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Fulltext Food poisoning outbreak in UiTM, Dungun, Terengganu, 1999.

Faizan, G., Balkis, A.K., Kasemani, E., Che Mohd Shabri, A., Amirullah, M.A.

Malaysian Journal of Public Health Medicine, 2002;2(1):50-53.
MyJurnal

Food poisoning is still a major problem in the state of Terengganu. The study was conducted during an episode of food poisoning outbreak which occurred in October, 1999, at Universiti Tekonologi Mara (UiTJ1rO, Dungun to determine the etiology, mode of transmission, source and the risk factors of the outbreak and hence to take appropriate remedial actions and preventive measures. A retrospective cohort study was conducted amongst 925 students using a standard questionnaire as well as environmental investigation and bacterial subtyping. All the samples were Malay females, age ranging jrom /9 — 22 years. It was found that majority ofthe victims (72 %) presented with abdominal cramp, 68.5% headache, 60.0% diarrhea, 55.2% fever, 45.0% nausea, 39.0% muscle
ache and 3]. 7% vomiting. The epidemic curve suggested of a common source of infection and the most probable food that has been contaminated was taken during lunch hour on October 20'I'1999, Statistical analysis showed that spices jiied chicken and "nasi minyak" were significantly associated with the illness (p < 0. 05). The most likely causative organism was Salmonella spp as supported by the clinical presentation and incubation period of the disease, identdication of contaminated food, bacterial subtyping result and environmental findings. Following the outbreaks, several remedial actions were taken including immediate close—up ofthe canteen for I4 days, treatment for the cases and health examination and typhoid immunization for all food handlers.

Matched MeSH terms: Diarrhea
Fulltext Parasitic infection in a young man presenting with non-specific abdominal pain

Farnaza A, Baha L

Malays Fam Physician, 2010;5(3):148-150.
PMID: 25606208 MyJurnal

A 27-year-old man presented with a two-week history of central colicky abdominal pain associated with loose stools. Further history revealed that he had been exposed to contaminated waters. Stool investigation by direct wet stool smears revealed the presence of Entamoeba histolytica and Blastocystis hominis cysts. A diagnosis of amoebiasis secondary to E. histolytica and concurrent B. hominis infestation was made. We would like to emphasise the importance of clinical history including recent travel to endemic areas. Any suspicion of parasitic infection should prompt the clinician to investigate. Early diagnosis and management would prevent serious complications associated with E. Histolytica infection.

Matched MeSH terms: Diarrhea
Fulltext Survival study and haemolysin activity of Escherichia coli in raw and pasteurized milk produced in Negeri Sembilan

Farra Amira Mohamed, Aimi Nadia Ramli,, Noorlis Ahmad

Journal of Academia Universiti Teknologi MARA Negeri Sembilan, 2020;8(1):66-77.
MyJurnal

Demand for milk has increased in Malaysia due to the increased in awareness of healthy foods consumption.
Hence, research of milk is crucial to ensure that it is not contaminated with Escherichia coli. This study
evaluated the survival of Escherichia coli at different temperature and haemolysin activity of Escherichia
coli on blood agar. A total of 8 samples of raw fresh and pasteurized milk were collected from nearby farm
and market in Negeri Sembilan, Malaysia. After an overnight exposure to four different temperatures of
0
0C, 280C, 350C and 450C, the bacteriological test of milk was evaluated for the presence of Escherichia
coli. Overall, all raw fresh milk sampled exceeded the acceptable limit of bacterial count of 1 x 105 CFU/ml.
Raw fresh milk recorded the highest count at 35oC with 4.4 x 107 CFU/ml and the lowest at 0oC with 8.3 x
104 CFU/ml. The presence of Escherichia coli was detected in 7/20(35%) of the total raw fresh milk
samples. All pasteurized milk showed no presence of Escherichia coli due to the effectiveness of heat
treatment. Haemolysin test showed no haemolytic activity. Milk contaminated with Escherichia coli can
cause diarrheal, gastrointestinal diseases and urinary infection. Hence, it is important to study the survival
rate of Escherichia coli and its pathogenicity in milk to ensure public safety.

Matched MeSH terms: Diarrhea
Fulltext On malarial diarrhoea, and its relation to chronic intestinal flux

Galloway DJ

Journal of the Straits Medical Association, 1893;4:22-7.

