as the culture taken from the left calf during incision and drainage (I&D) procedure showed a mixed growth. She eventually underwent surgical debridement twice, together with the administration of several courses of intravenous antibiotics leading to her full recovery after 45 days. This case demonstrates the challenge in making a prompt diagnosis of septic arthritis and probable Type II necrotizing fasciitis in an immunocompetent adult without underlying risk factors. Any delay in diagnosis and treatment would have increased the risk of damage to her knee joint and this may be fatal even in a previously healthy young adult.

Matched MeSH terms: Arthritis, Infectious
Fulltext Septic arthritis in rheumatology: review of five cases

Muhayidina AD, Said MS

J Clin Med Res, 2009 Aug;1(3):173-7.
PMID: 22493652 DOI: 10.4021/jocmr2009.08.1254

This report illustrates five cases of patients admitted to medical ward in HUKM, diagnosed and treated as septic arthritis over the course of two months. Their age ranged from 32 to 67 years old with one patient had history of monoarticular pain and the other four had polyarticular pain. Two of these patients had pre-existing joint disease, namely gouty arthritis and rheumatoid arthritis, and another patient with background history of mixed connective tissue disease on long term steroid therapy. The diagnosis of septic arthritis was made mainly from clinical assessment, supported by synovial fluid assessment and blood investigations. All patients received minimum of two weeks intravenous antibiotic followed by one month course of antibiotic. All of them had arthrocentesis for diagnostic and therapeutic purposes and two had laparoscopic arthroscopy with wash out done.

Matched MeSH terms: Arthritis, Infectious
Clinical and radiological features of imported chikungunya fever in Japan: a study of six cases at the National Center for Global Health and Medicine

Mizuno Y, Kato Y, Takeshita N, Ujiie M, Kobayashi T, Kanagawa S, et al.

J Infect Chemother, 2011 Jun;17(3):419-23.
PMID: 20862507 DOI: 10.1007/s10156-010-0124-y

Chikungunya fever (CHIKF) is currently distributed in Africa and in South and Southeast Asia; outbreaks have occurred periodically in the region over the past 50 years. After a large outbreak had occurred in countries in the western Indian Ocean region in 2005, several countries reported cases of CHIKF from travelers who had visited affected areas. In Japan, there have been only 15 cases of CHIKF patients so far, according to the National Institute of Infectious Diseases. Therefore, to evaluate the clinical and radiological features associated with the disease, we describe 6 imported cases of CHIKF. All of the patients had had prolonged arthralgia on admission to our hospital, and diagnosis was confirmed with specific antibodies by using an IgM-capture enzyme-linked immunoassay and a plaque reduction neutralizing antibody assay. Magnetic resonance imaging (MRI) of one patient revealed erosive arthritis and tenosynovitis during the convalescence stage. Clinicians should be aware of the late consequences of infection by the chikungunya virus (CHIKV) and recognize the possible association of subacute and chronic arthritis features. In addition, competent vectors of CHIKV, Aedes aegypti, can now be found in many temperate areas of the eastern and western hemispheres, including Japan. This fact raises concern that the virus could be introduced and become established in these areas. This necessitates an increased awareness of the disease, because imported cases are likely to contribute to the spread of CHIKV infection wherever the competent mosquito vectors are distributed.

Matched MeSH terms: Arthritis, Infectious/diagnosis; Arthritis, Infectious/epidemiology; Arthritis, Infectious/virology
Fulltext Melioidotic septic arthritis: a case report and literature review

