exudates and Diarrhea

Although the current pandemic of cholera originated in Asia, reports of cholera cases and outbreaks in the region are sparse. To provide a sub-regional assessment of cholera in South and Southeast Asia, we collated published and unpublished data from existing surveillance systems from Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam.. Data from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available.. From 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases.. We present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.

Topics: Asia, Southeastern; Bangladesh; Cambodia; Cholera; Developing Countries; Diarrhea; Epidemiological Monitoring; Humans; India; Malaysia; Nepal; Pakistan; Philippines; Thailand; Vietnam

Strongyloides stercoralis infection can persist in the host for several decades, and patients with cancer and other clinical conditions who are exposed to immunosuppressive therapy are at risk of developing hyperinfection.. This is a case of angioimmunoblastic T-cell lymphoma (AITL) in a patient with lymphadenopathy and bulky neck mass. Severe sepsis and episodes of diarrhea were observed upon the first cycle of cyclophosphamide, doxorubicin, oncovin (vincristine) and prednisone (CHOP) regime chemotherapy preceded by high dose of dexamethasone. There was Klebsiella pneumoniae bacteremia and moderate eosinophilia. Rhabditiform S. stercoralis larvae were observed in the stool, and this was confirmed by real-time PCR. Strongyloides-specific IgG and IgG4 were also positive. The patient was treated with oral albendazole (400mg/day) for 3 days and intravenous tazocin (4.5gm/6 hours) for 5 days; however he succumbed following multi-organ failure.. This is likely a case of Strongyloides hyperinfection with secondary bacteremia.

Topics: Aged; Animals; Cyclophosphamide; Diarrhea; Doxorubicin; Fatal Outcome; Humans; Immunoblastic Lymphadenopathy; Injections, Intravenous; Malaysia; Male; Prednisone; Shock, Septic; Strongyloides stercoralis; Strongyloidiasis; Treatment Outcome; Vincristine

Plesiomonas shigelloides is a common pathogen in tropical regions, whereas it is rarely isolated in temperate climates. It is most often found in surface water and fish. During the last 10 years it was found to cause gastroenteritis 6 times in Ludwigshafen. Not all of these patients reported a trip to foreign countries.. A 54-year-old male patient was hospitalized after a trip to Malaysia with strong greenish watery diarrhea and chills. On physical examination we saw a dehydrated patient in severely reduced general condition. The stool frequency was 30/d. The laboratory examinations only showed elevated parameters of inflammation. Plesiomonas shigelloides was cultivated in the stool cultures. With appropriate substitution of fluid and electrolytes, and antidiarrheal therapy the patient resumed a normal diet without any complications. Three days later his bowel movements were normal and his general condition was greatly improved. We withheld antibiotic therapy because of the noncomplicated course of illness.. In Germany infections with Plesiomonas shigelloides are rare, an increase is observed because of increasing tourism to tropical regions. The course of infection is sometimes asymptomatic, but usually patients develop an acute gastroenteritis. Especially immunocompromised patients can show serious courses of infection. Plesiomonas shigelloides should be included in the differential diagnosis of acute gastroenteritis after journeys to tropical regions. Some of our patients, however, denied traveling to tropical regions. They also denied consuming seafood, which indicates a risk of infection in Germany. Still an infection with Plesiomonas shigelloides seems to be rare in northern European countries.

Topics: Diarrhea; Europe; Gastroenteritis; Gram-Negative Bacterial Infections; Humans; Malaysia; Male; Middle Aged; Plesiomonas; Travel

Diosmectite is a clay used to treat children with acute watery diarrhea. However, its effects on stool output reduction, the key outcome for pediatric antidiarrheal drugs, have not been shown.. Two parallel, double-blind studies of diosmectite efficacy on stool reduction were conducted in children 1 to 36 months old in Peru (n = 300) and Malaysia (n = 302). Inclusion criteria included 3 or more watery stools per day for less than 72 hours and weight/height ratios of 0.8 or greater. Exclusion criteria were the need for intravenous rehydration, gross blood in stools, fever higher than 39 degrees C, or current treatment with antidiarrheal or antibiotic medications. Rotavirus status was determined. Diosmectite dosage was 6 g/day (children 1-12 months old) or 12 g/day (children 13-36 months old), given for at least 3 days, followed by half doses until complete recovery. Patients were assigned randomly to groups given diosmectite or placebo, in addition to oral rehydration solution (World Health Organization).. Children in each study had comparable average ages and weights. The frequencies of rotavirus infection were 22% in Peru and 12% in Malaysia. Similar amounts of oral rehydration solution were given to children in the diosmectite and placebo groups. Stool output was decreased significantly by diosmectite in both studies, especially among rotavirus-positive children. In pooled data, children had a mean stool output of 94.5 +/- 74.4 g/kg of body weight in the diosmectite group versus 104.1 +/- 94.2 g/kg in the placebo group (P = .002). Diarrhea duration was reduced by diosmectite, which was well tolerated.. These results show that diosmectite significantly decreased stool output in children with acute watery diarrhea, especially those who were rotavirus-positive.

Topics: Child, Preschool; Diarrhea; Double-Blind Method; Feces; Gastrointestinal Agents; Humans; Infant; Malaysia; Male; Peru; Placebos; Rotavirus; Silicates; Time Factors; Treatment Outcome

Rotaviruses are major causative agents of acute diarrhea in children under 5 years of age in Malaysia. However, a rotavirus vaccine has not been included in the national vaccination program. To date, only two studies have been carried out in the state of Sabah, Malaysia, although children in this state are at risk of diarrheal diseases. Previous studies showed that 16%-17% of cases of diarrhea were caused by rotaviruses and that equine-like G3 rotavirus strains are predominant. Because the prevalence of rotaviruses and their genotype distribution vary over time, this study was conducted at four government healthcare facilities from September 2019 through February 2020. Our study revealed that the proportion of rotavirus diarrhea increased significantly to 37.2% (51/137) after the emergence of the G9P[8] genotype in replacement of the G12P[8] genotype. Although equine-like G3P[8] strains remain the predominant rotaviruses circulating among children, the Sabahan G9P[8] strain belonged to lineage VI and was phylogenetically related to strains from other countries. A comparison of the Sabahan G9 strains with the G9 vaccine strains used in the RotaSiil and Rotavac vaccines revealed several mismatches in neutralizing epitopes, indicating that these vaccines might not be effective in Sabahan children. However, a vaccine trial may be necessary to understand the precise effects of vaccination.

Topics: Animals; Antigens, Viral; Diarrhea; Genotype; Horses; Malaysia; Phylogeny; Prevalence; Rotavirus; Rotavirus Infections; Rotavirus Vaccines

Rotavirus infection is a dilemma for developing countries, including Malaysia. Although commercial rotavirus vaccines are available, these are not included in Malaysia's national immunization program. A scarcity of data about rotavirus genotype distribution could be partially to blame for this policy decision, because there are no data for rotavirus genotype distribution in Malaysia over the past 20 years. From January 2018 to March 2019, we conducted a study to elucidate the rotavirus burden and genotype distribution in the Kota Kinabalu and Kunak districts of the state of Sabah. Stool specimens were collected from children under 5 years of age, and rotavirus antigen in these samples was detected using commercially available kit. Electropherotypes were determined by polyacrylamide gel electrophoresis of genomic RNA. G and P genotypes were determined by RT-PCR using type specific primers. The nucleotide sequence of the amplicons was determined by Sanger sequencing and phylogenetic analysis was performed by neighbor-joining method. Rotavirus was identified in 43 (15.1%) children with watery diarrhea. The male:female ratio (1.9:1) of the rotavirus-infected children clearly showed that it affected predominantly boys, and children 12-23 months of age. The genotypes identified were G3P[8] (74% n = 31), followed by G1P[8] (14% n = 6), G12P[6](7% n = 3), G8P[8](3% n = 1), and GxP[8] (3% n = 1). The predominant rotavirus circulating among the children was the equine-like G3P[8] (59.5% n = 25) with a short electropherotype. Eleven electropherotypes were identified among 34 strains, indicating substantial diversity among the circulating strains. The circulating genotypes were also phylogenetically diverse and related to strains from several different countries. The antigenic epitopes present on VP7 and VP4 of Sabahan G3 and equine-like G3 differed considerably from that of the RotaTeq vaccine strain. Our results also indicate that considerable genetic exchange is occurring in Sabahan strains. Sabah is home to a number of different ethnic groups, some of which culturally are in close contact with animals, which might contribute to the evolution of diverse rotavirus strains. Sabah is also a popular tourist destination, and a large number of tourists from different countries possibly contributes to the diversity of circulating rotavirus genotypes. Considering all these factors which are contributing rotavirus genotype diversity, continuous surveillance of rotavirus st

Topics: Antigens, Viral; Base Sequence; Capsid Proteins; Child, Preschool; Diarrhea; Feces; Female; Genotype; Humans; Infant; Malaysia; Male; Phylogeny; RNA, Viral; Rotavirus; Rotavirus Infections; Sequence Analysis, RNA

Tritrichomonas foetus is known to cause chronic diarrhea in the feline species in many different regions of the world. However, there is a paucity of information on T. foetus among cats in Malaysia. This study was conducted to determine the prevalence of Tritrichomonas foetus in the pet and stray cat population in Klang Valley, Malaysia. A total of 201 pet and stray cats' fecal samples were collected in Klang Valley. 24 samples were cultured in the InPouch® TF Feline to observe for motile trophozoites. A nested PCR protocol was used to screen for T. foetus in the collected samples. The prevalence of T. foetus in the cat population in Klang Valley was 33%. There was no association between Tritrichomonas infection and age, sex, breed or management of the cats. However, statistical analysis revealed that stray cats were more likely to be infected with T. foetus compared to pet cats. This study confirmed for the first time the presence of T. foetus among the cat population in Klang Valley, Malaysia.

