Current Status of Standard Diagnostics and Treatment for Malaria, Tuberculosis, and Hepatitis in Myanmar

Malaria, tuberculosis, and hepatitis are common and notorious infectious diseases in Myanmar. Despite intensive efforts to control these diseases, their prevalence remains high. For malaria, which is a vector-borne disease, a remarkable success in the reduction of new cases has been achieved. However, the annual number of tuberculosis cases has increased over the last few decades, and the prevalence of chronic viral hepatitis infection has been high in Myanmar and other nearby countries. Early detection and prompt treatment are crucial to control these diseases. We have devoted our research efforts to understanding the status of these infectious diseases and working towards their eventual elimination for the last four years with the support of the Korea International Cooperation Agency. In the modern era, an infection that develops in one geographical area can spread globally because national borders do not effectively limit disease transmission. Our efforts to understand the status of infectious diseases in Myanmar will benefit not only Myanmar but also neighboring countries such as Korea.

Molecular Strain Typing of Mycobacterium tuberculosis: a Review of Frequently Used Methods

Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, remains one of the most serious global health problems. Molecular typing of M. tuberculosis has been used for various epidemiologic purposes as well as for clinical management. Currently, many techniques are available to type M. tuberculosis. Choosing the most appropriate technique in accordance with the existing laboratory conditions and the specific features of the geographic region is important. Insertion sequence IS6110-based restriction fragment length polymorphism (RFLP) analysis is considered the gold standard for the molecular epidemiologic investigations of tuberculosis. However, other polymerase chain reaction-based methods such as spacer oligonucleotide typing (spoligotyping), which detects 43 spacer sequence-interspersing direct repeats (DRs) in the genomic DR region; mycobacterial interspersed repetitive units–variable number tandem repeats, (MIRU-VNTR), which determines the number and size of tandem repetitive DNA sequences; repetitive-sequence-based PCR (rep-PCR), which provides high-throughput genotypic fingerprinting of multiple Mycobacterium species; and the recently developed genome-based whole genome sequencing methods demonstrate similar discriminatory power and greater convenience. This review focuses on techniques frequently used for the molecular typing of M. tuberculosis and discusses their general aspects and applications.

Phenotypic and Genotypic Analysis of Anti-Tuberculosis Drug Resistance in Mycobacterium tuberculosis Isolates in Myanmar

BACKGROUND: Tuberculosis (TB) is one of the most serious health problems in Myanmar. Because TB drug resistance is associated with genetic mutation(s) relevant to responses to each drug, genotypic methods for detecting these mutations have been proposed to overcome the limitations of classic phenotypic drug susceptibility testing (DST). We explored the current estimates of drug-resistant TB and evaluated the usefulness of genotypic DST in Myanmar. METHODS: We determined the drug susceptibility of Mycobacterium tuberculosis isolated from sputum smear-positive patients with newly diagnosed pulmonary TB at two main TB centers in Myanmar during 2013 by using conventional phenotypic DST and the GenoType MTBDRplus assay (Hain Lifescience, Germany). Discrepant results were confirmed by sequencing the genes relevant to each type of resistance (rpoB for rifampicin; katG and inhA for isoniazid). RESULTS: Of 191 isolates, phenotypic DST showed that 27.7% (n=53) were resistant to at least one first-line drug and 20.9% (n=40) were resistant to two or more, including 18.3% (n=35) multidrug-resistant TB (MDR-TB) strains. Monoresistant strains accounted for 6.8% (n=13) of the samples. Genotypic assay of 189 isolates showed 17.5% (n=33) MDR-TB and 5.3% (n=10) isoniazid-monoresistant strains. Genotypic susceptibility results were 99.5% (n=188) concordant and agreed almost perfectly with phenotypic DST (kappa=0.99; 95% confidence interval 0.96-1.01). CONCLUSIONS: The results highlight the burden of TB drug resistance and prove the usefulness of the genotypic DST in Myanmar.

