The recent death tolls and morbidities associated with two deadly viral haemorrhagic fevers (VHFs), i.e., Ebola and dengue, are simply shocking. By the end of August 2014, 65 672 people were afflicted with dengue fever (DF) in Malaysia, with 9505 from Kelantan, and there were 128 reported deaths. More astounding are the death tolls associated with Ebola: 3091 deaths from 6574 reported cases so far. It is not difficult to imagine the potential disaster if Ebola spreads beyond Africa. VHFs are characterised by an acute onset of fever, vascular disruption and a rapid progression to shock and death. The revised World Health Organization (WHO) 2012 classification (dengue with and without warning signs and severe dengue) is more clinically relevant and allows more streamlined admission. With good administrative support and public health and governmental efforts, the dengue epidemic in Malaysia is now more contained. However, there should be no laxity with the imminent lethal Ebola threat. Human-to-human transmission is an important mechanism for the spread of Ebola, and this calls for strict precautions regarding contact with any suspected cases. In contrast, the control and elimination of dengue would require successful control of the vectors and their breeding sites.
Dengue infection is a major cause of morbidity and mortality in Malaysia. To date, much research on dengue infection conducted in Malaysia have been published. One hundred and sixty six articles related to dengue in Malaysia were found from a search through a database dedicated to indexing all original data relevant to medicine published between the years 2000-2013. Ninety articles with clinical relevance and future research implications were selected and reviewed. These papers showed evidence of an exponential increase in the disease epidemic and a varying pattern of prevalent dengue serotypes at different times. The early febrile phase of dengue infection consist of an undifferentiated fever. Clinical suspicion and ability to identify patients at risk of severe dengue infection is important. Treatment of dengue infection involves judicious use of volume expander and supportive care. Potential future research areas are discussed to narrow our current knowledge gaps on dengue infection.
A 5-month-old Malay boy presented with purpuric papules and plaques on the face and extremities accompanied by fever, coryzal symptoms and bilateral lower limb oedema. There were also bullous linear purpuric lesions on the right upper limb. Blood and culture tests were normal. Histopathological tests showed leucocytoclastic vasculitis, confirming the diagnosis of acute haemorrhagic oedema of infancy. The patient achieved complete recovery after 2 weeks with no recurrence.
Studies have reported that only a small fraction of fever cases in malaria-endemic areas are actually caused by malaria. Much greater emphasis is now needed to step up attention to the appropriate management of nonmalarial acute undifferentiated febrile illness. There is an overlap at the start of clinical manifestations of different febrile illnesses which makes it difficult to adhere to the clinical guidelines. The development of rigorous guidelines based on high quality research and a consensus from the core group of content experts are needed. An innovative financing mechanism for universal access to such appropriate management should also be considered.
Matched MeSH terms: Fever of Unknown Origin/diagnosis*; Fever of Unknown Origin/drug therapy; Fever of Unknown Origin/economics
We report here the complete genome sequence of Salmonella enterica subsp. enterica serovar Typhi B/SF/13/03/195 obtained from a typhoid carrier, who is a food handler in Pasir Mas, Kelantan.
Chikungunya virus (CHIKV), an alphavirus of the family Togaviridae, causes fever, polyarthritis and rash. There are three genotypes: West African, Asian and East/Central/South African (ECSA). The latter two genotypes have caused global outbreaks in recent years. Recent ECSA CHIKV outbreaks have been associated with severe neurological disease, but it is not known if different CHIKV genotypes are associated with different neurovirulence. In this study, the neurovirulence of Asian (MY/06/37348) and ECSA (MY/08/065) strains of CHIKV isolated in Malaysia were compared. Intracerebral inoculation of either virus into suckling mice was followed by virus titration, histopathology and gene expression analysis of the harvested brains. Both strains of CHIKV replicated similarly, yet mice infected with MY/06/37348 showed higher mortality. Histopathology findings showed that both CHIKV strains spread within the brain (where CHIKV antigen was localized to astrocytes and neurons) and beyond to skeletal muscle. In MY/06/37348-infected mice, apoptosis, which is associated with neurovirulence in alphaviruses, was observed earlier in brains. Comparison of gene expression showed that a pro-apoptotic gene (eIF2αK2) was upregulated at higher levels in MY/06/37348-infected mice, while genes involved in anti-apoptosis (BIRC3), antiviral responses and central nervous system protection (including CD40, IL-10RA, MyD88 and PYCARD) were upregulated more highly in MY/08/065-infected mice. In conclusion, the higher mortality observed following MY/06/37348 infection in mice is due not to higher viral replication in the brain, but to differentially expressed genes involved in host immune responses. These findings may help to identify therapeutic strategies and biomarkers for neurological CHIKV infections.
