1
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Wen YT, Cheng AC, Podin Y. Precision Medicine for Sepsis Management in Low- and Middle-Income Countries-Melioidosis as a Model? Am J Respir Crit Care Med 2024; 209:237-238. [PMID: 38055331 PMCID: PMC10840778 DOI: 10.1164/rccm.202311-2056ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Yeo Tsin Wen
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore, Singapore
- National Centre for Infectious Diseases Singapore, Singapore
- Department of Infectious Diseases Tan Tock Seng Hospital Singapore, Singapore
| | - Allen C Cheng
- Professor/Director Infectious Diseases Monash Health School of Clinical Sciences Monash University Melbourne, Victoria, Australia
- Director of Infection Prevention and Healthcare Epidemiology Professor in Infectious Diseases Epidemiology Alfred Hospital Melbourne, Victoria, Australia
| | - Yuwana Podin
- Institute of Health and Community Medicine University of Malaysia, Sarawak Sarawak, Malaysia
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2
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Hall CM, Somprasong N, Hagen JP, Nottingham R, Sahl JW, Webb JR, Mayo M, Currie BJ, Podin Y, Wagner DM, Keim P, Schweizer HP. Exploring Cefiderocol Resistance Mechanisms in Burkholderia pseudomallei. Antimicrob Agents Chemother 2023; 67:e0017123. [PMID: 37133377 PMCID: PMC10269091 DOI: 10.1128/aac.00171-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023] Open
Abstract
Cefiderocol is a siderophore cephalosporin designed mainly for treatment of infections caused by β-lactam and multidrug-resistant Gram-negative bacteria. Burkholderia pseudomallei clinical isolates are usually highly cefiderocol susceptible, with in vitro resistance found in a few isolates. Resistance in clinical B. pseudomallei isolates from Australia is caused by a hitherto uncharacterized mechanism. We show that, like in other Gram-negatives, the PiuA outer membrane receptor plays a major role in cefiderocol nonsusceptibility in isolates from Malaysia.
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Affiliation(s)
- Carina M. Hall
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
| | - Nawarat Somprasong
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
| | - Johannah P. Hagen
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
| | - Roxanne Nottingham
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jason W. Sahl
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jessica R. Webb
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Mark Mayo
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bart J. Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - David M. Wagner
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Paul Keim
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Herbert P. Schweizer
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
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3
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Mohan A, Paranchothy M, Segaran S, Wong RSC, Chor YK, Podin Y, Ooi MH. Fatal Pediatric Melioidosis and the Role of Hyperferritinemic Sepsis-Induced Multiple-Organ Dysfunction Syndrome. Am J Trop Med Hyg 2022; 107:393-396. [PMID: 35895426 PMCID: PMC9393471 DOI: 10.4269/ajtmh.22-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/23/2022] [Indexed: 08/03/2023] Open
Abstract
Melioidosis is reported to cause a high fatality rate in children, even in the absence of risk factors for disease. The aim of this study was to identify characteristics of fatal pediatric melioidosis infection. We performed a retrospective analysis of children aged < 15 years with culture-confirmed melioidosis admitted to Bintulu Hospital in Sarawak, Malaysian Borneo, from January 2011 to December 2020. Forty-one children had culture-confirmed melioidosis. Nine (22%) had a fatal outcome; 8 (89%) had no predisposing risk factors. Bacteremia, septic shock, and acute respiratory distress syndrome were present in all fatalities. Demographic characteristics, presenting manifestation, and disseminated infection were not significantly associated with mortality, whereas the presence of splenomegaly, cytopenia, disseminated intravascular coagulation, and hepatobiliary dysfunction, all of which are features of hyperferritinemic sepsis-induced multiple-organ dysfunction syndrome, were associated with mortality. Hyperferritinemic sepsis-induced multiple-organ dysfunction syndrome may be a key component in the pathogenesis of fatal pediatric melioidosis.
