The discovery of antibiotics had been one of the most significant events in the history of medicine. Antibiotics had saved countless number of lives and had contributed significantly to the health of mankind.The emergence of resistance is however a major threat to the continued usefulness of antibiotics. There are now strains of bacteria which are resistant to virtually all available antibiotics and these strains are increasingly being encountered in clinical practice. The development of new agents had not kept pace with resistance and it is unlikely that there will be major breakthroughs in the near future. The world needs to conserve and prolong the useful lives of the existing agents. This can only be achieved through good antibiotic stewardship programmes. As antibiotic resistance is a global threat all major stakeholders have to work together to meet this challenge.
An emerging infection is defined as an infection which has newly appeared in a population while a re-emerging infection is one which has existed in the past but its incidence is rapidly increasing. The reasons for the emergence and re-emergence of infections are not well understood but appear to be associated with factors that involve the pathogen, the host and the environment. These factors are often inter-related and act together in a complex manner to bring about changes in patterns of infection. Pathogens are extremely resourceful and possess mechanisms to adapt to new hosts and environments as well as to acquire new virulence traits. Host factors include herd immunity, social behaviour and demographics. Environmental factors like the climate, deforestation and new technologies have an impact on the emergence of infections. The challenge is to contain an infection when it emerges but more importantly to prevent its emergence in the first place. As the emergence of an infection is complex and multifactorial, a multidisciplinary approach is required. Health based strategies alone are insufficient. Social, economic and environmental measures and the political will to implement appropriate policies are equally important.
Infection is an important cause of morbidity and mortality in immunocompromised patients. The high risk of infection is not only the consequence of the underlying disease but also the result of the diagnostic, monitoring and therapeutic procedures performed on these patients. Infections may be exogenous or endogenous in origin. The prevention of exogenous infections requires a high standard of hygiene. As many infections are acquired in hospitals, an effective control of nosocomial infection programme is crucial in preventing infections in the immunocompromised. Prevention of endogenous infections involves suppression of the aerobic bacterial flora (selective decontamination) and measures to maintain gastrointestinal epithelial integrity to reduce risk of translocation of intestinal flora. Boosting the host immunity through passive and active immunisation should also be considered. Prevention of infection in the immunocompromised is no easy task and requires a multidisciplinary approach.
Staphylococcal infection is common in Malaysian hospitals. A recent survey of 22 Malaysian hospitals revealed that staphylococci were isolated from almost 40% of positive blood cultures. A more detailed analysis of such cases in our own hospital showed that almost 70% of Staphylococcus aureus and about 16% of coagulase-negative staphylococcal isolates were associated with clinically-significant disease. Staphylococcal bacteraemia was seen mainly in neonatal sepsis, skin and soft tissue infections, pneumonia, arthritis, osteomyelitis, endocarditis and postoperative sepsis. Multiply-resistant S. aureus were encountered in all the hospitals surveyed. Resistance rates to penicillin ranged from 40% to almost 100% while methicillin resistance rates of up to 25% were reported from several hospitals.
Leptospirosis is a re-emerging zoonotic infection. In developing countries large outbreaks have occurred in urban slums and following floods. Individuals from developed nations are also now more frequently exposed to the infection as a result of international travel and greater participation in certain outdoor recreational activities. Leptospirosis remains a diagnostic challenge since it often presents as a non-specific febrile event and laboratory diagnosis is still currently inadequate. Rapid tests may not be sufficiently sensitive in early disease and culture facilities are not widely available. A severe pulmonary haemorrhagic form of the infection is increasingly being encountered in many countries including Malaysia. The control of leptospirosis is largely dependent on general hygienic measures and rodent control. An effective human vaccine is still not available. There remains much that is unknown about this disease and there is scope and opportunity for good quality research.
Many infections are associated with occupations. Involvement in a particular occupation may place the person at higher direct risk of contracting certain infections. In some instances the life-style associated with the occupation results in a higher risk of exposure to the infection. The link between the infection and the workplace is often missed by the attending physician. This may be due to a lack of awareness on the part of the physician. Sometimes a direct link can be difficult to prove without the use of sophisticated molecular epidemiological tests. This has led to gross under-diagnosis and under-reporting of such cases. It is however important that occupational infections be diagnosed as adequate preventive measures need to be implemented. Furthermore the patient may be eligible for monetary compensation under the relevant occupational safety laws of the country.
Cerebral Palsy (CP) describes a group of chronic conditions affecting body movement and muscle coordination caused by damage to one or more areas of the brain, occurring at any time during foetal development to infancy. This research was carried out to learn how parents of children with cerebral palsy (CP) had found and accessed services provided for them in Selangor and Kuala Lumpur. It was based in the Spastic Children's Association of Selangor and Federal Territory (SCAS&FT) among 96 of 201 parents of children who use the facilities and services provided by the SCAS&FT through questionnaires and face-to-face interviews. There was a satisfactory level of availability and accessibility of contacting and using the services provided by SCAS&FT in terms of respondent satisfaction. However, parents had varying levels of awareness of the different classes and activities carried out by the school. Efforts to improve knowledge regarding the services available for children with CP in the general population and among parents of these children should be promoted.
Infectious diarrhoea is the second most common cause of morbidity and mortality worldwide. The WHO estimates that about 2.5 million people die annually as a result of infectious diarrhoea, most of them children. In 2002 about 1.6 million children under the age of five in developing countries died from diarrhoeal disease. In the United States between 211- 375 million episodes of diarrhoeal disease occur annually resulting in 73 million physician consultations and 1.8 million hospitalisations with over 3,000 deaths.
Over the past two decades there has been numerous new associations between chronic diseases traditionally considered non-infectious with infectious agents. This list of diseases include peptic ulcer, coronary heart disease, neuropsychiatric disorders, haematological disorders and malignancies. These associations have been made possible through improvements in diagnostic tests based on molecular biology techniques. The discovery of these associations is important as it opens up exciting opportunities for the prevention and treatment of many diseases hitherto considered incurable.