Current status of infectious diseases among migrants and non-citizens in Malaysia

The mass movement of migrants to Malaysia for employment is one of the factors contributing to the emergence and re-emergence of infectious diseases in this country. Despite mandatory health screening for migrants seeking employment, prevalence records of infectious diseases amongst migrant populations in Malaysia are still within negligible proportions. Therefore, the present review highlights the incidence, mortality and overall status of infectious diseases amongst migrants' populations in Malaysia, which maybe be useful for impeding exacerbation of inequalities among them and improving our national health system thru robust and effective emergency responses in controlling the prevalent diseases found among these populations and maybe, Malaysian citizens too. Peer-reviewed articles from January 2016 to December 2020 were searched through online platform including SCOPUS, PubMed, Science Direct, and Google Scholar. Non-peer-reviewed reports and publications from ministry and government websites including data from related agencies were also scoured from in order to ensure that there are no cases being overlooked, as most published articles did not have migrants as the research subjects. A total of 29 studies had been selected in the final analysis. Migrants in Malaysia were at higher risk for tuberculosis, malaria, lymphatic filariasis, cholera, leprosy and leptospirosis. Lymphatic filariasis was still endemic among this population while thousand cases of TB and cholera had been reported among them due to cramp living conditions and poor sanitation in their settlements respectively. While malaria had gradually decreased and become sporadic, the influx of migrant workers had led to the rising of imported malaria cases. Low cases of leprosy had been recorded in Malaysia but a significant proportion of it was contributed by migrant workers. As for leptospirosis, studies found that there are prominent cases among migrant workers, which particularly highest within workers with lower educational attainment. Infectious diseases are still prevalent among migrants in Malaysia due to various interplay factors including their working sectors, country of origin, immunization status, type of settlement, impoverished living conditions, and language and cultural barriers that impeding access to health facilities.

Poverty related diseases amongst Malaysia's low-income community: a review

Poverty, as proven by several studies, is a driving force behind poor health and hygiene practices. This review attempts to outline common communicable and non-communicable diseases that disproportionately affect Malaysia's 2.91 million low-income households. The current study also looks into the government's housing and healthcare programmes for this demographic to improve their health and well-being. The initial examination yielded incredibly little research on this marginalised community, with event reporting typically generalised to the Malaysian community as a whole rather than analysing disease incidences based on household income, which would better reflect povertydriven diseases. As a result, there is an acute need for more accurate information on the epidemiology of diseases among the poor in order to address this public health issue and provide conclusions that can drive policy designs.

Molecular survey of head lice (Pediculus humanus capitis) infestation among disadvantaged children in Klang Valley, Malaysia

Ectoparasitic infestations including pediculosis capitis are common in people of disadvantaged communities as they live in overcrowded institutions, a condition that often favourable for disease transmission. In this study, we evaluated the prevalence of head lice infestation among disadvantaged children aged between five to 14 years-old living in five poor conditions located across the Klang Valley, Malaysia. Of total 335 children examined, 14% were positively infected with head lice. Molecular analysis using the universal cytochrome c oxidase subunit I ( COI) barcoding gene on total of 167 head lice collected in this study indicated they are belonging to the A and C clades; confirming the global distribution of clade A and expansion of clade C in Southeast Asia, which is reported for the first time in Malaysia.

Cutaneous leishmaniasis-Awareness, knowledge and practices among general population in rural and urban areas in Malakand region, Pakistan

Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.

