A 37-year-old woman presented with a short history of fever and bilateral lower limb
weakness. She also had impaired sensory function up to T4 spine level and lax anal tone.
Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the
spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite
medical and surgical interventions, her lower limb weakness persists. A high index of
suspicion is needed to recognise dengue-related neurological complications. This diagnosis
should be considered in any patients from dengue endemic areas presenting with acute
febrile illness with atypical neurological manifestations.
Salmonellosis continues to remain a health problem as the causative organism Salmonella spp. developed resistance to many of the antibiotics. As per World Health Organization (WHO), it is estimated that enteric fever, accounts for almost 16 million cases annually and over 600,000 deaths worldwide. Recent data revealed that the multi-drug resistance (MDR) rate of enteric fever was as high as 70% in Asian countries, as compared with the overall reported incidence of 50%. Emergence of MDR typhoid fever demands the use of newer antibiotics which also not offer promising effect in recent days. Effective antimicrobial therapy is required to control morbidity and prevent death from typhoid fever. The studies on PhoP/Q regulation revealed it as a best-characterized transcriptional regulation; a two-component system required for Salmonella pathogenesis which controls the expression of more than 40 genes. The PhoP DNA binding proteins possess positively charged amino acids such as arginine, lysine and histidine which present in the DNA binding site. Prevention of PhoP binding in phoP box may ultimately prevent the expression of many regulatory mechanism which plays vital role in Salmonella virulence. Deepness study of PhoP protein and various mutation swots may offer effectual controlling of MDR Salmonella.
Ebola virus disease (EVD), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), rabies and Nipah infections were examples of diseases that were related to bats and shook the world with a series of outbreak and epidemic. Through the understanding of bats as potential public health risk, awareness had become vital to prevent another outbreak. This pilot study was done to evaluate the appropriateness of the questionnaires and to determine preliminary data on knowledge, attitude and practices of bats-related infections. Residents of a village were recruited by randomly choosing houses from a list obtained from the local head village. Knowledge, attitude and practice were assessed using a 56-items questionnaire. The study recruited 100 respondents. The questionnaire’s Cronbach Alpha score was 0.817. Majority of the respondents were found to have good knowledge (71%), attitude (99%) and practice (64%) relating to bat-related infection. There was a weak positive correlation between knowledge and practice towards bat-related infections among residents of the study population. Majority (80%) of respondents did not aware that bats can cause rabies, and 84% did not know about rabies vaccination. The result of this pilot study provides a limited but valuable insight into bat-related infection. Overall, respondents had good knowledge, attitude and practice scores towards bats-related infection. However, more awareness is needed to key areas lacking such as in educating awareness about rabies in bats.
Introduction: Secondary Hemophagocytic Lymphohistiocytosis (HLH) is a condition seen in severe dengue that can be potentially fatal. Timely management using HLH-directed treatment such as steroids or etoposide have been seen to improve the outcome of patients however there is no protocol on how to manage the disease. Two criteria commonly used to guide the direction of treatment are namely the HLH-2004 criteria and the Hscore; with the latter being used more often. The best cut-off H score is 169 corresponding to a sensitivity of 93%, specificity of 86% and accurate classification of 90% of the patients. We described of five patients diagnosed with severe dengue compli-cated with HLH. Methods: 5 cases that were diagnosed with severe dengue with secondary HLH and received dexa-methasone were reviewed retrospectively and clinical data extracted. Results: All patients had fever beyond critical or leaking phase. Four out of five cases had Hscore higher than 169 and had a mean score of 181 with only one bone marrow performed. Three patients had concurrent leaking and bleeding and three patients had fast progression of se-vere transaminitis during the critical phase. The mean peak ferritin level was 21077 micro/L. The only bone marrow aspiration done revealed increased macrophages and hemophagocytic activity. All patients received a short course of dexamethasone and discharged well. Conclusion: Short course dexamethasone is effective in treatment of HLH in dengue despite the concerns of administration of steroids in bleeding dengue patient. Secondary HLH in dengue remains a clinical diagnosis with no conclusive diagnostic criteria. It should be suspected in a severe dengue patient with hyperferritinemia and persistent fever. Technical difficulty of performing bone marrow during severe dengue makes conclusive diagnosis remains elusive.
