Malaysia is a developing country with a range of parasitic infections. Indeed, soil-transmitted helminths and malaria parasites continue to have a significant impact on public health in Malaysia. In this article, the prevalence and distribution of these parasites, the problems associated with parasitic infections, the control measures taken to deal with these parasites and implications for the future will be discussed.
A study on prevalence and risk factors of Giardia duodenalis infection was conducted in rural communities of Malaysia. A total of 917 individuals between 2-70 years old (431 males and 486 females), participated in this study. The overall prevalence of G. duodenalis infection was 19.2%. The prevalence was significantly different between different age groups, but not genders. Our study indicated that age < or = 12 years old and the presence of family members infected with G. duodenalis were the risk factors of infection. Person-to-person contact within the family members was the possible mode of transmission. Health education on personal hygiene, together with the treatment of the infected people, may help in reducing and controlling this infection in these communities.
Classification of Theileria parasites of south-east Asian countries is still ambiguous due to the lack of basic studies, especially their molecular genetic information. In this study, we included 6 known species and 14 unclassified Theileria parasite isolates: Theileria annulata, Theileria parva, Theileria taurotragi, Theileria sergenti, Theileria buffeli, Theileria types Sable, Theileria types A, B, B1, B2, C, D, E, F, G, G1, Theileria type Medan (Indonesia), Theileria type Ipoh (Malaysia) and Theileria type Thong Song (Thailand). Small subunit ribosomal RNA (srRNA) nucleotide sequence data were collected by PCR, cloning and dideoxy sequencing. The srRNA nucleotide sequences were aligned and analyzed by distance methods, maximum parsimony algorithms and maximum likelihood methods to construct phylogenetic trees. Bootstrap analysis was used to test the strength of the different phylogenetic reconstructions. The data indicated that all of the tree-building methods gave very similar results. This study identified two groups of Theileria, the pathogenic and benign groups, which are strongly supported by bootstrap analysis. The analysis also indicated that three subgroups (A, B and C) were generated within the benign Theileria group whereas the classification of Theileria type D and Thong Song is questionable. However, more basic information such as life cycle differences, vectors, modes of transmission, virulent and genetic/sexual compatability is essential for clearer taxonomic definition of the benign Theileria parasites.
The genetics of human susceptibility to lymphatic filariasis, the genetic basis of filarial susceptibility in vector mosquitos, and the genetic constitution of human filarial parasites and their mosquito vectors are reviewed. It is evident that our present knowledge on the genetics of lymphatic filariasis is still very meagre. The need to study various genetic aspects of the disease is highlighted.
Two laboratory trials were conducted to determine the effect of the addition of spores (conidia) of the nematophagous fungus, Arthrobotrys oligospora, on the development of the ruminant parasite, Strongyloides papillosus, in cultures of bovine faeces. Both studies showed that at a concentration of 2000 conidia/g faeces virtually eliminated infective larvae (> 99% reduction), following 14 days incubation under ideal conditions (25 degrees C and saturated humidity) for free-living development of this parasite species. In one trial, a high level of control was also observed at a 10-fold decrease in conidia concentration (200 spores/g faeces). This work has demonstrated, in principle, that A. oligospora could provide a practical biological control agent against S. papillosus infecting intensively raised young ruminants in the humid tropics/subtropics.
Epidemiological studies have been conducted to determine the association between fish and disease. The fish were obtained from rivers, streams, ponds and lakes but few from aquaculture farms. While no defined studies have been carried out in Malaysia, baseline data show that fish obtained from aquaculture farms (mixed farming) contributed to cases of opisthorchiasis and clonorchiasis.