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Affiliation(s)
- Anand Mohan
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Malini Paranchothy
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Sakthy Segaran
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Richard Siu-Chiu Wong
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Yek-Kee Chor
- Department of Pediatrics, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
- Department of Pediatrics, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
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4
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Sia TLL, Mohan A, Ooi MH, Chien SL, Tan LS, Goh C, Pang DCL, Currie BJ, Wong JS, Podin Y. Corrigendum to: Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia. Open Forum Infect Dis 2022; 9:ofab653. [PMID: 35097155 PMCID: PMC8794067 DOI: 10.1093/ofid/ofab653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tonnii L L Sia
- Infectious Disease Unit, Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
- Department of Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Lee-See Tan
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Charles Goh
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | | | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jin-Shyan Wong
- Borneo Medical Centre, Kuching, Sarawak, Malaysia
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
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5
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Sia TLL, Mohan A, Ooi MH, Chien SL, Tan LS, Goh C, Pang DCL, Currie BJ, Wong JS, Podin Y. Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia. Open Forum Infect Dis 2021; 8:ofab460. [PMID: 34646909 PMCID: PMC8500297 DOI: 10.1093/ofid/ofab460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022] Open
Abstract
Background Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections. Methods We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016. Results One hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B pseudomallei. The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections. Conclusions Gentamicin-susceptible B pseudomallei infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B pseudomallei infections in Sarawak are clonal and to ascertain their environmental drivers and niches.
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Affiliation(s)
- Tonnii L L Sia
- Infectious Disease Unit, Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.,Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia.,Department of Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Lee-See Tan
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Charles Goh
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | | | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jin-Shyan Wong
- Borneo Medical Centre, Kuching, Sarawak, Malaysia.,Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
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Mohan A, Podin Y, Liew DW, Mahendra Kumar J, Lau PST, Tan YY, Tai YP, Gill RS, Shanmugam R, Chien SL, Tan LS, Mat Sani NA, Manan K, Ooi MH. Fine-needle aspiration to improve diagnosis of melioidosis of the head and neck in children: a study from Sarawak, Malaysia. BMC Infect Dis 2021; 21:1069. [PMID: 34654392 PMCID: PMC8520244 DOI: 10.1186/s12879-021-06754-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Melioidosis, the infection caused by Burkholderia pseudomallei, is associated with a high case fatality rate, due in part to difficulties in clinical recognition and diagnostic confirmation of the disease. Although head and neck involvement is common in children, specific disease manifestations differ between geographic regions. The aim of this study was to provide a detailed description of melioidosis of the head and neck among children in Sarawak, Malaysia, and determine if fine-needle aspiration of suspected head or neck lesions could improve melioidosis diagnosis. Methods We conducted a retrospective descriptive study of all children aged < 12 years with culture-confirmed melioidosis presenting with head and neck manifestations and admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2020. Fine-needle aspiration of head and neck lesions suspected to be due to melioidosis with inoculation in blood culture bottles (FNA + BCB) was used from the beginning of 2016. Results Of 34 children with culture-confirmed melioidosis, 20 (59%) had an infection involving one or more sites in the head and neck. Of these, 17 (85%) were diagnosed in or after 2016. Cervical lymph nodes were the most common organ or site affected, involved in 19 (95%) children. Clinical presentations of B. pseudomallei lymph node infections were highly variable. Five (25%) children had salivary gland involvement. Lacrimal gland involvement (dacryocystitis) and skin or soft tissue infection (scalp abscess) were less frequent. B. pseudomallei was isolated from the head or neck using FNA + BCB in 15 (75%) children and by standard culture methods of direct plating of pus on agar following incision and drainage in only 2 (10%) children. B. pseudomallei was isolated from non-head or neck specimens or blood in 3 (15%) children. Conclusions Manifestations of pediatric head and neck melioidosis in Sarawak, Malaysia, differ from those of other regions. Fine-needle aspiration, mainly of affected cervical lymph nodes, facilitates B. pseudomallei detection and enables confirmation of melioidosis infections. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06754-9.
