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Fulltext The human-primate interface in the New Normal: Challenges and opportunities for primatologists in the COVID-19 era and beyond

Lappan S, Malaivijitnond S, Radhakrishna S, Riley EP, Ruppert N

Am J Primatol, 2020 Aug;82(8):e23176.
PMID: 32686188 DOI: 10.1002/ajp.23176

The emergence of SARS-CoV-2 in late 2019 and human responses to the resulting COVID-19 pandemic in early 2020 have rapidly changed many aspects of human behavior, including our interactions with wildlife. In this commentary, we identify challenges and opportunities at human-primate interfaces in light of COVID-19, focusing on examples from Asia, and make recommendations for researchers working with wild primates to reduce zoonosis risk and leverage research opportunities. First, we briefly review the evidence for zoonotic origins of SARS-CoV-2 and discuss risks of zoonosis at the human-primate interface. We then identify challenges that the pandemic has caused for primates, including reduced nutrition, increased intraspecific competition, and increased poaching risk, as well as challenges facing primatologists, including lost research opportunities. Subsequently, we highlight opportunities arising from pandemic-related lockdowns and public health messaging, including opportunities to reduce the intensity of problematic human-primate interfaces, opportunities to reduce the risk of zoonosis between humans and primates, opportunities to reduce legal and illegal trade in primates, new opportunities for research on human-primate interfaces, and opportunities for community education. Finally, we recommend specific actions that primatologists should take to reduce contact and aggression between humans and primates, to reduce demand for primates as pets, to reduce risks of zoonosis in the context of field research, and to improve understanding of human-primate interfaces. Reducing the risk of zoonosis and promoting the well-being of humans and primates at our interfaces will require substantial changes from "business as usual." We encourage primatologists to help lead the way.

Matched MeSH terms: Pneumonia, Viral/prevention & control*; Pneumonia, Viral/transmission
Fulltext HOspitalised Pneumonia Extended (HOPE) Study to reduce the long-term effects of childhood pneumonia: protocol for a multicentre, double-blind, parallel, superiority randomised controlled trial

Chang AB, Fong SM, Yeo TW, Ware RS, McCallum GB, Nathan AM, et al.

BMJ Open, 2019 Apr 24;9(4):e026411.
PMID: 31023759 DOI: 10.1136/bmjopen-2018-026411

INTRODUCTION: Early childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young children at increased risk of such sequelae if any residual lower airway infection and inflammation in their developing lungs can be treated successfully by longer antibiotic courses. In contrast, shortened antibiotic treatments are being promoted because of concerns over inducing antimicrobial resistance. Nevertheless, the optimal treatment duration remains unknown. Outcomes from randomised controlled trials (RCTs) on paediatric pneumonia have focused on short-term (usually <2 weeks) results. Indeed, no long-term RCT-generated outcome data are available currently. We hypothesise that a longer antibiotic course, compared with the standard treatment course, reduces the risk of chronic respiratory symptoms/signs or bronchiectasis 24 months after the original pneumonia episode.
METHODS AND ANALYSIS: This multicentre, parallel, double-blind, placebo-controlled randomised trial involving seven hospitals in six cities from three different countries commenced in May 2016. Three-hundred-and-fourteen eligible Australian Indigenous, New Zealand Māori/Pacific and Malaysian children (aged 0.25 to 5 years) hospitalised for community-acquired, chest X-ray (CXR)-proven pneumonia are being recruited. Following intravenous antibiotics and 3 days of amoxicillin-clavulanate, they are randomised (stratified by site and age group, allocation-concealed) to receive either: (i) amoxicillin-clavulanate (80 mg/kg/day (maximum 980 mg of amoxicillin) in two-divided doses or (ii) placebo (equal volume and dosing frequency) for 8 days. Clinical data, nasopharyngeal swab, bloods and CXR are collected. The primary outcome is the proportion of children without chronic respiratory symptom/signs of bronchiectasis at 24 months. The main secondary outcomes are 'clinical cure' at 4 weeks, time-to-next respiratory-related hospitalisation and antibiotic resistance of nasopharyngeal respiratory bacteria.
ETHICS AND DISSEMINATION: The Human Research Ethics Committees of all the recruiting institutions (Darwin: Northern Territory Department of Health and Menzies School of Health Research; Auckland: Starship Children's and KidsFirst Hospitals; East Malaysia: Likas Hospital and Sarawak General Hospital; Kuala Lumpur: University of Malaya Research Ethics Committee; and Klang: Malaysian Department of Health) have approved the research protocol version 7 (13 August 2018). The RCT and other results will be submitted for publication.
TRIAL REGISTRATION: ACTRN12616000046404.

