Entamoeba histolytica, the causative agent of human amoebiasis remains a significant cause of morbidity and mortality in developing countries and is responsible for up to 100,000 deaths worldwide each year. Entamoeba dispar, morphologically indistinguishable from E. histolytica is more common in humans in many parts of the world. Similarly Entamoeba moshkovskii, which was long considered to be a free-living amoeba is also morphologically identical to E. histolytica and E. dispar, and is highly prevalent in some E. histolytica endemic countries. Humans are the host of infection and there would not appear to be other meaningful animal reservoirs of E. histolytica. Entamoeba. histolytica can be present in sewage and contaminated water. The infection is mainly transmitted via ingestion of water or food contaminated by faeces containing E. histolytica cysts. Clinical features of amoebiasis range from asymptomatic colonization to amoebic dysentery and invasive extraintestinal amoebiasis, which is manifested most commonly in the form of abscesses in liver and lungs. The epidemiology of amoebiasis has dramatically changed since the separation of E. histolytica and E. dispar species and the worldwide prevalence of these species has not been estimated until recently. Morever, E. moshkovskii, another morphologically indistinguishable human parasitic Entamoeba was not mentioned or considered as a contributor to the prevalence figures in endemic areas. Amoebiasis is still a major health problem especially in aboriginal settlements and amongst people living in remote area in Malaysia. However, until now there is only one data currently available to indicate the true prevalence and incidence of E. histolytica and E. dispar. Further studies are needed to determine the burden of E. histolytica, E. dispar and E. moshkovskii infections in Malaysia. In the present review, we briefly summarize all methods use in diagnosing Entamoeba species, ranging from microscopic identification to molecular detection such as culture and isoenzyme analysis, antibody detection tests, antigen detection tests, immunochromatographic assays, conventional PCR, real-time PCR and loop-mediated isothermal amplification (LAMP).
This cross-sectional study was to compare and categorize potential breeding sites of dengue vectors, Aedes aegypti and Aedes albopictus at three different places, namely, an urban (Taman Permas Jaya, Johor Bahru, Johor), a suburban (Kg. Melayu Gelang Patah, Johor Bahru, Johor) and a rural (Felda Simpang Waha, Kota Tinggi, Johor) habitats in Malaysia. Larval surveys were conducted once in every two months at each habitat over a period of 11 months from August 2000 until June 2001. There was a significant difference between the three study sites in terms of potential breeding sites inspected (p<0.001). There were more potential breeding sites found in the rural area when compared to the urban and suburban habitats. The mean Potential Container Index (PCI) values in descending order were as follows: rural habitat (57.72)>suburban (29.35)>urban habitat (16.97). Both breeding sites and potential breeding sites were the nominator and the total number of containers inspected as the denominator in the formula of PCI, thus the latter could be a potential indicator to initiate anti-dengue campaign at the community level to rid off potential Aedes breeding sites. The three most common potential breeding sites of Aedes species were similar for urban and suburban habitats (flower pots, pails and bowls respectively). However, flower pots, vases and tyres were the three most common potential breeding sites for the rural habitat. Another finding in this study was that various types of larval habitats were found indoors and outdoors for both species.
One hundred and sixty eight rats were trapped from the National Service Training Centres (NSTC) in Kelantan and Terengganu from October 2008 to May 2009. Microscopic agglutination test (MAT) was performed to detect the presence of agglutinating antibodies to Leptospira among the rats caught. All the MAT positive rats were identified as Rattus tiomanicus. In Kelantan, 17.3 % (14/81) of the rats had leptospiral antibodies to serovars Icterohaemorrhagiae (12.3%), Canicola (2.5%), Ballum (1.2%), and Pyrogenes (1.2%). In Terengganu, 18.4% (16/87) of the rats had antibodies to serovars Icterohaemorrhagiae (15%), Canicola (1.1%), Pyrogenes (1.1%) and Hebdomadis (1.1%). This study indicated that Leptospira serovars were prevalent in the rat population in the study areas and could be a source of infection to humans. Therefore, control of the rat population in all NSTC is critical to prevent outbreaks of leptospirosis amongst the NSTC trainees.
