The effectiveness of ICSI versus conventional IVF in couples with non-male factor infertility: study protocol for a randomised controlled trial

Study questions

Does ICSI result in a higher live birth rate as compared with conventional IVF in couples with non-male factor infertility?

What is known already

ICSI is primarily indicated for severe male factor infertility. While the use of ICSI for couples with non-male factor infertility has been increasing worldwide, this is not supported by data from randomised controlled trials. Evidence from non-randomised studies suggest no benefit from ICSI compared with conventional IVF in non-male factor infertility, if not a harm.

Study design, size, duration

This randomised, open-label, multi-centre trial aims to compare the effectiveness of one ICSI cycle and one conventional IVF cycle in infertile couples with non-male factor infertility. A total of 1064 couples will be randomly allocated to an ICSI group and a conventional IVF group. The estimated duration of the study is 30 months.

Participants/materials, setting, methods

Eligible couples are those whose husbands’ total sperm count and motility are normal, have undergone ≤2 previous IVF/ICSI attempts, use antagonist protocol for ovarian stimulation, agree to have ≤2 embryos transferred and are not participating in another IVF study at the same time. Women undergoing IVM cycles, using frozen semen or having a poor fertilisation (≤25%) in previous cycle will not be eligible. Couples will be randomised to undergo ICSI or conventional IVF (1:1) with ongoing pregnancy resulting in live birth after the first embryo transfer of the started treatment cycle as the primary endpoint. All analyses will be conducted on an intention-to-treat basis. Effect sizes will be summarised as relative risk (RR), with precision evaluated by 95% CIs.

STUDY FUNDING/COMPETING INTEREST(S)

All authors declare having no conflict of interests with regards to this trial. This work was supported by a grant from MSD [MISP #57508].

Trial registration number

NCT03428919.

Trial registration date

8 February 2018.

DATE OF FIRST PATIENT’S ENROLMENT

16 March 2018.

Morphology of Glycycometus malaysiensis, a domestic mite in Malaysia

Glycycometus malaysiensis is an allergenic domestic mite found in houses. G. malaysiensis is known to be highly similar to and is often mistaken as Blomia tropicalis, one of the major house dust mite species that causes asthma and allergic diseases in many tropical and subtropical regions. It was also suggested that these mites cross-react with each other and that the prevalence of G. malaysiensis might be higher than previous reports. A review on the taxonomic keys as well as light and scanning electron micrographs of G. malaysiensis are presented to appreciate the fine morphological structures of G. malaysiensis. The mouth, setae, legs (trochanter, femur, genu, tibia and tarsus) and the sexual organs (genital openings, genital setae and genital suckers) of G. malaysiensis are outlined. The morphology of G. malaysiensis is also compared with that of B. tropicalis to delineate the key features for the differentiation between these two mite species.

Live birth rate after human chorionic gonadotropin priming in vitro maturation in women with polycystic ovary syndrome

BACKGROUND

In vitro maturation (IVM) has some advantages over conventional in vitro fertilization (IVF), particularly in polycystic ovary syndrome (PCOS) where the risk of ovarian hyperstimulation is high. We studied the live birth rate in a large series of PCOS women undergoing human chorionic gonadotropin (hCG)-priming IVM.

METHODS

This retrospective study included women with PCOS aged 18-42 years undergoing IVM with hCG priming. We reported live birth rate after the first embryo transfer and cumulative live birth rate from embryos obtained in the IVM cycle. We also performed logistic regression to assess which factors predicted number of oocytes and live birth.

RESULTS

We included 921 women (age 28.9±3.5 years, body mass index 21.8±3.1 kg/m2, infertility duration 3.7±2.6 years, 81% primary infertility, 88% first IVF attempt, 94% ovulation induction failure). Live birth rate after the first embryo transfer was 31.7%, with a cumulative live birth rate from the cycle of 33.7%. High anti-Müllerian hormone levels predicted a high number of oocytes and a high oocyte maturation rate while the opposite was the case when luteinizing hormone levels were high.

CONCLUSIONS

In women with PCOS, hCG priming IVM was feasible and resulted in acceptable live birth rates.

Laboratory contact and topical evaluations of household disinfectants against house dust mites Dermatophagoides pteronyssinus and Dermatophagoides farinae (Acari: Pyroglyphidae)

The contact and topical activity of two household disinfectants containing chloroxylenol and benzyl chlorophenol against, Dermatophagoides pteronyssinus and Dermatophagoides farinae mites were evaluated in the laboratory. For contact activity, 30 adult mites were placed for 24 hrs on Whatman No. 1 filter paper impregnated with disinfectant. For topical activity, each disinfectant was directly applied to individual body of all 30 dust mites and observed for 24hrs. All treatments were replicated 12 times. Chloroxylenol disinfectant was found to be more effective compared to benzyl chlorophenol disinfectant in killing pyroglyphid mites.