Topics: Animals; Animals, Wild; Cat Diseases; Cats; Diarrhea; Feces; Female; Malaysia; Male; Pets; Prevalence; Protozoan Infections, Animal; Tritrichomonas foetus

Cryptosporidium spp. is identified as an important cause of diarrhoeal morbidity and mortality worldwide particularly in children below five years of age and immunocompromised individuals. Infections are present among cattle and humans. Until now, there is no report on its prevalence in humans in Kuantan. The aim of this study is to record the prevalence and associated risk factors of Cryptosporidium spp. infection among children admitted to Hospital Tengku Ampuan Afzan (HTAA), Kuantan.. This is a cross-sectional study conducted among children admitted to the Paediatrics ward in HTAA between December 2017 and May 2018. Faecal samples were examined using wet smear and Modified Ziehl-Neelsen (MZN) staining techniques. Data on demography and hygiene practices was collected using a pretested questionnaire, and analysed using SPSS version 22.. One hundred thirty five children (95.6% were of Malay ethnicity) were included in the study. The overall prevalence of Cryptosporidium spp. infection was 25.2%. The prevalence was slightly higher in females (28.1%) than males (23.1%). The prevalence was higher than expected. This study showed that some risk factors namely children's age and trash disposal methods were significantly associated with Cryptosporidium spp. infection (p<0.05).. Higher prevalence could possibly be due to an outbreak of this infection or until now undetected.

Topics: Child; Cross-Sectional Studies; Cryptosporidiosis; Cryptosporidium; Diarrhea; Feces; Female; Hospitals; Humans; Malaysia; Male; Prevalence; Retrospective Studies; Risk Factors

Accumulating evidence shows a high prevalence of

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Proteins; Bacterial Toxins; Clostridioides difficile; Clostridium Infections; Diarrhea; DNA, Bacterial; Enterotoxins; Feces; Female; Glutamate Dehydrogenase; Humans; Immunoenzyme Techniques; Indonesia; Malaysia; Male; Middle Aged; Polymerase Chain Reaction; Prevalence; Ribotyping; Thailand; Young Adult

The large livestock operations and dense human population of Southeast Asia are considered a hot-spot for emerging viruses.. To determine if the pathogens adenovirus (ADV), coronavirus (CoV), encephalomyocarditis virus (EMCV), enterovirus (EV), influenza A-D (IAV, IBV, ICV, and IDV), porcine circovirus 2 (PCV2), and porcine rotaviruses A and C (RVA and RVC), are aerosolized at the animal-interface, and if humans working in these environments are carrying these viruses in their nasal airways.. This cross-sectional study took place in Sarawak, Malaysia among 11 pig farms, 2 abattoirs, and 3 animal markets in June and July of 2017. Pig feces, pig oral secretions, bioaerosols, and worker nasal wash samples were collected and analyzed via rPCR and rRT-PCR for respiratory and diarrheal viruses.. In all, 55 pig fecal, 49 pig oral or water, 45 bioaerosol, and 78 worker nasal wash samples were collected across 16 sites. PCV2 was detected in 21 pig fecal, 43 pig oral or water, 3 bioaerosol, and 4 worker nasal wash samples. In addition, one or more bioaerosol or pig samples were positive for EV, IAV, and RVC, and one or more worker samples were positive for ADV, CoV, IBV, and IDV.. This study demonstrates that nucleic acids from a number of targeted viruses were present in pig oral secretions and pig fecal samples, and that several viruses were detected in bioaerosol samples or in the nasal passages of humans with occupational exposure to pigs. These results demonstrate the need for future research in strengthening viral surveillance at the human-animal interface, specifically through expanded bioaerosol sampling efforts and a seroepidemiological study of individuals with exposure to pigs in this region for PCV2 infection.

Topics: Animals; Cross-Sectional Studies; Diarrhea; Farmers; Female; Humans; Malaysia; Male; Occupational Exposure; Respiratory Tract Infections; Swine; Swine Diseases; Virus Diseases; Viruses

Microsporidia are obligate intracellular parasitic fungi causing chronic diarrhea, particularly among immunocompromised patients. The current method used for diagnosis is based on conventional microscopy, which does not differentiate parasites at the species level. The present study was carried out to identify microsporidian species in immunocompromised patients. From March 2016 to March 2017, a total of 289 archived stool samples were examined microscopically for microsporidian spores using Gram-chromotrope Kinyoun (GCK) stain. Positive stool samples by microscopy were subjected to polymerase chain reaction and sequencing for species identification. Based on microscopy examination, the overall prevalence of microsporidian infections was 32.2% (93/289; 95% CI = 27.1-37.8). Of these stool samples, 45 samples were successfully amplified and confirmed as

Topics: Adolescent; Adult; Animals; Child; Diarrhea; DNA, Fungal; Enterocytozoon; Feces; Female; HIV Infections; Humans; Immunocompromised Host; Malaysia; Microsporidiosis; Middle Aged; Neoplasms; Prevalence; Spores, Fungal

Globally, diarrhoea is one of the major causes of morbidity and mortality among children under than 5 years of age. There is a scarcity of published data on acute gastroenteritis (AGE) prevalence in Malaysia among children. This study aims to determine factors associated with diarrhoea in children aged less than 5 years in Malaysia.. Data from the National Health and Morbidity Survey 2016 conducted by Ministry of Health was analysed. This nationwide survey involved 15,188 children below five years old. The survey was carried out using a two-stage stratified sampling design to ensure national representativeness. The Questionnaire from UNICEF's Multiple Indicator Cluster Survey (MCIS) was adapted to suit local requirements. Analysis was done using SPSS Version 23. Descriptive followed by multiple logistic regression were done to identify relevant factors.. The prevalence of diarrhoea among children under five in Malaysia was 4.4% (95% CI: 3.8,5.2). Analysis using logistic regression indicated that only ethnicity and usage of untreated water were significantly associated with diarrhoea among children after controlling for relevant factors. By ethnicity, children in the 'Other Bumiputera' group had 2.5 times the odds of having diarrhoea compared to children of Malay ethnicity. Children of Indian ethnicity were also at higher risk, at almost double the odds, as well as other ethnic groups (1.5 times). Children who used untreated water supply were two times more likely to develop diarrhoea.. There is a higher risk of diarrhoea among children of 'Other Bumiputera' ethnicity, Indian ethnicities, and other ethnic groups and those who consume untreated water. Strategies to reduce diarrhoea among children should be targeted towards these at-risk populations. In addition, the Government must strive to ensure universal access to treated clean water in Malaysia and the Ministry of Health must focus on raising awareness on how to prevent diarrhoea.

Topics: Child, Preschool; Cross-Sectional Studies; Diarrhea; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Prevalence; Risk Factors

Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P < 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey. C. difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

Topics: Adult; Aged; Aged, 80 and over; Carrier State; Clostridioides difficile; Clostridium Infections; Cross Infection; Diarrhea; Feces; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Molecular Epidemiology; Prevalence; Ribotyping; Risk Factors; Tertiary Care Centers; Young Adult

Most studies of opportunistic infections focus on immunocompromised patients. However, there is a lack of information on microsporidiosis in healthy people (immunocompetent) worldwide. This study aimed to detect and identify microsporidia species in immunocompetent Orang Asli living in Pahang, Malaysia. Orang Asli is a collective term for a group of indigenous people that usually reside in the interior regions of Peninsular Malaysia. They comprise about 0.7% of the total population in Malaysia and 76% of them lived below the poverty line i.e., poor housing conditions with the lack of access to safe drinking water and adequate sanitation, contaminated environment, high illiteracy rate and unhygienic practices by these people. Stool samples were collected from 209 Orang Asli and analyzed for detecting the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis by polymerase chain reaction assay targeting small subunit ribosomal RNA gene. E. bieneusi was detected in 8 individuals (3.83%). This infection was commonly found in males than females (5.2% vs. 2.7%). All infected Orang Asli were adults, with a mean age of 44years. Diarrhea and other gastrointestinal symptoms were reported in one case (12.5%) among individuals infected with this species. These findings clearly show that exposure to E. bieneusi may actually be common than reported. The accurate detection and identification of microsporidian species by molecular technique will improve therapy, clinical manifestations and prognosis of this infection, as no antiparasitic therapy has been approved for E. bieneusi. It is hoped that these findings will allow the formulation of better health management and disease prevention advisories, and improvement in the standards of health in similar communities.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Child; Child, Preschool; Diarrhea; Enterocytozoon; Feces; Female; Humans; Immunocompetence; Malaysia; Male; Microsporidiosis; Middle Aged; Polymerase Chain Reaction; Risk Factors; Socioeconomic Factors; Young Adult

Infantile-onset inflammatory bowel disease (IO-IBD) with the onset of disease before 12 mo of age, is a different disease entity from childhood IBD. We aimed to describe the clinical features, outcome and role of mutation in interleukin-10 (IL-10) and interleukin-10 receptors (IL-10R) in Asian children with IO-IBD.. All cases of IO-IBD, defined as onset of disease before 12 mo of age, seen at University Malaya Medical Center, Malaysia were reviewed. We performed mutational analysis for. Six [13%; CD = 3, ulcerative colitis (UC) = 2, IBD-unclassified (IBD-U) = 1] of the 48 children (CD = 25; UC = 23) with IBD have IO-IBD. At final review [median (range) duration of follow-up: 6.5 (3.0-20) years], three patients were in remission without immunosuppression [one each for post-colostomy (IBD-U), after standard immunosuppression (CD), and after total colectomy (UC)]. Three patients were on immunosuppression: one (UC) was in remission while two (both CD) had persistent disease. As compared with later-onset disease, IO-IBD were more likely to present with bloody diarrhea (100%. The clinical features of IO-IBD in this Asian cohort of children who were negative for

Topics: Adolescent; Age of Onset; Asian People; Biological Products; Child; Child, Preschool; Colectomy; Colitis, Ulcerative; Crohn Disease; Diarrhea; DNA Mutational Analysis; Enteral Nutrition; Female; Gastrointestinal Hemorrhage; Hepatitis, Autoimmune; Humans; Immunosuppression Therapy; Infant; Infant, Newborn; Inflammatory Bowel Diseases; Interleukin-10; Malaysia; Male; Mutation; Receptors, Interleukin-10

The magnitude of shigellosis in developing countries is largely unknown because an affordable detection method is not available. Current laboratory diagnosis of Shigella spp. is laborious and time consuming and has low sensitivity. Hence, in the present study, a molecular-based diagnostic assay which amplifies simultaneously four specific genes to identify invC for Shigella genus, rfc for S. flexneri, wbgZ for S. sonnei, and rfpB for S. dysenteriae, as well as one internal control (ompA) gene, was developed in a single reaction to detect and differentiate Shigella spp. Validation with 120 Shigella strains and 37 non-Shigella strains yielded 100% specificity. The sensitivity of the PCR was 100 pg of genomic DNA, 5.4 × 10(4) CFU/ml, or approximately 120 CFU per reaction mixture of bacteria. The sensitivity of the pentaplex PCR assay was further improved following preincubation of the stool samples in gram-negative broth. A preliminary study with 30 diarrhoeal specimens resulted in no cross-reaction with other non-Shigella strains tested. We conclude that the developed pentaplex PCR assay is robust and can provide information about the four target genes that are essential for the identification of the Shigella genus and the three Shigella species responsible for the majority of shigellosis cases.