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Affiliation(s)
- Anand Mohan
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia.,Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Da-Wei Liew
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Jeevithaa Mahendra Kumar
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Peter Sie-Teck Lau
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Yee-Yen Tan
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Yi-Pinn Tai
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Ranveer Singh Gill
- Department of Otorhinolaryngology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Ram Shanmugam
- Department of Otorhinolaryngology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Lee-See Tan
- Department of Pathology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Nurul Asiah Mat Sani
- Department of Pathology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Kamilah Manan
- Department of Radiology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.,Department of Pediatrics, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
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Chang CY, Lau NLJ, Currie BJ, Podin Y. Disseminated melioidosis in early pregnancy - an unproven cause of foetal loss. BMC Infect Dis 2020; 20:201. [PMID: 32143598 PMCID: PMC7060584 DOI: 10.1186/s12879-020-4937-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background Melioidosis is a potentially life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Melioidosis is difficult to diagnose due to its diverse clinical manifestations, which often delays administration of appropriate antibiotic therapy. Case presentation Melioidosis is uncommon in pregnancy but both spontaneous abortion and neonatal melioidosis have been reported. We report a case of bacteraemic melioidosis in a young woman with a subsequent spontaneous abortion, with B. pseudomallei cultured from a high vaginal swab as well as blood. Conclusion It remains unclear in this and previously reported cases as to whether the maternal melioidosis was sexually transmitted.
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Affiliation(s)
- Chee Yik Chang
- Medical Department, Kapit Hospital, Ministry of Health, Kapit, Malaysia
| | - Nina Lee Jing Lau
- Obstetrics and Gynaecology Department, Kapit Hospital, Ministry of Health, Kapit, Malaysia
| | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Yuwana Podin
- Institute of Health and Community Medicine, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
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8
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Mohan A, Munusamy C, Tan YC, Muthuvelu S, Hashim R, Chien SL, Wong MK, Khairuddin NA, Podin Y, Lau PST, Ng DCE, Ooi MH. Invasive Salmonella infections among children in Bintulu, Sarawak, Malaysian Borneo: a 6-year retrospective review. BMC Infect Dis 2019; 19:330. [PMID: 30999894 PMCID: PMC6471830 DOI: 10.1186/s12879-019-3963-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background Invasive Salmonella infections result in significant morbidity and mortality in developing countries. In Asia, typhoid and paratyphoid fever are reported to be the major invasive Salmonella infections, while invasive non-typhoidal Salmonella (iNTS) infections are believed to be uncommon. Data from Sarawak, in Malaysian Borneo, are limited. Methods A retrospective study identifying all children aged < 15 years with invasive Salmonella infections from 2011 to 2016 was conducted in Bintulu Hospital in Sarawak. Population incidences, clinical and bacterial characteristics were examined. Results Forty-four patients were identified during the 6-year study period: 43 had iNTS infection and 1 had typhoid fever. The average annual iNTS incidence was 32.4 per 100,000 children aged < 5 years. None of the children had malaria or HIV infection, and only 7% were severely malnourished. Salmonella Enteritidis and Salmonella Java were the commonest NTS serovars identified. Pneumonia was the most common manifestation of iNTS disease, present in 20 (47%) children. Other manifestations included gastroenteritis, fever without a source, septic arthritis and meningitis. Salmonella Enteritidis was identified in 76% of those with pneumonia, significantly more frequently than in children with other manifestations. Over 25% of children with iNTS developed severe disease and nearly 10% suffered long term morbidity or mortality. While 78% of Salmonella Java isolates were multi-drug resistant, nearly all other isolates were susceptible to most antimicrobials, including ampicillin. Conclusions Bintulu Division in Sarawak observed a very high incidence of childhood iNTS infections. Enteric fever was uncommon. The epidemiology of invasive Salmonella infections in Malaysian Borneo differs considerably from that of neighbouring countries in Asia.