Sero-prevalence study of IgE responses to allergens from Malaysian house dust (HDM) and storage mites (SM)

Allergens of Dermatophagoides and Blomia species are well-characterized but not for other species. This study was conducted to determine the prevalence of allergic sensitization to house dust (HDM) and storage mites (SM). One hundred adult subjects (aged ≥ 18) were recruited. The mite specific IgE of all allergic subjects were higher compared with healthy subjetcs despite being not statistically significant except for D. farinae and G. malaysiensis. The mean serum IgE levels against HDM and SM for allergic subjects were significantly higher compared with those in healthy subjects. They were mainly sensitized to Dermatophagoides farinae (35%) and Glycycometus malaysiensis (37%). Immunoblots revealed not all allergic subjects showed positive immuno-reactivity against the mites tested. Single or multiple bands were observed for different species. The subjects were commonly sensitized to Group 2 (9-12 kDa), 10 (38 kDa) and 18 (40-48 kDa) allergens. Twenty-one out of 60 allergic subjects were sensitized to either one or more species. The majority of them (71%) were sensitized to single species. The allergic subjects were mainly sensitized to D. pteronyssinus, followed by Tyrophagus putrecentiae and Aleuroglyphus ovatus. Seven were solely sensitized to HDM while 10 were solely sensitized to SM. Four subjects were sensitized to both. Pre-adsorption study revealed no cross-reactivity. There was difference between the prevalence and reactivity to allergens of HDM and SM in these subjects. Both ELISA and immunoblot did not correlate well but can complement each other in improving the detection of mite allergens to the species level.

Acarine ectoparasites of Panti Forest Reserve in Johore, Malaysia

OBJECTIVE

To identify the presence of acarine ectoparasites and determine whether there is any potential public health risk in Panti Forest Reserve, Johore, Malaysia.

METHODS

Trapping of animals and avifauna was conducted simultaneously along 5 expedition trails using 150 wire traps, 10 harp traps and 30 mist nets for 6 consecutive nights. A total of 140 animals consisting of 7 species of birds, 19 species of bats, 6 species of rodents and 1 species of tree-shrew as well as 8 myriapods were examined.

RESULTS

Infestation rates of ticks, mesostigmatid mites and chiggers on animals examined were 24.3%, 28.6% and 27.9%, respectively. Infestation on bats was low (1.5%) and none occurred on birds. Majority of ticks extracted were at immature stages (78.9%). Genera of ticks on animals were Amblyomma, Dermacentor, Haemaphysalis and Ixodes. Ixodes granulatus was the only species of ticks identified from the animals. Examination of ticks under vegetation revealed 54% adults leading to identification of 3 species of ticks. A total of 7 species of mesostigmatid mites were found. 6 species were on rodent, Maxomys surifer and another one species, Laelaps nuttalli was found only on Leopoldamys sabanus. Laelaps sanguisugus was the only mesostigmatid found infesting tree-shrews. Seven genera of chiggers were identified. From this, 5 genera were on rodents, 4 genera on tree-shrews and 1 genus on a bat.

CONCLUSIONS

A total of 16 genera, 2 sub-genus and 14 species of acarine ectoparasites were found in this area. Findings of the survey demonstrate the presence of three spesies of acarine ectoparasites which have potential health risk i.e. Ixodes granulatus, Laelaps nuttalli and Leptotrombidium deliense.

Antigenic profile of Blomia tropicalis, Aleuroglyphus ovatus and Glycycometus malaysiensis

House dust mites and storage mites are well-known causes for allergenic diseases. The aim of this study was to investigate the immunogenic sites of Blomia tropicalis, Aleurogyphus ovatus and Glycycometus malaysiensis. The mites were maintained in a culture medium at 25ºC and 75% relative humidity. Mites were harvested either with heat escape or floatation method, purified, homogenized, quantified and used for the production of polyclonal antibody and immunostaining. For each species of mites, five male mice and five male rats were randomly selected and immunized intraperitoneally with respective crude mite extract at two-weekly intervals. Blomia tropicalis, A. ovatus or G. malaysiensis whole mites and paraffin-embedded mite sections were immunostained with the respective polyclonal antibody. The faecal pellets of mites were intensely stained for all the three species in the present study. The legs of sectioned A. ovatus were not immunogenic as compared with those of G. malaysiensis and B. tropicalis. The outer layer (cuticle) of whole mites and the eggs for these species were very immunogenic. Hence, the polyclonal antibodies obtained in this study may serve as potential tools in detecting the eggs and immature mites in environmental samples. Future studies should focus on the antigenic components of eggs since they were relatively abundant in dust and highly antigenic as seen in the present study.