Raja NS

J Microbiol Immunol Infect, 2007 Apr;40(2):178-82.
PMID: 17446969

Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in southeast Asia and northern Australia. In recent years, the incidence of melioidosis has increased worldwide. Septic arthritis is a rare but well-recognized manifestation of melioidosis. Patients with underlying medical conditions, such as diabetes mellitus, renal impairment, cirrhosis, and malignancy are at greater risk. The presentations of melioidotic septic arthritis often mimic other disease processes and patients may not always be clinically septic. We present a case of septic arthritis due to B. pseudomallei in a 66-year-old male with diabetes mellitus presenting with a history of fever and ankle swelling. Follow-up ankle X-ray showed soft tissue swelling. Synovial fluid and blood samples grew B. pseudomallei. The patient improved gradually after parenteral administration of ceftazidime (2 g 8-hourly) and cotrimoxazole (1440 mg 8-hourly). He was discharged on oral cotrimoxazole (1440 mg 12-hourly), doxycycline (100 mg 12-hourly), and chloramphenicol (500 mg 6-hourly) for 6 months. This case highlights the possible occurrence of melioidotic septic arthritis, and the importance of prompt initiation of appropriate antimicrobials to achieve good outcomes.
Study site: Emergency department, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Arthritis, Infectious; Arthritis, Infectious/complications; Arthritis, Infectious/drug therapy*; Arthritis, Infectious/microbiology
Fulltext Identification of Neisseria gonorrhoeae as the causative agent in a case of culture-negative dermatitis-arthritis syndrome using real-time PCR

Kimmitt PT, Kirby A, Perera N, Nicholson KG, Schober PC, Rajakumar K, et al.

J Travel Med, 2008;15(5):369-71.
PMID: 19006515 DOI: 10.1111/j.1708-8305.2008.00240.x

Sexually transmitted infections (STIs) are an increasingly common and important cause of a fever in a returning traveler. Systemic complications of STIs, human immunodeficiency virus seroconversion illness, and secondary syphilis are diagnoses that can easily be missed. We present a case of culture-negative disseminated gonococcal infection presenting with fever, malaise, polyarthralgia, arthritis, and a rash that developed following orogenital contact and was diagnosed using real-time polymerase chain reaction. This technology has major potential to improve the speed and sensitivity of diagnosis and consequent management of patients with this syndrome.
Study site: United Kingdom (patient had recent travel to Thailand and Malaysia)

Matched MeSH terms: Arthritis, Infectious/microbiology*
Fulltext Melioidosis: a localised osteomyelitis in a cat

Lim, M.L., Ismail, S.S., Rahman, N., Watanabe, M.

Jurnal Veterinar Malaysia, 2015;27(1):24-26.
MyJurnal

Melioidosis is a zoonotic disease as a result of infection by Burkholderia pseudomallei. It is of significant public health
concern due to its ubiquitous nature with high morbidity and mortality in humans and animals. In cats, the disease is usually reported
with abscess formation in lung, liver and spleen, however, isolated articular melioidosis is rare. A 1-year-old, a female Domestic
Shorthair cat was presented to University Veterinary Hospital, Universiti Putra Malaysia (UVH-UPM) with swollen right elbow and
non weight bearing lameness of the right forelimb. Physical examination revealed pyrexia, soft tissue swelling and pain upon
palpation of the right elbow joint. Radiographs of the right forelimb revealed osteolysis at the distal third of the humerus and
proximal radius and ulna, cortical thinning at the olecranon and soft tissue swelling around the elbow joint. Bacterial culture of the
joint fluid revealed positive growth for Burkholderia pseudomallei. Unfortunately, the owner opted to euthanise the cat citing
personal reasons. Upon necropsy, there was presence of multiple caseous nodules within the right elbow joint cavity only and none
of the other limbs, lung, spleen and liver was affected. It is important for veterinarian to be aware of septic arthritis and osteomyelitis
form of melioidosis.

Matched MeSH terms: Arthritis, Infectious
Osteomyelitis in childhood -the natural history documented by radiographs

Singh, H.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):74-76.
MyJurnal

It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.