Accurate diagnosis of human filarial infections still remains a problem for clinicians and co-ordinators of filariasis control programs. Diagnosis of filariasis is based on parasitological, histopathological, clinical and immunological approaches. No significant advances have been made for the first three approaches although some refinements in their use and interpretation of results have occurred. For the immunological approach, intradermal tests and antibody detection assays using crude parasite extracts generally lack specificity and/or sensitivity to discriminate between past and present filarial infections in humans. Antigen detection assays would therefore provide a more accurate indication of active filarial infections. Several monoclonal antibodies to various stages of lymphatic filarial parasites have been developed and appear potentially useful for filarial antigen detection.
Strongyloides stercoralis infection is of low prevalence in Malaysia. We report an unusual case presenting primarily with gastric symptoms. The patient was a 72 years old Chinese male admitted for progressive weight loss and abdominal bloating. Gastroscopic examination revealed mucosal prepyloric elevations in the gastric mucosa. Gastric strongyloidiasis was confirmed by the presence of adult forms, as well as ova and larval rhabditiform stages of the worm in the gastric mucosal crypts. We believe that this is the first histologically documented case of gastric strongyloidiasis in Malaysia.
A modified nested polymerase chain reaction (PCR) method for detection of Plasmodium falciparum, P. vivax and P. malariae was combined with a simple blood collection and deoxyribonucleic acid (DNA) extraction method and evaluated in Malaysia. Finger-prick blood samples from 46 hospital patients and 120 individuals living in malaria endemic areas were spotted on filter papers and dried. The simple Chelex method was used to prepare DNA templates for the nested PCR assay. Higher malaria prevalence rates for both clinical (78.2%) and field samples (30.8%) were obtained with the nested PCR method than by microscopy (76.1% and 27.5%, respectively). Nested PCR was more sensitive than microscopy in detecting mixed P. falciparum and P. vivax infections, detected 5 more malaria samples than microscopy on the first round of microscopical examination, and detected malaria in 3 microscopically negative samples. Nested PCR failed to detect parasite DNA in 2 microscopically positive samples, an overall sensitivity of 97.4% compared to microscopy. The nested PCR method, when coupled with simple dried blood spot sampling, is a useful tool for collecting accurate malaria epidemiological data, particularly in remote regions of the world.
Ninety-six randomly selected farms, located throughout peninsular Malaysia, were surveyed for goat nematodes resistant to benzimidazoles (BZ). On 33 farms BZ resistance was demonstrated by means of an egg hatch assay. Haemonchus contortus was found to be the main species involved in anthelmintic resistance. There was a positive association between the frequency of anthelmintic treatments on a farm and the presence of benzimidazole resistance. To assess the value of the egg hatch assay, faecal egg count reduction (FECR) tests were also performed on 20 farms. On six farms the LD50 of thiabendazole (TBZ) was less than 0.10 micrograms ml-1 and the FECR higher than 95% and on ten farms with an LD50 TBZ of over 0.10 micrograms ml-1 a FECR of less than 95% was measured. On four farms the FECR was less than 95%, although the egg hatch assay showed LD50 TBZ values of less than 0.10 micrograms ml-1 and on two of these three farms a controlled efficacy test confirmed the presence of BZ resistant H. contortus. From these results it can be concluded that the egg hatch assay underestimated the true incidence of benzimidazole resistance. Levamisole resistance was detected with a FECR test on two of ten farms investigated.
Intestinal protozoa are found in all communities in Malaysia and among all ethnic groups. Prevalence of intestinal protozoa is not affected by ethnicity but by living conditions. Communities with both basic amenities of safe water supply and proper toilets have lower prevalence than those with one or none of the amenity. Cryptosporidium is an important intestinal protozoon in Malaysia and should be included in future field and laboratory studies and also in laboratory diagnosis for pathogens. Much interest will be centered on Blastocystis hominis in future studies in view that it may be a cause of diarrhea.