Topics: Bacteriological Techniques; Diarrhea; DNA, Bacterial; Feces; Gram-Negative Bacteria; Humans; Malaysia; Polymerase Chain Reaction; Sensitivity and Specificity; Sequence Analysis, DNA; Shigella; Species Specificity; Stem Cells

Breast cancer is the leading cause of cancer-related death among women in Malaysia. A diagnosis is very stressful for women, affecting all aspects of their being and quality of life. As such, there is little information on quality of life of women with breast cancer across the different ethnic groups in Malaysia. The purpose of this study was to examine the quality of life in Malay and Chinese women newly diagnosed with breast cancer in Kelantan.. A descriptive study involved 58 Malays and 15 Chinese women newly diagnosed with breast cancer prior to treatment. Quality of life was measured using the Malay version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-specific module (QLQ-BR23). Socio-demographic and clinical data were also collected. All the data were analyzed using SPSS version 20.0.. Most of the women were married with at least a secondary education and were in late stages of breast cancer. The Malay women had lower incomes (p=0.046) and more children (p=0.001) when compared to the Chinese women. Generally, both the Malay and Chinese women had good functioning quality-of-life scores [mean score range: 60.3-84.8 (Malays); 65.0-91.1 (Chinese)] and global quality of life [mean score 60.3, SD 22.2 (Malays); mean score 65.0, SD 26.6 (Chinese)]. The Malay women experienced more symptoms such as nausea and vomiting (p=0.002), dyspnoea (p=0.004), constipation (p<0.001) and breast-specific symptoms (p=0.041) when compared to the Chinese.. Quality of life was satisfactory in both Malays and Chinese women newly diagnosed with breast cancer in Kelantan. However, Malay women had a lower quality of life due to high general as well as breast-specific symptoms. This study finding underlined the importance of measuring quality of life in the newly diagnosed breast cancer patient, as it will provide a broader picture on how a cancer diagnosis impacts multi-ethnic patients. Once health care professionals understand this, they might then be able to determine how to best support and improve the quality of life of these women during the difficult times of their disease and on-going cancer treatments.

Topics: Adult; Breast Neoplasms; China; Constipation; Cross-Sectional Studies; Diarrhea; Fatigue; Female; Humans; Malaysia; Middle Aged; Nausea; Pain; Quality of Life; Sleep Initiation and Maintenance Disorders; Socioeconomic Factors; Stress, Psychological; Surveys and Questionnaires; Vomiting; Young Adult

There is increasing evidence for the role of microscopic inflammation in patients with IBS. We aimed to examine the prevalence of microscopic colitis and inflammation in Malaysian IBS patients with diarrhoea (IBS-D).. Consecutive patients who met the Rome III criteria for IBS-D and asymptomatic controls were prospectively recruited. Colonoscopy was performed in all study subjects and systematic biopsies taken from all segments of the colon. The diagnosis of lymphocytic colitis and collagenous colitis was made using previously defined criteria. Patients with post infectious IBS were excluded.. 120 subjects (74 IBS-D, 46 controls) were recruited during the study period. In the IBS-D group, the colonoscopic (macroscopic) findings were as follows; normal findings n = 58 (78.4%), diverticula disease n = 5 (6.8%), diminutive polyps n = 9 (12.2%) and haemorrhoids n = 2(2.7%). No subject under the age of 40 had any significant findings. Microscopically, there was only one case (1.3%) with histology consistent with collagenous colitis. However, the IBS-D patients had a higher prevalence of moderate microscopic inflammation (n = 11, 14.9%) compared to controls (n = 1, 2.2%) (p = 0.005).. 'Classical' microscopic colitis is uncommon in Malaysian patients with IBS-D but a significant number of adults showed evidence of microscopic inflammation.

Topics: Adolescent; Adult; Aged; Biopsy; Case-Control Studies; Colitis, Collagenous; Colitis, Lymphocytic; Colon; Colonoscopy; Diarrhea; Female; Humans; Malaysia; Male; Microscopy; Middle Aged; Young Adult

To investigate the psychometric properties of the developed 21 item questionnaire to measure definitions, attitudes and management practices in relation to diarrhea during enteral nutrition (DAPonDEN).. Data were analyzed using exploratory factor analysis from a cross sectional study of 102 nurses aged 18 and over, conducted from December 2011 to February 2012 in Malaysia. Face and content validity of DAPonDEN were first evaluated by few expert panels and patients. For this study, adult nurses were recruited from the adult wards.. In the final model, three items in DAPonDEN were dropped. In the exploratory factor analysis, five factors were extracted that explained a total of 55% of the variation in the remaining 18 items. The Kaiser-Meyer-Olkin (KMO) value was 0.723. For definition, there were two underlying factors: 'Key items in defining diarrhea' and 'non-key items in defining diarrhea'. For attitude there was a single factor. For practice, there were two underlying factors: 'enteral nutrition (EN) related' and 'awareness related'.. The items in each of the underlying dimensions seem to measure the respective concepts for definition, attitude and practices adequately. The 18-items DAPonDEN instrument can be a suitable education tool to be used in relation to diarrhea during EN.

Topics: Adult; Attitude of Health Personnel; Cross-Sectional Studies; Diarrhea; Enteral Nutrition; Factor Analysis, Statistical; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Nurses; Professional Competence; Psychometrics; Surveys and Questionnaires

This study describes the prevalence of Clostridium difficile toxin (CDT) in loose stool samples from inpatients aged more than two years of a tertiary hospital. A total of 175 samples that had been examined were from stool samples that were sent to the Medical Microbiology & Parasitology Laboratory for various clinical indications. The toxin was detected by a commercial immunochromatograhic test, and the patients' demography, clinical features, treatment and outcomes were analyzed from their medical records. Clostridium difficile toxin was positive in 24 (13.7%) of the stool samples. Male and female were 11 (45.8%) and 13 (54.2%) respectively, with the majority of them aged more than 50 years. Most were from medical wards (n = 21, 87.5%), with the rest from surgical wards (n = 2, 8.3%) and intensive care units (n = 1, 3.4%). All the CDT positive patients had history of prior antibiotic usage within 6 weeks before the detection of the toxin. The mean duration of antibiotics usage was 17.75 (+/- 13.75) days, while the mean duration of diarrhea was 5.21((+/- 5.85) days. Eighteen patients had underlying medical illnesses that were diabetes mellitus, chronic renal disease, hypertension, ischaemic heart disease, cerebrovascular disease and malignancy; with seven of them being CDT positive while on chemotherapy. Stool occult blood test was positive in 15 patients whereas presence of pus cells in the CD positive stool samples were detected in 21 patients. The duration of hospitalization among the patients was 27.96 (+/- 23.22) days.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Child; Child, Preschool; Clostridioides difficile; Clostridium Infections; Diarrhea; Enterotoxins; Feces; Female; Humans; Intestines; Malaysia; Male; Middle Aged; Young Adult

This study aimed to determine the emotional impact on parents of young children who require hospitalisation for acute diarrhoea (AD), and the disruption of daily activities experienced and costs incurred by them.. A prospective study was conducted on children below two years of age with AD admitted to two urban hospitals in Malaysia. Parents were interviewed on the emotional impact and disruption of daily activities experienced by them, as well as the extra costs incurred as a result of the hospitalisation of their child.. The parents of 85 children (median age 13 months; boys n = 58, 68%; girls n = 27, 32%) were recruited for the study. The proportions of parents who reported that they were very worried about the symptoms of diarrhoea, vomiting and fever in their child were 82%, 83% and 78%, respectively. Parents also reported being upset, helpless, mentally and physically exhausted, and having experienced loss of sleep and disruption of daily routine during the hospitalisation of their child (median four days). The median extra cost (including out-of-pocket cost and loss of income) incurred by parents as a result of the hospitalisation was USD 252.86, which constituted 16% of the combined monthly family income.. Although short, AD-related hospitalisation in young children has considerable emotional impact and creates significant distress, in addition to causing significant financial burden for parents.