Ebola virus is a lipid-enveloped filamentous virus that affects human and non-human primates and consists of several types of protein: nucleoprotein, VP30, VP35, L protein, VP40, VP24, and transmembrane glycoprotein. Among the Ebola virus proteins, its matrix protein VP40 is abundantly expressed during infection and plays a number of critical roles in oligomerization, budding and egress from the host cell. VP40 exists predominantly as a monomer at the inner leaflet of the plasma membrane, and has been suggested to interact with negatively charged lipids such as phosphatidylinositol 4,5-bisphosphate (PIP2) and phosphatidylserine (PS) via its cationic patch. The hydrophobic loop at the C-terminal domain has also been shown to be important in the interaction between the VP40 and the membrane. However, details of the molecular mechanisms underpinning their interactions are not fully understood. This study aimed at investigating the effects of mutation in the cationic patch and hydrophobic loop on the interaction between the VP40 monomer and the plasma membrane using coarse-grained molecular dynamics simulation (CGMD). Our simulations revealed that the interaction between VP40 and the plasma membrane is mediated by the cationic patch residues. This led to the clustering of PIP2 around the protein in the inner leaflet as a result of interactions between some cationic residues including R52, K127, K221, K224, K225, K256, K270, K274, K275 and K279 and PIP2 lipids via electrostatic interactions. Mutation of the cationic patch or hydrophobic loop amino acids caused the protein to bind at the inner leaflet of the plasma membrane in a different orientation, where no significant clustering of PIP2 was observed around the mutated protein. This study provides basic understanding of the interaction of the VP40 monomer and its mutants with the plasma membrane.
Ebola virus (EBOV) is one of the lethal viruses, causing more than 24 epidemic outbreaks to date. Despite having available molecular knowledge of this virus, no definite vaccine or other remedial agents have been developed yet for the management and avoidance of EBOV infections in humans. Disclosing this, the present study described an epitope-based peptide vaccine against EBOV, using a combination of B-cell and T-cell epitope predictions, followed by molecular docking and molecular dynamics simulation approach. Here, protein sequences of all glycoproteins of EBOV were collected and examined via in silico methods to determine the most immunogenic protein. From the identified antigenic protein, the peptide region ranging from 186 to 220 and the sequence HKEGAFFLY from the positions of 154-162 were considered the most potential B-cell and T-cell epitopes, correspondingly. Moreover, this peptide (HKEGAFFLY) interacted with HLA-A*32:15 with the highest binding energy and stability, and also a good conservancy of 83.85% with maximum population coverage. The results imply that the designed epitopes could manifest vigorous enduring defensive immunity against EBOV.
Global warming is the main concern in today’s century as it comes with numerous side effects to the natural environment. Open Top Chambers (OTC) consist of metal constructions with transparent vertical side-walls and a frustum on top. An opening in the middle of the frustum allows an air exchange to reduce temperature and humidity effects in the chamber. The size of the open top chamber which is located in Universiti Putra Malaysia is slanted 60o, 50cm tall, 2.08m basal diameter hexagon chamber. The Open Top Chamber experiments were carried out to determine how much global warming has affected and is still affecting the temperature, pH, the moisture and the growth of the microbes in the tropical soil. The aim of this study is to elucidate the effects of temperature increase on the soil microbes’ population and on the pH of the soil. The study was conducted to observe the effect of heat on the population of soil microbes and the pH of the soil which was collected on the same day for 6 consecutive months. The microbes from the samples were grown on agar plates. The population of microbes on the plates were used as values were for Colony Forming Unit (CFU) value calculations. The effects of OTCs on mean temperature showed a large range of CFU values throughout the 6 months but did not differ significantly between studies. Increases in mean monthly and diurnal temperature were strongly related, indicating that the presence of warming effect by the OTCs. Such predictive power allows a better mechanistic understanding of observed biotic response to experimental warming. This study will be useful for the understanding of the global warming effect on microbes. The Open Top Chamber experiment has proven to be one of the effective model for global warming research and data collected especially on the growth of soil microbial obtained would be of great use for further experiments.
