Multiple ambler class A ESBL genes among Klebsiella pneumoniae isolates in a Malaysian district hospital

Detailed reports regarding the distribution and activity of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are currently not widely available in the Malaysian setting. This study was conducted to determine the ESBL genes distribution rate, phenotypic detection, and antimicrobial susceptibility patterns among beta-lactam resistant Klebsiella pneumoniae isolated from a Malaysian district hospital. K. pneumoniae isolates were collected from a microbiology laboratory at Hospital Pakar Sultanah Fatimah, Malaysia. Following exclusion and inclusion criteria, 141 isolates were selected for this study. K. pneumoniae was identified by phenotypic method, whilst antibiotics' susceptibility patterns were determined by the Kirby-Bauer method, as described in Clinical Laboratory Standard Institute (CLSI) guidelines (Oxoid, UK; Becton-Dickenson, USA). Detection of Ambler Group A ESBL gene (blaSHV, blaTEM, blaCTX-M-1, blaCTX-M-2, blaCTX-M-8, blaCTX-M-9, and blaCTX-M-25) was done using polymerase chain reaction (PCR). ESBL genes were found in 85.8% of K. pneumoniae (121 of 141) isolates. Only blaSHV, blaTEM, blaCTX-M-1, and blaCTX-M-9 were detected among K. pneumoniae isolates with distribution rates of 75.2% (106 of 141), 41.1% (58 of 141), 44% (62 of 141), and 0.7% (1 of 141), respectively. There was no blaCTX-M-2, blaCTX-M-8, or blaCTX-M-25 detected from any isolates in this study. Sequencing of representative amplicons revealed blaSHV as SHV-12, blaTEM as TEM-1, blaCTX-M-1 as CTX-M-15, and blaCTX-M-9 as CTX-M-18. The phenotypic detection rate of ESBL was 71.6% (101 of 141), whilst 9.2% (13 of 141) were positive for carbapenemase. AmpC beta-lactamase was detected in 22% (31 of 141) of all isolates. Antibiotic resistance was between 44.6% (netilmicin) and 97.2% (cefotaxime). Based on ESBL genes distribution, blaSHV was a predominant gene found in one of Malaysian district hospitals, notwithstanding having blaTEM, blaCTX-M-1, and blaCTX-M-9. Despite carrying multiple ESBL genes, some strains were positive for carbapenemase or AmpC beta-lactamase, which resulted in high antimicrobial resistance rates

Trends and estimation of Hepatitis B infection cases in Malaysia, 2003–2030

Hepatitis B virus (HBV) infection is an upcoming public health problem in Malaysia. This study analysed the trend of Hepatitis B (HB) cases from 2003 to 2012 and project the cases for an 18-year period (2013–2030). Based on the national data of annual reported cases and the Malaysian population projections (2010–2040), trend/regression lines were fitted to analyse the trend and estimated HB incidence. The number of HB cases decreased for six consecutive years and began to increase from 2010 onwards. During the 10-year period (2003–2012), the highest number of HB cases was reported in Sabah, followed by Pahang and Wilayah Persekutuan; the lowest was reported in Perlis. The exponential curve shows a decrease of HB cases by an average of 6.3%. However, the polynomial curve shows fluctuations in the trend, with a higher degree of R-square (0.8655). Most states appear to be at moderate vulnerability to HBV infection (Kedah, Perak, Negeri Sembilan, Terengganu, Sabah, and Sarawak), except for Melaka, Wilayah Persekutuan, and Selangor, which were at high risk of HB incidences. Overall, the estimated HB cases indicate that the number of cases and the incidence rates will increase in the future in all states, except for Penang. As the estimated HB cases and incidence rates show an increasing pattern, the government should strengthen their strategies in the management of HB and take preventive measures such as educating the public through awareness programmes, conducting compulsory blood screening, and sustaining the Expanded Programme on Immunization effectively

VACCINATION ATTITUDE AMONG HEALTHCARE WORKERS AT THE EARLY PHASE OF COVID-19 IN MALAYSIA

Background: Healthcare workers’ (HCWs) vaccination hesitancy during a pandemic can be problematic for the health system as these workers need to be fully vaccinated. Aims: This study aimed to determine the level of vaccine hesitancy and its associated factors among HCWs at the beginning of the COVID-19 pandemic. Methods: A cross-sectional study was conducted among randomly selected HCWs of a tertiary hospital in the state of Selangor, Malaysia, using an online questionnaire. The questions were designed to collect information on HCWs’ sociodemographic and health status and attitude towards vaccination. Higher scores for the four scales on attitude towards vaccination denote a higher level of vaccine hesitancy. Results: Of the 380 respondents (98% response rate), the overall score depicted low vaccine hesitancy despite the scores being slightly higher on worrying over unforeseen future effects and concerns about commercial profiteering. Women demonstrated a lower preference for natural immunity compared to men. Conclusion: In the context of this study, vaccine hesitancy among HCWs was low, which may indicate good acceptance. However, concerns about unforeseen future effects and commercial profiteering need to be addressed, and health education and promotion activities on the male workers in terms of preference for natural immunity need to be enhanced. Keywords: attitude, COVID-19, healthcare workers, vaccine hesitanc

