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Low prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia

Menon BS, Abdullah S, Mahamud F, Morgan UM, Malik AS, Choo KE, et al.

Southeast Asian J Trop Med Public Health, 2001 Jun;32(2):319-22.
PMID: 11556583

The aim of this prospective study was to determine the prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia. Over a 19 month study period, 258 stool samples were examined from 159 children; 109 with diarrhea and 50 controls without diarrhea. Modified Ziehl-Neelsen staining method and a polymerase chain reaction (PCR) assay were used to detect C. parvum and the samples were also examined for the presence of other intestinal parasites. Only 1 of the 109 (0.9%) children with acute diarrhea was positive for C. parvum by microscopy and PCR. Thirty-one percent of children were infested with other intestinal parasites, the most common being Ascaris lumbricoides and Trichuris trichiura. In conclusion, we found C. parvum to be an uncommon infective agent in hospitalized children with or without diarrhea in Kota Bharu, Malaysia.

Matched MeSH terms: Diarrhea/etiology; Diarrhea/parasitology
Definitions, attitudes, and management practices in relation to diarrhea during enteral nutrition: a survey of patients, nurses, and dietitians

Majid HA, Emery PW, Whelan K

Nutr Clin Pract, 2012 Apr;27(2):252-60.
PMID: 22223668 DOI: 10.1177/0884533611431986

Diarrhea is a common complication in patients receiving enteral nutrition (EN), and understanding this problem among patients and healthcare professionals is required. The aim of the study was to investigate patients', nurses', and dietitians' definitions of diarrhea during EN, the attitudes of nurses and patients toward it, and the management practices of nurses and dietitians in response to diarrhea during EN.

Matched MeSH terms: Diarrhea/etiology; Diarrhea/nursing; Diarrhea/therapy*
Prevalence of Giardia lamblia with or without diarrhea in South East, South East Asia and the Far East

Dib HH, Lu SQ, Wen SF

Parasitol Res, 2008 Jul;103(2):239-51.
PMID: 18425689 DOI: 10.1007/s00436-008-0968-6

This article is a review of the latest information on the prevalence of G. lamblia in South Asia, South East Asia and Far East, characterizing the current endemic situation within these regions. Around 33 published papers from 2002-2007 were collected on G. lamblia. The included countries were Nepal, Bangladesh, India, Cambodia, Vietnam, Malaysia, Philippines, Indonesia, Thailand, Republic of Korea, and China. Only five published papers were discarded because data was extracted before 2002-2007 or they are not included within our regions, emphasizing more on G. lamblia in animals, or performed at extensive molecular level. The prevalence of G. lamblia varied markedly between studies illustrating higher levels in the urban than in the rural areas, more among poor communities, slightly higher in males than in females with age range of 2-5-year-old children, and among university students, old-aged people, HIV-positive patients, and gastric carcinoma patients. Though G. lamblia is not a life-threatening parasite, nevertheless, it is still considered as the most common water-borne diarrhea-causing disease. It is important to understand the etiology, frequency, and consequences of acute diarrhea in children. Routine surveillance such as bi-annual follow-up treatments, treating G. duodenalis cysts and other protozoa oocysts detected in ground water sources, and continuous health education are the most preventive measures.

Matched MeSH terms: Diarrhea/diagnosis; Diarrhea/epidemiology*; Diarrhea/parasitology
Rotavirus and other enteropathogens in childhood acute diarrhoea: a study of two centres in Malaysia

Lee WS, Rajasekaran G, Pee S, Karunakaran R, Hassan HH, Puthucheary SD

J Paediatr Child Health, 2006 Sep;42(9):509-14.
PMID: 16925536

To study the role of rotavirus in children hospitalised for acute gastroenteritis (AGE) in two urban hospitals in Malaysia.

Matched MeSH terms: Diarrhea/microbiology; Diarrhea/epidemiology; Diarrhea/virology*
Fulltext Phytochemicals and biological activity of Tetracera scandens Linn. Merr. (Dilleniaceae): A short review

Nokhala A, Siddiqui MJ

J Pharm Bioallied Sci, 2020 07 18;12(3):217-222.
PMID: 33100780 DOI: 10.4103/jpbs.JPBS_192_19

Tetracera scandens is a southeast Asian shrub that belongs to family Dilleniaceae. Over the years, different parts of the plant have been used for the management of different diseases, including diabetes mellitus, hypertension, rheumatism, diarrhea, hepatitis, and inflammation. This variety of medical indications has attracted the attention of many researchers to this plant species, leading to the conduction of many research studies on different parts of the plant. These studies have confirmed some of the aforementioned activities of the plant, whereas other indications remain to be ascertained. This article is an attempt to summarize the studies conducted on T. scandens and to explore the isolated phytochemicals.