Matched MeSH terms: Diarrhea
Fulltext Jejunal interposition for short bowel syndrome in a septuagenarian

Gee T, Lim SY, Sudhakaran N, Hassan MF

J Surg Case Rep, 2019 Apr;2019(4):rjz095.
PMID: 30997009 DOI: 10.1093/jscr/rjz095

Short bowel syndrome in adults occurs as a result of massive small intestinal resection commonly due to severe Crohn's disease, volvulus or tumors. Diarrhea and weight loss are hallmarks of malabsorption which are aggravated if the colon is removed along with the small intestinal resection. Enteral nutrition autonomy is difficult to achieve in such cases of malabsorption where parenteral nutrition are required more often than not. We report a case of short bowel syndrome with severe malabsorption following extensive small bowel removal. The patient eventually underwent intestinal rehabilitation surgery and achieved independence from parenteral nutrition.

Matched MeSH terms: Diarrhea
Presence of calcium antagonist activity explains the use of Syzygium samarangense in diarrhoea

Ghayur MN, Gilani AH, Khan A, Amor EC, Villaseñor IM, Choudhary MI

Phytother Res, 2006 Jan;20(1):49-52.
PMID: 16397921

Syzygium samarangense (Family; Myrtaceae) or 'makopa', as it is commonly known, is native to Malaysia, some islands of Indonesia and to Far East in general. This study was undertaken to rationalize the use of this plant in hypermotility states of the gut. The hexane extract of S. samarangense (Ss.Hex) was found to dose-dependently (10-3000 microg/mL) relax the spontaneously contracting isolated rabbit jejunum. When tested for a possible calcium channel blocking (CCB) activity, the extract (10-1000 microg/mL) relaxed the high K+-induced contractions and also decreased the Ca++ dose-response curves in a dose-dependent manner (30-100 microg/mL), confirming the CCB activity. Four flavonoids isolated from the hexane extract were tested for a possible spasmolytic activity. All flavonoids, identified as: 2'-hydroxy-4',6'-dimethoxy-3'-methylchalcone (SS1), 2',4'-dihydroxy-6'-methoxy-3',5'-dimethylchalcone (SS2), 2',4'-dihydroxy-6'-methoxy-3'-methylchalcone (SS3) and 7-hydroxy-5-methoxy-6,8-dimethylflavanone (SS4), showed dose-dependent (10-1000 microg/mL) spasmolytic activity with SS2 being the most potent. These results indicate that the presence of compounds with spasmolytic and calcium antagonist activity may be responsible for the medicinal use of the plant in diarrhoea.

Matched MeSH terms: Diarrhea/drug therapy*
Pathology of experimental neonatal diarrhoea from Escherichia coli

Ghosh HK

Med J Malaya, 1970 Sep;25(1):34-7.
PMID: 4249491
Matched MeSH terms: Diarrhea, Infantile/etiology*; Diarrhea, Infantile/pathology
Heavy Trichuris infection and amoebic dysentery in Orang Asli children. A comparison of the two diseases

Gilman RH, Davis C, Fitzgerald F

Trans R Soc Trop Med Hyg, 1976;70(4):313-6.
PMID: 1006759

Children with heavy Trichuris infestation were compared with paediatric amoebic dysentery patients and normal children. Heavy Trichuris infestation was diagnosed by visualization of worms on anoscopy. Patients with heavy Trichuris infection had a longer duration of disease, more frequent hospitalization and a higher rate of rectal prolapse than did patients with amoebiasis. Five Trichuris children also had clubbing. Trichuris patients had lower mean haematrocrits (27%) and serum albumin (3-3 gm%) than did patients with amoebiasis (32% and 3-7 gm% respectively). Coinfection with Shigella and Salmonella was significantly increased in patients with heavy Trichuris infection compared to both amoebic and control group children. Trichuris patients were infected with Entamoeba histolytica more frequently (46%) than normal children. Heavy Trichuris infection is the probable cause of symptoms and signs seen in these patients.

Matched MeSH terms: Diarrhea/etiology
Fulltext Lactase deficiency and lactose intolerance in a multiracial Asian population in Malaysia