Post-era mass drug administration: an update on intestinal parasitic infections in urban poor communities in Peninsular Malaysia

The health impact of a Malaysian national helminth control program which provided school-based anthelmintic chemotherapy from 1974 to 1983 was re-visited after three decades post MDA and associated risk factors amongst urban poor communities identified. Stool samples collected were screened using the formalin ethyl-acetate concentration technique recovered at least one species of helminth and/or protozoan. Despite a steady decline observed between 1974-1983 however, post MDA infections continue to persist in pockets of communities moderately (18.9%; n=39/206) with higher infection recorded amongst PPR flat residents (22.5%, n=16/71). Among risk factors identified, waste management method was the primary factor for Ascaris lumbricoides infections (n=33; 16.0%), whereas age, education, employment and source of drinking water were significant risk factors for cryptosporidiosis. Despite the government's efforts to improve health through the provision of basic amenities to the general public, higher prevalence values amongst PPR flat dwellers suggests the need to implement targeted chemotherapeutic treatment of, once a year deworming as recommended by World Health Organization when the baseline prevalence of soil-transmitted helminth infections in the community is over 20%, in addition to preventive measures though improvements in health awareness programs and improved waste management methods.

Impact of pH on the viability and morphology of Blastocystis isolates

Blastocystis sp. is ubiquitous in avian, mammalian and human hosts and propagates in either neutral or slightly alkaline conditions within the host's gastro-intestinal tract. Of the few previous studies on this enteric protozoan parasite in feline and canine hosts, prevalence values have been shown to range between 0 to 70.8%. In view of the close association between humans, and canine and feline hosts as companion animals, faecal samples of 180 Felis catus and 82 Canis lupus, collected from Penang and Kuala Lumpur, Malaysia, were initially screened by in vitro cultivation followed by molecular characterization. No positive isolates were identified in culture but in 12 feline samples DNA barcoding detected a zoonotic subtype Blastocystis ST1 for the first time. Consequently, avian and human isolates, which had previously been successfully cultured, were used to investigate the impact of pH on the viability and morphology of Blastocystis sp. The use of Trypan blue showed that the number of viable cells increased when exposed to pH 4 and a significant increase in viability occurred in pH values of 5 to 7. Development of Blastocystis cells in both isolates was suppressed in media less than pH 5 followed by the disappearance of viable cells from avian isolates in more acidic media below pH 4. Morphologically at pH 4 cells from avian isolates were less rounded, and with wrinkled / shrunken surfaces, than the more normal rounded cells from human isolates. On the other hand, at values below pH 3, no viable cells in human isolates were visible. The present findings therefore confirm that gastro-intestinal pH is an important determinant of Blastocystis viability and consequently influences the epidemiology of infection within avian, mammalian and human hosts.

Genetic diversity of rodent Blastocystis sp. from Peninsular Malaysia

Rodents are ubiquitous zoonotic vectors for many human pathogens including Blastocystis sp. In this study, we examined the prevalence and subtypes of Blastocystis sp. in rodents captured from Peninsular Malaysia. A total of 293 rodents predominantly brown rat (Rattus norvegicus) (290 of 293, 99.0%) and house shrew (Suncus murinus) (3 of 293, 1.0 %), were captured in the vicinity of popular eateries in two cities (Kuala Lumpur and Ipoh) in Peninsular Malaysia. In vitro cultivation method showed presence of Blastocystis sp. in approximately half (133 of 290, 45.9%) of the brown rats tested. Among the 47 Blastocystis isolates subtyped using partial small subunit ribosomal RNA gene analysis, ST4 was the most abundant (43 of 47, 91.5%) followed by ST1 (2 of 47, 4.3%), ST5 (1 of 47, 2.1%) and ST7 (1 of 47, 2.1%). Our findings highlighted the importance of rodents as a source of Blastocystis sp. infection in Malaysia and showed the high prevalence of ST4 within the rodent population infected with Blastocystis sp.

Current status of Blastocystis in cockroaches

There are few reports on Blastocystis spp. infections in invertebrate hosts namely, cockroaches. Due to their close proximity to humans especially to their dwellings prompted this study as these organisms could possibly play a role in human transmission. A total of 151 cockroaches consisted predominantly of nymph and adult stages were captured from several types of dwellings in the state of Perak and Selangor, Malaysia. Approximately half (40.4%) of the cockroach intestinal contents screened were positive and were found associated to two main factors, host-stage and types of dwellings. The granular and vacuolated forms were the most common cell form found in the in vitro cultures and were morphologically similar to B. hominis. However, the surface coat observed was thick with an electron lucent area observed in the central vacuole. The isolates grew in room temperature but optimal growth was observed at a 24ºC similar to the reptilian Blastocystis with a high number of cells were recovered. Using the DNA barcoding method, two isolates were identified as ST3 (allele 56), one isolate was consider as the new subtype with close relation to allele 114.