Matched MeSH terms: Arthritis, Infectious
Fulltext Patient-reported Outcome Measures of Revision Total Hip Arthroplasty for Prosthetic Joint Infection is not Inferior to Aseptic Revision Total Hip Arthroplasty

Lim J, Pang HN, Tay K, Chia SL, Yeo SJ, Lo NN

Malays Orthop J, 2020 Nov;14(3):73-81.
PMID: 33403065 DOI: 10.5704/MOJ.2011.012

Introduction: This study aims to investigate whether patients undergoing two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) and one-stage revision THA for aseptic reasons have similar clinical outcomes and patient satisfaction during their post-operative follow-up. We hypothesise that the two-stage revision THA for PJI is associated with poorer outcomes as compared to aseptic revision THA.
Materials and Methods: We reviewed prospectively collected data in our tertiary hospital arthroplasty registry and identified patients who underwent revision THA between 2001 and 2014, with a minimum of two years follow-up. The study group (two-stage revision THA for PJI) consists of 23 patients and the control group (one-stage revision THA for aseptic reasons) consists of 231 patients. Patient demographics, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford Hip Score (OHS), Short Form-36 (SF-36) scores and patient reported satisfaction were evaluated. Student's t-test was used to compare continuous variables between the two groups. Statistical significance was defined as p <0.05.
Results: The pre-operative demographics and clinical scores were relatively similar between the two groups of patients. At two years, patients who underwent revision THA for PJI reported a better WOMAC Pain Score and OHS as compared to aseptic revision THA. A similar proportion of patients were satisfied with their results of surgery in both groups (p=0.093).
Conclusions: Although patients who underwent revision THA for PJI had poorer pre-operative functional scores (WOMAC function and SF-36 PF), at two years follow-up, these two groups of patients have comparable post-operative outcomes. Interestingly, patients who had revision THA for PJI reported a better clinical outcome in terms of OHS and WOMAC Pain score as compared to the aseptic group. We conclude that the revision THA for PJI is not inferior to aseptic revision THA in terms of patient satisfaction and clinical outcomes.

Matched MeSH terms: Arthritis, Infectious
Fulltext Septic arthritis of lumbar facet joint with co-existing spondylolisthesis - a case report

Khoo C, Thevarayan S, Rengsen P, Deepak AS

Malays Orthop J, 2010;4(2):48-50.
MyJurnal

We report a rare case of septic arthritis of the lumbar facet joint (SALFJ) with co-existing spondylolisthesis of the L5 on S1 vertebra and discuss possible differential diagnoses, diagnostic difficulties and management of this condition.

Matched MeSH terms: Arthritis, Infectious
Fulltext Bedside continuous irrigation and drainage as an interim local treatment for septic arthritis of the knee in the medically unstable patient: a case report

Khoo SS, Loi KW, Tan KT, Suhaeb AR, Simmrat S

Malays Orthop J, 2015 Jul;9(2):57-59.
PMID: 28435613 MyJurnal DOI: 10.5704/MOJ.1507.003

Septic arthritis is a surgical emergency. Prompt diagnosis and immediate treatment reduce the destruction of articular cartilage and give better outcome. We describe a simple, minimally invasive closed tube irrigation system for the initial treatment of septic arthritis of the knee in a patient with complex medical problems who was unfit to undergo surgery.

Matched MeSH terms: Arthritis, Infectious
The Results of Two-stage Revision for Methicillin-resistant Periprosthetic Joint Infection (PJI) of the Hip

Santoso A, Yoon TR, Park KS, Anwar IB, Utomo P, Soetjahjo B, et al.