Goh LH, Mohd Said R, Goh KL

JGH Open, 2018 Dec;2(6):307-310.
PMID: 30619942 DOI: 10.1002/jgh3.12089

Background and Aims: There have been few reports on lactase deficiency (LD) and lactose intolerance (LI) in Malaysia, which has a peculiar mix of three distinct major Asian races-Malay, Chinese, and Indian. The aim of this study was to determine the prevalence of LD and LI in a young multiethnic Malaysian population.
Methods: Lactase activity was measured with a 13CO2 lactose breath test using an infrared spectrometer. Each subject took 25 g of lactose naturally enriched in 13CO2 together with 250 mL of water after an overnight fast. Breath samples were collected at baseline and at 15-min intervals for 180 min. Subjects were asked to report gastrointestinal (GI) symptoms following ingestion of the lactose test meal.
Results: Of the 248 subjects tested, 216 (87.1%) were lactase deficient. We found no significant differences in the presentation of LD between gender and races. LD was found in 87.5% of males and 86.8% of females (P = 0.975) and in different races: Chinese (88.5%) versus Malay (83.1%) (P = 0.399), Indian (90.5%) versus Malay (P = 0.295), and Chinese versus Indian (P = 0.902). LI was diagnosed in only 49 (19.8%) subjects; 35 patients had diarrhea, while the remainder had at least two other GI symptoms after the lactose meal.
Conclusion: The prevalence of LD was high in all three major ethnic groups-Malays, Chinese, and Indians. Ironically, the prevalence of LI was low overall.

Matched MeSH terms: Diarrhea
Fulltext Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children

Guarino A, Lo Vecchio A, Dias JA, Berkley JA, Boey C, Bruzzese D, et al.

J Pediatr Gastroenterol Nutr, 2018 11;67(5):586-593.
PMID: 29901556 DOI: 10.1097/MPG.0000000000002053

OBJECTIVE: Despite a substantial consistency in recommendations for the management of children with acute gastroenteritis (AGE), a high variability in clinical practice and a high rate of inappropriate medical interventions persist in both developing and developed countries.The aim of this study was to develop a set of clinical recommendations for the management of nonseverely malnourished children with AGE to be applied worldwide.
METHODS: The Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN) Working Group (WG) selected care protocols on the management of acute diarrhea in infants and children aged between 1 month and 18 years. The WG used a 3-step approach consisting of: systematic review and comparison of published guidelines, agreement on draft recommendations using Delphi methodology, and external peer-review and validation of recommendations.
RESULTS: A core of recommendations including definition, diagnosis, nutritional management, and active treatment of AGE was developed with an overall agreement of 91% (range 80%-96%). A total of 28 world experts in pediatric gastroenterology and emergency medicine successively validated the set of 23 recommendations with an agreement of 87% (range 83%-95%). Recommendations on the use of antidiarrheal drugs and antiemetics received the lowest level of agreement and need to be tailored at local level. Oral rehydration and probiotics were the only treatments recommended.
CONCLUSIONS: Universal recommendations to assist health care practitioners in managing children with AGE may improve practitioners' compliance with guidelines, reduce inappropriate interventions, and significantly impact clinical outcome and health care-associated costs.

Matched MeSH terms: Diarrhea/therapy*
Incidence and determinants of acute diarrhoea in Malaysia: a population-based study

Gurpreet K, Tee GH, Amal NM, Paramesarvathy R, Karuthan C

J Health Popul Nutr, 2011 Apr;29(2):103-12.
PMID: 21608419

Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease.

Matched MeSH terms: Diarrhea/epidemiology*
Fulltext Association between drinking water sources and diarrhea with malnutrition among kindergarten's children in Baghdad city, Iraq

Hasanain, F.G., Jamsiah, M., Zaleha, M.I., Azmi M. Tamil, Mohammed, A.A.

Malaysian Journal of Public Health Medicine, 2012;12(1):45-48.
MyJurnal

Malnutrition is associated with childhood diseases such as diarrhea or other severe illness. Children who suffer from
repeated episodes of diarrhea are more likely to suffer from malnutrition. In addition, the source of drinking water is
a very important factor affecting the nutritional status. The objective of this study was to find out the prevalence of
malnutrition condition among children aged 3 to 5 years old and the factors associated with it. A cross sectional study
using simple random sampling was conducted among 220 children aged 3 to 5 years old from four kindergartens in
Baghdad city, Iraq. Nutritional assessment was carried out using the indicator weight-for-age z-score based on World
Health Organization cut off points. Acute malnutrition was found in 18.2 % of the respondents. In this study 65 % of
the respondents used tap water to drink as compared to 35 % who used sterilized bottles as source of drinking water.
The environmental factors mainly the source of drinking water was significantly associated with child nutritional
status (p=0.034). The prevalence of diarrhea and admissions to the hospital due to diarrhea were also significantly
associated with malnutrition (p < 0.01, p

Matched MeSH terms: Diarrhea
Effect of nitazoxanide on diarrhea: A systematic review and network meta-analysis of randomized controlled trials

Hashan MR, Elhusseiny KM, Huu-Hoai L, Tieu TM, Low SK, Minh LHN, et al.