Topics: Diarrhea; Female; Health Care Costs; Hospitalization; Humans; Infant; Malaysia; Male; Parents; Prospective Studies; Stress, Psychological; Surveys and Questionnaires; Urban Population

To survey irritable bowel syndrome (IBS) using Rome III criteria among Malays from the north-eastern region of Peninsular Malaysia.. A previously validated Malay language Rome III IBS diagnostic questionnaire was used in the current study. A prospective sample of 232 Malay subjects (80% power) was initially screened. Using a stratified random sampling strategy, a total of 221 Malay subjects (112 subjects in a "full time job" and 109 subjects in "no full time job") were recruited. Subjects were visitors (friends and relatives) within the hospital compound and were representative of the local community. Red flags and psychosocial alarm symptoms were also assessed in the current study using previously translated and validated questionnaires. Subjects with IBS were sub-typed into constipation-predominant, diarrhea-predominant, mixed type and un-subtyped. Univariable and multivariable analyses were used to test for association between socioeconomic factors and presence of red flags and psychosocial alarm features among the Malays with IBS.. IBS was present in 10.9% (24/221), red flags in 22.2% (49/221) and psychosocial alarm features in 9.0% (20/221). Red flags were more commonly reported in subjects with IBS (83.3%) than psychosocial alarm features (20.8%, P < 0.001). Subjects with IBS were older (mean age 41.4 years vs 36.9 years, P = 0.08), but no difference in gender was noted (P = 0.4). Using univariable analysis, IBS was significantly associated with a tertiary education, high individual income above RM1000, married status, ex-smoker and the presence of red flags (all P < 0.05). In multiple logistic regression analysis, only the presence of red flags was significantly associated with IBS (odds ratio: 0.02, 95%CI: 0.004-0.1, P < 0.001). The commonest IBS sub-type was mixed type (58.3%), followed by constipation-predominant (20.8%), diarrhea-predominant (16.7%) and un-subtyped (4.2%). Four of 13 Malay females (30.8%) with IBS also had menstrual pain. Most subjects with IBS had at least one red flag (70.8%), 12.5% had two red flags and 16.7% with no red flags. The commonest red flag was a bowel habit change in subjects > 50 years old and this was reported by 16.7% of subjects with IBS.. Using the Rome III criteria, IBS was common among ethnic Malays from the north-eastern region of Peninsular Malaysia.

Topics: Adult; Asian People; Constipation; Diarrhea; Female; Health Care Surveys; Humans; Irritable Bowel Syndrome; Logistic Models; Malaysia; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prevalence; Prospective Studies; Psychometrics; Risk Factors; Surveys and Questionnaires; Young Adult

A study was carried out to investigate the effects of feeding liquid metabolite combinations produced by Lactobacillus plantarum strains on growth performance, diarrhoea incidence, faecal pH, microfloral counts, short-chain fatty acids (SCFA) and intestinal villus height and crypt depth of postweaning piglets. A total of 120 piglets (26 days old) were randomly assigned evenly into five treatment groups treated with same basal diet: (1) -ve control (free antibiotic); (2) + ve control (0.03% of chlortetracycline); (3) Com 1 (0.3% metabolite of TL1, RG11 and RI11 strains); (4) Com 2 (0.3% metabolite of TL1, RG14 and RS5 strains); (5) Com 3 (0.3% metabolite of RG11, RG14 and RI11 strains). After 5 weeks, the average daily feed intake was not significantly different (P > 0.05) among the treatments and feed conversion ratio was the highest (P < 0.05) in the -ve control group. In addition, diarrhoea incidence was reduced when piglets were fed with metabolite combinations. Faecal lactic acid bacteria (LAB) counts were significantly higher (P < 0.05) in metabolite treatment groups than in the groups without metabolites. However, the treatment of Com 2 metabolite resulted lower (P < 0.05) faecal pH and Enterobacteriaceae (ENT) than the -ve control group. In contrast, total faecal SCFA of Com 2 were significantly higher (P < 0.05) than the -ve control group. The villus height of duodenum was higher (P < 0.05) in the + ve control and Com 2 groups as compared to -ve control group. The results obtained in this study showed that feeding metabolite combinations could improve growth performance, and increase the population of gut LAB and faecal SCFA of postweaning piglets.

Topics: Animal Husbandry; Animals; Diarrhea; Dietary Supplements; Fatty Acids, Volatile; Feces; Hydrogen-Ion Concentration; Intestinal Mucosa; Lactobacillus plantarum; Linear Models; Malaysia; Mice; Microvilli; Sus scrofa; Swine; Swine Diseases

Topics: Capsid Proteins; Child, Preschool; Diarrhea; Humans; Infant; Malaysia; Phylogeny; RNA, Viral; Rotavirus; Rotavirus Infections

Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease.

Topics: Adolescent; Adult; Child; Child, Preschool; Cross-Sectional Studies; Demography; Diarrhea; Educational Status; Female; Humans; Incidence; Infant; Interviews as Topic; Malaysia; Male; Middle Aged; Multivariate Analysis; Risk Factors; Rural Population; Socioeconomic Factors; Young Adult

About 1.8 million people die annually from acute diarrheal disease globally. A nationwide cross-sectional survey was conducted via face-to-face interview with eligible subjects to determine the incidence and health seeking behavior of Malaysians with acute diarrheal disease (ADD). An acute diarrheal episode was defined as having three or more loose stools in any 24 hour period during the four weeks period prior to the interview. The exclusion criteria included pre-existing chronic diarrhea, such as with cancer of the bowel, ulcerative colitis or Chrohn's disease. Forty three point three percent of those with ADD (95% CI 41.3-45.4) sought treatment for the illness. Younger age groups (0-4 years, 67.7%; 95% CI 61.5-73.4; 5-9 years, 56.5%; 95% CI 48.6-64.1) were more likely to seek care for ADD. Seventy-one point eight percent of those seeking treatment, (95% CI 69.0-74.4) did so within 12 hours of the onset of symptoms. Most people with ADD sought treatment at private clinics. The main reasons given for not seeking treatment were the illness was mild and did not warrant treatment and the practice of self-medication (22.4%; 95% CI 20.0-24.9). These findings show self-medication is a major health seeking behavior among Malaysians with ADD. Self-medication of ADD deserves more in-depth study to ensure it is safe.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Child; Child, Preschool; Cross-Sectional Studies; Diarrhea; Ethnicity; Female; Humans; Infant; Interviews as Topic; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Self Medication; Severity of Illness Index; Socioeconomic Factors; Time Factors; Young Adult

Cytomegalovirus (CMV) infection can present with severe manifestations that are associated with significant morbidity and mortality, especially in immunocompromised patients. CMV infections in immunocompetent patients are usually transient and do not exhibit many symptoms. However, in some patients, the manifestations can be severe. We report CMV colitis in two immunocompetent patients; one in a young man who was critically ill with septicaemia and significant non-bloody diarrhoea that responded to specific CMV treatment, and another in an elderly woman who presented with nonspecific abdominal pain and fever that resolved without specific CMV treatment.

Topics: Abdominal Pain; Adult; Biopsy; Colitis; Colon; Critical Care; Cytomegalovirus Infections; Diarrhea; Female; Humans; Inflammation; Malaysia; Male; Middle Aged; Sepsis

This study examined the temporal distribution of rotavirus genotypes in Malaysia. Rotaviruses from children with diarrhea admitted to hospitals in 1996 (n = 93) and 2007 (n = 12) in two different regions of Peninsular (West) Malaysia were analyzed for their G and P genotypes using a hemi-nested RT-PCR assay. In the 2007 samples, the dominant strain was G9P[8]. It was identified in 42% of the samples. Different strains all possessing the G1 genotype were identified in the rest of the samples. In contrast, 81% of the samples collected in 1996 were the G1P[8] strain. No strains with G9 genotype were detected in samples collected in 1996.

Topics: Child, Preschool; Diarrhea; Genotype; Hospitalization; Humans; Infant; Malaysia; Molecular Epidemiology; Prevalence; Rotavirus; Rotavirus Infections

Acetaminophen poisoning is a common clinical problem, and early identification of patients with more severe poisoning is key to improving outcomes.. This study intends to document prevalence, clinical characteristics, and predictors of gastrointestinal (GI) manifestations and to assess the impact of these manifestations on outcome in patients with acetaminophen poisoning.. This is a retrospective cohort study of hospital admissions for acute acetaminophen poisoning conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. Statistical Package for Social Sciences (SPSS) 15 was used for data analysis.. Two hundred and ninety-one patients were studied; their mean age was 23.01 +/- 7.4 years and 76.6% had GI manifestations. Multiple logistic regression showed that significant risk factors for GI manifestations were present among patients who reported acetaminophen dose ingested >or=10 g (p < 0.001), and latency time more than 8 hours (p = 0.030). GI manifestations at first admission predicted poorer outcomes in terms of estimated acetaminophen levels to be a possible toxic (p < 0.001), elevated bilirubin levels (p = 0.002), prolonged prothrombin time (PT; p = 0.002), elevated creatinine level (p = 0.028), declination of potassium level (p < 0.001), and prolonged hospital stay (p < 0.001).. GI manifestations were common among patients with acetaminophen poisoning. This study suggests that the presence of GI manifestations at first presentation appears to be an important risk marker of subsequent hepatotoxicity and nephrotoxicity.

Topics: Acetaminophen; Adult; Analgesics, Non-Narcotic; Bilirubin; Chemical and Drug Induced Liver Injury; Cohort Studies; Creatinine; Diarrhea; Female; Humans; Length of Stay; Logistic Models; Malaysia; Male; Nausea; Pharmacoepidemiology; Potassium; Prevalence; Prognosis; Prothrombin Time; Retrospective Studies; Statistics, Nonparametric; Vomiting; Young Adult

Acute gastroenteritis (AGE) is a common illness among infants and children contributing to significant mortality and morbidity. As such, appropriate treatment received prior to hospital admission is of utmost importance. This retrospective observational study aimed to determine preadmission management in paediatric patients prior to hospital admission. Two hundred and twenty-two case notes of paediatric AGE patients were reviewed over a 12-month period. One hundred and fifty-four patients received medications prior to admission with 143 (92.9%) patients received known classes of medications. Antipyretic agents were the most commonly prescribed (69.2%), followed by antibiotics (38.5%), anti-emetics (35.7%), oral rehydration salts (29.4%) and antidiarrhoeals (28.0%). The mean duration of stay in hospital was slightly shorter in patients, who received prior medications than those who did not (2.22 vs. 2.32 days respectively). Seventy per cent of children admitted for AGE were treated suboptimally prior to hospital admission with oral rehydration salts being largely under-utilized, despite their proven efficacy and safety. Sex, race and age had no influence on the type of preadmission treatment. A greater effort should be made to educate the general public in the appropriate treatment of AGE.