Malays Orthop J, 2020 Mar;14(1):18-23.
PMID: 32296477 DOI: 10.5704/MOJ.2003.003

Introduction: Periprosthetic joint infection (PJI) of the hip due to methicillin-resistant bacteria is difficult to treat and remain a challenge for arthroplasty surgeon.
Material and Methods: Retrospective review was done to the patients who received two-stage revisions with an antibiotic loaded cement-spacer for PJI of the hip between January 2010 to May 2015. We found 65 patients (65 hips) with positive culture findings. Eight patients were lost to follow-up and excluded from the study. Among the rest of the 57 patients, methicillin-resistant infection (MR Group) was found in 28 cases. We also evaluate the 29 other cases that caused by the other pathogen as control group. We compared all of the relevant medical records and the treatment outcomes between the two groups.
Results: The mean of follow-up period was 33.7 months in the methicillin-resistant group and 28.4 months in the control group (p = 0.27). The causal pathogens in the methicillin-resistant group were: Methicillin-resistant Staphylococcus aureus (MRSA) in 10 cases, Methicillin-resistant Staphylococcus epidermidis (MRSE) in 16 cases and Methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in two cases. The reimplantation rate was 92.8% and 89.6% in the methicillin-resistant and control group, respectively (p= 0.66). The rates of recurrent infection after reimplantation were 23.1% (6/26) in the methicillin-resistant group and 7.6% (2/26) in the control group (p= 0.12). The overall infection control rate was 71.4% (20/28) and 89.6% (26/29) in the methicillin-resistant and control group, respectively (p = 0.08). Both groups showed comparable baseline data on mean age, BMI, gender distribution, preoperative ESR/CRP/WBC and comorbidities.
Conclusions: Two-stage revision procedure resulted in low infection control rate and high infection recurrency rate for the treatment of methicillin-resistant periprosthetic joint infection (PJI) of the hip. Development of the treatment strategy is needed to improve the outcome of methicillin-resistant periprosthetic joint infection (PJI) of the hip.

Matched MeSH terms: Arthritis, Infectious
Fulltext Septic hip dislocation with a preserved femoral head: successful outcome following open reduction

Kamal J, Abdul Halim AR, Sharaf I

Medicine & Health, 2017;12(2):335-340.
MyJurnal

Septic arthritis of the hip in children represents a serious disorder with unfavourable long-term sequelae. In neonates, a poor hip outcome is expected especially if the treatment was delayed. Late sequelae can lead to structural joint damage and instability, causing deformity and dislocations which ultimately may result in limb length discrepancy, early degenerative changes and limited range of motion. Surgery at the appropriate time can improve the hip condition and functional outcome. Previous classifications of post septic hip sequelae are useful guides for treatment, but did not discuss one particular group of patient. This group-septic hip dislocation with a preserved femoral head, has recently been described as a distinct entity. This report highlights an 11-year follow-up of a 2-year-old child who had a successful outcome following open reduction and varus derotation
osteotomy for a septic hip dislocation with a preserved femoral head.
Keywords: septic arthritis, hip dislocation, child, infection

Matched MeSH terms: Arthritis, Infectious*
The distribution and prevalence of group A arbovirus neutralizing antibodies among human populations in Southeast Asia and the Pacific islands

Tesh RB, Gajdusek DC, Garruto RM, Cross JH, Rosen L

Am J Trop Med Hyg, 1975 Jul;24(4):664-75.
PMID: 1155702

Plaque reduction neutralization tests, using five group A arboviruses (chikungunya, Ross River, Getah, Bebaru and Sindbis), were done on sera from human populations in 44 Southeast Asia and Pacific island localities. Specificity of the plaque neutralization test was determined by examining convalescent sera from patients with known alphavirus infections. Chikungunya-specific neutralizing antibodies were demonstrated in sera of persons living in South Vietnam, Northern Malaysia, Indonesia (Kalimantan and Sulawesi), as well as Luzon, Marinduque, Cebu and Mindanao islands in the Philippines. Evidence of Ross River virus infection was found among populations living in West New Guinea and Papua New Guinea mainland, the Bismark Archipelago, Rossel Island and the Solomon Islands. There appeared to be no geographic overlap in the distribution of chikungunya and Ross River viruses, with the separation in their distribution corresponding with Weber's line in the Pacific. Sindbis neutralizing antibodies were found in 7 of 21 populations sampled, but in general the prevalence of infection was low. Four sera, from Vietnam, Malaysia and Mindanao gave monospecific reactions with Getah virus. No evidence of specific Bebaru virus infection was detected. The epidemiology of these five alphaviruses in Southeast Asia and the Pacific islands is discussed.