The genetic variability of classical swine fever virus was studied by comparative nucleotide sequence analysis of 76 virus isolates, collected during a half century from three continents. Parts of the E2 (gp55) and the polymerase gene coding regions of the viral genome were amplified by RT-PCR and DNA fragments of 254 and 207 bp, respectively, were sequenced. The comparative sequence analysis of the E2 region revealed two main phylogenetic groups of CSFV, indicating that the virus apparently evolved from two ancestor nodes. Group I (represented by Brescia strain) consisted of old and recent American and Asian viruses, as well as old English isolates from the 1950s. This group was subdivided into three subgroups, termed I.A-I.C. Group II (represented by Alfort strain) consisted of relatively recent isolates from Europe, together with strain Osaka, which was isolated in Japan from a pig of European origin. Based on genetic distances the group was divided into subgroups II.A and II.B. Malaysian isolates were branched into both groups, indicating multiple origins for contemporaneous outbreaks in that country. All ten vaccine strains tested were branched in group I, implying a common ancestor. The Japanese Kanagawa strain, isolated in 1974, and the British Congenital Tremor strain from 1964 were the most distinct variants of CSFV in our collection. The comparison of the nucleotide sequences of the polymerase coding region of 32 European strains distinguished subgroups II.A and II.B which were similar to the corresponding subgroups of the E2 phylogenetic tree. Thus, the results revealed that the E2 region and the polymerase coding regions seem to be appropriate for the grouping of CSFV isolates from all over the world, distinguishing two major groups of the virus. The reliability of these regions for phylogenetic analysis is indicated by the similarity of the results obtained from the two separate parts of the CSFV genome.
West Nile virus (WNV) is a zoonotic single-strand RNA arbovirus (family Flaviviridae: Flavivirus), transmitted among avian hosts in enzootic cycles by a mosquito vector. The virus has a significant disease effect on humans and equines when it bridges into a cycle with various sequelae with epidemic potential. This study was carried out to identify the potential spectrum of WNV hosts in three geographic areas with climatologically distinct features: Malaysia, Qatar, and the United States of America (U.S.). Serum samples were collected from avian and mammal species suspected to be reservoirs for the virus at these areas in a cross-sectional epidemiologic study. The samples were tested for the presence of antibodies against the virus using an enzyme-linked immunosorbent assay. Data on putative risk factors were also collected and analyzed for significance of association with seropositivity using the logistic regression analysis. Among the tested avian and mammalian species, raccoons had the highest seroconversion rate (54%) followed by crows (30%), horses (27%), camels (10%), other avian species (7%), and canine species (3%). It was almost twice as likely to detect seroconversion among these mammalian and avian species in the fall in comparison to other seasons of the year. Only mammalian and avian species and seasons of the year were significantly associated with the likelihood of seroconversion to WNV when we controlled for other factors in the multivariate analysis. Our data from the U.S. showed that raccoons and camels are susceptible to infection by the virus and may play a role in the perpetuation of endemic foci for the disease.