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Affiliation(s)
- Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia. .,Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Chandran Munusamy
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Yee-Chin Tan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Sobana Muthuvelu
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Rohaidah Hashim
- Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Ming-Kui Wong
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | | | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | | | - David Chun-Ern Ng
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.,Department of Paediatrics, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.,Department of Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
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Brizee S, van Passel MWJ, van den Berg LM, Feakes D, Izar A, Lin KTB, Podin Y, Yunus Z, Bleijs DA. Development of a Biosecurity Checklist for Laboratory Assessment and Monitoring. Appl Biosaf 2019; 24:83-89. [PMID: 32655326 PMCID: PMC7323818 DOI: 10.1177/1535676019838077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction: Laboratory biosecurity is of continuously growing interest due to increasing concerns about deliberate misuse of biological materials and emerging biological risks. These risks continue to be magnified by globalization, the rapid pace of scientific development, and dual-use technologies. Worldwide laboratory capacities are expanding, which calls for concrete actions to improve laboratory biosafety and biosecurity practices to protect researchers and the community. Hence, laboratories require comprehensive biorisk management programs to minimize the risk of accidental and deliberate release of infectious biological materials. Objective: Malaysia has prioritized the concern of national biosecurity and aims to consolidate laboratory biosecurity performance to detect and prevent the deliberate release of biological agents. Methods: Two 3-day workshops were organized over the course of four months in which Malaysia collaborated with The Netherlands. This bilateral engagement aimed to integrate biosecurity practices in their national biorisk management programs, and resulted into a comprehensive biosecurity checklist for laboratory assessment and monitoring. Results: This biosecurity checklist is based on Malaysian and Dutch expert opinions and national and international guidelines and regulations. The biosecurity checklist is a survey-driven tool that consists of a set of concrete questions for each key biosecurity area, which are discussion points for assessment. Conclusion: We display a practical biosecurity checklist for laboratory assessment and monitoring. Although the presented checklist was the template for the specific Malaysia checklist, it could serve as a template for other countries.
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Affiliation(s)
- Sabrina Brizee
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mark W J van Passel
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Linda M van den Berg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Daniel Feakes
- Biological Weapons Convention Implementation Support Unit, United Nations Office for Disarmament Affairs, Palais des Nations, Geneva, Switzerland
| | - Ana Izar
- Biological Weapons Convention Implementation Support Unit, United Nations Office for Disarmament Affairs, Palais des Nations, Geneva, Switzerland
| | - Kathryn Tham Bee Lin
- Science and Technology Research Institute for Defence (STRIDE), Ministry of Defence Malaysia, Kajang, Selangor Darul Ehsan, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Zalini Yunus
- Science and Technology Research Institute for Defence (STRIDE), Ministry of Defence Malaysia, Kajang, Selangor Darul Ehsan, Malaysia
| | - Diederik A Bleijs
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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10
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Sia T, Podin Y, Chuah TB, Wong JS. Melioidosis: an unusual cause of infective endocarditis: a case report. Eur Heart J Case Rep 2018; 2:yty055. [PMID: 31020134 PMCID: PMC6177064 DOI: 10.1093/ehjcr/yty055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/07/2018] [Indexed: 01/08/2023]
Abstract
Introduction As a causal organism in infective endocarditis, Burkholderia pseudomallei is rare. Burkholderia pseudomallei is intrinsically resistant to aminoglycosides but a gentamicin-susceptible strain was discovered in Sarawak, Malaysian Borneo in 2010. We report the first occurrence of infective endocarditis due to the gentamicin-susceptible strain of B. pseudomallei. Case presentation A 29-year-old man presented with pneumonia and melioidosis septicaemia. His condition was complicated with infective endocarditis and septic emboli to the brain. Despite difficulties in reaching a diagnosis, the patient was successfully treated using intravenous gentamicin and ceftazidime and was discharged well. Discussion The role of gentamicin in the treatment of the gentamicin-susceptible strain of B. pseudomallei remains unclear.