Matched MeSH terms: Arthritis, Infectious/immunology
The use of butazolidine in gonococcal arthritis

Burns NP

Med J Malaya, 1956 Jun;10(4):313-9.
PMID: 13399533
Matched MeSH terms: Arthritis, Infectious*
Fulltext A child with septic arthritis of hip: a rarely encountered cause

Abdul Halim AR, Norhamdan Y, Ramliza R

Med J Malaysia, 2011 Jun;66(2):154-5.
PMID: 22106702 MyJurnal

We report a rare case of septic arthritis in a healthy child caused by Salmonella enteritidis. No predisposing factor was detected. Salmonella enteritidis was isolated from the infected joint tissue obtained following surgical drainage. Based on the culture and sensitivity report, he was treated with a 6-week course of antibiotic. He improved dramatically without any detrimental sequelae at end of one year.

Matched MeSH terms: Arthritis, Infectious; Arthritis, Infectious/diagnosis*; Arthritis, Infectious/etiology; Arthritis, Infectious/therapy*
Fulltext Can intra-articular therapies prior to total knee arthroplasty increase the risk of periprosthetic infection?

Yeo QY, Lye DC, Sathappan SS

Med J Malaysia, 2015 Feb;70(1):54-6.
PMID: 26032534

Intra-articular therapies, such as steroid injection, viscosupplement injection and acupuncture, are common non-surgical options for patients with osteoarthritis of the knee. With any intra-articular injection or acupuncture procedure, there is a potential for inoculation with bacteria leading to possible knee infection. The authors report a patient who incurred an acute infection found after a total knee arthroplasty attributed to prior acupuncture procedure done as part of conservative treatment.

Matched MeSH terms: Arthritis, Infectious
Fulltext An epidemiological study of septic arthritis in Kuala Lumpur Hospital

Razak M, Nasiruddin J

Med J Malaysia, 1998 Sep;53 Suppl A:86-94.
PMID: 10968188

Forty-one patients with 42 joint infections were admitted to the hospital between June 1989 and June 1994. An overview on the behaviour of septic arthritis in both children and adults, at presentation and after various types of treatment was done. There were 32 knees, 7 hips, 2 elbows and 1 shoulder. Duration of symptoms, type of organism, type of joint drainage, presence of preexisting joint problems and presence of osteomyelitis are among the important factors with prognostic significance. Seventy three percent of patients with less than 7 days duration of symptoms had satisfactory results. Whereas when the duration of symptoms exceeded 7 days, 75% of the patients had unsatisfactory outcome. All cases with poor outcome had positive cultures. Staphylococcus aureus was responsible for 77% of the culture-positive cases. All Staphylococcus aureus in this study were penicillin-resistant but sensitive to cloxacillin. There were 3 instances where Staphylococcus became resistant to cloxacillin following recurrence of septic arthritis. However, they were still sensitive to third generation cephalosporin. Staphylococcus aureus was capable of producing poor results even when the case was treated early. Other organisms were gram-negative bacilli which infect patients with suppressed immune system, that is, intravenous drug abuser, systemic steroid therapy and diabetes mellitus. Open arthrotomy was the method of drainage used in all hip sepsis. This method was also the most reliable method of joint drainage in other joints compared to aspiration method when frank pus was already present. Most immuno-compromised patients recovered badly from septic arthritis. Associated adjacent osteomyelitis, preexisting chronic arthritis and recent intra-articular fractures were also noted to adversely affect the functional outcome.

Matched MeSH terms: Arthritis, Infectious/microbiology; Arthritis, Infectious/epidemiology*; Arthritis, Infectious/therapy

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