Matched MeSH terms: Pneumonia/drug therapy*; Pneumonia/epidemiology
Fulltext Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei

Chaw L, Koh WC, Jamaludin SA, Naing L, Alikhan MF, Wong J

Emerg Infect Dis, 2020 Nov;26(11):2598-2606.
PMID: 33035448 DOI: 10.3201/eid2611.202263

We report the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across different settings in Brunei. An initial cluster of SARS-CoV-2 cases arose from 19 persons who had attended the Tablighi Jama'at gathering in Malaysia, resulting in 52 locally transmitted cases. The highest nonprimary attack rates (14.8%) were observed from a subsequent religious gathering in Brunei and in households of attendees (10.6%). Household attack rates from symptomatic case-patients were higher (14.4%) than from asymptomatic (4.4%) or presymptomatic (6.1%) case-patients. Workplace and social settings had attack rates of <1%. Our analyses highlight that transmission of SARS-CoV-2 varies depending on environmental, behavioral, and host factors. We identify red flags for potential superspreading events, specifically densely populated gatherings with prolonged exposure in enclosed settings, persons with recent travel history to areas with active SARS-CoV-2 infections, and group behaviors. We propose differentiated testing strategies to account for differing transmission risk.

Matched MeSH terms: Pneumonia, Viral/epidemiology*; Pneumonia, Viral/transmission
Epidemiology. Breaking the chain in Bangladesh

Stone R

Science, 2011 Mar 4;331(6021):1128-31.
PMID: 21385693 DOI: 10.1126/science.331.6021.1128
Matched MeSH terms: Pneumonia, Viral/epidemiology; Pneumonia, Viral/prevention & control; Pneumonia, Viral/virology
Fulltext Nocardiosis in a patient with rheumatoid arthritis treated with rituximab and a summary of reported cases

Ngiu CS, Said MS, Periyasamy P, Low SF

BMJ Case Rep, 2010;2010.
PMID: 22778377 DOI: 10.1136/bcr.11.2009.2421

Rituximab is a B-cell-depleting monoclonal anti-CD20 antibody. It is widely used in haematology and rheumatology. However, usage of rituximab in immunosupressed patient has been associated with various opportunistic infections. The authors reported a case of refractory rheumatoid arthritis treated with rituximab, which later presented with non-resolving pneumonia with pulmonary nodule. Percutaneous computer tomogram guided lung biopsy was arranged to confirm the suspicion of tuberculosis, but did not yield conclusive results. Later, she presented left-chest abscess and underwent incision and drainage. The pus culture and sensitivity confirmed pulmonary nocardiosis with chest wall dissemination. She was treated with 2-week course of trimethoprim sulfamethoxazole and responded. The authors also reviewed published cases of nocardiosis post-rituximab.

Matched MeSH terms: Pneumonia, Bacterial/diagnosis; Pneumonia, Bacterial/drug therapy; Pneumonia, Bacterial/etiology*
Fulltext Lessons learned about opportunistic infections in southeast Asia

Nissapatorn V

Southeast Asian J. Trop. Med. Public Health, 2008 Jul;39(4):625-41.
PMID: 19058599

Southeast Asia is a region where the number of people infected with HIV/AIDS is one of the fastest growing in the world. Tuberculosis (TB) has grown along with the HIV epidemic. TB is not only the most common AIDS-defining illness but is also the leading cause of morbidity and mortality in AIDS patients. Cryptococcosis (meningitis or disseminated) is one of the most common opportunistic infections in AIDS patients. Cryptococcal meningitis is the first in the differential diagnosis considered with meningeal irritation. Penicillosis, a unique systemic mycosis, is an important emerging public health problem and has been classified as an AIDS defining illness in endemic areas like Thailand. Pneumocystis carinii (jiroveci) pneumonia has been one of the most important opportunistic infections in AIDS patients. Among parasitic infections, cryptosporidiosis is the most common intestinal protozoan infection relating to diarrhea in AIDS patients and toxoplasmosis is the only parasitic infection of the nervous system with a substantial incidence, up to 14.8%. Cytomegalovirus (CMV) retinitis has a lower prevalence compared to other opportunistic infections. In the era of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections has significantly reduced in the past few years. Subsequently, the phenomena of immune restoration inflammatory syndrome (IRIS) in AIDS patients has been reported in this region as a result of HAART.

Matched MeSH terms: Pneumonia, Pneumocystis/microbiology; Pneumonia, Pneumocystis/epidemiology; Pneumonia, Pneumocystis/virology
Fulltext Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and the Philippines

Azmi S, Aljunid SM, Maimaiti N, Ali AA, Muhammad Nur A, De Rosas-Valera M, et al.