Matched MeSH terms: West Nile Fever/epidemiology; West Nile Fever/veterinary*; West Nile Fever/virology
An outbreak of pneumonia occurred among 1,491 recruits undergoing training at the Army Recruit Training Center, Port Dickson, Negeri Sembihxn, between july to August 2000. They had reported for training 2 weeks before and were placed in new modern concrete 4 floors buiMing with well ventilated dorm. A total of 70 recruits were ajjfected and one died. The attack rate was 4.7% and the case fatality rate was 1.4%. The outbreak ajfected recruits from all the jive companies; J (21/299,
30.0%) , G (19/298, 27.1 %), I (14/298, 20.0%), H (13/298, 18.6%) and F (3/298, 4.3%) . The main presenting symptoms were fever (68/70, 97.1%), cough (62/70, 88.6%), and chest pain (35/70, 50 .0%) . This was a common site outbreak with the mode of spread from person to person through infected droplet. The outbreak has three peaks, which was at lst, 4th and 6th week respectively and lasted for eight weeks. The organisms isobted through blood culture were Streptococcal pneumoniae and Klebsiella pneumoniae. All the cases were managed and treated as in-patients at four dijjferent hospitals depending on the severity of the illness. The main control activities carried out were separation of ill recruits from the healthy, reducing the number of recruits in the dormitories and encourage recruits to drink a lot of water while in training.
INTRODUCTION: The World Health Organization (WHO) declared the Ebola virus disease (EVD) epidemic to be a public health emergency of international concern. Healthcare workers (HCWs) are at the highest risk of infection, as they may come into contact with patients' blood or fluids. This study was conducted to assess knowledge and attitudes of HCWs towards EVD in India.
METHODOLOGY: A descriptive, cross-sectional study was conducted in a multispecialty public sector referral hospital of Telangana, India. Knowledge and attitude of HCWs were evaluated using a pre-validated questionnaire. A sample of 278 participants was selected to participate in this study. The Chi-squared test was used to assess the relationship between attitudes and demographic characteristics. Logistic regression was used examine the association between knowledge and study variables.
RESULTS: Of 257 participants who responded (92.4% response rate), 157 (61.1%) were females. The majority of the respondents were physicians (n = 117, 45.5%). Radio and television were the major sources of information about EVD reported by participants (89%). Overall knowledge of HCWs was poor (mean knowledge score: 6.57 ± 2.57). Knowledge of physicians and experienced workers (≥ 10 years) was significantly higher than their respective groups. The overall attitude of the participants was positive (mean attitude score: 1.62 ± 0.57). Significant positive correlations between knowledge and attitude were observed.
CONCLUSIONS: The findings indicate that participants lack basic understanding of EVD. We recommend future studies be conducted across India to identify and subsequently bridge the knowledge gaps among HCWs.
We studied the emergency preparedness and perceived response for Ebola virus disease among various health care providers in Malaysia using a self-report questionnaire. Most of the health care providers felt that they were able to respond to Ebola virus disease and were aware of the level of preparedness needed during emergency.
Unsteady mixed convection flow of Casson fluid towards a nonlinearly stretching sheet with the slip and convective boundary conditions is analyzed in this work. The effects of Soret Dufour, viscous dissipation and heat generation/absorption are also investigated. After using some suitable transformations, the unsteady nonlinear problem is solved by using Keller-box method. Numerical solutions for wall shear stress and high temperature transfer rate are calculated and compared with previously published work, an excellent arrangement is followed. It is noticed that fluid velocity reduces for both local unsteadiness and Casson parameters. It is likewise noticed that the influence of a Dufour number of dimensionless temperature is more prominent as compared to species concentration. Furthermore, the temperature was found to be increased in the case of nonlinear thermal radiation.
An assessment on the use of acetaminophen (paracetamol) among consumers would
provide guidance for implementing strategies to overcome the misuse of acetaminophencontaining
products. This study aims to evaluate Malaysian consumers’ practices,
perceptions and understanding regarding the use of acetaminophen. A semi-structured
qualitative study utilising face-to-face interviews was conducted among 14 consumers
aged 24 to 82 years old who live in Pulau Pinang, Malaysia. Transcripts of all the
interviews were generated from audio tapes and were analysed for the issues and themes
emerging from the text; the transcripts were independently coded and verified by experts.