Genotypic characterization of Malaysian human isolates of Streptococcus pneumoniae from carriage and clinical sources

This study characterized carriage and clinical pneumococcal isolates for serotypes, penicillin susceptibility, virulence genes and restriction fragment length polymorphism (RFLP) pattern of penicillin binding protein (PBP) genes. DNA fingerprint of isolates was generated by BOX-PCR. Majority of serotypes were 23F followed by 19F, 19A and 6A. Twenty-four percent of isolates were penicillin non-susceptible (PNSP). All of the targeted virulence genes were detected in all isolates with the exception of pili; 20.6% (n = 22) for PI-1 and 14.0% (n = 15) for PI-2. Of the 13 isolates which carried both PI-1 and PI-2, 10 were of clinical origin. Digested pbp-DNA produced three PBP-RFLP profiles for pbp1a (A1 to A3), six profiles for pbp2b (B1 to B6) and seven for pbp2x (X1 to X7) mostly in PNSPs. Based on BOX-PCR analysis, the majority of isolates were genetically diverse with a small number of potentially related isolates carrying pili genes. No obvious genotypic association was observed pertaining to carriage and clinical origin of isolates

Occult hepatitis B infection among vaccinated cohort

BACKGROUND: Occult hepatitis B is characterized by undetectable levels of surface antigen, but detectable levels of viral DNA and is becoming a major global threat due to: (i) the effect on the health of children born to carrier mothers despite the presence of passive immunoglobulin at birth (ii) immune escape of current vaccines; and (iii) spread through blood and blood products in post transfusion infection, organ donation, and sexual transmission. The aim of this study is to investigate occult hepatitis B virus among vaccines. METHOD: Four hundred and eight, vaccinee were recruited for this study. All samples were tested for hepatitis B surface antigen, hepatitis B surface and core antibodies using enzyme-linked immunosorbent assay kit (DRG International Inc., USA). Positive samples were re-tested to exclude false positive results. Molecular technique using a nested polymerase chain reaction was done using primers specific to the surface gene. RESULTS: Persistence of hepatitis B surface antibodies (≥10 IU/L) was found in 62.5% (255/408) with 37.5% (153/408) having anti-HBs<10 IU/L in circulation. Hepatitis B core antibodies among vaccinated cohort were found to be 5.0% (20/408). Of which 80% (16/20) of the hepatitis B core antibodies positive, have positive hepatitis B surface antibodies (≥10 IU/L) while 20% (4/20) are negative (<10 IU/L). The former is indicating immunity as a result of previous infection and the latter group are referred to as isolated anti-core, as described in previous studies (1). However none of the samples is hepatitis B surface antigen positive. Hepatitis B viral DNA was detected in all the core antigen positive individuals, contrary to studies in Turkey and Taiwan and in line with other similar studies(2). Occult hepatitis B infections have significant clinical importance since they can become reactivated when the immune system is suppressed and can be transmitted through blood or blood product transfusion, organs transplant, and sexual intercourse. CONCLUSION: The result of this study shows occult chronic HBV infection among adults who were vaccinated against hepatitis B vaccine at infant. The anti-HBs produced were induced by the vaccine they received but do not provide protection against the mutant’s variant suggesting primary infection with mutant’s hepatitis B virus

An overview of hepatitis B virus surface antigen mutant in the Asia Pacific

Hepatitis B virus infection is a serious health problem worldwide, and more than 350 million people are chronic carriers, constituting a major global threat. Southeast Asia and the Western Pacific have the highest levels of endemicity in the world, with an estimated seroprevalence ranging between 2% and 31%. Mutations in the hepatitis B surface antigen (HBsAg) have been reported in many parts of the world but are most common in Asian infants; such mutants have several clinical effects, such as the development of hepatocellular carcinoma. Diagnostic failures by commercial assays have reduced the diagnostic effectiveness of HBsAg detection. For example the substitution of an amino acid in the major hydrophilic region of the S gene reduces the binding of hepatitis B surface antibodies leading to immune escape. The safety of blood transfusion may be compromised by current screening tests due to escape from being neutralised by antibodies induced by HBsAg mutants, and undetectable levels of viral surface protein. Data on the epidemiology of HBsAg mutation in Asia Pacific are scant; however, this manuscript has reviewed the available information on the epidemiology of HBsAg mutation in Asia Pacific

Antimicrobial susceptibility pattern and distribution of ExoU and exoS in clinical isolates of Pseudomonas Aeruginosa at a Malaysian hospital.