The occurrence of major outbreaks of dengue, and other vector borne diseases such as chikungunya and zika in tropical and subtropical regions has rendered control of the diseases a top-priority for many affected countries including Malaysia. Control of the mosquito vectors Aedes aegypti and Aedes albopictus through the reduction of breeding sites and the application of insecticides to kill immature forms and adults are the main control efforts to combat these diseases. The present study describes the association between Ae. albopictus and Ae. aegypti in shared breeding sites. This study is important given that any measure taken against one species may affect the other. A yearlong larval survey was conducted in four dengue endemic areas of Penang Island. Sorenson's coefficient index indicated that no association between number of the immatures of the two species regardless of container size and study location. Therefore, the mean number Ae. albopictus immature was not decreased in the presence of Ae. aegypti in shared breeding container. However Ae. aegypti appeared to prefer breeding in habitats not occupied by Ae. albopictus, the two species sharing breeding sites only where available containers were limited. In control efforts, eliminating the preferred breeding containers for one species might not affect or reduce the population of the other species.
Megaselia scalaris (Loew) is a cosmopolitan polyphagous small fly with the ability of exploiting variety of ecological niches. Different life history stages act as detritivore, parasite, and parasitoid of wider spectrum of plant and animal matter under natural and laboratory conditions. Here, for the first time we present the opportunistic parasitism of M. scalaris on Otobius megnini, which act as a vector of Q fever and is capable of causing paralysis, toxic conditions, otoacariasis and otitis in humans and other animals. Tick samples from the ear canals of 14 thoroughbred horses were brought to the laboratory and several days later, larvae of M. scalaris were found feeding on immature stages of O. megnini. When the development was completed pupae were found attached to adult ticks and all nymphs were found dead. This context reveals the capability of M. scalaris surviving on O. megnini and the risk of their invading ear canals of horses.
The specific heats (Csp) of neat polyvinyl alcohol (NPVOH) and 40 phr glycerol plasticized polyvinyl alcohol (PPVOH) were measured using a method known as power compensate differential scanning calorimetry. A high purity sapphire (Al2O3) was used as a reference material. NPVOH has a melting temperature of approximately 480 K, while PPVOH has a value of 30 K lower than NPVOH. The amplitude increment of Csp for NPVOH was also higher than PPVOH at melting stage. Overall, Csp of NPVOH is lower than PPVOH because glycerol has reduced the rigidity of PVOH and subsequently induced the motion of molecular structure at an elevated temperature. Based on the specific heat outcomes, neat PVOH and glycerol plasticized PVOH required 1173.544 J/g and 1946.631 J/g, respectively, to heat from 330 to 550 K.
Past major flooding events for the state of Johore, Malaysia were recorded in 1926, 1967, 1968 and 1971. However, major meteorological phenomena that hit Johore on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) were claimed to be the worst flood disaster in Johore in a 100 years. All eight districts were affected displacing 157,018 and 155,368 population during the first and the second wave event respectively. The Johore Health Department deployed substantial number of medical and health personnel to deal with the Johore flood crisis. Flood-related data were collected on daily basis between 19th December 2006 and 19th February 2007 using spreadsheet format from Flood Operational Rooms located at respective District Health Offices. Among flood victims 34,530 were found to have non-communicable diseases and 19,670 with communicable diseases. No major food- and water-borne disease outbreaks, such as cholera and typhoid, were reported in Johore. High success of public health measures was depending on the workforce of medical and health personnel on the ground. On the other hand, voluntary services offered by non-governmental organisations (NGOs), private sector and other volunteers should be well coordinated without compromising regulatory and ethical requirements. Crisis guidelines and plan of actions shall be updated so that they would be more relevant to the crises encountered on the ground.