Topics: Acute Disease; Analgesics, Non-Narcotic; Anti-Bacterial Agents; Antidiarrheals; Antiemetics; Child; Child, Preschool; Diarrhea; Female; Fluid Therapy; Gastroenteritis; Histamine H1 Antagonists; Hospitals, Teaching; Humans; Infant; Length of Stay; Malaysia; Male; Medication Errors; Patient Admission; Patient Education as Topic; Retrospective Studies

This retrospective study examined the G/P type of rotavirus in RNA samples that have previously been e-typed by RNA-PAGE in 1996. The results were then compared to 2007 samples to ascertain the extent of changes that may have occurred in this 11-years time interval. The G and P genotypes were determined by hemi-nested PCR and further analysed by phylogenetic study. In 1996, the G/P combination G1P[8], G(UT)P[8] and G1P(UT) prevalence rate were 81%, 9% and 7%, respectively. As expected, the G9 genotype which has already emerged worldwide was identified in 42% of the 2007 samples with the remaining 33% G1P[8] and 25% G1P(UT) Analysis of the RNA pattern showed that majority of the isolates were long e-type in both series, nevertheless minor differences within electropherotypes were observed. Genetic diversity in some strains of the human group A rotaviruses was analysed by phylogenetic methods. These findings will help in the decision to introduce rotavirus vaccines within the next decade.

Topics: Child; Diarrhea; Female; Genotype; Humans; Malaysia; Male; Molecular Epidemiology; Phylogeny; Polymerase Chain Reaction; Prevalence; Retrospective Studies; RNA, Viral; Rotavirus; Rotavirus Infections; Time Factors

This cross-sectional study determined the prevalence of cryptosporidiosis in HIV-infected patients using polymerase chain reaction (PCR). Stool specimens were collected from HIV infected patients who were admitted to Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia, for various indications from December 2004 to December 2005. A modified acid-fast stain was performed on the direct stool smears, then the stool specimens were further tested using nested PCR targeting the 18S rRNA gene of Cryptosporidium parvum, with a built-in internal control (IC). Out of 59 samples, 11 were positives. Nested PCR identified a total of nine samples (16%) compared to microscopy, which identified only three samples. All PCR negative results showed IC amplicons, suggesting that these samples were true negatives and were not due to inhibition of PCR. This study highlights the importance of molecular diagnosis in determining the true prevalence and epidemiology of C. parvum.

Topics: Adult; AIDS-Related Opportunistic Infections; Animals; Cross-Sectional Studies; Cryptosporidiosis; Cryptosporidium parvum; Diarrhea; Feces; HIV Infections; Humans; Immunocompromised Host; Malaysia; Microscopy; Polymerase Chain Reaction; RNA, Ribosomal, 18S; Sensitivity and Specificity

We aimed to determine the outcome of nutritional intervention in children with moderate to severe malnutrition following persistent diarrhoea (PD), referred to a tertiary referral unit in Malaysia. Thirty-one (44%) of the 71 children (median age 19 months) with PD had moderate to severe malnutrition on admission. Fifty-three (75%) required dietary modification and 15 (21%) needed parenteral nutrition (PN, median duration 96 days). Of the 70 patients in whom remission of diarrhoea could be ascertained, 64 (91%) achieved remission. Three required home PN. At three months after discharge, there was a significant improvement in the mean weight-for-height z-score as compared to the original score at initial presentation (from -1.83 +/- -1.77 to -0.80 +/- -1.17; p < 0.001), although 12 (22%) of the 55 patients in whom nutritional status could be ascertained still had moderate to severe malnutrition. In conclusion, moderate to severe malnutrition was a common complication following PD resulting from diverse causes. With appropriate therapy, remission can be achieved in majority of patients, although a small number of patients needed home PN because of persistence of diarrhoea.

Topics: Child; Child, Preschool; Cohort Studies; Diarrhea; Female; Hospitalization; Humans; Infant; Malaysia; Male; Malnutrition; Nutrition Therapy; Retrospective Studies; Severity of Illness Index; Treatment Outcome

This study was conducted to reassess the risk factors for giardiasis in communities of the Orang Asli (indigenous people) in Pahang, Malaysia. Stool samples were collected from 321 individuals (2-76 years old; 160 males, 161 females). Data were collected via laboratory analysis of faecal samples and a pre-tested standard questionnaire. River water samples were tested for Giardia cysts and Cryptosporidium oocysts. The overall prevalence of G. intestinalis infection was 23.7%. Children < or =12 years old had the highest infection rate and have been identified as a high risk group (odds ratio (OR)=6.2, 95% CI 1.5-27.0, P<0.005). The risk of getting giardiasis also appeared to be significantly associated with drinking piped water (OR=5.1, 95% CI 0.06-0.7, P<0.005) and eating raw vegetables (OR=2.4, 95% CI 0.2-0.6, P<0.005). In conclusion, sociodemographic factors have always been associated with the high prevalence of Giardia infections in Malaysia. However, the present study also highlights the need to look into the possibility of other risks such as water and food transmission routes. In future, it is necessary that these two aspects be considered in control strategies.

Topics: Adolescent; Adult; Aged; Analysis of Variance; Animals; Child; Child, Preschool; Diarrhea; Feces; Female; Giardia lamblia; Giardiasis; Humans; Hygiene; Malaysia; Male; Middle Aged; Rural Health; Socioeconomic Factors; Water; Water Supply

To study the role of rotavirus in children hospitalised for acute gastroenteritis (AGE) in two urban hospitals in Malaysia.. A 12-month prospective study (January to December 2002), in children younger than 14 years with AGE hospitalised to the paediatric units of University of Malaya Medical Centre (UMMC), Kuala Lumpur; and Hospital Sultanah Aminah (HSA), Johor Bahru, Malaysia was conducted.. In 2002, 399 and 1307 children with AGE were admitted to UMMC and HSA, respectively. Two hundred and eighty-eight (72%) stool samples from UMMC and 901 (69%) samples from HSA were analysed. Rotavirus was the most common aetiological agent identified in both centres (average 32%; UMMC 35%, HSA 30%, P = 0.94). The peak age group for rotavirus-related hospitalisation was 24-35 months for UMMC and 12-23 months for HSA. Nine percent of patients hospitalised for rotavirus infection in UMMC and 22% of patients in HSA were older than 5 years of age. An outbreak of rotavirus infection within the communities served by both centres resulting in an increase in hospital admissions of rotavirus gastroenteritis was observed in both units from January to March 2002.. The peak age group for rotavirus-related hospital admission in this study was much older, between 12 to 35 months. It is uncertain whether this was related to the outbreak of rotavirus gastroenteritis observed within two urban areas from January to March 2002 causing re-infection with rotavirus in older children.

Topics: Acute Disease; Adolescent; Age Distribution; Campylobacter; Child; Child, Preschool; Diarrhea; Enterobacteriaceae; Female; Gastroenteritis; Hospitalization; Humans; Infant; Infant, Newborn; Malaysia; Male; Prospective Studies; Rotavirus; Rotavirus Infections; Seasons

The objectives of the study were to describe the epidemiology and strain characterization of rotavirus (RV), to determine the proportion of hospitalizations for diarrhea attributable to RV among children under 5 years of age, and to estimate the disease burden of RV diarrhea in Malaysia.. All children 0-59 months of age admitted for acute gastroenteritis to Kuala Lumpur Hospital (KLH) or Hospital Umum Sarawak (HUS) were surveyed. The periods of surveillance were from February 1, 2001 to April 30, 2003 in KLH and April 1, 2001 to March 31, 2003 for HUS.. The highest rate of RV-associated diarrhea was among children aged 6-17 months, accounting for 55% of RV-associated diarrhea. There was no seasonality observed in either hospital. P[8]G9 strains were predominant, accounting for 73% of all strains in both hospitals, 80% from KLH and 61% from HUS. There was no mortality.. RV was responsible for 38% of hospitalizations for diarrhea. It was most common in the 6-17 months age group. There was no seasonality observed for RV-associated diarrhea. The most prevalent strain of RV was P[8]G9. The estimated incidence of RV-associated diarrhea was 27 per 10000 population under the age of 5 years per year.

Topics: Age Factors; Child, Preschool; Diarrhea; Female; Hospitalization; Hospitals, Urban; Humans; Incidence; Infant; Infant, Newborn; Malaysia; Male; Prospective Studies; Rotavirus; Rotavirus Infections; Seasons

Accurate national estimates of the disease burden associated with rotavirus diarrhea are essential when considering implementation of a rotavirus vaccination program. We sought to estimate rotavirus disease-associated morbidity and mortality in Malaysia, using available sources of information.. We analyzed national data from the Ministry of Health (Kuala Lumpur, Malaysia) to derive rates of hospitalization, clinic visits, and deaths related to acute gastroenteritis (AG) among children <5 years of age. The number of events attributable to rotavirus infection was estimated by multiplying age-stratified rates of detection of rotavirus from 2 hospital surveillance sites by national data.. In 1999 and 2000, an average of 13,936 children (1 in 187 children) were hospitalized annually for AG. Surveillance of visits to outpatient clinics for AG identified an average of 60,342 such visits/year between 1998 and 2000. The AG-associated mortality rate was 2.5 deaths/100,000 children. On the basis of the finding that 50% of children were hospitalized for rotavirus diarrhea, we estimated that 1 in 61 children will be hospitalized for rotavirus disease and that 1 in 37 children will seek treatment as an outpatient.. Among Malaysian children, there is a significant burden associated with AG- and rotavirus disease-related hospitalizations and outpatient visits, and this burden potentially could be prevented by the use of rotavirus vaccines.