Matched MeSH terms: Diarrhea
Effect of diarrhoea on Tacrolimus trough level in a post liver transplant patient

Tan ST, Yoong BK

Med J Malaysia, 2020 11;75(6):734-735.
PMID: 33219186

Tacrolimus, which bonds to an immunophilin, FK506 binding protein (FKBP) has emerged as one of the most widely used immunosuppressant post solid organ transplantation. It offers excellent patient survival rates post-transplantation and a lesser number of acute rejections as compared to cyclosporine. Tacrolimus has a narrow therapeutic window with overexposure leading to acute and chronic forms of nephrotoxicity. Remarkably few data have been published on the overexposure to tacrolimus following mild diarrhoea in post-transplant patients who received treatment with tacrolimus. We observed a post-liver transplant patient with increased trough level of tacrolimus during severe diarrhoea with no complications following a timely adjustment on the dose of tacrolimus.

Matched MeSH terms: Diarrhea
First molecular detection of Tritrichomonas foetus in domestic cats in Klang Valley, Malaysia

Tan LP, Megat Abd Rani PA, Sharma RSK, Syed Hussain SS, Watanabe M

Trop Biomed, 2020 Sep 01;37(3):756-762.
PMID: 33612788 DOI: 10.47665/tb.37.3.756

Tritrichomonas foetus is known to cause chronic diarrhea in the feline species in many different regions of the world. However, there is a paucity of information on T. foetus among cats in Malaysia. This study was conducted to determine the prevalence of Tritrichomonas foetus in the pet and stray cat population in Klang Valley, Malaysia. A total of 201 pet and stray cats' fecal samples were collected in Klang Valley. 24 samples were cultured in the InPouch® TF Feline to observe for motile trophozoites. A nested PCR protocol was used to screen for T. foetus in the collected samples. The prevalence of T. foetus in the cat population in Klang Valley was 33%. There was no association between Tritrichomonas infection and age, sex, breed or management of the cats. However, statistical analysis revealed that stray cats were more likely to be infected with T. foetus compared to pet cats. This study confirmed for the first time the presence of T. foetus among the cat population in Klang Valley, Malaysia.

Matched MeSH terms: Diarrhea
Fulltext Quantitative detection and characterization of Shiga toxin-producing Escherichia coli O157 and non-O157 in raw vegetables by MPN-PCR in Malaysia

Loo, Y. Y., Puspanadan, S., Goh, S. G., Kuan, C. H., Chang, W. S., Lye, Y. L., et al.

International Food Research Journal, 2013;20(6):3313-3317.
MyJurnal

Foodborne diseases are mainly caused by bacterial contamination which can lead to severe diarrhea. This study aimed to detect the presence of Shiga toxin-Producing Escherichia coli O157, Escherichia coli non-O157 and virulence gene in raw vegetables. The samples were purchased from wet market and hypermarket in Selangor. The detections were carried out by using the combination methods of Most Probable Number-Polymerase Chain Reaction (MPNPCR). A total of 37(18.5%) samples were found to be contaminated by STEC. Out of these 37 isolates, four (10.8%) of the isolates were E. coli O157 while 33(89.2%) were E. coli nonO157. However, there was no E. coli O157:H7 detected in all the samples. The occurrence of Shiga toxin-Producing E. coli in edible raw vegetables samples suggests the importance of this pathogen in vegetables. Therefore, more studies are required to remove this pathogen from vegetables.

Matched MeSH terms: Diarrhea
Fulltext Food poisoning outbreak among Health Institute A staff 1st June 2010

Riana, K.A.H., Azahadi, O., Rohani, I., Zainol Ariffin, P., Maznieda, M., Siti Zubaidah, A.

