A five-year retrospective review of snakebite patients admitted to a tertiary university hospital in Malaysia

BACKGROUND Although the majority of the snakebite cases in Malaysia are due to non-venomous snakes, venomous bites cause significant morbidity and mortality if treatment measures, especially ant-venom therapy, are delayed. METHODS To determine the demographic characteristics, we conducted a retrospective study on all snakebite patients admitted to the Emergency Department of Hospital Universiti Sains Malaysia (HUSM) from January 2006 to December 2010. RESULTS In the majority of the 260 cases that we found (138 cases or 52.9%), the snake species was unidentified. The most common venomous snakebites among the identified species were caused by cobras (52 cases or 20%). Cobra bites are significantly more likely to result in severe envenomation compared to non-cobra bites. Post hoc analysis also showed that cobra bite patients are significantly less likely to have complete recovery than non-cobra bite patients (48 cases, 75.0% vs. 53 cases, 94.6%; p = 0.003) and more likely to result in local gangrene (11 cases, 17.2% vs. 3 cases, 5.4%; p = 0.044). CONCLUSION Cobra bites are significantly more likely to result in severe envenomation needing anti-venom administration and more likely to result in local gangrene, and the patients are significantly less likely to have complete recovery than those with non-cobra bites

Dirofilaria causing eye infection in a patient from Malaysia

Human dirofilariasis caused by Dirofilaria immitis and Dirofilaria repens have been reported in Malaysia. This is the fourth reported case of dirofilariasis caused by D. repens. The patient was a Chinese male from Kuching Sarawak, Malaysia who presented with a one day history of redness and itchiness over the temporal aspect of his left eye. A worm was seen and later removed from beneath the conjunctiva under local anesthesia and based on the morphological characteristics, it was identified as an immature Dirofilaria repens

ParaSitic iNFEctiON: a rEcUrriNg PHENOmENON iN maLaYSia

Abstract. A total of 255 patients including 179 (70.2%) of non-HIV and 76 (29.8%) HIV-infected patients were recruited in this descriptive study. The subjects was significantly found to be male Chinese (157; 61.6% vs 74; 47.1%) followed by female Malays (98; 38.4% vs 35; 35.7%) (p<0.05). The majority of subjects (124; 48.6%) were in the age group of 21-39 years, however, no statistical difference was found between the various age groups (p>0.05). Overall seroprevalence of latent Toxoplasma infection was 82/183 (44.8%) being; 3 (3.7%) positive for IgM, 74 (90.2%) for IgG, and 5 (6.1%) for IgG and IgM antibodies. The prevalence was more relatively found in the Chinese (28; 15.3%) and Malays (27; 14.8%) than others (p<0.05). While, 23/76 (30.3%) of HIV-positive patients were shown Toxoplasma seropositivity. The majority of these subjects (138/181; 76.2%) were significantly asymptomatic (p = 0.000), while the others were clinically evident cases of toxoplasmosis. Of this, 37 patients were included in differential diagnosis relating to ocular diseases and only 4 patients were confirmed as having ocular toxoplasmosis. Toxoplasmic encephalitis (TE) was based on presumptive diagnosis, particularly found in 5 patients with AIDS. Seventeen patients were clinically diagnosed as having malaria being; 8 for P. vivax, 4 for P. falciparum, 3 for P. malariae, and 2 for mixed infections. All cases resolved satisfactorily after treatment with antimalarial drugs. Other important emerging parasitic diseases were also detected in these patients including amebiasis (2), blastocystosis (1), cryptosporidiosis (1), filariasis (1), and giardiasis (2) during the time of this study

Intestinal myiasis in a Malaysian patient caused by larvae of Clogmia albipunctatus (Diptera: Psychodidae)

Clogmia albipunctatus (Duckhouse) is a cosmopolitan fly belonging to the family Psychodidae and is one of the medically important insects associated with urban environments ( Smith and Thomas 1979 ). Psychodid larvae can cause myiasis in humans through infestation of healthy or traumatized tissues ( Hall and Smith 1993 ). Human myiasis can be presented in various forms with cutaneous myiasis the most common form ( Tu et al. 2007 ). Other infestation sites include nasal, aural, pulmonary, ophthalmic cavities, body cavities, and the gastrointestinal and urogenital systems ( Tu et al. 2007 , El-Badry et al. 2014 ). Intestinal myiasis may result from accidental ingestion of larvae. Subsequently, this form of myiasis presents symptoms such as nausea, vomiting, abdominal pain and distention, loss of appetite, weight loss, and episodic diarrhea ( Ramana 2012 ). This is the second reported case of human intestinal myiasis in Malaysia caused by larvae of C. albipunctatus . Microscopic examination revealed the structure of the larvae and DNA barcoding established the species identity

Retrospective study of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) patients at University Malaya Medical Center, Kuala Lumpur, Malaysia in the year 2005