Blastocystis hominis has long been described as a non pathogenic protozoan parasite until recently when claims have been made that it can result in pathogenic conditions. Of the 729 stool samples (614 from survey and 115 from pediatric wards) examined, 18.1% of them were found to be positive for one or more intestinal protozoan cyst. The commonest was Giardia intestinalis (8.4%) Followed by Entamoeba coli (7.1%) and Entamoeba histolytica (5.1%) in the normal children without symptoms of diarrhea. When diarrheic stools were examined, the commonest parasite encountered was Giardia (20.4%), followed by E. coli (15.9%) and E. histolytica (9.7%). Blastocystis was observed in 4.4% of the children who had diarrhea and 1.1% among the children taken from the normal population in the rural areas.
The gastrointestinal helminth infection status of 1574 children living in a slum area of Kuala Lumpur, Malaysia was assessed by quantitative coprology. Almost two-thirds were infected with Trichuris trichiura, 49.6% with Ascaris lumbricoides, and 5.3% with hookworm. Infection prevalence rose rapidly to a stable asymptote at 7 years of age, and the age-intensity profile was convex with maximal values in the 5-10 year age classes. This pattern was the same for males and females, but differed markedly between different ethnic groups. The frequency distributions of A. lumbricoides and T. trichiura were highly overdispersed (k values were 0.21 and 0.27, respectively), and age-dependent over the 0-8 year age classes. This suggests that the force of infection with these nematodes is lower in infants than in older children.
Schistosomiasis in Southeast Asia, caused by Schistosoma japonicum, Schistosoma mekongi and Schistosoma japonicum-like, have been reported from six different countries. The S. japonicum infections are highly prevalent in the Philippines with Oncomelania hupensis quadrasi as the vector snail, and in localized areas in Indonesia with O.h. lindoensis as the snail vector. The S. mekongi infections are recent discovery in the Lower Mekong Basin in Laos and Kampuchea, with Tricula aperta as the vector snail. The S. japonicum-like infections are found as isolated cases diagnosed by the finding of S. japonicum-like eggs in the faeces, rectal biopsy, tissue biopsy or at necropsy in Thailand and Malaysia. The control measures of schistosomiasis have been implemented in the Philippines and Indonesia, while further research studies are being conducted in Thailand and Malaysia.
Food-borne parasitic zoonoses are emerging as major public health problems in most countries because they are widespread and pose a medical challenge. Not only are they important from an economic standpoint, but they also cause severe sequalae in all those affected. The extent of parasitic zoonoses in Malaysia is considered a "tip of the iceberg" problem. Cases of zoonotic diseases, like porocphaliasis, sarcocystosis, toxoplasmosis, cysticercosis, hydatidosis, echinostomiasis, and gnathostomiasis are traced and documented. An epidemiologic reassessment of methods is suggested to determine the extent of these parasitoses in Malaysia.
Two groups of goats were dosed with 20,000 and 40,000 sheep-derived strain (SDS) larvae of Trichostrongylus colubriformis respectively. Over a period of 42 days, goats dosed with 40,000 larvae lost more weight than goats dosed with 20,000 larvae. Anaemia was not observed in infected goats, but total serum proteins, albumins and phosphorus fell with infection.
Schistosomiasis was discovered in Malaysia in 1975 in an autopsy case. Since 1975 autopsies, surveys, and resurveys have been carried out to identify animal hosts, snail intermediate hosts, and reservoir hosts. Seroepidemiologic tests involving enzyme-linked immunosorbent and circumoval precipitin methods have been used to determine the true incidence and prevalence of this protean disease among the Orang Aslis (aborigines) in Malaysia. With the use of better epidemiologic and parasitologic tools, more cases of schistosomiasis are being reported.
Plasmodium falciparum drug sensitivities to chloroquine and mefloquine were assessed with WHO in vitro microtechnique test kits in 5 localities near the border with Thailand in Peninsular Malaysia. 105 of 113 (92.9%) parasite isolates were successfully tested and 103 (98.1%) showed resistance to chloroquine with parasite growth even at greater than or equal to 5.7 pmol of the drug. All these isolates were sensitive to mefloquine, parasite growth being inhibited at less than or equal to 11.3 pmol of the drug.