Morphological and molecular detection of Blastocystis in wildlife from Tioman Island, Malaysia

Blastocystis infection is widely reported in wildlife, livestocks and in non-human primates however, occurrence in Malaysian wildlife is scarce. A wildlife survey on Tioman Island captured six water monitor lizard (Varanus salvator), four mouse-deer (Tragulus sp.) and one Malayan porcupine (Hystrix brachyura) based on convenience sampling. Intestinal contents from each animal were subjected to in vitro cultivation method using Jones medium supplemented with 10% horse serum. Low prevalence of infections was detected with only 1/6 (16.7%) water monitor lizard and 1/4 (25%) mouse-deer infected. The vacuolated form was the most common cell form found in both cultures with similar morphology to B. hominis. However, the monitor lizard isolate propagated well in the laboratory for several months using Jones medium while mouse-deer isolate could not be maintained for more than a week. The reptilian isolates grew optimally at a lower temperature of 24ºC compared to 37ºC for the mouse-deer isolate. Using the DNA barcoding method, both isolates were confirmed to be Blastocystis sp. Sequence obtained from a monitor lizard isolate has 94% sequence identity to B. lapemi, an isolate recovered from a reptile sea-snake whereas a mouse-deer isolate has 99% sequence identitical to B. hominis HJ01-7. The phylogenetic tree revealed that the monitor lizard isolate were positioned within the herptiles clade (clade VIII) while the mouse deer isolate located at the homoithermal clade (clade IV). The present paper is the first report on the presence as well as genetic characteristics of Blastocystis in wildlife captured from Tioman Island, Pahang.

Serological and molecular identification of Leptospira spp. in swine and stray dogs from Malaysia

Leptospirosis is endemic in Malaysia with Leptospira species extensively isolated from domestic and wild animals. Rats were found to be the principal maintenance hosts followed by cattle, pigs, and dogs. The objectives of this study were to isolate and identify Leptospira serovars circulating among swine from three different farms and also from stray dogs and cats from Klang valley, Selangor, Malaysia. Urine and kidney samples collected from 150 stray dogs, 50 cats and 81 swine were inoculated into semi-solid Ellinghausen McCullough Johnson and Harris (EMJH) media supplemented with additional 5-Fluorouracil. Dark field microscopy revealed only one positive culture of Leptospira from dog and swine samples, but all cat samples were negative. The PCR technique using published primers detected 11 positives in urine samples of dogs and 5 positives from swine. The microscopic agglutination test (MAT) confirmed the presence of two serovars in both dog and swine populations namely, L. interrogans serovar Canicola and L. interrogans serovar Pomona (MAT > 100), with Not I-PFGE analyses separating these two serovars into distinct profiles. Despite the low prevalence in stray dogs, the latter may play an important role in the contamination of the environment. Swine can also pose a potential risk of infection to humans and other domestic animals, especially those living close to swine farms. Thus improving hygiene and eradication of rodents in swine farms are likely to reduce the risk of infection.

Isolation and Identification of an Emerging Pathogen, Kocuria marina, from Rattus rattus diardii

Members of the genus Kocuria are commonly found in the environment and they are also commensals of the mammalian skin and oropharynx mucosa. Human infections, although rare, are increasingly being reported recently suggesting that this genus has mostly been overlooked or misidentified. Its transmission route however, is still not known. We report here the isolation and identification of a Kocuria marina isolate from the lung of a wild urban rat (Rattus rattus diardii) caught at a wet market. The isolate was susceptible to most of the commonly used antibiotics. The finding suggests a possibility that rats could be a vector for K. marina.