Int J Infect Dis, 2016 May 24;49:87-93.
PMID: 27235085 DOI: 10.1016/j.ijid.2016.05.021

To describe the incidence, mortality, cost, and length of stay (LOS) of hospitalized community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in three Southeast Asian countries: Malaysia, Indonesia, and the Philippines.

Matched MeSH terms: Pneumonia
Fulltext A two-year review on epidemiology and clinical characteristics of dengue deaths in Malaysia, 2013-2014

Woon YL, Hor CP, Hussin N, Zakaria A, Goh PP, Cheah WK

PLoS Negl Trop Dis, 2016 05;10(5):e0004575.
PMID: 27203726 DOI: 10.1371/journal.pntd.0004575

BACKGROUND: Dengue infection is the fastest spreading mosquito-borne viral disease, which affects people living in the tropical and subtropical countries. Malaysia had large dengue outbreaks in recent years. We aimed to study the demographics and clinical characteristics associated with dengue deaths in Malaysia.

METHODS: We conducted a retrospective review on all dengue deaths that occurred nationwide between 1st January 2013 and 31st December 2014. Relevant data were extracted from mortality review reports and investigational forms. These cases were categorized into children (<15 years), adults (15-59 years) and elderly (≥60 years) to compare their clinical characteristics.

RESULTS: A total of 322 dengue deaths were reviewed. Their mean age was 40.7±19.30 years, half were females and 72.5% were adults. The median durations of first medical contact, and hospitalization were 1 and 3 days, respectively. Diabetes and hypertension were common co-morbidities among adults and elderly. The most common warning signs reported were lethargy and vomiting, with lethargy (p = 0.038) being more common in children, while abdominal pain was observed more often in the adults (p = 0.040). But 22.4% did not have any warning signs. Only 34% were suspected of dengue illness at their initial presentation. More adults developed severe plasma leakage (p = 0.018). More than half (54%) suffered from multi-organ involvement, and 20.2% were free from any organ involvement. Dengue deaths occurred at the median of 3 days post-admission. Dengue shock syndrome (DSS) contributed to more than 70% of dengue deaths, followed by severe organ involvement (69%) and severe bleeding (29.7%).

CONCLUSION: In Malaysia, dengue deaths occurred primarily in adult patients. DSS was the leading cause of death, regardless of age groups. The atypical presentation and dynamic progression of severe dengue in this cohort prompts early recognition and aggressive intervention to prevent deaths.

TRIAL REGISTRATION: National Medical Research Registry (NMRR, NMRR-14-1374-23352).

Matched MeSH terms: Pneumonia/mortality; Pneumonia/epidemiology; Pneumonia/virology
Fulltext "Melioidosis in Antioquia, Colombia: an emerging or endemic disease? A cases series"

Montúfar FE, Ochoa JE, Ortega H, Franco L, Montúfar MC, Monsalve A, et al.

Int J Infect Dis, 2015 Aug;37:50-7.
PMID: 26051974 DOI: 10.1016/j.ijid.2015.05.023

Melioidosis is endemic in Malaysia, the southwest of Thailand, and northern Australia. The incidence in Thailand is 4.4/1000000 inhabitants, where it causes 19% of community-acquired pneumonia (CAP) and 20% of bacteremic pneumonia, and the mortality is 50%. Sporadic cases have been described in Central and South America. The objective of this study was to describe the clinical and epidemiological features and ecological characteristics of melioidosis in Antioquia, Colombia.

Matched MeSH terms: Pneumonia
Fulltext PCR-based construction and transformation of CodY gene deletion construct in Streptococcus Pneumoniae

Aisyah Mohamed Rehan, Mohammad Izwan Enche Othman, Nor Munirah Mohd Amin, Intan Azura Shahdan, Hanani Ahmad Yusof@Hanafi

International Medical Journal Malaysia, 2017;16(11):7-7.
MyJurnal

Streptococcus pneumoniae (S. pneumoniae) is a gram-positive diplococci belonging to the genus Streptococcus and it is a well-studied pathogenic bacterium. Pneumococcal diseases such as otitis media, pneumonia, sepsis and meningitis caused by pathogenic strains of S. pneumoniae still brought significant mortality and morbidity worldwide. The pathogenicity of S. pneumoniae is exerted by various virulence factors and one of it is the enzyme hyaluronate lyase. Hyaluronate lyase plays a major role in
the invasive capability of S. pneumoniae. Its mechanism of action and crystallographic
structure have been determinedbut its regulatory mechanism is still poorly understood.
Drawing connections between the nutritional behaviour and invasive property of S.
pneumoniae, CodY regulator is hypothesized as a potential hyaluronate lyase regulator.
This work was aimed to construct CodY deficient mutant of S. pneumoniae to form
foundational work for the study of CodY regulatory effect on hyaluronate lyase.