Scanning electron micrographs of medically important dust mite, Suidasia pontifica (Acari: Astigmata: Saproglyphidae) in Malaysia

Scanning electron microscope (SEM) images of dust mites, Suidasia pontifica, is presented to provide an improved visualization of the taxonomic characters of these mites. Suidasia pontifica can easily be identified by its scale-like cuticle, presence of external vertical setae (ve), longer external scapular setae (sce) compared to internal scapular setae (sci) and 3 ventral spines on apex of tarsus I. The differences in morphology of male and female S. pontifica are also discussed.

Effects of microwave radiation on house dust mites, Dermatophagoides pteronyssinus and Dermatophagoides farinae (Astigmata: Pyroglyphidae)

Dermatophagoides pteronyssinus and Dermatophagoides farinae mites are commonly found in house dust, and are important sources of allergens affecting humans. Various approaches to killing the mites have been examined. This study investigated the mortalities of adult mites exposed to 2,450 MHz microwave radiation produced by 3 ovens at various exposure times and power settings. The ovens all had 3 power settings. The average maximum water temperatures generated at high, medium and low power settings were 99.4 +/- 0.2, 84.1 +/- 0.4 and 44.8 +/- 0.9 degrees C, respectively. At high and medium settings, there was 100.0% mortality in both species when exposed for 300 seconds. The mean mortality rates at low power were 10.8 +/- 0.7% for D. pteronyssinus and 9.7 +/- 2.6% for D. farinae. When mites were exposed in the presence of culture media, the mortality rates decreased with increasing weight of media. The mean mortality with the largest amount of media tested at high power setting was 61.4%.

Burst firing induces postsynaptic LTD at developing mossy fibre-CA3 pyramid synapses

Synaptic development is an activity-dependent process utilizing coordinated network activity to drive synaptogenesis and subsequent refinement of immature connections. Hippocampal CA3 pyramidal neurons (PYRs) exhibit intense burst firing (BF) early in development, concomitant with the period of mossy fibre (MF) development. However, whether developing MF-PYR synapses utilize PYR BF to promote MF synapse maturation remains unknown. Recently, we demonstrated that transient tonic depolarization of postsynaptic PYRs induces a persistent postsynaptic form of long-term depression (depolarization-induced long-term depression, DiLTD) at immature MF-PYR synapses. DiLTD induction is NMDAR independent but does require postsynaptic Ca(2+) influx through L-type voltage gated Ca(2+) channels (L-VGCCs), and is expressed as a reduction in AMPAR function through the loss of GluR2-lacking AMPARs present at immature MF-PYR synapses. Here we examined whether more physiologically relevant phasic L-VGCC activation by PYR action potential (AP) BF activity patterns can trigger DiLTD. Using combined electrophysiological and Ca(2+) imaging approaches we demonstrate that PYR BF effectively drives L-VGCC activation and that brief periods of repetitive PYR BF, produced by direct current injection or intrinsic network activity induces NMDAR-independent LTD by promoting Ca(2+) influx through the activated L-VGCCs. This BF induced LTD, just like DiLTD, is specific for developing MF-PYR synapses, is PICK1 dependent, and is expressed postsynaptically. Our results demonstrate that DiLTD can be induced by phasic L-VGCC activation driven by PYR BF, suggesting the engagement of natural PYR network activity patterns for MF synapse maturation.

Scanning electron micrographs of two species of Sturnophagoides (Acari: Astigmata: Pyroglyphidae) mites in Malaysia

Scanning electron microscope (SEM) images of two dust mites, Sturnophagoides brasiliensis and Sturnophagoides halterophilus, are presented to provide an improved visualization of the taxonomic characters of these mites. Sturnophagoides halterophilus can be differentiated from S. brasiliensis by their expanded genu and femur of leg I. The differences in morphology of male and female S. brasiliensis are also discussed.

Ticks (Ixodidae) and other ectoparasites in Ulu Muda Forest Reserve, Kedah, Malaysia

A survey of ticks and other ectoparasites was carried out during a national biodiversity scientific expedition at Ulu Muda Forest Reserve, Kedah, Malaysia from 23-29 March 2003. A total of 161 animals comprising 20 species of birds, 16 species of bats, six species of non-volant small mammals and 12 species of reptiles were examined for ticks and other ectoparasites. From these animals, nine species in five genera of ticks, 10 species in two families of Mesostigmatid mites and five species of chiggers were collected. Three of the ectoparasitic species found, Dermacentor auratus, Ixodes granulatus and Leptotrombidium deliense are of known public health importance. This survey produced the first list of ticks and other ectoparasites in the forest reserve and the third study of ectoparasites in Kedah. Fourteen species of these ectoparasites are new locality records.

