The incidence of infections due to beta-lactamase-producing Neisseria gonorrhoeae is increasing in many parts of the world. An epidemiologic survey of infections caused by beta-lactamase-producing strains of N. gonorrhoeae at the University Hospital, Kuala Lumpur, from February 1977 to December 1985 (106 months) showed that the incidence rose from 4.8% (two cases) in 1977 to 49.4% (39 cases) by the end of 1985. The highest incidence of gonococcal infections was found to be in the group aged 20-39 years; the male-to-female ratio was 1.55:1. The mean inhibitory concentrations of benzylpenicillin were 0.12 microgram/ml for non-beta-lactamase-producing strains and 16 micrograms/ml for isolates of N. gonorrhoeae that produce beta-lactamase.
170 clinical isolates of Pseudomonas aeruginosa were tested for in vitro susceptibility to gentamicin, amikacin, tobramycin, netilmicin, kanamycin, streptomycin, cefotaxime, ceftriaxone, cefoperazone, ceftazidime, moxalactam, azlocillin, piperacillin and ticarcillin. Against 93 gentamicin-sensitive strains, the most active antibiotics were in descending order, ceftazidime, tobramycin, gentamicin, amikacin, and the ureidopenicillins. Against 77 gentamicin-resistant strains, only ceftazidime, amikacin and moxalactam had mode minimum inhibitory concentrations within achievable peak serum levels after standard therapeutic dosage. There was no correlation between cephalosporin resistance and aminoglycoside resistance except for cefoperazone, which, together with the ureidopenicillins and ticarcillin, showed marked decrease in activity against gentamicin-resistant strains.
During the period 1971-1982, 57 salmonella strains other than S. typhi and S. paratyphi were isolated from sites other than stools and blood. Cerebrospinal fluid was the commonest specimen followed by urine and pus. The commonest serotypes of the 22 encountered were S. typhimurium and S. enteritidis. Twenty-four of the 57 patients were children under one year of age. These findings highlight the need to remember the unusual manifestation of salmonellosis in differential diagnoses.
The incidence of Campylobacter jejuni in patients with and without diarrhoea was studied in Kuala Lumpur, Malaysia. C. jejuni was recovered from 3.8% and 4.3% of diarrhoeal stools of children and adults, respectively. From the patients without diarrhoea, the relative isolation rates for children and adults were 2.6% and 0%, respectively. Dual infections occurred in two children, with Salmonella and enteropathogenic Escherichia coli being the other enteric pathogen in each case. Cary-Blair medium was found to be an effective transport medium in recovering C. jejuni. Campylobacter enteritis occurred in patients of various age groups, indicating that this organism should be sought routinely by diagnostic laboratories in faecal specimens from patients with diarrhoea.
Four strains of S. typhi isolated in Malaysia were found to show resistance to chloramphenicol and other antibiotics. In two of these strains it was possible to show that this resistance was transferable.
This problem which is widespread in neighbouring countries and undetected in Malaysia till recently has now been shown to exist in this country. Fears that the incidence of such strains will increase in the future are expressed and the need for vigilance is emphasised.
Studies were carried out on the suppression of both exploratory and spontaneous locomotor activities in the mouse by a non-polar fraction from a methanol extract of the dried leaves of Psidium guajava. Shortly after intraperitoneal administration of this fraction, typical narcotic-like effects were observed, including catalepsy, analgesia, Straub tail, shallow respiratory movements and exophthalmos. The dose for 90% suppression of exploratory activity was between 3.3 and 6.6 mg/kg intraperitoneally and the onset of action was 6-8 min. The duration of activity was dose-dependent and, for a dose of 13.2 mg/kg given intraperitoneally, it was found to be more than 6 h. Qualitatively similar results on exploratory activity were obtained when the extract was administered orally. Doses of 3.3-6.6 mg/kg i.p. depressed spontaneous locomotor activity and tunnel running was curtailed. Higher doses abolished the spontaneous locomotor reflex action. A flavonoid compound or compounds appear to account for the activity seen.
Pulmonary aspergilloma is by no means uncommon in Malaysia. The lack of documentation of its occurrence in Malaysia, is mainly due to the lack of clinical awareness, and the absence of facilities for the proper diagnosis of the infection.
Twenty-nine adult patients with culture-positive thoracic empyema were seen at the University Hospital Kuala Lumpur from 1984 to 1988. Cough, fever, chest pain, dyspnoea and weight loss were the common presenting symptoms. The empyema in 16 patients was associated with primary bronchopulmonary infections, nine occurred following thoracentesis of culture-sterile pleural effusions, two occurred as post-thoracic surgery complications, one following a subdiaphragmatic abscess and one as a result of a stab wound. The most common culture isolates were Streptococcus milleri, Pseudomonas aeruginosa and Klebsiella pneumoniae. Closed tube thoracostomy, the most common form of drainage procedure employed, was able to effect a cure or control of the empyema in 11 out of 19 patients in whom it was used.
