Seroprevalence of acute dengue in a Malaysian tertiary medical centre

Objectives: The aims of this study were to determine the seroprevalence of acute dengue in Universiti Kebangsaan Malaysia [UKM] Medical Centre and its correlation with selected haematological and biochemical parameters

Methods: This cross-sectional study was conducted from January to June 2015. A patient was serologically diagnosed with acute dengue if the dengue virus IgG, IgM or NS-1 antigen was reactive

Results: Out of 1,774 patients suspected to have acute dengue, 1,153 were serologically diagnosed with the infection, resulting in a seroprevalence of 64.9%. Dengue-positive patients had a lower mean platelet count [89 x 10[9]/L] compared to the dengue-negative patients [171 x 10[9]/L] [p<0.0001]. The mean total white cell count was also lower in the dengue-positive cases [4.7 x 10[9]/L vs. 7.2 x 10[9]/L; p<0.0001]. The mean haematocrit was higher in patients with acute dengue [42.5% vs. 40.0%; p<0.0001]. Likewise, the serum alanine transaminase level was also higher in patients with acute dengue [108 U/L vs. 54 U/L; p<0.0001]

Conclusions: Dengue is very prevalent in UKM Medical Centre as most patients suspected to have acute dengue had serological evidence of the infection. The platelet count was the single most likely parameter to be abnormal [i.e. low] in patients with acute dengue

Screening for New Delhi metallo-Beta-lactamase-1 in Enterobacteriaceae: is there a role for the modified Hodge test?

Objective: The New Delhi metallo-Beta-lactamase-1 [NDM-1] enzyme is a plasmid-encoded enzyme that inactivates carbapenem antibiotics. This study aims to ascertain if the modified Hodge test [MHT] has a role in screening for NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility

Methods: Over a period of one year, all Enterobacteriaceae isolates from all clinical specimens with reduced susceptibility to at least one carbapenem were subjected to MHT and conventional polymerase chain reaction [PCR] detection of the NDM-1 gene

Results: A total of 13,098 Enterobacteriaceae isolates were screened and 63 [0.48%] had reduced susceptibility to at least one carbapenem. Out of the 63 isolates, 45 [71.4%] were MHT-positive. The NDM-1 gene was detected in 18 of the 63 isolates [28.6%]. All 18 PCR-positive isolates were also MHT-positive. Thus, the sensitivity and specificity of the MHT in detecting NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility are 100% and 40%, respectively

Conclusion: The MHT is a useful test to screen for the presence of NDM-1 in Enterobacteriaceae with reduced carbapenem susceptibility. However, due to its rather low specificity, all MHT-positive isolates should be subjected to alternative tests [e.g. PCR] for confirmation, especially if other types of carbapenemases [e.g. KPC] are prevalent

Paecilomyces lilacinus fungaemia in an AIDS patient:the importance of mycological diagnosis

Fungaemia due to Paecilomyces lilacinus is generally not considered in AIDS patients because this condition is not categorised as an AIDS-indicator illness. We report a case of a 25-year-old lady who presented to our hospital with Guillain-Barre Syndrome, with the subsequent development of refractory fungaemia, multi-organ failure and disseminated intravascular coagulopathy. Amphotericin B was given as empirical antifungal therapy. HIV screening was reactive and Paecilomyces lilacinus was isolated from her blood. The fungaemia did not resolve after one week of amphotericin B treatment. The addition of itraconazole was also unsuccessful in clearing the fungaemia. Accurate mycological diagnosis is important in the care of AIDS patients with fungaemia because of the risk of treatment failure with empirical therapy

Molecular characterization of two Bangladeshi infectious bursal disease virus isolates using the hypervariable sequence of VP2 as a genetic marker

Two Bangladeshi infectious bursal disease virus (IBDV) isolates collected in 2007, termed GB1 and GB3, were subjected to comparative sequencing and phylogenetic analyses. Sequence analysis of a 474-bp hypervariable region in the VP2 gene revealed that among four major amino acid substitutions observed in the strains, two were unique to GB1 and GB3 (Ser217Leu and Ala270Thr) while one substitution was only found in GB1 (Asn299Ser). Among IBDVs from Bangladesh including GB1 and GB3, the rate of identity and homology was around 97~99%. The amino acid sequences of GB1 and GB3 differ from those of previous Bangladeshi IBDV isolates and contain amino acid substitutions Pro222Ala and Asn299Ser (in GB3 only). Phylogenetic analysis revealed that GB1 and GB3 are grouped with other very virulent IBDVs of European and American origin in contrast to two previously isolated Bangladeshi IBDV strains (GenBank accession Nos. AF362776 and AF260317), which belong to the Asian group. It was concluded that GB1 and GB3 belong to a very virulent group of IBDVs. However, amino acid sequences of GB1 and GB3 differ from those of the other Bangladeshi IBDVs by one or two amino acids encoded in the hypervariable region of the VP2 gene.

Dengue in Malaysia: an epidemiological perspective study

Dengue is a mosquito-transmitted infection and is an important health problem in Asia for its fatality. The objective of the study was to determine some epidemiological parameters relating to age, gender, community, and prevalence nature, serology and disease severity. One hundred forty nine dengue suspected sera samples were obtained from suspected patients presenting with dengue symptoms. The samples collected were analyzed by serological detection of Immunoglobulin-M [IgM], Immunoglobulin G [IgG], virus culture in cell- line C36/36 and Reverse Transcriptase Polymerase Chain Reaction [RT-PCR]. The studies showed that out of 149 sera samples, 48 [32.2%] were detected dengue virus by cell culture and RT-PCR and 108 [72.5%] positive by serology. Of the 108 cases, 40 [26.8%] were positive to IgM, 61 [41%] were positive to both IgG and IgM, and 7[4.7%] cases were positive to IgG only. Prevalence of dengue was higher in age group 20-29 years and infection was more in male and in Malay population. Epidemic intensity was the highest in the month of June. Dengue is highly endemic in Malaysia and age group 20-29 was vulnerable to infection, male infected more than female and infection was higher in Malay community. Effective preventive and control measures may be strengthened to reduce the infections

Drug resistance and susceptibility of mycobacterium tuberculosis identified at university Kebangsaan Malaysia medical centre

The prime objective of the study was to evaluate drug resistance and susceptibility of Mycobacterium tuberculosis isolated at University Kebangsaan Malaysia Medical Centre. A total number of 726 specimens in the form of sputum and bronchial lavage obtained from patients suspected to tuberculosis were analysed for confirmatory identification and antibiotic susceptibility testing. The bacteria was identified initially by culture and staining and finally by BDProbeTecTM ET Mycobacteria kits [2008]. All Mycobacterium tuberculosis isolates were subjected to antibiotic susceptibility against streptomycin, isoniazid, rifampicin and ethambutol using BACTECTM MGITTM 960 system. Out of 726 specimens 16 [32.65%] were identified as mono drug resistance 7 [14.29%] as poly drug resistance, 4 [8.16%] as multi-drug resistance [MDR-TB]. Identified TB bacteria were analysed in the light of sources of samples where brief history of the patients' age, gender and community noted. Bacteriologic testing with antibiotic sensitivity, standardized treatment with supervision and patient support, provision and management of the drugs used in treatment are necessary for effective treatment of tuberculosis