Residual activity of benzyl benzoate against Dermatophagoides pteronyssinus (Acari: Pyroglyphidae)

The residual effect of a commercial spray containing 2.0% benzyl benzoate against Dermatophagoides pteronyssinus was evaluated in the laboratory. Filter papers treated with benzyl benzoate were dried for 2 hours and placed in Petri dishes. Adult mites were then added and mortality was assessed following 24 hour contact and at succeeding 4 weeks intervals up to week 28 post-treatment using the same treated filter papers. There was 100% mortality at 24 hours post-treatment, declining progressively to 71% by week 28. Probit analysis estimated a median lethal time (LT50) of 59 weeks.

Scanning electron micrographs of Blomia tropicalis (Acari:Astigmata: Echimyopodidae), a common house dust mite in Malaysia

Many finer taxonomic characters of Blomia tropicalis are not distinctly visible under conventional light microscopy. Scanning electron micrographs of this mite are therefore presented in this paper for better appreciation of the inconspicuous features of the morphology of the species. The differences in morphology of male and female B. tropicalis are also briefly discussed.

A survey of ectoparasites in Gunung Stong Forest Reserve, Kelantan, Malaysia

A survey of ticks and other ectoparasites was carried out during a national biodiversity scientific expedition at Gunung Stong Forest Reserve, Kelantan, Malaysia from 23-29 May 2003. A total of 272 animals comprised of 12 species of birds, 21 species of bats, 7 species of rodents and 2 species of insects were examined for ticks and other ectoparasites. From these animals, 5 species in 4 genera of ticks; 7 species in 2 families of Mesostigmatid mites and 5 species of chiggers were collected. Among the ectoparasites found were Ixodes granulatus and Leptotrombidium deliense, which are of known medical importance. A tick island consisting of 10 nymphal stages of Dermacentor spp was observed feeding on Rattus tiomanicus.

The first graduates in 1910

The Medical School in Singapore was founded on 3 July 1905 and named the Straits and Federated Malay States Government Medical School. There were 23 students in the first enrollment; 16 students attended the full course, while 7 attended a 2-year course for hospital assistants. The pioneer group of 7 that graduated in May 1910 (the Magnificent Seven) consisted of Drs Chen Su Lan, Edwin Williborod deCruz, and John Gnanapragasam from Singapore; Drs Willie Carnegie and Mark W Chill from Penang; Dr SR Krishnan from Seramban and Dr John Scott Lee from Ipoh. In December 1910, a further 6 students graduated. Of this first batch of 13 graduates in 1910, we describe the careers of 6; no records exist of the remaining 7.

Our dilemma: the self-marginal people

Cultural diversity is nowadays a common phenomenon in most developed countries. Its impact is felt in daily life, as well as in health care settings. Hospital del Mar, due to its geographical location, receives some of the 34.7% of immigrants from a varied cultural background. Endeavours are made to promote cultural awareness among staff and to facilitate communication. However, a Spanish Gypsy group, albeit not immigrants, are by large the problematic cultural group. A questionnaire study was conducted to validate the difficulty in treating these Gypsies versus migrant patients. The questionnaire was distributed to different health care professionals in the hospital. The result is not surprising. The problems encountered with the migrant patients are mainly due to language barrier. Concerning these Gypsies who speak fluent Spanish, the problems are by far more extensive. These are often generated by their abiding cultural values, distinctive lifestyle, low educational level and rejection of the shared norms of the majority. Any attempt to encourage adherence to hospital rules are often futile as a result of the gypsies' negative attitudes. Staff have expressed occasional feelings of weariness when dealing with such situations.

In vitro demonstration of the hemolytic, cytotoxic activities and induction of apoptosis in Orientia tsutsugamushi infected L929 mouse fibroblast cells

Using cultured mouse fibroblast L929 cells, this study demonstrated the hemolytic and cytotoxic activities and induction of apoptosis in cells infected with Orientia tsutsugamushi. Low levels of hemolytic activity were detected using heavily infected cells. No hemolysin or cytotoxin were detected in the infected culture fluid regardless of the pathogenicity of the O. tsutsugamushi strains in mice. Using propidium iodide uptake assay, acridine orange/ethidium bromide staining and terminal deoxynucleotide transferase-mediated dUTP-digoxigenin nick-end labeling assay, apoptosis was observed in L929 cells infected with Karp and Gilliam strains.