The Indirect Fluorescent Antibody Test (IFAT) and thin blood smears were conducted to establish the prevalence of Ehrlichia canis infection in dogs presented for treatment by pet owners at five private and one government veterinary clinic. Results showed that 15% of the dogs were positive for the parasite via IFAT, but none using blood smears. However, infected dogs did not show severe clinical symptoms of canine monocytic ehrlichiosis (CME).
Plasmodium knowlesi in humans is life threatening, is on the increase and has been reported from most states in Malaysia. Anopheles latens and Anopheles cracens have been incriminated as vectors. Malaria is now a zoonoses and is occurring in malaria free areas of Malaysia. It is also a threat to eco-tourism. The importance of the vectors and possible control measures is reviewed here.
Nosocomial blood stream infection (or nosocomial bacteremia) is a common problem in hospitals worldwide, including Malaysia. A three-year prospective cohort study (October 2003-March 2007) of the incidences, risk factors, and patterns of the microorganisms causing bacteremia was conducted using a validated surveillance form in three intensive care units (ICUs) in Malaysia. Center for Disease Control criteria were used to diagnose bacteremia. Patients were monitored from admission until the end point of study, which was the first detection of bacteremia in the blood in each patient. The frequency of occurrence of bacteremia with clinical symptoms was 10.7% (n=23). Bacteremia was observed to occur within a mean length of stay of 10 days in ICU. The rate of device-related infection was 10.4% per device utilization days with a device utilization rate of 95.9%/1000 patient days. The total number of patient days was 2309 and the period of device utilization was 2211 days. The common bacteria detected were extended-spectrum beta-lactamases (ESBLs) Klebsiella pneumoniae (n=6); Pseudomonas aeruginosa (n=6); Acinetobacter species (n=5); Methicillin-resistant Staphylococcus aureus (MRSA)(n=3); and (non- ESBL) Klebsiella pneumoniae (n=2). Multivariable analysis using Cox Proportional Hazard Model showed that the predictors for developing bacteremia were cancer, MRSA carriage, duration of central venous catheter (CVC) infusion, frequency change of CVC, and the administration of hydrocortisone drugs. These results indicate that a combination of nursing and medical interventions as well as patients' severity of illness could lead to bacteremia in ICU. Strategic implementation of quality assurance measures in ICUs could help to control this problem.
Bovine lungworm Dictyocaulus viviparus is highly endemic in temperate regions. However, the occurrence of the lungworm has not been reported in any South East Asian country. The main aim of the present study was to detect the presence of lungworm in cattle in peninsular Malaysia and to examine the morphology of the parasite. A cross-sectional study was carried out in which 602 animals from four large scale government cattle farms and one dairy smallholder farm were sampled. In addition, 283 lungs from 11 abattoirs around the country were examined. Faecal samples were examined using the Baermann technique while post-mortem examination was performed on the lungs. Approximately 5% of faecal samples and 1% of lungs were positive for lungworm. Based on the morphology of adult lungworm, eggs and first stage larvae, Malaysian bovine lungworms were D. viviparus.
This is a survey of 120 children for scabies and head lice infestations in a welfare home in Pulau Pinang. Children from this welfare home (Rumah Kanak-Kanak Taman Bakti, Kepala Batas, Pulau Pinang) were randomly selected. Majority of them were Malays (72.5%) and the rest were Indians. The infestation rates were highest in the 10-12 years age group with 46% and 70% for scabies and head lice respectively. Head lice was more commonly seen in girls (65%) than boys (29%). Scabies was more commonly seen in boys (50%) than girls (16%). Overall prevalence rate for scabies was 31% and for head lice infestation was 49%.