This study was conducted to determine the antibiotic susceptibility pattern and distribution of exoU and exoS among 44 clinical isolates of P. aeruginosa collected from different patients over a 3-month period in 2010 at a major Malaysian hospital. Susceptibility data by disk diffusion method for cefepime (30 μg), ceftazidime (30 μg), gentamicin (10 μg), piperacillin-tazobactam (100/10 μg) and ciprofloxacin (5 μg) were available for 38 isolates. Resistance to ceftazidime and piperacillin-tazobactam was the most common (74%) with five isolates not susceptible to three or more different antibiotics. PCR detection of exoU and exoS of all 44 isolates showed the former gene to be present in 18 and exoS in 41. In analyzing the two genes together, 17 isolates were detected for exoU and exoS with only two being negative for both genes. Only one isolate was detected for exoU alone whereas 24 for exoS alone. Distribution of the genes in relation to antibiotic susceptibility was inapplicable due to the majority of the isolates having similar susceptibility patterns, but the tendency of exoU-carrying isolates to be present in male patients (83%) and respiratory sites (61%) was observed (p < 0.050). The finding warrants further investigation in a larger sample of isolates

Genotypic characterization of Streptococcus pneumoniae serotype 19F in Malaysia

Streptococcus pneumoniae is an epidemiologically important bacterial pathogen. Recently, we reported the antibiotic susceptibility patterns of a limited collection of pneumococcal isolates in Malaysia with a high prevalence of erythromycin resistant strains. In the present study, 55 of the pneumococcal isolates of serotype 19F were further analysed by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The generated genotypic patterns were then correlated with the antibiograms previously reported. Forty-seven different PFGE profiles (PTs) were obtained, showing that the isolates were genetically diverse. MLST identified 16 sequence types (STs) with ST-236 being predominant (58.2%), followed by ST-81 (10.3%). Among the ST-236 isolates, 22 were erythromycin resistant S. pneumoniae (ERSP) and 15 were trimethoprim/sulfamethoxazole (TMP/SMX) resistant, while among ST-81, four isolates were ERSP and two were TMP/SMX resistant. The high prevalence of erythromycin resistant serotype 19F isolates of ST-236 in this study has also been reported in other North and South East Asian countries

Prevalence, clinical manifestations and predictors of immune reconstitution inflammatory syndrome among HIV-infected patients in Malaysia infectious disease centre: a retrospective study

Introduction: Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical deterioration experienced by some HIV-infected patients in response to antiretroviral therapy (ART). There is still limited published data on IRIS from this region including Malaysia. This study aimed to determine IRIS prevalence, clinical manifestations and possible predictors among HIV-infected patients in an infectious disease centre in Peninsular Malaysia. Method: This retrospective study was conducted in Hospital Sungai Buloh involving secondary data of 256 HIV-infected patients who were initiated on ART in the year 2017. Medical record of each patient was reviewed for up to 12 months following ART initiation to identify IRIS diagnosis which was made by the treating physician. Relevant clinical and laboratory information were retrieved from hospital electronic database. Results: IRIS has occurred in 17.6% of patients. Infections by Mycobacterium tuberculosis (53.3%), Pneumocystis jirovecii (11.1%) and Talaromyces marneffei (6.6%) were the commonest three aetiologies of IRIS. Subacute lupus erythematosus was the only non-infectious IRIS identified. Baseline HIV viral load, CD4+ T-cell count and haemoglobin level between IRIS and non-IRIS patients were significantly different. Risk of developing IRIS was increased seven times in patients with CD4+ T-cell count 5.5 log10 copies/ml prior to ART initiation. Conclusion: Mycobacterium tuberculosis infections were the highest IRIS manifestation. Although rare, non-infectious IRIS does occur and should be part of the differential diagnosis. Patients with positive predictors should be appropriately monitored for possible IRIS development once initiated on ART

Hepatitis E c=virus: an emerging enigmatic and underestimated pathogen

Hepatitis E virus (HEV) is an RNA virus causing hepatitis E disease. The virus is of one serotype but has diverse genotypes infecting both humans and animals. Based on evidence from seroprevalence studies, about 2 billion people are estimated to have been infected with HEV globally. HEV, therefore, poses a significant public health and economic challenge worldwide. HEV was discovered in the 1980s and was traced back to the 1955 – 1956 outbreak of hepatitis that occurred in India. Subsequently, several HEV epidemics involving thousands of individuals have occurred nearly annually in different countries in Asia and Africa. Initially, the virus was thought to be only enterically transmitted, and endemic in developing countries. Due to the environmental hygiene and sanitation challenges in those parts of the world. However, recent studies have suggested otherwise with the report of autochthonous cases in industrialised countries with no history of travel to the so-called endemic countries. Thus, suggesting that HEV has a global distribution with endemicity in both developing and industrialised nations. Studies have also revealed that HEV has multiple risk factors, and modes of transmission as well as zoonotic potentials. Additionally, recent findings have shown that HEV leads to severe disease, particularly among pregnant women. In contrast to the previous narration of a strictly mild and self-limiting infection. Studies have likewise demonstrated chronic HEV infection among immunocompromised persons. Consequent to these recent discoveries, this pathogen is considered a re – emerging virus, particularly in the developed nations. However, despite the growing public health challenges of this pathogen, the burden is still underestimated. The underestimation is often attributed to poor awareness among clinicians and a lack of routine checks for the disease in the hospitals. Thus, leading to misdiagnosis and underdiagnosis. Hence, this review provides a concise overview of epidemiology, diagnosis, and prevention of hepatitis E