Journal of Health Management, 2012;10(1):41-51.
MyJurnal

Purpose - An outbreak of food poisoning had occurred in Health Institute A on 1st June 2010 which involved twenty four staffs. Six of them were hospitalized and eighteen received outpatient treatment. A case control study was done to describe the epidemiological characteristics of the outbreak and to determine the source of infection.
Design/methodology/approach - Food samples, rectal swab from cases, environmental and hand swab from the food handlers were also taken and sent for microbiological analysis.
Finding- The outbreak was explosive, and the prominent clinical features were abdominal pain (62.2%), fever (51.4%), and diarrhea (56.8%). The onset time was between 9-24 hours and the median incubation period was at 15 hours. The possible source of the outbreak was durian gravy (OR= 14.00,95%CI: 2.72-92.55, p<0.001, food attack rate: 100%) and rotijala (OR= 6.69, 95%CI: LB5-24.23, p<0.001, food attack rate: 95%), The microbiological investigation revealed that various microorganisms including Salmonella spp, The food was supplied by the same food supplier from Caterer B since 2006 and the assessment of the kitchen showed that the cleanliness rate was only 54,3% with positive results of Coliform in all utensils and areas investigated in the kitchen.
Conclusion- In conclusion, the most probable causative organism based on signs and symptoms, epidemiological analysis and microbiological results was Salmonella spp. from contaminated food seryed during the ceremony. Education on food safety and food hygiene especially personal hygiene and hand washing should be emphasized continuously for prevention of future outbreak,

Matched MeSH terms: Diarrhea
Fulltext Parasitic infection in a young man presenting with non-specific abdominal pain

Farnaza A, Baha L

Malays Fam Physician, 2010;5(3):148-150.
PMID: 25606208 MyJurnal

A 27-year-old man presented with a two-week history of central colicky abdominal pain associated with loose stools. Further history revealed that he had been exposed to contaminated waters. Stool investigation by direct wet stool smears revealed the presence of Entamoeba histolytica and Blastocystis hominis cysts. A diagnosis of amoebiasis secondary to E. histolytica and concurrent B. hominis infestation was made. We would like to emphasise the importance of clinical history including recent travel to endemic areas. Any suspicion of parasitic infection should prompt the clinician to investigate. Early diagnosis and management would prevent serious complications associated with E. Histolytica infection.

Matched MeSH terms: Diarrhea
Fulltext The health benefits of probiotics

Yap, Wei Boon, Rina Anak Sujang

Jurnal Sains Kesihatan Malaysia, 2014;12(2):41-44.
MyJurnal

There has been a significant increase in research on probiotics-associated health benefits in the last 20 years. Many studies carried out in vitro and clinically show that consumption of probiotics inhibits the growth of pathogenic microorganisms. Furthermore, the consumption of probiotics also enhances the host immune response and decreases the levels of carcinogenesis-inducing enzymes. These positive outcomes have led to the use of probiotics in prevention and treatment of infectious diseases like bacterial or antibiotic associated diarrhea, chronic inflammatory bowel diseases and colon cancer. This review summarises literature pertaining to mechanistic actions of probiotics in improving the well-being of hosts.

Matched MeSH terms: Diarrhea
Fulltext Gastrojejunocolic fistula: A case report

Khairussaleh B.J., Kyaw, T.H.

International Medical Journal Malaysia, 2009;8(2):43-45.
MyJurnal

Benign gastrojejunocolic fistula is mostly due to Bilroth II operations. It typically presents with a triad of feculent vomiting, weight loss and chronic diarrhoea but sometimes the diagnosis is not straight forward. We discuss a case that presented and was investigated as intestinal obstruction however diagnosed with gastrojejunocolic fistula during surgery.

Matched MeSH terms: Diarrhea
Fulltext Comparison between yogurt and commercial probiotics in the duration of diarrhea in pediatric age group

Aamer Naseer, Humayun Iqbal Khan, Mian Jawad Ahmad, Rabia Tariq, Atif Amin Baig

Malaysian Journal of Paediatrics and Child Health, 2017;23(1):0-0.
MyJurnal

Objective: To compare the mean duration of diarrhea between children taking yogurt and with the group taking commercial probiotics, containing lactobacillus in acute watery diarrhea. Materials and

Methods: This descriptive study was conducted in the Department of Pediatrics, Services Hospital, Lahore. The duration of this cross sectional study was 6 months, from June 2013 to November 2013. A total of 200 children suffering from acute watery diarrhea were involved in the study after the informed consent under the said hospital. Their demographic information was recorded and later divided in two groups of 100 each; group A received yogurt and group B was given commercial probiotic. The duration of diarrhea was observed in both groups. The results were compared by using independent sample t-test.

Results: The average duration of diarrhea in group A, was 1.98 + 1.31 day while that in group B was 3.09 + 1.64 days. Student's t-test was applied and the difference between the two groups was found to be statistically significant (p< 0.05).