Isolation and PCR detection of rickettsiae from clinical and rodent samples in Malaysia

Isolation of rickettsiae from patients' blood samples and organ samples of wild rodents from areas with high seroprevalence of rickettsial infections was attempted using cell culture assay and animal passages. L929 mouse fibroblast cells grown in 24 well tissue culture plate were inoculated with buffy coat of febrile patients and examined for the growth of rickettsiae by Giemsa, Gimenez staining and direct immunofluorescence assay. No rickettsiae were isolated from 48 patients' blood samples. No symptomatic infections were noted in mice or guinea pigs infected with 50 organ samples of wild rodents. There was no rickettsial DNA amplified from these samples using various PCR detection systems for Orientia tsutsugamushi, typhus and spotted fever group rickettsiae.

Expression of recombinant proteins of Orientia tsutsugamushi and their applications in the serodiagnosis of scrub typhus

In this study, recombinant proteins that encompassed the AD I-AD III regions of 56 kDa immunodominant gene of 2 Orientia tsutsugamushi (OT) serotypes; Gilliam and TA763 were expressed in Escherichia coli. Both recombinant proteins exhibited serologic cross-reactivity with the rabbit antisera against various OT serotypes, as evaluated by enzyme-linked immunosorbent assay (ELISA), but not against other rickettsial species, including Rickettsia typhi, R. prowazekii and TT118 SFG rickettsiae. The feasibility of using the recombinant proteins as a diagnostic reagent was further evaluated by ELISA using sera from blood donors and scrub typhus patients. The results suggested a higher affinity of the antihuman IgM than IgG with both recombinant proteins. The IgM ELISA findings were agreeable with the results of indirect immunoperoxidase (IIP) assay especially with sera of high antibody (1:1600). However, more than one antigen are probably needed for development of an effective assay for serodiagnosis of scrub typhus in endemic areas.

Antigenic types of Orientia tsutsugamushi in Malaysia

The seroprevalence of various Orientia tsutsugamushi (OT) strains among Malaysian patients with suspected scrub typhus infections was determined using an indirect immunoperoxidase (IIP) assay. IgG against a single OT strain were detected in six sera (3 Karp, 1 Gilliam and 2 TC586), whereas IgM antibodies against a single OT strain (Gilliam) were noted in 3 sera (Gilliam). IgG reactive to all OT strains were present in 33 (47.1%) of the 70 sera and IgM reactive to all OT strains were present in 22 (78.6%) of the 28 sera. The fact that most sera were reactive to multiple OT strains suggests that group-specific antigens are involved in scrub typhus infections, whereas very few were due to strain-specific epitopes present on these strains. Peak IgG and IgM titers were noted more frequently against Gilliam, Karp, and TA763 strains: this suggests that these strains may be the commonest infecting strains among Malaysian patients. Two predominant OT polypeptides consistently reacted with patients' sera were the 70 kDa and 56 kDa proteins.

Virulence of Malaysian isolates of Orientia tsutsugamushi in mice

The pathogenicity of Malaysian isolates of Orientia tsutsugamushi was investigated by a mouse virulence assay. The isolates could be differentiated as low (4 isolates), moderately (3 isolates) and highly virulent (2 isolates) based on the different responses in infected mice. No direct correlation between severity of human scrub typhus infections and virulence of the O. tsutsugamushi in mice was observed. Mice infected with virulent strains of O. tsutsugamushi showed splenomegaly, ascitis accumulation and enlargement of kidneys and livers whereas avirulent O. tsutsugamushi strains were asymptomatic and exhibited ruffled fur for a short period after infection. There was low antibody response in mice infected with isolates of low pathogenicity as compared with those of highly virulent isolates. Upon dissection of the infected mice, enlargement of mouse organs such as spleen, kidney and liver was noted. Presence of rickettsemia in mice was confirmed by the growth of O. tsutsugamushi in the L929 cells when inoculated with blood from infected mice. O. tsutsugamushi was also cultured from the peritoneal exudates of the infected mice. However, DNA of O. tsutsugamushi was only detected in the peritoneal exudates (by PCR) and blood (by cell culture) and not from other tissue samples.

House dust mite fauna in the Klang Valley, Malaysia

Allergy to house dust mites (HDM) is an important cause of asthma and rhinitis in Malaysia. This study was carried out to evaluate the dust mite fauna in the Klang Valley. Dust samples were collected from 20 houses from March 1994 to February 1995. Thirty-three dust samples from mattresses were examined monthly for the occurrence of HDM. A total of 22 species in 9 families of HDM was identified. The most common and densely populated species was Blomia tropicalis with an average density of 8,934 mites/g of dust. Dermatophagoides pteronyssinus was the next in abundance, followed by Malayoglyphus intermedius. All houses surveyed were found to be infested with HDM and every house had at least 6 species of HDM. B. tropicalis and D. pteronyssinus were found in all mattresses. HDM in the Klang Valley were found to be highly prevalent and present in high densities. In this study, counts of D. pteronyssinus was found to exceed the proposed exposure threshold of 500 mites/g dust, for triggering acute asthma. Although counts of B. tropicalis exceeded D. pteronyssinus, no conclusion could be made because there is currently no exposure threshold for triggering acute asthma, for this species. Monthly distribution of B. tropicalis and D. pteronyssinus showed 2 peaks and 4 peaks, respectively. The major peak for D. pteronysinus was in January 1995 whereas for B. tropicalis, the major peak was more variable and occurred between November 1994 to January 1995. Both the species showed minor peak in April 1994.