A leptospiral isolate from a bovine kidney was found to be antigenically different from all previously recognized serovars of Leptospira interrogans based on the cross-agglutinin absorption test. The new serovar belongs to the Sejroe serogroup, and the name Leptospira interrogans serovar unipertama is proposed for it, with strain K2-1 as the reference strain.
Over a 12 months period, out of 25,411 livebirths, 155 neonates (6.1 per 1000 livebirths) had proven septicemia by blood culture. The mortality rate was 26.5%. Septicemia was more common among the very low birthweight and preterm neonates of gestation of 30 weeks or less. 45.8% of the septicemia occurred during the first 48 hours of life. Staphylococcus epidermidis was the most common causative organism. However, mortality was highest among neonates who acquired multiresistant nosocomial infection during the later part of neonatal life.
Acute-phase serum samples collected during an outbreak of dengue fever and dengue haemorrhagic fever in Penang, Malaysia, were tested by a method involving antibody-dependent enhancement of infectivity in the mouse macrophage-like cell line, P388D1. 58 of 71 (81.7%) serologically positive cases yielded virus.
Perforated appendix is a serious surgical condition that carries a high morbidity. Antibiotic treatment is often started before the availability of bacteriological reports. The choice of antibiotics would depend on the bacteriology associated with perforated appendix. In a retrospective survey of the bacteriology of peritoneal pus obtained from cases of perforated appendix at the General Hospital, Kuala Lumpur, E. coli was found to be the most commonly encountered organism. This was followed in order of decreasing frequency by streptococci, Bacteroides species, Klebsiella-Enterobacter group and Pseudomonas aeruginosa. From the results of the antibiotic sensitivities an antibiotic regimen comprising of a combination of gentamicin, metronidazole and penicillin is recommended as appropriate chemotherapy in perforated appendix.
Two new venalstonine derivatives, viz., venacarpines A and B, and one new dioxokopsan derivative, kopsorinine, in addition to the kopsifolines A-F, and 11 other known alkaloids, were isolated from a Malayan Kopsia species. The structures of the new alkaloids were determined using NMR and MS analysis.
A two-step SYBR Green I real time polymerase chain reaction (PCR, real time PCR) for the detection of Newcastle disease virus (NDV) was developed. A melting curve analysis was performed to distinguish specific from non-specific products and primer dimers. Regardless of different virus pathotypes the melting temperature (Tm) ranged from 86 degrees C to 87 degrees C. The sensitivity of the real time PCR was compared with the reverse transcription (RT)-nested PCR enzyme-linked immunosorbent assay (ELISA, RT-nested PCR ELISA). Whereas the detection limit of the real time PCR was 10 pg DNA, the RT-nested PCR ELISA and conventional PCR could only detect up to 1 ng and 10 ng DNA, respectively. Thus the real time PCR offers a sensitive, rapid and convenient method for screening large number of NDV specimens.
Human enterovirus 71 has emerged as an important pathogen in the Asia Pacific region and it is important to be able to make a rapid and specific diagnosis for outbreak control. Recent Asian strains of Coxsackievirus A16 have changes in the VP1 gene which causes mispriming of widely used primers for human enterovirus 71 specific identification.
Ten new indole alkaloids, alstomaline (1), 10,11-dimethoxynareline (2), alstohentine (3), alstomicine (4), 16-hydroxyalstonisine (5), 16-hydroxyalstonal (6), 16-hydroxy-N(4)-demethylalstophyllal oxindole (7), alstophyllal (8), 6-oxoalstophylline (9), and 6-oxoalstophyllal (10), in addition to 21 other known ones, were obtained from the leaf extract of the Malayan Alstonia macrophylla. The structures were determined using NMR and MS analysis.
A filamentous phage bearing the peptide sequence TLTTKLY was isolated from a heptapeptide phage display library against a velogenic Newcastle disease virus (NDV). In order to investigate the potential of this specific phage as an immunological reagent in virus pathotyping, an enzyme-linked immunosorbent assay (ELISA)-based method was developed. This method can differentiate the velogenic strains from the mesogenic and lentogenic strains. An equilibrium-binding assay in solution showed that the interactions between the phage and all the NDV strains gave rise to two widely differing dissociation constants (Kdrel). Based upon the first Kdrel values, NDV strains can be classified into two groups; the first comprises the velogenic strains, and the second consists of the mesogenic and lentogenic strains. These results indicate a high degree of correlation between the binding affinities and pathotyping of NDV strains using the TLTTKLY phage.