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Affiliation(s)
- Tonnii Sia
- Medical Department, Hospital Bintulu, Jalan Nyabau, Bintulu, Sarawak, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Teik-Beng Chuah
- Radiology Department, Hospital Bintulu, Jalan Nyabau, Bintulu, Sarawak, Malaysia
| | - Jin-Shyan Wong
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia.,Borneo Medical Centre, Hospital Bintulu, Jalan Nyabau, Bintulu, Sarawak, Malaysia
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Nathan S, Chieng S, Kingsley PV, Mohan A, Podin Y, Ooi MH, Mariappan V, Vellasamy KM, Vadivelu J, Daim S, How SH. Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis. Trop Med Infect Dis 2018; 3:E25. [PMID: 30274422 PMCID: PMC6136604 DOI: 10.3390/tropicalmed3010025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/18/2018] [Accepted: 02/18/2018] [Indexed: 12/12/2022] Open
Abstract
Malaysia is an endemic hot spot for melioidosis; however, a comprehensive picture of the burden of disease, clinical presentations, and challenges faced in diagnosis and treatment of melioidosis is not available. This review provides a nonexhaustive overview of epidemiological data, clinical studies, risk factors, and mortality rates from available literature and case reports. Clinical patterns of melioidosis are generally consistent with those from South and Southeast Asia in terms of common primary presentations with diabetes as a major risk factor. Early diagnosis and appropriate management of Malaysian patients is a key limiting factor, which needs to be addressed to reduce serious complications and high mortality and recurrence rates. Promoting awareness among the local healthcare personnel is crucial to improving diagnostics and early treatment, as well as educating the Malaysian public on disease symptoms and risk factors. A further matter of urgency is the need to make this a notifiable disease and the establishment of a national melioidosis registry. We also highlight local studies on the causative agent, Burkholderia pseudomallei, with regards to bacteriology and identification of virulence factors as well as findings from host⁻pathogen interaction studies. Collectively, these studies have uncovered new correlations and insights for further understanding of the disease.
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Affiliation(s)
- Sheila Nathan
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | - Sylvia Chieng
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | | | - Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu 97000, Malaysia.
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia.
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia.
- Department of Paediatrics, Sarawak General Hospital, Kuching 93586, Malaysia.
| | - Vanitha Mariappan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Kumutha Malar Vellasamy
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Jamuna Vadivelu
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Sylvia Daim
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia.
| | - Soon-Hin How
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan 25200, Malaysia.
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Griffiths MJ, Ooi MH, Wong SC, Mohan A, Podin Y, Perera D, Chieng CH, Tio PH, Cardosa MJ, Solomon T. In Enterovirus 71 Encephalitis With Cardio-Respiratory Compromise, Elevated Interleukin 1 , Interleukin 1 Receptor Antagonist, and Granulocyte Colony-Stimulating Factor Levels Are Markers of Poor Prognosis. J Infect Dis 2012; 206:881-92. [DOI: 10.1093/infdis/jis446] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Griffiths M, Ooi MH, Wong SC, Mohan A, Podin Y, Perera D, Chieng CH, Tio PH, Cardosa MJ, Solomon T. 1648 Raised levels of interleukin 1β, interleukin 1 receptor antagonist and G-CSF predict fatality among encephalitis patients infected with enterovirus 71. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ooi MH, Wong SC, Mohan A, Podin Y, Perera D, Clear D, del Sel S, Chieng CH, Tio PH, Cardosa MJ, Solomon T. Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak. BMC Infect Dis 2009; 9:3. [PMID: 19152683 PMCID: PMC2637878 DOI: 10.1186/1471-2334-9-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 01/19/2009] [Indexed: 12/02/2022] Open