Acta Trop, 2020 Oct;210:105603.
PMID: 32598920 DOI: 10.1016/j.actatropica.2020.105603

We aimed to systematically review evidence pertaining to the safety and efficacy of nitazoxanide in treating infectious diarrhea. On September 21, 2017, we identified relevant studies using 12 databases. The estimates of the included studies were pooled as a risk ratio (RR). We conducted a network and pairwise random-effects meta-analysis for both direct and indirect comparisons of different organisms that are known to cause diarrhea. The primary and secondary analysis outcomes were clinical response until cessation of illness, parasitological response and adverse events. We included 18 studies in our analysis. In cryptosporidiosis, the overall estimate favored nitazoxanide in its clinical response in comparison with placebo RR 1.46 [95% CI 1.22-1.74; P-value <0.0001]. Network meta-analysis among patients with Giardia intestinalis showed an increase in the probability of diarrheal cessation and parasitological responses in comparison with placebo, RR 1.69 [95% CI 1.08-2.64, P-score 0.27] and RR 2.91 [95% CI 1.72-4.91, P-score 0.55] respectively. In Clostridium difficile infection, the network meta-analysis revealed a non-significantly superior clinical response effect of nitazoxanide to metronidazole 31 days after treatment RR 1.21 [95% CI 0.87-1.69, P-score 0.26]. In Entamoeba histolytica, the overall estimate significantly favored nitazoxanide in parasitological response with placebo RR 1.80 [95% CI 1.35-2.40, P-value < 0.001]. We highlighted the effectiveness of nitazoxanide in the cessation of diarrhea caused by Cryptosporidium, Giardia intestinalis and Entamoeba histolytica infection. We also found significant superiority of NTZ to metronidazole in improving the clinical response to G. intestinalis, thus it may be a suitable candidate for treating infection-induced diarrhea. To prove the superiority of NTZ during a C. difficile infection may warrant a larger-scale clinical trial since its superiority was deemed insignificant. We recommend nitazoxanide as an appropriate option for treating infectious diarrhea.

Matched MeSH terms: Diarrhea/drug therapy*; Diarrhea/etiology
Fulltext Tetracycline-resistant vibrio cholerae El Tor

Hassan H, Teh A

Med J Malaysia, 1993 Mar;48(1):95-6.
PMID: 8341181

http://www.e-mjm.org/1993/v48n1/Vibrio_Cholerae_El_Tor.pdf

Matched MeSH terms: Diarrhea/drug therapy; Diarrhea/microbiology*
Fulltext Molecular Diagnosis of Microsporidia among Immunocompromised Patients in Kuala Lumpur, Malaysia

Hassan NA, Lim YAL, Mahmud R, Mohd-Shaharuddin N, Wan Sulaiman WY, Ngui R

Am J Trop Med Hyg, 2018 Dec;99(6):1562-1566.
PMID: 30382015 DOI: 10.4269/ajtmh.17-0901

Microsporidia are obligate intracellular parasitic fungi causing chronic diarrhea, particularly among immunocompromised patients. The current method used for diagnosis is based on conventional microscopy, which does not differentiate parasites at the species level. The present study was carried out to identify microsporidian species in immunocompromised patients. From March 2016 to March 2017, a total of 289 archived stool samples were examined microscopically for microsporidian spores using Gram-chromotrope Kinyoun (GCK) stain. Positive stool samples by microscopy were subjected to polymerase chain reaction and sequencing for species identification. Based on microscopy examination, the overall prevalence of microsporidian infections was 32.2% (93/289; 95% CI = 27.1-37.8). Of these stool samples, 45 samples were successfully amplified and confirmed as Enterocytozoon bieneusi. No Encephalitozoon intestinalis was detected. Accurate identification of species might help clinicians to decide appropriate management strategies as dissemination risks and treatment response vary for different species, hence improving the management of microsporidian infections.

Matched MeSH terms: Diarrhea/diagnosis; Diarrhea/immunology*; Diarrhea/microbiology; Diarrhea/epidemiology
Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hassan SA, Rahman RA, Huda N, Wan Bebakar WM, Lee YY

J R Coll Physicians Edinb, 2013;43(2):103-7.
PMID: 23734349 DOI: 10.4997/JRCPE.2013.203

Clostridum difficile (C. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. We aimed to determine the rate and characteristics of hospital-acquired C. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards.