Comparison between Quantitative Buffy Coat (QBC) and Giemsa-stained Thin Film (GTF) technique for blood protozoan infections in wild rats

The quantitative buffy coat (QBC) technique and conventional Giemsa thin blood smear was compared to determine the sensitivity and specificity of the technique in detecting blood parasitic infection of the rodent populations from four urban cities in Peninsular Malaysia. A total of 432 blood samples from four rat species (Rattus norvegicus, Rattus rattus diardii, Rattus exulans and Rattus argentiventer) were screened using both techniques and successfully detected two blood protozoan species (Trypanosoma lewisi and Plasmodium sp.) with Trypanosoma lewisi predominantly infecting the population. Results showed that Giemsa-stained thin film (GTF) was the better detection method on blood parasitemia (46.7%) compared to Quantitative Buffy Coat method (38.9%) with overall detection technique sensitivity and specificity at 83.2% and 74.8% respectively. The sensitivity in detection of Trypanosoma lewisi was 84.4% with value slightly lower for Plasmodium sp. infections at 76.6%. Statistical analysis proved that GTF technique was significantly more sensitive in the detection of blood protozoan infections in the rodent population compared to QBC (p<0.05).

Identification of rickettsiae from wild rats and cat fleas in Malaysia

Rickettsioses are emerging zoonotic diseases reported worldwide. In spite of the serological evidence of spotted fever group rickettsioses in febrile patients in Malaysia, limited studies have been conducted to identify the animal reservoirs and vectors of rickettsioses. This study investigated the presence of rickettsiae in the tissue homogenates of 95 wild rats and 589 animal ectoparasites. Using PCR assays targeting the citrate synthase gene (gltA), rickettsial DNA was detected in the tissue homogenates of 13 (13.7%) wild rats. Sequence analysis of the gltA amplicons showed 98.6-100% similarity with those of Rickettsia honei/R. conorii/R. raoultii (Rickettsiales: Rickettsiaceae). Sequence analysis of outer membrane protein A gene (ompA) identified Rickettsia sp. TCM1 strain from two rats. No rickettsia was detected from Laelaps mites, Rhipicephalus sanguineus and Haemaphysalis bispinosa ticks, and Felicola subrostratus lice in this study. R. felis was identified from 32.2% of 177 Ctenocephalides felis fleas. Sequence analysis of the gltA amplicons revealed two genotypes of R. felis (Rf31 and RF2125) in the fleas. As wild rats and cat fleas play an important role in the enzoonotic maintenance of rickettsiae, control of rodent and flea populations may be able to reduce transmission of rickettsioses in the local setting.

The cat fur mite, Lynxacarus radovskyi Tenorio, 1974 (Acarina: Astigmata: Listrophoridae) from cat, Felis catus in peninsular Malaysia

The cat fur mite, Lynxacarus radovskyi Tenorio, 1974 (Acarina: Astigmata: Listrophoridae) is reported from cats, Felis catus from three sites in peninsular Malaysia. The first site is a Malay village, Kampong Menteri in Taiping, Perak, where the mites were found on local pet cats. The other two sites are urban cities of Kuala Lumpur, in the Federal Territory and Georgetown, in the island of Penang. Mites from the urban areas were collected from stray cats. Although several ectoparasites (fleas, mites, ticks and lice) have been previously reported, L. radovskyi is recorded herein for the first time on cats from peninsular Malaysia.

The dog louse Heterodoxus spiniger from stray cats in Penang, Malaysia

Stray cats collected from Georgetown, Penang from 2008 to 2010 were screened for ectoparasites via fine-tooth combing. Two cats from a total 102 examined were infested with the dog louse, Heterodoxus spiniger. Both cats, a juvenile male and female were found in close contact with each other prior to capture. The number of lice ranged from 5 and 14 in the male and female cat respectively. Other ectoparasites recovered included the common cat flea, Ctenocephalides felis, one louse species Felicola subrostratus, one tick species Haemaphysalis bispinosa and one mite species of Listrophoridae. The present study reports for the first time the finding of H. spiniger on cats from peninsular Malaysia.