Topics: Child, Preschool; Diarrhea; Female; Hospitals; Humans; Infant; Infant, Newborn; Malaysia; Male; Outpatients; Rotavirus; Rotavirus Infections; Sentinel Surveillance

Irritable bowel syndrome (IBS) is a common functional bowel disease in the West. Information on the prevalence of IBS in the Asian population is relatively scanty. The aims of the present study were to determine the prevalence of IBS and to assess the symptom subgroups based on the predominant bowel habit in a young adult population of Asian origin.. Basic demographic data and symptoms of IBS using the Rome I criteria were sought using a questionnaire administered to all apparently healthy students in a medical school. Other questions asked related to alcohol intake, smoking, chili consumption, dietary fiber intake, and to psychological and psychosomatic symptoms of anxiety, depression, insomnia, headache, and backache. The health-care seeking behavior of the subjects was also analyzed.. Of the 610 questionnaires administered, 533 complete responses were received (response rate of 87.4%). The responders comprised 229 men (43.0%) and 304 (57.0%) women with a mean age of 22 +/- 1.8 years. The ethnic distribution was Malays 278 (52.2%), Chinese 179 (33.6%), Indians 46 (8.6%), and others 30 (5.6%). Eighty-four (15.8%) reported symptoms consistent with the diagnosis of IBS, predominantly women. Sixty-five (77.4%) and six (7.1%) were of the constipation-predominant and diarrhea-predominant IBS subgroups, respectively. Thirteen (15.5%) subjects fell into the non-specific IBS subgroup. The self-reported psychological and psychosomatic symptoms of anxiety (P = 0.02), depression (P = 0.002), insomnia (P = 0.006), headache (P = 0.04), and backache (P = 0.006) were encountered more frequently in the subjects with IBS. Only 13.1% of the IBS group had consulted their health-care practitioner, and 20.2% reported self-medication.. Symptoms supportive of the diagnosis of IBS were common among young Malaysians, with a prevalence rate of 15.8%. There were significantly more women with IBS than men. Within the IBS population, the majority (77.4%) was of the constipation-predominant IBS subgroup. A significantly higher prevalence of psychological and psychosomatic symptoms was found in individuals with IBS. Only a minority sought medical advice for their symptoms.

Topics: Abdominal Pain; Adult; Constipation; Defecation; Diarrhea; Female; Health Surveys; Humans; Irritable Bowel Syndrome; Malaysia; Male; Prevalence; Students, Medical

Enteropathogenic Escherichia coli (EPEC) is a leading cause of diarrhea among infants in developing countries. A total of 38 EPEC isolates, obtained from diarrhea patients of Hospital Miri, Sarawak, were investigated through plasmid profile, antibiotic resistance and randomly amplified polymorphic DNA (RAPD) analysis. From the 8 types of antibiotics used, all isolates were 100% resistant to furoxime, cephalothin and sulphamethoxazole and showed high multiple antibiotic resistant (MAR) indexes, ranging from 0.5 to 1.0. In plasmid profiling, 22 isolates (58%) showed the presence of one or more plasmids in the range 1.0 to 30.9 mDa. The dendrogram obtained from the results of the RAPD-PCR discriminated the isolates into 30 single isolates and 3 clusters at the level of 40% similarity. The EPEC isolates were highly diverse, as shown by their differing plasmid profiles, antibiotic resistance patterns and RAPD profiles.

Topics: Adult; Diarrhea; DNA Fingerprinting; Drug Resistance; Escherichia coli; Escherichia coli Infections; Humans; Malaysia; Microbial Sensitivity Tests; Plasmids; Predictive Value of Tests; Random Amplified Polymorphic DNA Technique

A retrospective review of all stool samples obtained from children aged < 16 years with diarrhoea from University of Malaya Medical Centre (UMMC), Kuala Lumpur, from 1978 to 1997 was undertaken to ascertain the pattern of bacterial pathogens causing diarrhoea in children in an urban area in Malaysia. Of 26444 stool samples processed, 2989 (11%) were positive. The five most common bacterial pathogens isolated were non-typhoidal Salmonella (57%), enteropathogenic E. coli (EPEC) (14%), Shigella spp. (11%), Campylobacter spp. (5%) and Aeromonas spp. (4%). There was a significant reduction in the average percentage of positive isolation during the last 5 years of the study period as compared to the first 5 years (15.0% vs. 7.2%; r = -0.92, p = 0.0001). EPEC and Shigella spp. were less commonly isolated in the last five years compared with the first five years of the study (6% vs 21% p < 0.001 for E. coli; 7% vs 22%, p < 0.001 for Shigella spp.). This information is important for public health education in reducing the incidence of childhood diarrhoea further, and in the selection of appropriate antimicrobials in the management of extra-intestinal complications of childhood diarrhoea.

Topics: Academic Medical Centers; Adolescent; Age Distribution; Child; Child, Preschool; Diarrhea; Enterobacteriaceae; Enterobacteriaceae Infections; Hospitals, Urban; Humans; Infant; Malaysia; Retrospective Studies; Time Factors

The prevalence rate of trichuriasis in children in certain areas of Kelantan is high. However the Trichuris Dysentery Syndrome (TDS), a condition in children characterized by chronic diarrhoea, stunting and anaemia is said to be rare. A recent change in policy at our institution to lower the threshold for undertaking colonoscopy in children with chronic diarrhoea resulted in the detection of 6 cases of TDS in less than a year. The median age was 7 years (range 3-13) and the median duration of symptoms before diagnosis was 2 years (range 1-8). The insidious nature of TDS and the low level of awareness of this condition even among health care workers may result in considerable underdiagnosis.

Topics: Adolescent; Child; Child, Preschool; Diarrhea; Female; Growth; Humans; Malaysia; Male; Nutritional Status; Trichuriasis

The aim of this prospective study was to determine the prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia. Over a 19 month study period, 258 stool samples were examined from 159 children; 109 with diarrhea and 50 controls without diarrhea. Modified Ziehl-Neelsen staining method and a polymerase chain reaction (PCR) assay were used to detect C. parvum and the samples were also examined for the presence of other intestinal parasites. Only 1 of the 109 (0.9%) children with acute diarrhea was positive for C. parvum by microscopy and PCR. Thirty-one percent of children were infested with other intestinal parasites, the most common being Ascaris lumbricoides and Trichuris trichiura. In conclusion, we found C. parvum to be an uncommon infective agent in hospitalized children with or without diarrhea in Kota Bharu, Malaysia.

Topics: Animals; Case-Control Studies; Child; Child, Hospitalized; Child, Preschool; Cryptosporidiosis; Cryptosporidium parvum; Diarrhea; Female; Humans; Infant; Malaysia; Male; Polymerase Chain Reaction; Prevalence; Prospective Studies

To review the causes, clinical features and outcomes of Malaysian children who had chronic diarrhoea.. A prospective study was performed on children with diarrhoea of more than 14 days' duration who were managed at the Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur from 1 January 1996 to 31 December 1997.. Twenty-seven patients (14 boys and 13 girls) were studied. The median age of onset of diarrhoea was 6 months and the mean duration of symptoms before referral was 66.5 days. The underlying causes of diarrhoea were found to be: (i) prolonged diarrhoea due to well-defined entities (intestinal lymphangiectasia, two cases; congenital glucose-galactose malabsorption, one case; post-small bowel resection, one case; (ii) postenteritis diarrhoea (cow's milk protein intolerance, eight cases; secondary lactose intolerance, four cases; transient monosaccharide intolerance, one case; (iii) gastrointestinal infections (nontyphoid Salmonella gastroenteritis, three cases; trichuriasis, two cases; amoebiasis, one case; adenovirus, one case; (iv) cases in which a firm diagnosis could not be established (three cases). The mean duration of hospital admission was 63 days. Sixteen cases required a change in diet, while nine cases required total parenteral nutrition. One death occurred.. Chronic childhood diarrhoea in Malaysia had a variety of aetiologies. A specific diagnosis could be established in 90% of cases. Making a diagnosis was important because this led to appropriate therapy and a good outcome in 96% of cases.

Topics: Age of Onset; Child, Preschool; Chronic Disease; Diarrhea; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Prospective Studies; Treatment Outcome

The risk factors and modes of death following acute diarrhoeal illness in children admitted to University Hospital, Kuala Lumpur between 1982 and 1997 were studied retrospectively. Among 4,689 cases of acute gastroenteritis admitted, ten deaths were noted. The case mortality rate was 2.1/1000 admissions. All deaths were infants below one year, with eight females and two males. Acute renal failure and acute pulmonary oedema were common preceding events. Female sex, infants less than twelve months, the presence of hyper or hyponatraemia and moderate to severe dehydration on admission were risk factors for deaths.

Topics: Acute Disease; Diarrhea; Female; Hospital Mortality; Humans; Infant; Infant, Newborn; Malaysia; Male; Risk Factors

Escherichia coli strains isolated from patients with diarrhea or hemolytic uremic syndrome (HUS) at Pusan University Hospital, South Korea, between 1990 and 1996 were examined for traits of the O157:H7 serogroup. One strain isolated from a patient with HUS belonged to the O157:H7 serotype, possessed a 60-MDa plasmid, the eae gene, and ability to produce Shiga toxin 1 but not Shiga toxin 2. Arbitrarily primed PCR analysis suggested that this strain is genetically very close to a O157:H7 strain isolated in Japan.