Abstract
Background Human enterovirus 71 (HEV71) can cause Hand, foot, and mouth disease (HFMD) with neurological complications, which may rapidly progress to fulminant cardiorespiratory failure, and death. Early recognition of children at risk is the key to reduce acute mortality and morbidity. Methods We examined data collected through a prospective clinical study of HFMD conducted between 2000 and 2006 that included 3 distinct outbreaks of HEV71 to identify risk factors associated with neurological involvement in children with HFMD. Results Total duration of fever ≥ 3 days, peak temperature ≥ 38.5°C and history of lethargy were identified as independent risk factors for neurological involvement (evident by CSF pleocytosis) in the analysis of 725 children admitted during the first phase of the study. When they were validated in the second phase of the study, two or more (≥ 2) risk factors were present in 162 (65%) of 250 children with CSF pleocytosis compared with 56 (30%) of 186 children with no CSF pleocytosis (OR 4.27, 95% CI2.79–6.56, p < 0.0001). The usefulness of the three risk factors in identifying children with CSF pleocytosis on hospital admission during the second phase of the study was also tested. Peak temperature ≥ 38.5°C and history of lethargy had the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 28%(48/174), 89%(125/140), 76%(48/63) and 50%(125/251), respectively in predicting CSF pleocytosis in children that were seen within the first 2 days of febrile illness. For those presented on the 3rd or later day of febrile illness, the sensitivity, specificity, PPV and NPV of ≥ 2 risk factors predictive of CSF pleocytosis were 75%(57/76), 59%(27/46), 75%(57/76) and 59%(27/46), respectively. Conclusion Three readily elicited clinical risk factors were identified to help detect children at risk of neurological involvement. These risk factors may serve as a guide to clinicians to decide the need for hospitalization and further investigation, including cerebrospinal fluid examination, and close monitoring for disease progression in children with HFMD.
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Affiliation(s)
- Mong How Ooi
- Department of Paediatrics, Sibu Hospital, Sibu, Sarawak, Malaysia.
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Ooi MH, Solomon T, Podin Y, Mohan A, Akin W, Yusuf MA, del Sel S, Kontol KM, Lai BF, Clear D, Chieng CH, Blake E, Perera D, Wong SC, Cardosa J. Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease. J Clin Microbiol 2007; 45:1858-66. [PMID: 17446325 PMCID: PMC1933032 DOI: 10.1128/jcm.01394-06] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human enterovirus 71 and coxsackievirus A16 are important causes of hand-foot-and-mouth disease (HFMD). Like other enteroviruses, they can be isolated from a range of sterile and nonsterile sites, but which clinical sample, or combination of samples, is the most useful for laboratory diagnosis of HFMD is not clear. We attempted virus culture for 2,916 samples from 628 of 725 children with HFMD studied over a 3 1/2-year period, which included two large outbreaks. Overall, throat swabs were the single most useful specimen, being positive for any enterovirus for 288 (49%) of 592 patients with a full set of samples. Vesicle swabs were positive for 169 (48%) of 333 patients with vesicles, the yield being greater if two or more vesicles were swabbed. The combination of throat plus vesicle swabs enabled the identification of virus for 224 (67%) of the 333 patients with vesicles; for this patient group, just 27 (8%) extra patients were diagnosed when rectal and ulcer swabs were added. Of 259 patients without vesicles, use of the combination of throat plus rectal swab identified virus for 138 (53%). For 60 patients, virus was isolated from both vesicle and rectal swabs, but for 12 (20%) of these, the isolates differed. Such discordance occurred for just 11 (10%) of 112 patients with virus isolated from vesicle and throat swabs. During large HFMD outbreaks, we suggest collecting swabs from the throat plus one other site: vesicles, if these are present (at least two should be swabbed), or the rectum if there are no vesicles. Vesicle swabs give a high diagnostic yield, with the added advantage of being from a sterile site.