One hundred sera of Malaysian cattle were used in this seroprevalence study for bovine babesiosis. All sera were obtained from the Serological Unit of the Veterinary Research Institute (VRI), Ipoh, Perak. The sera were tested using a Veterinary Medical Research & Development (VMRD) commercial Indirect Immunofluourescent Antibody Test (IFAT) kit. The results showed that 17.0% were found to be positive for Babesia bovis, 16.0% for Babesia bigemina, and 9.0% for both B. bovis and B. bigemina infections.
In a very closed and overcrowding environment, influenza transmission during Hajj season is almost inevitable. The aim of this study was to determine the association between pre-morbid conditions and influenza-like illness (ILI) amongst Hajj pilgrims. A cross-sectional study was conducted amongst Malaysian Hajj pilgrims in year 2007. Survey forms were distributed at Madinatul-Hujjaj, Jeddah and Tabung Haji Clinic, Medina, Saudi Arabia where pilgrims stay on transit before returning to Malaysia. Allergic rhinitis was significantly associated with sore throat (p=0.047), longer duration of cough (p=0.017) and runny nose (p=0.016). Pilgrims who suffered from chronic obstructive pulmonary diseases (COPD) had significant association with longer duration of cough (p=0.041) and those with diabetes mellitus had significant association with longer duration of sore throat (p=0.048). Underlying asthma was significantly associated with severe influenza like illness requiring admission to hospital for further treatment of respiratory symptoms (p=0.016). Based on these findings, we suggest those with underlying asthma should be discouraged from participating in the hajj and they should seek early treatment if they develop respiratory symptoms.
This study aims to determine the level of knowledge and to understand their attitude towards smoking and secondly to determine how sociodemographic background, smoking status and knowledge on the health risks of smoking contribute toward the development of such attitude. A total of 10,545 respondents age 18 years and above across Malaysia were interviewed. Results indicated that level of knowledge and attitude varied by gender, education level, smoking status, age, ethnicity and smoker category. Smokers' low education, poor knowledge on the dangers of smoking and being males had more positive or greater impact on their attitudes towards smoking. Formulation and implementation of a holistic programme aimed at increasing knowledge and attitude change that accounts for sociodemographic background of the population is recommended in order to bring down smoking rates and thus reduce smoking related health problems in this country.
Rodents were collected from five wet markets (Chow Kit, Dato Keramat, Setapak, Jinjang and Kepong) in Kuala Lumpur, Federal Territory between March to April 2006. Ninety seven rats were trapped using wire traps measuring 29 x 22 x 50 cm baited with fruits, coconuts, dried fish or sweet potatoes. A total of 17 different species of parasites were identified from three species of rats out of which 11 (65%) were identified to be zoonotic. The helminths identified from the urban rats were nematodes- Capillaria hepatica, Gongylonema neoplasticum, Heterakis spumosa, Heterakis sp., Masterphorus muris, Nippostrongylus brasiliensis, Physolaptera sp., Pterogodermatis sp., Rictularia tani and Syphacia muris; cestodes- Hymenolepis nana, Hymenolepis diminuta, Hymenolepis sabnema, Hymenolepis sp., Raillietina sp. and Taenia taeniaeformis, and acanthocephalan- Moniliformis moniliformis. The following parasites are of potential medical importance: C. hepatica, G. neoplasticum, R. tani, S. muris, H. diminuta, H. nana, Raillietina sp. and T. taeniaeformis.
An epidemiological cross-sectional study was undertaken to determine the endemicity of malaria among the Orang Asli population of Raub, Pahang. Malaria endemicity was measured in terms of the prevalence of parasitaemia and splenomegaly. A total of 520 Orang Asli were examined. The point prevalence of malaria was 24.2% (95% CI 20.7-25.1), with Plasmodium falciparum (67.5%) being the predominant species. Children < 12 years were at least 3.7 times more likely to be parasitaemic compared to those older. The prevalence of malaria among children 2-<10 years was 38.1% (95% CI 31.6-50.0). Spleen rate among children 2-<10 years old was 22.3% (95% CI 17.1-28.3). The average enlarged spleen size was 1.2. These findings classify the study area as being mesoendemic. Malaria control activities among the Orang Asli should focus on protecting vulnerable subgroups like young children. Measuring the level of malaria endemicity at regular intervals is fundamental in evaluating the effectiveness of malaria control programs.