Matched MeSH terms: Pneumonia; Streptococcus pneumoniae
Fulltext A Case of a Large Sub-retinal Abscess Secondary to Klebsiella pneumoniae Endophthalmitis in a Pyelonephritis Patient

Mohd-Ilham I, Zulkifli M, Yaakub M, Muda R, Shatriah I

Cureus, 2019 May 14;11(5):e4656.
PMID: 31316877 DOI: 10.7759/cureus.4656

Endogenous endophthalmitis is an ocular emergency, with severe sight-threatening complications. We report a case of unilateral endogenous Klebsiella pneumonia endophthalmitis with a large sub-retinal abscess in a 39-year-old lady that developed four days after presentation with sepsis secondary to urinary tract infections and pyelonephritis. Despite immediate treatment with intravenous (IV) and intravitreal antibiotics, her eye condition deteriorated. A pars plana vitrectomy was performed, and the sub-retinal abscess was removed, followed by silicone oil tamponade. Subsequently, she regained her vision to 6/36 with complete regression of the intraocular inflammation and sub-retinal abscess.

Matched MeSH terms: Pneumonia
Identifying SARS-CoV-2-related coronaviruses in Malayan pangolins

Lam TT, Jia N, Zhang YW, Shum MH, Jiang JF, Zhu HC, et al.

Nature, 2020 07;583(7815):282-285.
PMID: 32218527 DOI: 10.1038/s41586-020-2169-0

The ongoing outbreak of viral pneumonia in China and across the world is associated with a new coronavirus, SARS-CoV-21. This outbreak has been tentatively associated with a seafood market in Wuhan, China, where the sale of wild animals may be the source of zoonotic infection2. Although bats are probable reservoir hosts for SARS-CoV-2, the identity of any intermediate host that may have facilitated transfer to humans is unknown. Here we report the identification of SARS-CoV-2-related coronaviruses in Malayan pangolins (Manis javanica) seized in anti-smuggling operations in southern China. Metagenomic sequencing identified pangolin-associated coronaviruses that belong to two sub-lineages of SARS-CoV-2-related coronaviruses, including one that exhibits strong similarity in the receptor-binding domain to SARS-CoV-2. The discovery of multiple lineages of pangolin coronavirus and their similarity to SARS-CoV-2 suggests that pangolins should be considered as possible hosts in the emergence of new coronaviruses and should be removed from wet markets to prevent zoonotic transmission.

Matched MeSH terms: Pneumonia, Viral/epidemiology; Pneumonia, Viral/transmission; Pneumonia, Viral/virology
Lo, the ever confounding nipple shadow!

Boo WH, Chan YC

Malays Fam Physician, 2020;15(3):79-82.
PMID: 33329866

The discovery of a solitary pulmonary nodule (SPN) on chest imaging can be alarming for both the clinician and the patient. In the absence of a uniform guideline, managing SPN is nothing short of challenging for primary care physicians (PCPs). We present a case here of a patient presenting with prolonged cough who also displayed unilateral SPN on her chest radiograph. Through further examination, this presence was later shown to be a nipple shadow simulating SPN, and the patient was spared unnecessary testing and psychological distress.

Matched MeSH terms: Pneumonia, Pneumocystis
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: Pneumonia; Streptococcus pneumoniae
Paradoxical worsening of chest radiographs secondary to immune reconstitution syndrome (IRIS) in a patient with advanced HIV infection and Rhodococcus pneumonia

Koh KC, Ibrahim NM, Ong SCL

Med J Malaysia, 2020 03;75(2):164-166.
PMID: 32281599

We present a rare case of post-antiretroviral therapy (ART) paradoxically worsening of radiological findings in a patient with advanced HIV-infection on treatment for Rhodococcus pneumonia who was misdiagnosed with pulmonary tuberculosis. Despite clinical improvement, serial chest radiographs showed deteriorations a month after starting ART. This was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS) which spontaneously resolved without any treatment.

Matched MeSH terms: Pneumonia
Fulltext A COVID-19 conference at AIDS 2020: Virtual

Pozniak A, Bekker LG, Kamarulzaman A, Gandhi M, Horton R, Das P, et al.