Conclusions: Treatment with yogurt significantly decreases the mean duration of diarrhea as compared to probiotic among patients with acute watery diarrhea.

Matched MeSH terms: Diarrhea
Fulltext Aseptic abscess syndrome associated with traveler's diarrhea after a trip to Malaysia

Panos Z, Giannopoulos G, Papangeli E, Antalis E, Pavli A, Spathis A, et al.

IDCases, 2016;6:23-5.
PMID: 27672562 DOI: 10.1016/j.idcr.2016.09.001

The first, to our knowledge, case of the aseptic abscesses syndrome as a complication of traveler's diarrhea after a trip to Malaysia is presented. The patient failed to respond to several antimicrobials. The diagnosis was histologically confirmed and the patient only responded to immunomodulatory therapy with corticosteroids and methotrexate. Travel physicians should be aware of this entity reviewed herein in the context of traveler's diarrhea.

Matched MeSH terms: Diarrhea
A brief review of fifty years of medical history in Selangor, Federation of Malaya

Milne JJC

Med J Malaya, 1948;2:161-73.

This is an interesting piece of Colonial history, compiled, one presumes, from official reports. It cannot satisfactorily be summarized. The author deals with his subject under various heads: hospitals, health legislation, dangerous infectious diseases, prevailing diseases, beriberi, fever and malaria, dysentery, and diarrhoea, influenza and enteric fever. In a table are given the numbers of cases of smallpox, cholera, plague, beriberi, dysentery, diarfhoea and fevers reported each year from 1890 to 1939. The only one of these to show steady reduction is beriberi, which began to decline from figures over 2,000 per annum before the 1914-18 war to 69-444 per annum from 1930 to 1939. Plague was never common and neither cholera nor smallpox was responsible for large numbers of cases. The author does not give any systematic accounts of the outstanding investigations made during the period, but rather quotes opinions expressed by Government servants, medical or lay, in their reports. Charles Wilcocks.

Matched MeSH terms: Diarrhea
Enteropathy-associated T-cell Lymphoma (EATL) with intracranial metastasis : a rare and dismal condition

Chuah YY, Tashi T, Lee YY, Fu TY, Shih CA

Acta Gastroenterol Belg, 2020 4 2;83(1):77-80.
PMID: 32233276

Background: Enteropathy-associated T-cell lymphoma (EATL) is a rare type of gastrointestinal non-Hodgkin's Lymphoma. EATL with intracranial metastasis is even rarer. We report a case of EATL with intracranial metastasis.
Case Presentation: A 36-years old man presented with five weeks history of intractable diarrhea. Colonoscopy was normal, but abdominal computed tomography (CT) scan revealed mural thickening at duodenojejunal junction, and subsequent jejunofiberoscopy showed a circumferential ulceration at the jejunum. Histo-immunopathology confirmed the diagnosis of enteropathyassociated T-cell lymphoma (EATL) type II. His disease course proved to be aggressive and refractory to standard front-line chemotherapy, and eventually progressed through second-line salvage regimen with CNS and intracranial involvement. He died nine months after the initial diagnosis.
Conclusion: EATL with brain metastasis is a very rare occurrence with dismal prognosis.

Matched MeSH terms: Diarrhea
Fulltext Emergence of equine-like G3 strains as the dominant rotavirus among children under five with diarrhea in Sabah, Malaysia during 2018-2019

Amit LN, Mori D, John JL, Chin AZ, Mosiun AK, Jeffree MS, et al.