This paper reports the occurrence of helminth and protozoan infections on small ruminants from eight farms situated in Kinta and Perak Tengah district, Perak. The results of this survey indicate that helminthiasis and coccidiosis is rampant in sheep and goat farms. Several anthelmintics have been used for the control of helminths. The smallholders depended on health and extention services from the State Veterinary Department. This survey is part of an ongoing programme by the Department of Veterinary Services to upgrade services and report the current status of parasitic diseases in the state.
Acinetobacter spp. is a known nosocomial pathogen causing a wide range of clinical diseases mainly pneumonia, wound infections and blood stream infections (BSI). A cross sectional descriptive study was performed to determine the prevalence of Acinetobacter infection in Hospital Universiti Sains Malaysia, Kelantan (HUSM). The risk factors of Acinetobacter BSI were determined by 1:1 case control analytical study, involving fifty-eight confirmed cases of Acinetobacter BSI patients compared to the cases caused by Gram-negative bacteria. The prevalence of Acinetobacter BSI in the HUSM was 6.11% (95% CI 4.88-7.53%). The attack rate of Acinetobacter BSI was 2.77 episodes per 1000 hospital admissions. Acinetobacter BSI patients were mostly located in intensive care unit and had a longer intensive care unit stay. In univariate analysis, the risk factors for Acinetobacter BSI include prior exposure to antimicrobial agents such as penicillins, aminoglycosides and cephalosporins, mechanical ventilation, presence of nasogastric tube, arterial catheter and urinary catheter. In multivariate analysis, the independent risk factors for Acinetobacter BSI were prior treatment with cephalosporins (OR 3.836 95% CI 1.657-8.881 p=0.002) and mechanical ventilation (OR 3.164 95% CI 1.353-7.397 p=0.008). This study revealed that rational use of antimicrobial agents is of paramount importance to control Acinetobacter BSI.
Orang Asli are the indigenous minority peoples of peninsular Malaysia. Despite proactive socioeconomic development initiated by the Malaysian Government in upgrading the quality of life of the Orang Asli communities since 1978, they still remained poor with a current poverty rate of 76.9%. Poverty exacerbates the health problems faced by these communities which include malnourishment, high incidences of infectious diseases (eg. tuberculosis, leprosy, malaria) and the perpetual problem with intestinal parasitic infections. Studies reported that the mean infection rate of intestinal parasitic infections in Orang Asli communities has reduced from 91.1% in 1978, to 64.1% in the subsequent years. Although the results was encouraging, it has to be interpreted with caution because nearly 80% of studies carried out after 1978 still reported high prevalence (i.e. >50%) of soil-transmitted helminthiases (STH) among Orang Asli communities. Prior to 1978, hookworm infection is the most predominant STH but today, trichuriasis is the most common STH infections. The risk factors for intestinal parasitic infections remained unchanged and studies conducted in recent years suggested that severe STH infections contributed to malnutrition, iron deficiency anaemia and low serum retinol in Orang Asli communities. In addition, STH may also contribute to poor cognitive functions and learning ability. Improvements in socioeconomic status in Malaysia have shown positive impact on the reduction of intestinal parasitic infections in other communities however, this positive impact is less significant in the Orang Asli communities. In view of this, a national parasitic infections baseline data on morbidity and mortality in the 18 subgroups of Orang Asli, will assist in identifying intervention programmes required by these communities. It is hope that the adoption of strategies highlighted in the World Health Organisation- Healthy Village Initiatives (WHO-HVI) into Orang Asli communities will ensure the whole mechanism of delivery and empowerment by the government agencies become more efficient and productive in alleviating intestinal parasitic infections in these communities.