First report on sensitization to allergens of a house dust mite, Suidasia pontifica (Acari: Saproglyphidae)

A species of house dust mite, Suidasia pontifica, was recently shown to produce allergens affecting man. The species may be as important as other allergen producing mite in sensitization and causing allergic symptoms in Malaysians. Surveys conducted demonstrated that 80% of the houses surveyed were positive for this mite with densities ranged from 2 to 50 mites per gram of dust. Colonies of the species has been successfully established and materials from those colonies have been used to produce extracts for studies on sensitization to the mites. A total of 85 suspected allergic rhinitis patients were tested and 74.1% demonstrated positive reactions. Extract of this mite should be considered for routine diagnostic testing and possible immunotherapy.

Antibodies to Orientia tsutsugamushi, Rickettsia typhi and spotted fever group rickettsiae among febrile patients in rural areas of Malaysia

A serosurvey was conducted in 1995-97 among 1596 febrile patients from 8 health centres in Malaysia for antibodies against Orientia tsutsugamushi (OT), Rickettsia typhi (RT) and TT118 spotted fever group rickettsiae (SFGR) by using an indirect immunoperoxidase assay. A total of 51.4% patients had antibody against at least 1 of those rickettsiae. Antibody to SFGR was most prevalent (42.5%), followed by RT (28.1%) and OT (24.9%). The seroprevalences of antibodies to SFGR, RT or OT alone were 12.4, 3.6 and 4.3%, respectively. Antibodies against more than 1 species of rickettsiae were presence in 31.1% of the patients, suggesting the possibility of co-infection, previous exposures or serological cross-reactivities. Seroprevalence of the various rickettsiae varied according to locality, with SFGR antibodies being the most prevalent in most areas. There was no significant association of prevalence of rickettsial antibody with gender. The seroprevalence of OT, SFGR and RT increased with patient age but an increase of antibody titre with age was not significant. Those working in the agricultural sectors had significantly higher seroprevalence of OT, SFGR and RT than those not related with agricultural activities. Scrub typhus remains a public health problem with an estimated annual attack rate of 18.5%. Tick typhus and murine typhus as shown in this serosurvey appear much more widespread than scrub typhus in this country.

Human otoacariasis

Accidental entry of insects and other arthropods is a common aetiology of aural foreign bodies (FB) presenting to accident and emergency departments. A retrospective study revealed that the FB in almost half (148) of 348 cases of aural FB investigated at the Universiti Sains Malaysia Hospital was an arthropod. The most common arthropod encountered was the cockroach, followed by a cattle tick. The high prevalence of tick infestation of the human ear canal (i.e. human otoacariasis) currently appears to be unique to the Malaysian state of Kelantan. The presentation of patients with intra-aural ticks, the methods used to remove the ticks, the complications encountered, and recommendations for an appropriate course of action in such cases are discussed.

House dust mite fauna of tropical Singapore

INTRODUCTION AND AIMS

Sensitization to house dust mites is very common in the tropics. This study evaluated the dust mite fauna in Singaporean homes.

METHODS

A total of 134 dust samples from 50 homes were evaluated. Dust mites were isolated, identified and quantified by standard techniques.

RESULTS

Dust mites were isolated from 130/134 (97%) samples, with mites identified in all samples from sofas (n = 21) and carpets (n = 13), and 49/50 (98%) and 47/50 (94%) from mattresses and bedroom floors, respectively. All samples from sofas and carpets had more than 500 mites/g compared with 47/50 (94%) and 23/50 (46%) from mattresses and floors, respectively. Blomia tropicalis was the predominant mite (62% of total mites) followed by D. pteronyssinus (16% of total mites). Eight samples had a predominance of Sturnophagoides brasiliensis and Tarsonemus granarius. Other species that accounted approximately 1% of mites identified included D. farinae, Austroglycyphagus malaysiensis, Cheyletus malaccensis, Malayoglyphus intermedius, Suidasia pontifica and Tyrophagus putrescentiae.