Current trends of antibiotic sensitivity pattern of bacterial pathogens isolated from dysentery cases from clinics

A cross-sectional descriptive clinic based study was carried out among 150 dysentery cases attending the three general practitioners clinics from February 1998 to June 1999. The cases comprised 62 percent males and 38 percent females. The age range was from six months to 72 years. The siolated bacterial pathogens were Enteropathogenic Escherichia coli (EPEC) (8 percent);Enterotoxigenic Escherichia coli (ETEC) (6.7 percent); Shigella species (6.7 percent),out of which were Shigella flexneri (50 percent), Shigella dysenteriae (40 percent)and Shigella sonnei (10 percent). The antibiotic susceptibility revealed that EPEC were sensitive to amikacin, augmentin, furazolidone, gentamicin, netilmicin, norfloxacin, nalidixic acid (83.3 percent) each, sisomycin and chloramphenicol (75 percent)each, cephalothin, streptomycin and neomycin (66.7 percent) each, and septrin (58.3 percent). They were resistant to ampicillin (66.7 percent), tetracycline (75 percent), and carbenicillin (66.7 percent). Shigella species were sensitive to netilmicin (100 percent), norfloxacin (100 percent), amikacin, augmentin, furazoli-done, gentamicin (80 percent) each, cephalothin, nalidixic acid, neomycin, septrin (70 percent)each. They were sesistant to streptomycin (100 percent),chloramphenicol (80 percent), tetracycline (80 percent), carbenicillin (70 percent)and ampicillin (60 percent).

Current trends of antibiotic susceptibility pattern of bacterial pathogens isolated from dysentery cases from clinics

A cross-sectional descriptive clinic based study was carried out among 150 dysentery case attending the three general practioners' clinic from February 1998 to June 1999.The cases comprised 62 patients males and 38 percent females.The age range was from six month to 72 years.The isolated bacterial pathogens were Enteropathogenic Escherichia Coli (EPEC) (8 percent); Enterotoxigenic Escherichia coli (ETEC) (6.7 percent); shigella species (6.7 percent), out of which were Shigella Flexneri (50 percent), shigella dysenteiae (40 percent) and shigella sonnei(10 percent).The antibiotics susceptibility revealed that EPEC were sensitive to amikacin, augmentin, furazolidone, gentamicin, netilmicin, norfloxacin, nalidixic acid (83.3 per cent ) each; sisomycin and chloramphenicol (75 per cent ) each, cephalothin, streptomycin and neomycin (66.7 percent) each, septrin (58.3 percent).They were resistant to ampicillin (66.7 percent), tetracycline (75 percent) and carbinicillin (66.7 percent).Shigella species were sensitive to netilmicin (100 percent), norfloxacin (100 percent), amikacin, augamentin, furazolidone, gentamicin (80 percent) each, cephalothin, nalidixic acid, neomycin, septrin (70 percent) each.They were resistant to streptomycin (100 percent), chloramphenicol (80 percent), tetracycline (80 percent), carbenicillin (70 percent) and ampicillin (60 percent).

Survival of Vibrio Cholerae 01 and 0139 strains in some foods of Yangon

The purpose of this study was to determine the survival of Vibrio cholerae 01 and 0139 in foods which are usually offered by street vendors in Yangon. Survival was tested at room temperature (28 degree C-34 degree C) and 4 degree C in melon, mohinga, lethoke and sugar cane juice samples by artifical contamination of food samples. Both Vibrio cholerae 01 and 0139 could survive up to 4 hours at room temperature and up to 24 hours at 4 degree C. The growth was obvious in lethoke and sugar cane juice samples and static in melon and Mohinga samples.

Effect of food supplementation during the third trimester, on outcome of pregnancy

The effect of energy supplemention during pregnancy on outcome was assessed in a trial in Sanchaung Township, Yangon, Myanmar Women who were 26-28 weeks pregnant coming to the Sanchaung Health Centre for antenatal care were assigned to three study groups. Group I consisted of women who had normal weight-for-height according to gestational age. Group II and III consisted of women who were malnourished (< 80 percent weight-for height) pregnant women matched by age and parity. Group II was supplemented with 500 kcal/d during the third trimester, whereas Group III was unsupplemented. There was a positive correlation between socio-economic score and total caloric intake and protein intake per day. There was also a significant difference between supplemented and unsupplemented malnourished group. However, there was no significant difference between the normal and malnourished group with supplementation. Thus, energy supplementation for short duration, during the third trimester is sufficient of improve outcome of pregnancy as judged by birth weight, length and head circumference of infants.