PLoS One, 2021;16(7):e0254784.
PMID: 34320003 DOI: 10.1371/journal.pone.0254784

Rotavirus infection is a dilemma for developing countries, including Malaysia. Although commercial rotavirus vaccines are available, these are not included in Malaysia's national immunization program. A scarcity of data about rotavirus genotype distribution could be partially to blame for this policy decision, because there are no data for rotavirus genotype distribution in Malaysia over the past 20 years. From January 2018 to March 2019, we conducted a study to elucidate the rotavirus burden and genotype distribution in the Kota Kinabalu and Kunak districts of the state of Sabah. Stool specimens were collected from children under 5 years of age, and rotavirus antigen in these samples was detected using commercially available kit. Electropherotypes were determined by polyacrylamide gel electrophoresis of genomic RNA. G and P genotypes were determined by RT-PCR using type specific primers. The nucleotide sequence of the amplicons was determined by Sanger sequencing and phylogenetic analysis was performed by neighbor-joining method. Rotavirus was identified in 43 (15.1%) children with watery diarrhea. The male:female ratio (1.9:1) of the rotavirus-infected children clearly showed that it affected predominantly boys, and children 12-23 months of age. The genotypes identified were G3P[8] (74% n = 31), followed by G1P[8] (14% n = 6), G12P[6](7% n = 3), G8P[8](3% n = 1), and GxP[8] (3% n = 1). The predominant rotavirus circulating among the children was the equine-like G3P[8] (59.5% n = 25) with a short electropherotype. Eleven electropherotypes were identified among 34 strains, indicating substantial diversity among the circulating strains. The circulating genotypes were also phylogenetically diverse and related to strains from several different countries. The antigenic epitopes present on VP7 and VP4 of Sabahan G3 and equine-like G3 differed considerably from that of the RotaTeq vaccine strain. Our results also indicate that considerable genetic exchange is occurring in Sabahan strains. Sabah is home to a number of different ethnic groups, some of which culturally are in close contact with animals, which might contribute to the evolution of diverse rotavirus strains. Sabah is also a popular tourist destination, and a large number of tourists from different countries possibly contributes to the diversity of circulating rotavirus genotypes. Considering all these factors which are contributing rotavirus genotype diversity, continuous surveillance of rotavirus strains is of utmost importance to monitor the pre- and post-vaccination efficacy of rotavirus vaccines in Sabah.

Matched MeSH terms: Diarrhea/epidemiology; Diarrhea/pathology*; Diarrhea/virology
Prevalence of Clostridium difficile infection and colonization in a tertiary hospital and elderly community of North-Eastern Peninsular Malaysia

Zainul NH, Ma ZF, Besari A, Siti Asma H, Rahman RA, Collins DA, et al.

Epidemiol Infect, 2017 Oct;145(14):3012-3019.
PMID: 28891459 DOI: 10.1017/S0950268817002011

Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P < 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey. C. difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

Matched MeSH terms: Diarrhea/etiology; Diarrhea/microbiology; Diarrhea/epidemiology
Fulltext Detection and genetic characterization of canine astroviruses in pet dogs in Guangxi, China

Zhou H, Liu L, Li R, Qin Y, Fang Q, Balasubramaniam VR, et al.

Virol J, 2017 08 17;14(1):156.
PMID: 28814340 DOI: 10.1186/s12985-017-0823-4

BACKGROUND: Astroviruses (AstVs) have been reported to infect and cause gastroenteritis in most animal species. Human AstVs were regarded the causative agent of viral diarrhea in children. In dogs, little is known about the epidemiology and clinical significance of AstV infection.
FINDINGS: In this study, we collected and tested 253 rectal swabs from pet dogs; of which 64 samples (25.3%) tested positive for AstVs with diarrhea and 15 more samples (5.9%) also was identified as AstVs, however without any clinical signs. Phylogenetic analysis of 39 partial ORF1b sequences from these samples revealed that they are similar to AstVs, which can be subdivided into three lineages. Interestingly, out of the 39 isolates sequenced, 16 isolates are shown to be in the Mamastrovirus 5/canine astrovirus (CAstV) lineage and the remaining 23 isolates displayed higher similarities with known porcine astrovirus (PoAstV) 5 and 2. Further, analysis of 13 capsid sequences from these isolates showed that they are closely clustered with Chinese or Italy CAstV isolates.
CONCLUSIONS: The findings indicate that CAstVs commonly circulate in pet dogs, and our sequencing results have shown the genomic diversity of CAstVs leading to increasing number of clusters.

Matched MeSH terms: Diarrhea
Fulltext Early onset muscarinic manifestations after wild mushroom ingestion

Chew KS, Mohidin MA, Ahmad MZ, Tuan Kamauzaman TH, Mohamad N

Int J Emerg Med, 2008 Sep;1(3):205-8.
PMID: 19384518 DOI: 10.1007/s12245-008-0054-y

Despite being a favorite delicacy, only 200-300 of the 5,000 known mushroom species have been clearly established to be safe for consumption. Cases of mushroom poisoning have been reported with diverse clinical syndromes. A syndromic classification of mushroom poisoning has recently been developed to facilitate early interventions. We present a series of five cases of mushroom poisoning with muscarinic manifestations to highlight the difficulties we faced with exact species and toxin identification and the importance of this syndromic classification. The common symptoms in our case series are blurred vision, diarrhea, vomiting, and abdominal cramps.

Matched MeSH terms: Diarrhea

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