Acute mastoid abscess is common in daily practice. In children, it is usually caused by unsuccessful treatment or partially treated acute otitis media (AOM). Some authors had reported that chronic suppurative otitis media (CSOM) can be the source of infection but it is usually associated with the presence of cholesteatoma. A case of an acute mastoid abscess in a 7 year old girl is presented. She had a history of severe otalgia with left post auricular swelling for 3 days. Clinically she was febrile, the left otoscopy showed diffuse post auricular swelling and sagging of the posterior wall of the external canal. She underwent an emergency cortical mastoidectomy for the left mastoid abscess and had an uneventful recovery. In conclusion, this patient was partially treated with antibiotics which increased the risk for ‘masked mastoiditis’, and she later developed a mastoid abscess. Therefore we advocate that all AOM patients should be treated with antibiotics at least for a duration of one week.
Food borne diseases like cholera, typhoid fever, hepatitis A, dysentery and food poisoning occur as the results of ingestion of foodstuffs contaminated with microorganisms or chemical. The true incidence of food borne disease in Malaysia is unknown, however the incidence is low ranging from 1.56 to 0.14 cases per 100,000 population and the food poisoning cases is on the rise as the evident by the incident rate of 62.47 cases per 100,000 population in 2008 and 36.17 in 2009. The rapid population growth and demographic shift toward ageing population, changing eating habit such as consumption of raw or lightly cooked food, long storage of such food, lack of education on basic rules of hygienic food preparation and food trading without appropriate microbiological safety procedure become contributing factors for food borne diseases. Food borne disease in Malaysia is in the rise and the direct and indirect cost management of FBD will become one of the most common issues to face by the government. The world is spending millions and millions in cost of treatment due to food borne diseases. The information on this paper was collected via findings of previous journals, data and statistics from the MOH of Malaysia and WHO websites. As a result, authors found that the prevention and management of the food borne disease outbreak needs to be addressed seriously.
Acute suppurative thyroiditis is a rare disorder. We saw a 24 year old man with this condition that present atypically. The patient had a non-tender thyroid enlargement associated with fever and leukocytosis. FNA cytology clinched the diagnosis. The abscess was associated with Klebsiella pneumoniae septicemia and required surgical drainage after failing antibiotic therapy.
Objective: The clinical characteristics and out-come offebrile convulsions in children admitted to the University Hospital in Kubang Kerian were analysed in this retrospective study.
Method: The medical records of 244 children aged between 6 months to 5 years who presented with their first convulsions between January 1989 to December 1990 were reviewed. Patients were followed till one year after their first febrile convulsions.
Results: The mean age of presentation was 18.26 (s.d. 11.83) months. One hundred and thirty (54.5%) were males. Complex febrile convulsions were noted in 47.5% and simple febrile convulsions in 52.5%. Seventy-two children (29.5%) were less than one year old at the time offirst febrile convulsions. A family history offebrile convulsions was significantly higher in the complexfebrile convulsions group. Ten children (4.1%) presented with prolonged first febrile convulsions. Data on 117 children on follow-up were available for analysis. Recurrence of febrile convulsions occurred in fifty children (46.7%) with mean interval of 6.53 (s.d. 5.25) months. There was significant difference in children who presented with febrile convulsions at age of less than one year old and having family history offebrile convulsions with regard to recurrence. Three children developed epilepsy at a mean age of 31.56 months. Identifiable causes of febrile convulsions were upper respiratory infection, presumed viral infection (fever with rashes) and acute gastro-enteritis. Laboratory investiga-tions that were done were not helpful.
Conclusions: Children with a family history of febrile convulsions were more likely to develop complex febrile convulsions. Routine investi-gations were rarely helpful. The recurrence rate is significantly influenced by the age of presentation and family history of febrile convulsions in siblings or either parent. The types offebrile convulsions did not significantly influence the recurrent rate.