Topics: Bacterial Toxins; Diarrhea; DNA, Bacterial; Escherichia coli Infections; Escherichia coli O157; Hemolytic-Uremic Syndrome; Humans; Japan; Korea; Malaysia; Polymerase Chain Reaction; Shiga Toxin 1; Shiga Toxin 2; Virulence

Typhoid fever, which is endemic in Malaysia, affects all age groups and it has been stated that classical features described in textbooks were absent in children. The aim of this study was to find out whether this was true in the local setting and hence a retrospective study was undertaken.. Fifty-four paediatric patients satisfied the inclusion criteria and all were seen consecutively during the study period of 10 years. Patients' records were reviewed for demographic data such as age, sex, ethnicity, clinical features, therapy and results of laboratory tests.. Fever was the most common presenting symptom and diarrhoea was more common than constipation. Isolation of S typhi from blood and/or stools was the most important diagnostic tool *85.2%) and of these 99% had significant Widal titres. Clinical and bacteriological relapse occurred in 5 children (3%) who were successfully treated with ceftriaxone. The absence of mortality and low level of complications indicates either a mild nature of the disease or to early recognition or prompt and appropriate therapy.

Topics: Ceftriaxone; Cephalosporins; Child; Child, Preschool; Constipation; Diarrhea; Disease Progression; Female; Humans; Infant; Malaysia; Male; Retrospective Studies; Salmonella typhi; Treatment Outcome; Typhoid Fever

A 43-year-old woman developed abdominal pain and diarrhea following a travel to Malaysia. Examinations in another hospital proved no evidence of infection, an empirical antibiotic therapy with ciprofloxacin yielded no benefit. One and a half year later, the patient was admitted to our department because of persistent diarrhea and wasting. Laboratory tests showed megaloblastic anemia, folate deficiency and steatorrhea. Stool specimens for bacterial pathogens and parasites were negative. Endoscopy and biopsy from the distal portion of the duodenum revealed broadening and shortening of the villi and an increased infiltration of the lamina propria by chronic inflammatory cells (plasma cells and lymphocytes). In conclusion, diagnosis of tropical sprue was established. The therapy comprised of tetracycline for six weeks and folic acid for six months. Subsequently, the diarrhea disappeared, the patient continuously gained weight and was free of any complaints. The complete remission following this regimen proved the suspected diagnosis. Differential diagnosis in any patient who recently returned from the tropics may be a challenge. Tropical sprue predominantly occurs during or after a longer stay in endemic areas. However, if chronic diarrhea and signs of malabsorption develop after a short journey to India, South-East Asia and parts of the Caribbean, tropical sprue has to be considered, too.

Topics: Adult; Biopsy; Diagnosis, Differential; Diarrhea; Female; Follow-Up Studies; Humans; Intestinal Mucosa; Malaysia; Sprue, Tropical; Travel

A 57-year-old man, while on travel in Malaysia, suffered from diarrhea after he ate fruits. He developed limbs weakness without sensory disturbance after his return to Japan. Serum from the patient had high IgG anti-GM1 antibody titer. Campylobacter jejuni was isolated from his stool. The serotype belonged to PEN 5. The patient received double-filtration plasmapheresis 7 times during from days 6 to 17. Muscle strength began to recover gradually on day 10, and returned to normal 5 months after the onset of neurologic symptoms. Repeated neurophysiologic studies indicated that the axonal degeneration of motor nerves was predominant process. This case suggests that Guillain-Barré syndrome is a complication of traveler's diarrhea.

Topics: Campylobacter Infections; Campylobacter jejuni; Diarrhea; Feces; Humans; Malaysia; Male; Middle Aged; Polyradiculoneuropathy; Travel

The production of heat-labile (LT) and heat-stable (ST) enterotoxins, colonisation factor antigens (CFAs) and haemagglutinins was investigated amongst 310 Escherichia coli (E. coli) isolates obtained from 62 children under the age of five, with diarrhoea. Twenty-one isolates were found to produce enterotoxins, of which fifteen (71%) isolates produced ST only, 2 (10%) produced LT only and 4 (19%) produced both LT and ST. However, none of the isolates demonstrated any of the common CFAs identified to date, but 8 out of the 21 isolates demonstrated haemagglutination with rabbit, sheep or human group A erythrocytes, suggesting the presence of putative CFAs, yet unidentified.

Topics: Bacterial Proteins; Child, Preschool; Developing Countries; Diarrhea; Enterotoxins; Enzyme-Linked Immunosorbent Assay; Escherichia coli; Escherichia coli Infections; Fimbriae Proteins; Hemagglutination Tests; Humans; Infant; Malaysia

Approximately 57% of clinical and 33% of poultry isolates examined produced a cytotoxin. Cytotoxic activity was detected in 25 (50%) isolates of Campylobacter of which 12 were isolated from bloody diarrhea and 9 from watery stools. The cytotoxin titers were low, ranging from 2 to 16. The crude filtrates from 50 Campylobacter isolates showed no cytotoxic effect in Vero cells, no fluid accumulation in suckling mice and no hemolytic activity.

Topics: Animals; Bacterial Toxins; Campylobacter; Cells, Cultured; Chlorocebus aethiops; Cytotoxins; Diarrhea; Hemolysis; Humans; Malaysia; Mice; Vero Cells

Blastocystis hominis has long been described as a non pathogenic protozoan parasite until recently when claims have been made that it can result in pathogenic conditions. Of the 729 stool samples (614 from survey and 115 from pediatric wards) examined, 18.1% of them were found to be positive for one or more intestinal protozoan cyst. The commonest was Giardia intestinalis (8.4%) Followed by Entamoeba coli (7.1%) and Entamoeba histolytica (5.1%) in the normal children without symptoms of diarrhea. When diarrheic stools were examined, the commonest parasite encountered was Giardia (20.4%), followed by E. coli (15.9%) and E. histolytica (9.7%). Blastocystis was observed in 4.4% of the children who had diarrhea and 1.1% among the children taken from the normal population in the rural areas.

Topics: Adolescent; Animals; Blastocystis hominis; Blastocystis Infections; Child; Child, Preschool; Diarrhea; Female; Humans; Infant; Intestinal Diseases, Parasitic; Malaysia; Male; Prevalence

Stool specimens from 334 infants and young children hospitalized with diarrhea in the General Hospital, Kuala Lumpur, Malaysia between August and November, 1987 were analyzed for the presence of rotavirus double-stranded (ds) RNA by polyacrylamide gel electrophoresis. Of the 334 specimens analyzed, 32 (9.6%) were positive for rotavirus RNA. One specimen (designated G147) exhibited a ds RNA electropherotype profile characteristic of Group C rotavirus and was selected for further characterization. In Northern blot hybridization studies, the gene 5 segment of strain G147 hybridized with a cDNA probe generated from the cloned gene 5 (which encodes the VP6 inner capsid protein that is group specific) of porcine Group C rotavirus strain Cowden, confirming the classification of strain G147 in Group C. The association of Group C rotavirus with diarrheal illness in Malaysia is consistent with earlier studies that suggest a global distribution of this virus and supports the need for additional epidemiologic studies.

Topics: Child, Preschool; Diarrhea; Feces; Gastroenteritis; Genes, Viral; Humans; Infant; Malaysia; RNA, Double-Stranded; RNA, Viral; Rotavirus; Rotavirus Infections

A total of 320 faecal specimens obtained from 295 patients (192 children and 103 adults) with diarrhoea and 47 faecal specimens from healthy adults were screened for Cryptosporidium oocysts. Faecal specimens were first screened by modified Ziehl Neelsen stain and specimens with oocysts were confirmed by direct immunofluorescence technique. Cryptosporidium oocysts were detected in 4 children but not in normal healthy adults or in diarrhoeic adults.

Topics: Animals; Child; Child, Preschool; Cryptosporidiosis; Diarrhea; Female; Humans; Infant; Malaysia; Male; Prevalence

The VP4 genetic groups of 151 field strains of human rotaviruses obtained from infants and young children with diarrhea from four locations in Malaysia were analyzed. The strains were adapted to growth in tissue culture and studied further by molecular hybridization of northern blotted RNA to PCR-generated cDNA probes representing amino acids 84-180 of the KU strain VP4, 83-181 of the DS-1 strain VP4, and 83-180 of either the 1076 or K8 strain VP4, representing VP4 genetic groups 1-4 (P1A, P1B, P2, and P3), respectively. The majority (79% of the field strains hybridized with the KU VP4 genetic group 1 probe and were associated with G1, G3, G4, untypable, or mixed G serotypes. VP4 genetic group 1 (P1A) strains were the most common in all locations in Malaysia between 1978-1988. Three strains which exhibited G3 and subgroup I specificity hybridized with the K8 VP4 genetic group 4 probe. These three VP4 genetic group 4 (P3) strains were detected in two different years and locations, extending the initial detection of this VP4 genetic group (the K8 strain) in Japan to a larger geographical area of Asia.

Topics: Alleles; Blotting, Northern; Child, Preschool; Diarrhea; DNA Probes; Electrophoresis, Agar Gel; Genes, Viral; Humans; Infant; Malaysia; Polymerase Chain Reaction; RNA, Viral; Rotavirus; Rotavirus Infections; Sensitivity and Specificity; Serotyping

Topics: Cholera; Diarrhea; Disease Outbreaks; Global Health; Humans; Malaysia; Vibrio cholerae

Intestinal protozoa are found in all communities in Malaysia and among all ethnic groups. Prevalence of intestinal protozoa is not affected by ethnicity but by living conditions. Communities with both basic amenities of safe water supply and proper toilets have lower prevalence than those with one or none of the amenity. Cryptosporidium is an important intestinal protozoon in Malaysia and should be included in future field and laboratory studies and also in laboratory diagnosis for pathogens. Much interest will be centered on Blastocystis hominis in future studies in view that it may be a cause of diarrhea.

Topics: Adolescent; Adult; Child; Chronic Disease; Diarrhea; Female; Humans; Intestinal Diseases; Malaysia; Male; Prevalence; Protozoan Infections; Toilet Facilities; Water Supply

A 1 year longitudinal study of 156 Malaysian children from urban and suburban areas in the Klang Valley revealed that the incidence rate of diarrhoea was 23.6 per 100 person-year with abnormal faeces reported on 0.26% of the total days of observation. Diarrhoea cases were detected in children from all socioeconomic classes. Rotavirus was isolated from 12% of the diarrheic children and asymptomatic rotavirus infection occurred in 3.2% of the children. All rotaviruses isolated were group A rotaviruses with long electrophoretypic pattern.

