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Aims@#Respiratory tract infections (RTIs) among Malaysian pilgrims are caused by exposure to zoonotic-potential respiratory pathogens, symptomatically and asymptomatically affected by rigorous pilgrimage rituals, overcrowding and other stressors. This study aimed to determine the prevalence, virulence and antibiotic resistance genes of selected zoonotic respiratory pathogens using polymerase chain reaction (PCR) assays among Hajj pilgrims from Kelantan state, Malaysia.@*Methodology and results@#Throat swab specimens were obtained from 189 Kelantan Hajj pilgrims in 2016 and examined by PCR for the identification of respiratory pathogens. Thirteen samples (6.88%) were positive for Streptococcus pneumoniae and four (2.11%) were positive for Klebsiella pneumoniae. All the samples were negative for Influenza A virus, MERS-CoV and Mycobacterium bovis. One sample was positive for S. pneumoniae virulence lytA gene. One sample was positive for K. pneumoniae virulence magA and K2A genes respectively, and three samples were positive for K. pneumoniae rmpA genes. Ten and seven samples were positive for S. pneumoniae mefA and pbpA antibiotic resistance genes respectively. Two samples were positive for K. pneumoniae blaKPC and blaOXA-48 antibiotic resistance genes. @*Conclusion, significance and impact of study@#This work provided insight into the existence of zoonotic respiratory pathogens inducing Hajj RTIs in Kelantan pilgrims. It showed promising findings for zoonotic studies in Hajj settings. The findings could be relevant in potential control measures for the management of zoonotic infections among Hajj pilgrims.
Subject(s)
Respiratory Tract Infections , Polymerase Chain Reaction , Bacterial ZoonosesABSTRACT
@#The flood disaster in Kelantan in 2014 had resulted in substantial health implications including increased cases of communicable diseases. There was a lack of community preparedness including customized health educations in the prevention and control of flood-related communicable diseases in the affected areas. The research was aimed to evaluate the effectiveness of community-based health education modules on flood-related communicable diseases among communities in Kelantan. Health education modules focusing on major food-related diseases were developed. A non-randomized community-controlled trial using the modules were conducted. Outcomes were assessed on knowledge, attitude and preventive practice scores to flood-related communicable diseases using a pre-validated questionnaire. Independent t test was used to compare mean scores between the intervention community (Tumpat) and the control community (Bachok) at 1-month post intervention. One-way independent ANOVA test was done to compare score differences at baseline (pre), post 1-month and post 2-month from repeated surveys among random samples within the intervention community. There were significant improvements in all knowledge components from 9.4% to 52.6% with 10% increment in attitude scores toward preventing behaviours on flood-related communicable diseases. When compared against the control community at one-month post-intervention, there were significantly higher knowledge on types of diseases, symptoms and risk factors as well as practice scores of drinking safe water and protective habits. This research demonstrated that community-based health education is effective in improving relevant knowledge, attitude and preventive practices among affected communities as part of their preparedness toward communicable diseases related to flood.
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@#Introduction: HIV is the leading cause of mortality and morbidity worldwide. There are two types of HIV, HIV-1, and HIV-2, which are geographically different in epidemiology and determinants. Objective: To determine the epidemiology and determinants of HIV-1 and HIV-1&2 in the three tertiary hospitals of Eastern Peninsular Malaysia. Method: A cross-sectional study of confirmed serologically HIV-1 and HIV-1&2 from January 2016 until December 2018. SPSS analysed all collected data, descriptive statistics for sociodemographic data and Pearson chi-square for the association between type of HIV with HCV, HBV, syphilis, and tuberculosis. In identifying the risk factor associated with HIV-1&2, several variables were tested by the Multiple Logistic Regression Model. A P-value of <0.05 was considered statistically significant. Results: Out of 519 serologically diagnosed HIV, 344 (66.28%) were HIV-1, and 175 (33.72%) were HIV-1&2. HIV positive were highly distributed in Malay male in both groups. Most HIV-1 patients were single, unemployed, and presented with tuberculosis. HIV-1&2 were single and employed, mostly asymptomatic at diagnosis. The commonest mode of transmission for HIV-1 was by sexual contact (31.87%), whereas IVDU (13.63%) in HIV-1&2. Co-infection with tuberculosis (P=0.005) and HCV (P<0.001) were significantly higher in HIV-1 as compared to HIV-1&2. IVDU was a significant determinant to develop HIV-1&2 (Adjusted OR: 3.5, 95% CI=1.875-5.227, P<0.001). Conclusion: HIV-1&2 was high in this study. Patients with HIV-1&2 present in less severe symptoms compared to the patient with HIV-1. A further molecular diagnostic study should be tested to confirm the type of HIV.
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Background: Treating patients with multidrug-resistant tuberculosis (MDR-TB) strains is more complicated, complex, toxic, expensive, than treating patients with susceptible TB strains. This study aims to compare the treatment outcomes and potential factors associated between patients with MDR-TB and non MDR TB infections in peninsular Malaysia. Methods: This study was a retrospective cohort study. Data were collected from the medical records of all registered MDR-TB patients and Non-MDR-TB patients at five TB hospitals in peninsular Malaysia from January 2010 to January 2014. Results: A total of 314 subjects were studied, including 105 MDR-TB cases and 209 non-MDRTB. After TB treatment, 24.8% of the MDR-TB patients and 17.7% of non MDR TB relapsed; 17.1% of the MDR-TB patients and 16.3% of non MDR TB defaulted from TB treatment. A significant difference seen in treatment success rate 17.1% for MDR-TB; 63.1% for non MDR TB (P < 0.001)). Mortality rate were 8.9% for MDR-TB; 13.2% for non MDR TB. Multivariable analysis showed the potential factors associated with poor treatment outcomes were presence of HIV infection (AOR, 1.09; 95%CI: 1.05, 1.75; P = 0.001) and previous TB treatment (AOR, 4.87; 95%CI: 2.84, 8.38; P = 0.001). Conclusion: This study revealed that the treatment success rate in patients with non MDR TB infection was higher than MDR-TB. Unsuccessful treatment was seen in MDR-TB associated with potential factors such as history of TB treatment, and presence of HIV infection.
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Methicillin-resistant Staphylococcus aureus [MRSA] is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide. The aim of the present study was to assess the burden of MRSA nosocomial infection, its association with factors of interest, and its antimicrobial susceptibility. This was a retrospective analysis of a database of all S aureus that were cultured from patients admitted to the different wards of Hospital Universiti Sains Malaysia [HUSM] over a period of 6 years. The MRSA infections rate was 10.0 per 1000 hospital admissions. The incidence density rate of MRSA infections during the study period was 1.8 per 1000 patient-days, with annual rates ranging from 0.95 to 3.47 per 1000 patient-days. Duration of hospitalization, previous antibiotic use, and bedside invasive procedures were significantly higher among MRSA than methicillin-sensitive S aureus patients [P>.05]. The highest number of MRSA infections were found in orthopedic wards [25.3%], followed by surgical wards [18.2%] and intensive care units [ICUs] [16.4%]. All MRSA isolates were resistant to erythromycin [98.0%], co-trimoxazole [94.0%] and gentamicin [92.0%]. Clindamycin was the best antibiotic with only 6% resistance. All MRSA isolates were sensitive to vancomycin. The rate of nosocomial MRSA infection per 1000 admissions was higher than that in other studies. The three factors associated most significantly with acquired MRSA infections included duration of hospitalization, antibiotic use, and bedside invasive procedures. This study confirmed that vancomycin-resistant S aureus has not yet been established in HUSM