Lancet, 2020 05 23;395(10237):1598-1599.
PMID: 32359401 DOI: 10.1016/S0140-6736(20)31026-6
Matched MeSH terms: Pneumonia, Viral
Fulltext Detection of Klebsiella pneumoniae in raw vegetables using Most Probable Number-Polymerase Chain Reaction (MPN-PCR)

Puspanadan, S., Afsah-Hejri, L., Loo, Y.Y., Nillian, E., Kuan, C.H., Goh, S.G., et al.

International Food Research Journal, 2012;19(4):1757-1762.
MyJurnal

Klebsiella pneumoniae (K. pneumoniae) is one of the most important members of Klebsiella genus in Enterobacteriacae family, which is responsible for pneumonia (the destructive lung inflammation disease). Vegetables are known as source of contamination with K. pneumonia. Raw vegetables are usually consumed in salads and other dishes. The aim of this study was to investigate the occurrence of K. pneumoniae in raw vegetables marketed in Malaysia. Two hundred commonly used salad vegetables (lettuces, parsley, cucumber, tomato and carrot) from hypermarkets and wet markets were investigated for presence of K. pneumoniae using Most Probable Number-Polymerase Chain Reaction (MPN-PCR). K. pneumoniae was found to be significantly more frequent (100%) and (82.5%) in lettuce and cucumbers, respectively. K. pneumoniae contamination was lowest in carrot samples (30%). All samples were contaminated with K. pneumoniae ranging from

Matched MeSH terms: Klebsiella pneumoniae; Pneumonia
Pharmacokinetic/Pharmacodynamics-Optimized Antimicrobial Therapy in Patients with Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia

Sulaiman H, Abdul-Aziz MH, Roberts JA

Semin Respir Crit Care Med, 2017 06;38(3):271-286.
PMID: 28578552 DOI: 10.1055/s-0037-1602716

Hospital-acquired pneumonia and ventilator-associated pneumonia continue to cause significant morbidity and mortality. With increasing rates of antimicrobial resistance, the importance of optimizing antibiotic treatment is key to maximize treatment outcomes. This is especially important in critically ill patients in intensive care units, in whom the infection is usually caused by less susceptible organisms. In addition, the marked physiological changes that can occur in these patients can cause serious changes in antibiotic pharmacokinetics which in turn alter the attainment of therapeutic drug exposures. This article reviews the various aspects of the pharmacokinetic changes that can occur in the critically ill patients, the barriers to achieving therapeutic drug exposures in pneumonia for systemically delivered antibiotics, the optimization for commonly used antibiotics in hospital- and ventilator-associated pneumonia, the agents that should be avoided in the treatment regimen, as well as the use of adjunctive therapy in the form of nebulized antibiotics.

Matched MeSH terms: Pneumonia/drug therapy; Pneumonia, Ventilator-Associated/drug therapy*
World War against COVID-19: How strong is our armamentarium?

Ramachandran V, Marimuthu RR, Chinnambedu RS

Med J Malaysia, 2020 05;75(3):314-315.
PMID: 32467555

No abstract provided.

Matched MeSH terms: Pneumonia, Viral/drug therapy*; Pneumonia, Viral/epidemiology*; Pneumonia, Viral/prevention & control
Fulltext Decolorization of Palm Oil Mill Effluent by Klebsiella Pneumonia ABZ11: Remediation Efficacy and Statistical Optimization of Treatment Conditions

Abdulsalam M, Man HC, Abidin ZZ, Yunos KF, Idris AI

Front Microbiol, 2020;11:675.
PMID: 32477278 DOI: 10.3389/fmicb.2020.00675

Colorants contained in palm oil mill effluent (POME) are recalcitrant and carcinogenic in nature. The commonly applied ponding treatment methods have been reported inefficient for remediating the concentration of the colorants before discharge. The need for sustainable and efficient treatment technique is crucial in order to preserve the environment. In this view, this study reported the first attempt to decolorize POME using a proliferate Klebsiella Pneumonia ABZ11 at varied inoculum sizes of 5-25% (v/v), initial color concentration (650-2,600 ADMI) and treatment time of 5-40 h. The treatment conditions were optimized using Response Surface Methodology. At optimal conditions of 20% (v/v) inoculum size, initial-color concentration of 2,600 ADMI, initial pH of 7 and 35 h treatment retention time, over 80.40% color removal was achieved with insignificant disparity compared with the model predicted value of 81.538%. Also, the Monod model excellently described the decolorization kinetic process with 0.9214 coefficient of correlation (R2), and the calculated maximum growth μ
max
) and half-saturation constant (K
s
) were 7.023 d-1 and 340.569 ADMI d-1, respectively. This study revealed that the Klebsiella Pneumonia ABZ11 was highly prolific and such feature may favor a synergistic biodegradation process.

Matched MeSH terms: Pneumonia

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