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Affiliation(s)
- Mong How Ooi
- Department of Paediatrics, Sibu Hospital, Ulu Oya Road, 96000 Sibu, Sarawak, Malaysia.
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Ooi MH, Wong SC, Podin Y, Akin W, del Sel S, Mohan A, Chieng CH, Perera D, Clear D, Wong D, Blake E, Cardosa J, Solomon T. Human Enterovirus 71 Disease in Sarawak, Malaysia: A Prospective Clinical, Virological, and Molecular Epidemiological Study. Clin Infect Dis 2007; 44:646-56. [PMID: 17278054 DOI: 10.1086/511073] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 10/23/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Human enterovirus (HEV)-71 causes large outbreaks of hand-foot-and-mouth disease with central nervous system (CNS) complications, but the role of HEV-71 genogroups or dual infection with other viruses in causing severe disease is unclear. METHODS We prospectively studied children with suspected HEV-71 (i.e., hand-foot-and-mouth disease, CNS disease, or both) over 3.5 years, using detailed virological investigation and genogroup analysis of all isolates. RESULTS Seven hundred seventy-three children were recruited, 277 of whom were infected with HEV-71, including 28 who were coinfected with other viruses. Risk factors for CNS disease in HEV-71 included young age, fever, vomiting, mouth ulcers, breathlessness, cold limbs, and poor urine output. Genogroup analysis for the HEV-71-infected patients revealed that 168 were infected with genogroup B4, 68 with C1, and 41 with a newly emerged genogroup, B5. Children with HEV-71 genogroup B4 were less likely to have CNS complications than those with other genogroups (26 [15%] of 168 vs. 30 [28%] of 109; odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.91; P=.0223) and less likely to be part of a family cluster (12 [7%] of 168 vs. 29 [27%] of 109; OR, 0.21; 95% CI, 0.10-0.46; P<.0001); children with HEV-71 genogroup B5 were more likely to be part of a family cluster (OR, 6.26; 95% CI, 2.77-14.18; P<.0001). Children with HEV-71 and coinfected with another enterovirus or adenovirus were no more likely to have CNS disease. CONCLUSIONS Genogroups of HEV-71 may differ with regard to the risk of causing CNS disease and the association with family clusters. Dual infections are common, and all possible causes should be excluded before accepting that the first virus identified is the causal agent.
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Affiliation(s)
- Mong How Ooi
- Department of Paediatrics, Sibu Hospital, Sibu, Malaysia
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Perera D, Yusof MA, Podin Y, Ooi MH, Thao NTT, Wong KK, Zaki A, Chua KB, Malik YA, Tu PV, Tien NTK, Puthavathana P, McMinn PC, Cardosa MJ. Molecular phylogeny of modern coxsackievirus A16. Arch Virol 2007; 152:1201-8. [PMID: 17308978 DOI: 10.1007/s00705-006-0934-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 12/21/2006] [Indexed: 10/23/2022]
Abstract
A phylogenetic analysis of VP1 and VP4 nucleotide sequences of 52 recent CVA16 strains demonstrated two distinct CVA16 genogroups, A and B, with the prototype strain being the only member of genogroup A. CVA16 G-10, the prototype strain, showed a nucleotide difference of 27.7-30.2% and 19.9-25.2% in VP1 and VP4, respectively, in relation to other CVA16 strains, which formed two separate lineages in genogroup B with nucleotide variation of less than 13.4% and less than 16.3% in VP1 and VP4, respectively. Lineage 1 strains circulating before 2000 were later displaced by lineage 2 strains.