The consumers had a positive attitude towards the popularity, safety and efficacy of
acetaminophen. The consumers predominantly used acetaminophen for pain and fever.
Some consumers tended to increase the frequency and dosage of acetaminophen
consumption if their condition persisted. Consumers had difficulty recognising the generic
acetaminophen-containing products available in the market. Health literacy investigations
have found that consumers have a lack of knowledge regarding the correct dosing
regimen for acetaminophen in adults and children. The consumers were not aware of the
precautions and toxicities of acetaminophen. To increase awareness of acetaminophen
poisoning in Malaysia, the consumers suggested that educational tools regarding the
proper use of acetaminophen are needed from the Ministry of Health and policy-makers.
The information gained from this study emphasises the importance of educational
interventions to educate the public on the proper use of acetaminophen in Malaysia.
Malaria remains one of the most important infectious diseases worldwide considering that 40% of the world’s population live in health risk areas and millions of febrile episodes due to malaria infection occur annually in children under the age of five in Africa alone and almost 3 million patients, primarily children, die each year. Among the various measures envisaged, to contain the disease, the concept of a vaccine to protect humans against malaria appears particularly attractive. The development of an effective malaria vaccine represents one of the most important approaches to provide cost-effective intervention, in addition to currently available malaria control strategies. Here, we review malaria as a public health problem and the status and promise in malaria vaccine development.
A study was conducted in Kelantan, Mabysia, in the year 2001 , to assess the typhoid reporting coverage and timeliness, and to estimate the annual incidence. Cases were persons given the diagnosis of typhoid clinically, and conhrmed cases are those with positive laboratory results. In all, 174/252 (69%) cases (95% CI = 63%-75%) were reported, ofwhich 89/131 (83%) within 7 days of diagnosis. The estimated annual typhoid incidence in Kelantan is 37/ 1 00,000.
In view of the risk of introduction of yellow fever into South-East Asia, comparative studies have been made of yellow fever vaccination in Malayan volunteers with a high prevalence of antibody to related viruses and in volunteers without related antibody. In a previous paper the neutralizing antibody responses of these volunteers were reported. The present paper describes the haemagglutinin-inhibiting (HI) antibody responses of the same groups of volunteers and discusses the relationship of these responses to the neutralizing antibody responses.The HI responses to yellow fever following vaccination closely paralleled the neutralizing antibody responses whether vaccination was subcutaneous or by multiple puncture. Volunteers with a high level of YF HI antibody due to infection with other group B viruses were found to be less likely to show a significant YF HI response than those without antibody. 90% of HI responses could be detected by the 21st day after vaccination.As with neutralizing antibody responses, volunteers given vaccine doses of 50-500 mouse intracerebral LD(50) subcutaneously gave greater responses than those given higher doses.
A comparison is made between atebrin-musonate and quinine bihydrochloride in the treatment of acute malaria. 286 cases of acute malaria due to Malayan strains of P. falciparum, P. vivax, and P. malariae, were treated in alternating sequence with one or other of these drugs. The rates at which the atebrin-musonate and the quinine case groups became trophozoite-free and fever-free are contrasted in a series of graphs. It is shown that there was a tendency for trophozoites to disappear from the peripheral blood and for temperatures to fall to normal somewhat earlier among cases treated with atebrin-musonate. No toxic effects of any importance were observed (but see footnote p. 657). Evidence is recorded which suggests that the minimal effective daily dose for an adult is 0·375 gramme (= atebrin 0·3 gramme). This dose when given either intramuscularly or intravenously on two successive days effected a rapid disappearance of parasites and fever. Intramuscular administration is regarded as the method of choice. It is noted that absorption of the drug from the muscles is very rapid, and that atebrin may be demonstrated in the urine within 10 minutes of an intramuscular injection of 0·3 gramme. A method of testing for the presence of atebrin in the urine which is sensitive to over one in a million is described. It was not possible to obtain precise data regarding the permanency of cure but an analysis of cases returning to hospital within 10 weeks of discharge suggests that relapses after atebrin-musonate treatment are probably fairly common.