This study observed the pattern of reported dengue infections, clinical manifestations, and circulating dengue serotypes in Negeri Sembilan, Malaysia. The aim of this study was to determine the co-circulation of the four different dengue virus serotypes in Negeri Sembilan. We analyzed the surveillance data (VEKPRO) from Negeri Sembilan State Health Department and National Public Health Laboratory, Malaysia on reported dengue infections from 1st January 2010 to 31st December 2010. There were 1466 reported dengue infections, 1342 (91.5%) cases were dengue fever (DF) and 124 (8.5%) were dengue hemorrhagic fever (DHF). The mean age was 32.2± 15.8 years old and most were young adults, aged 15 years old and older. Males (p < 0.05), and those residing in Seremban district (p < 0.05) were more likely to get dengue infections. Symptoms presented upon admission were fever (100%), headache (99.9%), myalgia and arthralgia (98.8%), rash(24.2%), petechiae (16.0%),bleeding tendencies (7.0%) and neurological deficits(1.2%). All four dengue serotypes (DEN 1 – 4) were present, the pre-dominant serotype was DEN-3, noted in January, then existed together with DEN-2 until around May. DEN-1 was the most pre-dominant circulating dengue serotype afterwards, reaching a peak in December 2010. Dengue affected all age groups particularly young adults and males. Most cases reported were in urban areas and Seremban district. Most of the dengue infections occurred in the first half of the year, with the DEN-2 and DEN-3 serotypes being the most predominant.
Introduction: Pneumonia is the most common diagnosis made in hospitalised children. The Malaysian Clinical Practice Guidelines on pneumonia and respiratory tract infections provides a comprehensive guidance in the local context. We evaluated the documented assessment and management of children diagnosed with pneumonia admitted to the children’s ward, Hospital Batu Pahat against this guideline.
Methods: We performed a retrospective analysis of hospital case notes for children admitted from January to May 2004.
Results: Ninety six case notes were analysed. Most patients (84%) had at least four positive clinical features leading to the diagnosis of pneumonia. 92% met the guideline criteria for admission. Sp02 was performed for 58% on admission, and 58% with reading below 95% received supplemental oxygen. Throughout hospital stay, each patient had an average of four investigations (range: 1 – 12). Among 23 patients who had further investigations, justifications were only recorded in seven patients (30.4%), and changes in management resulted in 23%. The most common antibiotic prescribed was intravenous Penicillin (97 %). In 17 patients who met the guideline classification for severe pneumonia, none received the recommended antibiotic combination. The median time to fever resolution was 22 hours (range 2 – 268), and median hospital stay was 3 days (range 1 – 12).
Conclusions: Although the quality of clinical assessment and antibiotic choices were acceptable, there was a failure to critically evaluate patients according to disease severity and initiate corresponding investigations and managements. Future efforts need to be directed at promoting further guideline adherence and the exercise of critical judgment in patient evaluation.
The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3 ), patients with CD4 counts ≤ 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ≤ 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.
Rubella is an acute and contagious disease which is mainly characterized by fever, rash, and cervical lymphadenopathy. This contagious disease spreads easily through nasopharyngeal secretions, droplet or direct contact with patients. Meanwhile clinical features of scarlet fever include a sore throat, skin rash and strawberry tongue. A descriptive study was conducted to describe the epidemiological characteristic of diseases at a Training Camp in Mersing. Data obtained on demographic details, onset and time of fever and rash or contact with ill person 14 to 21 days prior to symptoms. Screening and interview conducted for all suspected cases of Rubella. 47.4% of the cases presented on 5th June 2012 followed by 15.8% on 11th June 2012 and 13.5% on 12th June 2012. Maculo papular rash was the predominant presenting symptom among students with acute infection in this outbreak (100%) followed by fever (36.8%). Measles specific IgM was not detected in the serum taken but rubella specific IgM was detected in 66.7% (6/19) of samples. 55% (11/20) were positive for ASOT. 4 trainees had Rubella and Scarlet Fever co-infection. It was found out that the outbreak occurred among 391 residents in the camp who shared common places for activities such as lecture, physical activity and meal. Rapid dissemination was due to overcrowded environment and close contact during common activities of the residents. Theoretically co-infection would be presented with severe clinical symptoms but not in this outbreak where all affected trainees only presented with mild fever and rashes.
Typhoid fever is a systemic infection caused by Salmonella typhi, which may be associated with extra-intestinal
complications. Neurological manifestations, particularly Parkinsonism, are rarely reported. We report a
17-year-old patient with relapsed culture-proven Salmonella typhi infection who developed septic shock and
subsequently Parkinsonism. Lumbar puncture revealed acellular cerebrospinal fluid with raised protein level.
Magnetic resonance imaging revealed cerebral petechial haemorrhages resulted from small vessels vasculitis.
His symptoms resolved spontaneously after 3 months.