Matched MeSH terms: Diarrhea/chemically induced
Fulltext Prevalence of Clostridium difficile toxin in diarhoeal stool samples of patients from a tertiary hospital in North Eastern Penisular Malaysia

Hassan SA, Othman N, Idris FM, Abdul Rahman Z, Maning N, Abdul Rahman R, et al.

Med J Malaysia, 2012 Aug;67(4):402-5.
PMID: 23082450 MyJurnal

This study describes the prevalence of Clostridium difficile toxin (CDT) in loose stool samples from inpatients aged more than two years of a tertiary hospital. A total of 175 samples that had been examined were from stool samples that were sent to the Medical Microbiology & Parasitology Laboratory for various clinical indications. The toxin was detected by a commercial immunochromatograhic test, and the patients' demography, clinical features, treatment and outcomes were analyzed from their medical records. Clostridium difficile toxin was positive in 24 (13.7%) of the stool samples. Male and female were 11 (45.8%) and 13 (54.2%) respectively, with the majority of them aged more than 50 years. Most were from medical wards (n = 21, 87.5%), with the rest from surgical wards (n = 2, 8.3%) and intensive care units (n = 1, 3.4%). All the CDT positive patients had history of prior antibiotic usage within 6 weeks before the detection of the toxin. The mean duration of antibiotics usage was 17.75 (+/- 13.75) days, while the mean duration of diarrhea was 5.21((+/- 5.85) days. Eighteen patients had underlying medical illnesses that were diabetes mellitus, chronic renal disease, hypertension, ischaemic heart disease, cerebrovascular disease and malignancy; with seven of them being CDT positive while on chemotherapy. Stool occult blood test was positive in 15 patients whereas presence of pus cells in the CD positive stool samples were detected in 21 patients. The duration of hospitalization among the patients was 27.96 (+/- 23.22) days.

Matched MeSH terms: Diarrhea/microbiology*
Studies of bacterial disease in West Malaysian Orang Asli. Distribution of enteropathogens

Haug NL, Davis CE, Anandan J, Lim TW

Med J Malaya, 1969 Sep;24(1):24-31.
PMID: 4243839
Matched MeSH terms: Diarrhea/diagnosis; Diarrhea/drug therapy; Diarrhea/etiology
Reinfection of adult cattle with rotavirus B during repeated outbreaks of epidemic diarrhea

Hayashi M, Murakami T, Kuroda Y, Takai H, Ide H, Awang A, et al.

Can. J. Vet. Res., 2016 Jul;80(3):189-96.
PMID: 27408331

Rotavirus B (RVB) infection in cattle is poorly understood. The objective of this study was to describe the epidemiological features of repeated outbreaks of epidemic diarrhea due to RVB infection in adult cattle on a large dairy farm complex in Japan. In October 2002, approximately 550 adult cows and approximately 450 in February 2005 had acute watery diarrhea at several farms on the complex. Four months before the first outbreak, RVB antibody-positive rates at subsequently affected farms were significantly lower than at non-affected farms (30% to 32% versus 61% to 67%). During the acute phase of both outbreaks, RVB antibody-positive rates in diarrheal cows tested were as low as 15% to 26%. Most of the farms affected in the second outbreak were also involved in the first outbreak. Some adult cows with RVB diarrhea in the first outbreak showed not only RVB seroresponse, but also RVB shedding in the second outbreak, although none of these cows developed diarrhea. Nucleotide sequences of the VP7 and VP4 genes revealed a close relationship between RVB strains in both outbreaks. Taken together, these results indicate that outbreaks of epidemic RVB diarrhea in adult cows might be influenced by herd immunity and could occur repeatedly at the same farms over several years. To our knowledge, this is the first report on repeated RVB infections in the same cattle.

Matched MeSH terms: Diarrhea/veterinary*; Diarrhea/virology
Fulltext Low prevalence of 'classical' microscopic colitis but evidence of microscopic inflammation in Asian irritable bowel syndrome patients with diarrhoea

Hilmi I, Hartono JL, Pailoor J, Mahadeva S, Goh KL

BMC Gastroenterol, 2013;13:80.
PMID: 23651739 DOI: 10.1186/1471-230X-13-80

There is increasing evidence for the role of microscopic inflammation in patients with IBS. We aimed to examine the prevalence of microscopic colitis and inflammation in Malaysian IBS patients with diarrhoea (IBS-D).

Matched MeSH terms: Diarrhea/etiology

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