The aim of this retrospective study was to determine the number of dengue fever (DF) and dengue hemorrhagic fever (DHF) cases admitted to University Malaya Medical Center (UMMC) in the year 2005 together with their clinical presentations and epidemiology. The data for 2005 was collected from the medical records department of UMMC. A total of 1,279 cases were admitted in 2005 with DF (81, n=1,040) and DHF (19, n=239). January had the greatest number of cases of DF and DHF (22, n=281) and April had the least (4, n=49). The greatest number of DF cases (38, n=392) were seen in the 20-29 year age group, while the greatest number of DHF cases (32, n=76) were in the 10-19 year age group. In regard to race, the greatest number of cases were seen in Malays (48, DF; 49, DHF). Males were more commonly infected than females. The majority of patients infected were students (30, n=385). All patients with DF and DHF presented with fever. The symptoms reported included nausea and vomiting, joint pain, gum bleeding and dehydration. The mean value hemoglobin, white blood cell count and platelet count were 14.4 g/dl, 4 x103/dl, 75 x106/dl for DF and 15.1 g/dl, 4 x103dl,52x106/dl for DHF. The majority of patients were treated with hydration therapy. There were three deaths reported, caused by dengue shock syndrome (DSS)

Is there a risk of suburban transmission of malaria in Selangor, Malaysia?

Background The suburban transmission of malaria in Selangor, Malaysia’s most developed and populous state still remains a concern for public health in this region. Despite much successful control efforts directed at its reduction, sporadic cases, mostly brought in by foreigners have continued to occur. In addition, cases of simian malaria caused by Plasmodium knowlesi, some with fatal outcome have caused grave concern to health workers. The aim of this study was to investigate the possibility of local malaria transmission in suburban regions of Selangor, which are adjacent to secondary rainforests. Findings A malaria survey spanning 7 years (2006 - 2012) was conducted in Selangor. A total of 1623 laboratory confirmed malaria cases were reported from Selangor’s nine districts. While 72.6% of these cases (1178/1623) were attributed to imported malaria (cases originating from other countries), 25.5% (414/1623) were local cases and 1.9% (31/1623) were considered as relapse and unclassified cases combined. In this study, the most prevalent infection was P. vivax (1239 cases, prevalence 76.3%) followed by P. falciparum (211, 13.0%), P. knowlesi (75, 4.6%), P. malariae (71, 4.4%) and P. ovale (1, 0.06%). Mixed infections comprising of P. vivax and P. falciparum were confirmed (26, 1.6%). Entomological surveys targeting the residences of malaria patients’ showed that the most commonly trapped Anopheles species was An. maculatus. No oocysts or sporozoites were found in the An. maculatus collected. Nevertheless, the possibility of An. maculatus being the malaria vector in the investigated locations was high due to its persistent occurrence in these areas. Conclusions Malaria cases reported in this study were mostly imported cases. However the co-existence of local cases and potential Plasmodium spp. vectors should be cause for concern. The results of this survey reflect the need of maintaining closely monitored malaria control programs and continuous extensive malaria surveillance in Peninsula Malaysia

Annual Incidence of Snake Bite in Rural Bangladesh

Snake bite is one of the major causes of morbidity and mortality in many rural tropical areas. As a neglected public health problem, estimate of the risk is largely unknown. However, the associated personal and economic impact of snake bite is substantial across developing countries. This national survey investigated the risk and consequences of snake bite among the rural Bangladeshi population. We surveyed 18857 individuals from 24 out of 64 districts in Bangladesh where 98 snake bites including one death were reported. The estimated incidence density of snake bite is 623.4/ 100,000 person years (95% CI: 513.4–789.2/100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) received snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of them went directly to either a medical doctor or a hospital. The observed rate of snake bite in rural Bangladesh is substantially higher than anticipated. This coupled with poor access to health services led to an increase in related morbidity and mortality. An improvement in public health actions is therefore warranted

Quantifying the Emergence of Dengue in Hanoi, Vietnam: 1998–2009

Dengue is the most common vector-borne viral disease of humans, causing an estimated 50 million cases per year. The number of countries affected by dengue has increased dramatically in the last 50 years and dengue is now a major public health problem in large parts of the tropical and subtropical world. It is of considerable importance to understand the factors that determine how dengue becomes newly established in areas where the risk of dengue was previously small. Hanoi in North Vietnam is a large city where dengue appears to be emerging. We analyzed 12 years of dengue surveillance data in order to characterize the temporal and spatial epidemiology of dengue in Hanoi and to establish if dengue incidence has been increasing. After excluding the two major outbreak years of 1998 and 2009 and correcting for changes in population age structure over time, we found there was a significant annual increase in the incidence of notified dengue cases over the period 1999–2008. Dengue cases were concentrated in young adults in the highly urban central areas of Hanoi. This study indicates that dengue transmission is increasing in Hanoi and provides a platform for further studies of the underlying drivers of this emergence