This is a ten year (1999-2008) retrospective study of amebiasis in patients admitted to UMMC. A total of 34 cases were analyzed. The most common were amebic liver abscess 22(65%) and the rest were amoebic dysentery 12(35%). Majority of the cases occurred among Malaysians 29(85%), with Chinese 14(41%), followed by the Malays 9(26%) and the Indians 6(18%). Foreigners made up of one Indonesian, one Pakistani and three Myanmarese and constituted 5(15%) of the total cases. Males 24(71%) were more commonly affected. Most of the cases occurred between the age group of 40-49 years, 8(23%) and 60 years and above, 8(23%). Age group of 20-50 years constituted 20(60%) of the cases. The most common clinical presentations were fever with chills and rigors 26(76%), diarrhoea 20 (59%), right hypochondrium pain 17(50%), abdominal pain 17(50%), hepatomegaly 16 (47%) and jaundice 7(20%). All were discharged well after treatment except for one case of death in a 69-year-old Chinese male with amebic liver abscess.
This paper presents investigation of lungworm disease outbreaks that is based on retrospective examination of cases recorded between 1994 and 2000 on a government beef cattle breeding centre in the state of Pahang, peninsular Malaysia. The breed of cattle on the centre was Nelore and the mean population over a 7-year period (from 1994 to 2000) was 1612. All animals were allowed to graze on pasture and mixed grazing was practiced on the farm. The routine de-worming programme was performed using levamisole and ivermectin from 1994 to 1998 and abamectin in 1999 and 2000 on 1 to 3-month-old calves and an annual dose given to the adult cattle. Nelore was introduced into the farm in 1991, three years before the first outbreak from Brazil where Dictyocaulus viviparus infection had been reported. No lungworm infection had been observed in the farm prior to the animal introduction. Within the 7-year period, 36 fatalities occurred and the annual mortality rate due to lungworm infection was 0.31%. The highest rate was recorded in 1997. Among the total 36 deaths, about 75% of deaths occurred in calves aged between 6 months and 12 months, 67% were males and 33% were female cattle. The highest number of deaths (19%) occurred in the month of November. In conclusion, D. viviparus infection may have been introduced into a tropical climate along with consignments of cattle from lungworm endemic areas resulting in fatal disease outbreaks for a few years following the animal's initial introduction.
The Students' Resilience and Interpersonal Skills Development Education (STRIDE) is a preventive drug education programme. The rational of this programme is that preventive drug education has to begin early in age, before the development of social attitudes and behaviour of students. A pre and a post intervention surveys were performed to evaluate the impact of this programme. Nine schools from three states were identified to participate in the intervention. These schools were selected based on their locations in high-drug-use areas (where the prevalence of drug use exceeds 0.5% of the student population). The new intervention curriculum was put into practice for three months in the nine schools. The overall scores obtained by each respondent to assess their knowledge on drugs and its implications were analysed. The results showed that the programme made a positive impact from the pre to post intervention programme by using the Wilcoxon Signed Rank Test (p < 0.05). A high percentage of the questions showed significant evidence through the McNemar matched pair Chi-Squared test with Bonferonni correction that there were positive shifts in the answers by comparing the pre and post intervention results (p < 0.05). Recommendations have been discussed with the Ministry of Education to integrate this programme into the national primary school curriculum.
A survey of Caseous Lymphadenitis (CLA), a bacterial infection in sheep and goats was conducted on small ruminant farms in two districts in Perak, namely Kinta and Hilir Perak. The objective of this survey is to determine the status of CLA infection in small ruminants. A total of 8 farms were screened, involving a total of 579 animals. Agar Gel Precipitation Test (AGPT) and Enzyme Linked Immuno Absorbent Assay (ELISA) were conducted on serum samples obtained from the animals. Results show that 8.5% of the animals had a positive reaction for AGPT test. It was found that 36 samples (17%) were found positive using both AGPT and ELISA methods, 9 samples (4%) were found positive only using AGPT method, 14 samples (6%)were found positive only using ELISA and 157 samples (73%) were found negative using both methods. Since there is no available data on the prevalence of the disease in the country, further epidemiological studies as well as reliable diagnostic detection methods need to be assessed for aiding in control and eradication programmes for this disease.