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Affiliation(s)
- D Perera
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
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Podin Y, Gias ELM, Ong F, Leong YW, Yee SF, Yusof MA, Perera D, Teo B, Wee TY, Yao SC, Yao SK, Kiyu A, Arif MT, Cardosa MJ. Sentinel surveillance for human enterovirus 71 in Sarawak, Malaysia: lessons from the first 7 years. BMC Public Health 2006; 6:180. [PMID: 16827926 PMCID: PMC1543637 DOI: 10.1186/1471-2458-6-180] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 07/07/2006] [Indexed: 12/17/2022] Open
Abstract
Background A major outbreak of human enterovirus 71-associated hand, foot and mouth disease in Sarawak in 1997 marked the beginning of a series of outbreaks in the Asia Pacific region. Some of these outbreaks had unusually high numbers of fatalities and this generated much fear and anxiety in the region. Methods We established a sentinel surveillance programme for hand, foot and mouth disease in Sarawak, Malaysia, in March 1998, and the observations of the first 7 years are described here. Virus isolation, serotyping and genotyping were performed on throat, rectal, vesicle and other swabs. Results During this period Sarawak had two outbreaks of human enterovirus 71, in 2000 and 2003. The predominant strains circulating in the outbreaks of 1997, 2000 and 2003 were all from genogroup B, but the strains isolated during each outbreak were genetically distinct from each other. Human enterovirus 71 outbreaks occurred in a cyclical pattern every three years and Coxsackievirus A16 co-circulated with human enterovirus 71. Although vesicles were most likely to yield an isolate, this sample was not generally available from most cases and obtaining throat swabs was thus found to be the most efficient way to obtain virological information. Conclusion Knowledge of the epidemiology of human enterovirus 71 transmission will allow public health personnel to predict when outbreaks might occur and to plan interventions in an effective manner in order to reduce the burden of disease.
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Affiliation(s)
- Yuwana Podin
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Edna LM Gias
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Flora Ong
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Yee-Wei Leong
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Siew-Fung Yee
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Mohd Apandi Yusof
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - David Perera
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Bibiana Teo
- B Teo's Specialist Clinic, Kuching, Sarawak, Malaysia
| | - Thian-Yew Wee
- TY Wee Specialist Clinic for Children, Kuching, Sarawak, Malaysia
| | - Sik-Chi Yao
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Sik-King Yao
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Andrew Kiyu
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Mohd Taha Arif
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Mary Jane Cardosa
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
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Perera D, Podin Y, Akin W, Tan CS, Cardosa MJ. Incorrect identification of recent Asian strains of Coxsackievirus A16 as human enterovirus 71: improved primers for the specific detection of human enterovirus 71 by RT PCR. BMC Infect Dis 2004; 4:11. [PMID: 15122971 PMCID: PMC415548 DOI: 10.1186/1471-2334-4-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 05/04/2004] [Indexed: 11/23/2022] Open
Abstract
Background Human enterovirus 71 has emerged as an important pathogen in the Asia Pacific region and it is important to be able to make a rapid and specific diagnosis for outbreak control. Recent Asian strains of Coxsackievirus A16 have changes in the VP1 gene which causes mispriming of widely used primers for human enterovirus 71 specific identification. Methods Local strains of Coxsackievirus A16 were sequenced in the VP4 and VP1 genes and using sequence alignment tools, an improved set of primers were designed for specific identification of human enterovirus 71. These primers were evaluated against virus isolates as well as primary clinical specimens. Results A total of 218 virus strains were tested. All 39 human enterovirus 71 isolates were positive and none of the 38 Coxsackievirus A16, 127 other enteroviruses and 14 prototype flaviviruses and adenoviruses were positive when tested with the new primers. When aliquots of primary specimens known to have yielded human enterovirus 71 were retrospectively tested, we found that within 2 months of collection of the specimens, greater than 90% were positive but that the success rate diminished rapidly to 18% after 2 years storage. Conclusions Our new primers will be useful in rapid diagnosis of human enterovirus 71 infection, and can also be used as a screening tool in surveillance programmes for early warning of human enterovirus 71 transmission.
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Affiliation(s)
- David Perera
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Yuwana Podin
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Winnie Akin
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Cheng-Siang Tan
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Mary Jane Cardosa
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
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