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.

Prevalence of household drinkingwater contamination and of acute diarrhoeal illness in a periurban community in Myanmar

Background: A major health consequence of rapid population growth in urbanareas is the increased pressure on existing overstretched water and sanitationservices. This study of an expanding periurban neighbourhood of Yangon Region,Myanmar, aimed to ascertain the prevalence of acute diarrhoea in children under5 years; to identify household sources of drinking-water; to describe purificationand storage practices; and to assess drinking-water contamination at point-of-use.Methods: A survey of the prevalence of acute diarrhoea in children under 5years was done in 211 households in February 2013; demographic data werealso collected, along with data and details of sources of drinking water, waterpurification, storage practices and waste disposal. During March–August, a subsetof 112 households was revisited to collect drinking water samples. The sampleswere analysed by the multiple tube fermentation method to count thermotolerant(faecal) coliforms and there was a qualitative determination of the presence ofEscherichia coli.Results: Acute diarrhoea in children under 5 years was reported in 4.74%(10/211, 95% CI: 3.0–9.0) of households within the past two weeks. More thanhalf of the households used insanitary pit latrines and 36% disposed of their wasteinto nearby streams and ponds. Improved sources of drinking water were used,mainly the unchlorinated ward reservoir, a chlorinated tube well or purified bottledwater. Nearly a quarter of households never used any method for drinking-waterpurification. Ninety-four per cent (105/112) of water samples were contaminatedwith thermotolerant (faecal) coliforms, ranging from 2.2 colony-forming units(CFU)/100 mL (21.4%) to more than 1000 CFU/100 mL (60.7%). Of faecal(thermotolerant)-coliform-positive water samples, 70% (47/68) grew E. coli.Conclusion: The prevalence of acute diarrhoea reported for children under 5 yearswas high and a high level of drinking-water contamination was detected, thoughit was unclear whether this was due to contamination at source or at point-of-use.Maintenance of drinking-water quality in study households is complex. Furtherresearch is crucial to prove the cost effectiveness in quality improvement of drinkingwater at point-of-use in resource-limited settings. In addition, empowerment ofhouseholders to use measures of treating water by boiling, filtration or chlorination,and safe storage with proper handling is essential

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.

Case-control study of ectopic pregnancies in Myanmar: infectious etiological factors.

We studied the role of infections in ectopic pregnancy and the different methods of detecting Chlamydia trachomatis infection using serology, cervical and tubal PCR assays, by using a hospital-based, case-control study conducted between November 2007 and September 2009. The sample size was 339 with 113 cases and 226 controls. The cases were women admitted for the management of ectopic pregnancy while the controls were women admitted for spontaneous miscarriage. Both cases and controls were tested for syphilis and chlamydial infection by serology. In addition, cervical samples from controls and both cervical and tubal samples from cases were examined for the presence of chlamydia and gonococcal DNA. Sociodemographic data and past histories were collected using set Proforma. Independent variables for multivariate analysis included previous history of spontaneous abortion, ectopic pregnancy, symptoms of sexully transmitted infections (STI), and use of contraception. Women with a previous history of ectopic pregnancy (adjusted OR 28.3; 95% CI 5.8-138.8; p = 0.01) and a past history of having had symptoms of STI (adjusted OR 11.06; 95% CI 5.45-22.44; p = 0.0005) were significantly more likely to have an ectopic pregnancy than those without such a history. Syphilis serology was positive in 13.3% of ectopic pregnancy cases compared to only 3.5% of controls (crude OR 0.24; 95% CI -0.10-0.58; p = 0.001). From cervical swabs, chlamydia DNA was detected significantly more frequently in cases than controls (8.0% vs 2.2%; crude OR 0.261; 95% CI -0.09-0.80, p = 0.012) but gonorrhea DNA detection rates were not significantly different (3.5% vs 0.9%, crude OR 0.24; 95% CI -0.04-1.35; p = 0.1). Chlamydia was positive in cases only as diagnosed tubal samples for PCR in 17 (15.0%), cervical samples for PCR in 9 (8.0%) and IgM ELISA in 6 (5.3%). Among the three STI tested for in this study, C. trachomatis was the most frequently associated with ectopic pregnancy and was more frequently diagnosed by PCR on tubal samples than PCR on cervical samples or chlamydia IgM serology.