CONCLUSION

Dust mites were highly prevalent and present in high densities in Singaporean homes with B. tropicalis being the most prevalent species.

Evaluation of the MAST CLA allergy system for diagnosis of allergies to house dust mites and cats

The MAST CLA system was evaluated against skin prick test (SPT) for diagnosis of allergies to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cats. Forty three asthmatic children were examined by SPT and MAST CLA. Chi-square analysis indicated significant association between SPT and MAST CLA results for the house dust mites but not for cats. The sensitivities of MAST CLA for house dust mites and cats were 100 and 25% respectively; specificities were all less than 50%. The efficiency of MAST CLA for detection of allergy to the house dust mites was 88% and 44% for cats. A significant linear correlation was found between SPT wheal size and MAST CLA grade for D. farinae but not for D. pteronyssinus and cats. It is concluded that the MAST CLA allergy system can be used to supplement SPT for diagnosis of allergies to house dust mites but not to cats.

Life-cycle, longevity and fecundity of Blomia tropicalis (Acari: Glycyphagidae) in a tropical laboratory

In the present study on the life-cycle of Blomia tropicalis, freshly laid eggs were observed until they developed into adults; the development periods between stages were recorded. The eggs took an average of 22.9 +/- 6.4 days to develop to adults. For longevity experiments, newly emerged adults were kept at 25 degrees C and observed until they died. There was no significant difference in longevities of the different sexes (p = 0.053). Production of eggs by mated females were monitored until egg production stopped and the female died. Mated females and males survived an average of 32.2 +/- 15.4 and 30.9 +/- 17.7 days respectively. The difference in longevity of the mated females, and males was not significant (p = 0.747). Longevity of the mated females was found to be significantly (p < 0.05) shorter than unmated females.

Prevalence of allergy to some inhalants among rhinitis patients in Malaysia

This study was conducted to determine the seasonal prevalence of allergies to house dust, D. pteronyssinus, D. farinae, cat fur, dog hair, mixed moulds, mixed grass pollens and American cockroach. A total of 314 patients with clinically suspected allergic rhinitis was examined by prick test using commercial preparations of the above allergens. Total serum IgE of the patients was determined by a Sandwich ELISA. Ninety-six percent of the patients tested positive to more than one allergen. Most were positive to a combination of 4 allergens. More than 70% of the patients were positive to house dust, D. pteronyssinus, D. farinae and cat fur. Analysis indicates that for an individual who tests positive for house dust, there is a very high risk of the person being allergic to the dust mites and cat fur too. Most of the allergens had 2 peak period of high positive PT rates; mixed moulds and mixed grass pollens had 3 peaks. There was significant positive correlation between the monthly positive PT rates against mixed moulds and mixed grass pollens with maximum daily mean temperature and mean temperature at 14.00 hours.

Seasonal prevalence of air-borne pollen and spores in Kuala Lumpur, Malaysia

Aerosampling using Rotorod samplers was conducted in the Institute for Medical Research, Kuala Lumpur, Malaysia, from December 1991 to November 1993. Samples were collected twice a week between 10.00 hours to 12.00 hours. Rods were stained and examined microscopically. A total of 8 and 20 types of pollens and mold spores were collected, respectively. More mold spores were collected than pollens. Grass pollen constituted more than 40 percent of total pollen counts. Gramineae pollen counts peaked in March and September. The most abundant mold spore was Cladosporium followed by Rust, Nigrospora, Curvularia and Smut. Cladosporium counts peaked in February and August. Rust counts peaked in June and December whereas counts for Nigrospora peaked in February and October. Highest counts of Smut were recorded in March and October. Curvularia counts peaked in January, June and September.

Detection and characterization of Rickettsia tsutsugamushi (Rickettsiales: Rickettsiaceae) in infected Leptotrombidium (Leptotrombidium) fletcheri chiggers (Acari: Trombiculidae) with the polymerase chain reaction

We developed a method for detecting and characterizing the DNA of Rickettsia tsutsugamushi in chiggers (larval trombiculid mites) by polymerase chain reaction (PCR). Three procedures for extracting DNA from frozen chiggers were compared by evaluating the yield of PCR amplicand obtained with nine oligonucleotide primer pairs derived from the rickettsial 22 kD, 47 kD, groESL, 56 kD, and 110 kD antigen genes. Although extracts and primer pairs differed in amplification efficiency, R. tsutsugamushi DNA was successfully detected in extracts of colonized infected Leptotrombidium (Leptotrombidium) fletcheri (Wormersley & Heaslip) chiggers and in uninfected chigger extracts seeded with known amounts of Karp-strain rickettsiae. The 22 kD gene restriction fragment length polymorphisms (RFLP) observed in PCR amplicands from five rickettsial isolates obtained from the infected chigger colony over a 26-yr period were identical to those of PCR amplicands derived directly from infected chiggers taken from the same colony. This suggests that stable transmission of R. tsutsugamushi occurs in mites (62 generations), and isolates encompass the full genetic heterogeneity found in the chigger. PCR/RFLP analysis is an important new tool for investigating the complex epidemiology of scrub typhus rickettsiae in their mite vectors.

Development of ELISA for diagnosis of allergy to Dermatophagoides farinae

An indirect enzyme linked immunosorbent assay (ELISA) was developed for the diagnosis of allergy to a house dust mite, Dermatophagoides farinae. The efficacy of the ELISA was then evaluated against a prick test using a commercial allergen. Eighty five suspected allergic rhinitis patients from the Otorhinolaryngology Department, Kuala Lumpur General Hospital, were tested with the ELISA and prick test. Prick test and ELISA results were positive in 84.7% and 80.0% of the patients respectively. The ELISA was found to have 87.5% sensitivity, 61.5% specificity, 92.6% positive predictive value, 47.1% negative predictive value, 7.4% false positive and 52.9% false negative. There was total agreement between the prick test and ELISA for prick test grades of 3+ and 4+. It is concluded that the ELISA is a useful assay for detection of individuals who are highly sensitive to D. farinae.

Laboratory evaluation of two commercial repellants against Leptotrombidium fletcheri (Acari: Trombiculidae)

Two commercial repellants were evaluated in the laboratory against Leptotrombidium fletcheri chiggers. The active ingredient in one was DEET and in the other was citrus oil. Excito-toxicity effect was studied and it was determined by the time ("escape time") chiggers took to move off filter papers treated with the repellants. All chiggers exposed on filter papers treated with DEET died and did not move off the treated papers. None of the chiggers that were placed on papers treated with citrus oil were killed. Escape times on papers treated with a 2-sec spray of citrus oil were longer than those for the 4- and 8-sec sprays. The weights of citrus oil deposited increased with increasing spray times. Electron microscopy showed that the repellants had no effect on the texture of the filter papers. It was concluded that the spray containing DEET was more effective; however, both repellants should be further evaluated under field conditions for protection against chigger bites.

Laboratory evaluation of five pesticides for control of Leptotrombidium fletcheri (Acari: Trombiculidae)

Five pesticides were evaluated against laboratory colonies of Leptotrombidium fletcheri (Womersly and Heaslip) by the Pasteur pipet technique. The pesticides were dieldrin (LC50 = 3.6 ppm, LC99 = 18.2 ppm), bromopropylate (LC50 = 9.2 ppm, LC99 = 239.6 ppm), dicofol (LC50 = 27.8 ppm, LC99 = 118.1 ppm), fenthion (LC50 = 15.4 ppm, LC99 = 29.7 ppm), and malathion (LC50 = 84.7 ppm, LC99 = 313.9 ppm). Dieldrin was the most toxic. Dicofol was recommended for further evaluation in field trials.

Development of an enzyme-linked immunosorbent assay for detection of IgE antibodies specific to Dermatophagoides pteronyssinus

Allergy to Dermatophagoides pteronyssinus was determined in 61 rhinitis patients using prick test (PT), enzyme-immunoassay (EIA) and enzyme-linked immunosorbent assay (ELISA). A total of 43 patients tested positive with PT. Forty six patients were positive when tested with EIA and ELISA. With PT as standard test, EIA was found to have 83.7% sensitivity and 44.4% specificity; ELISA had 81.4% sensitivity and 38.9% specificity. There was a linear relationship between absorbance values obtained by EIA and ELISA. The performance time was 8 hours, 24 hours and 30 minutes for ELISA, EIA and PT respectively. The cost per test for ELISA, EIA and PT was US$ 0.20, US$ 5.20 and US$ 0.14 respectively. It was concluded that ELISA was more cost-effective than EIA should be used to supplement PT for a more complete diagnosis of allergy.

Crystal data on some potassium lithium metal sulphides (KLiMS2, M being Zn, Mn or Fe)

Compounds of the formula KLiMS2, where M is one of the divalent transition elements Zn, Mn or Fe, belong to the tetragonal crystal system. They are not, however, isomorphous. KLiZnS2: P, a = 6.600(5), c = 15.570(5) Å; KLiMnS2: P, a = 6.800(5), c = 11.055(5) Å; KLiFeS2: I, a = 3.840(5), c = 13.270(5) Å. X-ray powder diffraction data for all three compounds are given. The JCPDS Diffraction File Nos. for these compounds are: KLiZnS2 33-1494; KLiMnS2 33-1493; KLiFeS2 33-1492.