Topics: Child, Preschool; Diarrhea; Female; Humans; Incidence; Infant; Malaysia; Male; Rotavirus Infections; Suburban Population; Urban Population

In response to a recorded increasing incidence of diarrhoea in Tumpat District, Malaysia, a case-control study was performed to identify modifiable risk factors for the transmission of diarrhoea, in children aged 4-59 months. Ninety-eight pairs of children, matched on age and sex, were recruited prospectively from health centres. Exposure status was determined during a home visit. Interviewers were 'blinded' as to the disease status of each child. Odds ratios were measured through matched pair analysis and conditional logistic regression. Risk factors for diarrhoea identified were: reported--drinking of unboiled water, storage of cooked food before consumption and bottle feeding; and observations--animals inside the house and absence of washing water in latrines. Water quality, source of drinking water, reported hand washing behaviour, indiscriminate defecation by children, cup use and the absence of a functional latrine were not associated with diarrhoea. Nonsignificant associations were found for: accessibility of washing water source, type of water storage container and use of fly covers for food.. In February-March 1989, during home visits, health investigators collected data on 98 pairs of 4-59 month old children recruited from 5 government health centers in rural Tumpat District in Malaysia to identify the risk factors for transmission of diarrhea. The controls had acute respiratory infections. Households not boiling drinking water and children drinking that water were leading risk factors of diarrhea transmission (adds ration [OR]=15, p=.02 and OR=3.13, p.001, respectively). 80.3% of reported boiled drinking water samples did not have any fecal coliforms. Storage of cooked food for 2 hours before consumption was a risk factor OR of conditional logistic regression=3 for 2 hours, p=.02; 2.44 for 2 hours=1/2 day, p=.03; and 9.82 for 1.2 day, p=.03). Another risk factor was animals (cats and chickens) living inside the dwelling (OR=2.41, p=.06). Socioeconomic status could not account for these 2 risk factors. Even though having no latrine in the house was not associated with diarrhea (OR=1.7, p=5), no water available with which to wash the anus and hand in latrines located in those houses which had latrines was significantly associated with diarrhea (OR=2.8, p=.05). This may have reflected overall poor hygienic standards. Even though breast feeding did not have a strong protective effect against diarrhea, bottle feeding was significantly associated with diarrhea (OR=8.07, p=.06). The lack of negative association between breast feeding and diarrhea may have been due to the controls' had respiratory infections, and breast feeding does have a protective effect against them. These results can help health officials to develop intervention strategies to reduce the incidence of diarrhea in rural children in Malaysia.

Topics: Acute Disease; Case-Control Studies; Child, Preschool; Data Collection; Diarrhea; Female; Humans; Hygiene; Infant; Malaysia; Male; Matched-Pair Analysis; Odds Ratio; Regression Analysis; Risk Factors; Rural Population; Water Supply

Due to the increasingly documented prevalence of diarrhoeal diseases in Malaysia, a number of water-related programmes have been implemented in an attempt to improve health status through the reduction of incidence of waterborne communicable diseases associated with poor public water supplies. The implicit assumption underlying these projects is that the enhancement of the physical infrastructure, and subsequent improvements in the quality of the water supply, will substantially reduce water-related disease. The present study questions this hypothesis and uses a socio-ecological model as a framework to assess risk factors associated with the increased probability of waterborne disease. Research is centred on Port Dickson, a district which typifies existing water and sanitation conditions in much of semi-rural Malaysia. Health services utilization data and a 268-household diarrhoeal morbidity survey were used to measure the burden of illness of waterborne disease within the district and to identify predictors of morbidity. It was concluded that although treatment facilities will reduce the health burden in the region, a number of behavioural and sanitation factors may be more important and could act to minimize the potential impacts of improved water quality.

Topics: Adolescent; Adult; Child; Child, Preschool; Diarrhea; Ethnicity; Health Behavior; Health Knowledge, Attitudes, Practice; Health Status; Humans; Hygiene; Incidence; Infant; Infant, Newborn; Malaysia; Middle Aged; Models, Statistical; Prevalence; Risk Factors; Sanitation; Water Supply

The prevalence of Enterotoxigenic Escherichia coli (ETEC) in 433 stool samples from diarrhoeal cases of all ages was studied using two commercially available test kits for the detection of heat labile toxin (LT) and the infant mouse assay for the heat stable toxin (ST). 16 samples (3.7%) were positive for ETEC, of which nine were producing ST alone, six LT alone and only one was producing both LT and ST. Although the percentage of isolation rate was low, its occurrence was almost as common as the Shigella spp and Salmonella spp in the same study. Of the two test kits examined, the Phadebact ETEC-LT Test 50 (Pharmacia Diagnostics, Uppsala, Sweden) was found to be more suitable for use in a routine diagnostic laboratory. Ten out of 12 (83%) of the strains tested were resistant to one or more antibiotics.

Topics: Adolescent; Adult; Bacterial Toxins; Bacteriological Techniques; Child; Child, Preschool; Diarrhea; Enterotoxins; Escherichia coli; Escherichia coli Proteins; Feces; Humans; Infant; Malaysia; Middle Aged; Reagent Kits, Diagnostic; Sensitivity and Specificity

Over a period of 2 months, 35 of 69 (51%) cases of juvenile diarrhoea studied in eastern Malaysia were associated with rotavirus excretion; rotavirus associated diarrhoea occurred most commonly in the 6-24 month age group. Polyacrylamide gel electrophoresis (PAGE) of genome ribonucleic acid showed that only 4 rotavirus electropherotypes could be detected. Of those, 2 predominated and 2 were detected only once each; one of these may have been a reassortment of the two predominant electropherotypes. Analysis of the clinical features of patients excreting rotavirus subgroup 1 or 2, determined by PAGE, demonstrated that rotavirus subgroup 1 was associated with more hypotonic dehydration and need for intravenous therapy: lethargy was significantly more common among those excreting rotavirus subgroup 2.

Topics: Child, Preschool; Dehydration; Diarrhea; Diarrhea, Infantile; Electrophoresis, Polyacrylamide Gel; Feces; Female; Humans; Infant; Malaysia; Male; Rotavirus; Rotavirus Infections

Analysis of diarrhoeal disease patterns in Malaysia from 1981-1986 suggested that infectious hepatitis ranked as the most predominant diarrhoeal disease followed by typhoid, food poisoning, dysentery and cholera. Although these five major food and water-borne diseases are still endemic in this country, diarrhoeal diseases per se no longer become an important public health problem in Malaysia. Enforcement of the cholera control program brought the incidence of the disease to a minimal. Unfortunately, this fatal form of diarrhoeal disease caused the greatest mortality compared to the others. Seasonal influence also played a part in controlling the occurrence of the disease. There was a preponderance of diarrhoeal diseases during the rainy season implicating contaminated water as a source of transmission. Although greater than half of the population has been supplied with piped water and sanitary latrines, a lot more has to be done before diarrhoeal diseases could be eliminated from this country.

Topics: Child, Preschool; Cholera; Diarrhea; Dysentery; Foodborne Diseases; Hepatitis, Viral, Human; Humans; Infant; Malaysia; Socioeconomic Factors; Typhoid Fever

Topics: Child; Child, Preschool; Diarrhea; Humans; Infant; Malaysia; Rotavirus; Rotavirus Infections; Virulence

Topics: Child; Child, Preschool; Diarrhea; Diarrhea, Infantile; Feces; Female; Humans; Infant; Malaysia; Male; Microbial Sensitivity Tests; Penicillin Resistance; Vibrionaceae

Topics: Adult; Diarrhea; Feces; Female; Humans; Malaysia; Urease; Vibrio

A survey was conducted in six selected rural villages to obtain baseline data on socioeconomic status, nutrition, environmental sanitation and behavioural aspects in relation to diarrhoeal diseases, using a standard questionnaire. Subsequent to this, children 0-4 years of age were followed weekly for six months for diarrhoeal disease. Eleven variables representing socioeconomic status, nutritional status, housing condition, environmental sanitation, mother's knowledge and beliefs were investigated using stepwise logistic regression to determine significant predictors of diarrhoeal disease. Children who were below two years of age, living in conditions of poor sanitation and poor quality water supply, whose houses were prone to flooding and who had mothers whose sanitary habits were not influenced by their religious beliefs, were at significantly greater risk of diarrhoeal disease.

Topics: Child Nutritional Physiological Phenomena; Child, Preschool; Diarrhea; Female; Housing; Humans; Infant; Islam; Malaysia; Male; Risk; Rural Health; Sanitation; Socioeconomic Factors; Water Supply

Topics: Anti-Bacterial Agents; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Feces; Humans; Malaysia; Microbial Sensitivity Tests; Serotyping; Shigella

Topics: Child, Preschool; Diarrhea; Gastroenteritis; Humans; Infant; Infant, Newborn; Malaysia; Rotavirus Infections; Socioeconomic Factors

Topics: Adult; Campylobacter fetus; Campylobacter Infections; Child; Child, Preschool; Diarrhea; Diarrhea, Infantile; Humans; Infant; Malaysia

Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.

Topics: Acute Disease; Adolescent; Age Factors; Asia, Southeastern; Bangladesh; Child; Child, Preschool; Diarrhea; Female; Gastrointestinal Diseases; Humans; Infant; Influenza, Human; Malaysia; Male; Philippines; Sex Factors; Singapore; Thailand

Topics: Allied Health Personnel; Child; Community Health Workers; Diarrhea; Fluid Therapy; Humans; Malaysia; Mothers; Rural Population; Water Supply

Three species of commonly eaten shellfish found in Malaysian coastal waters were examined for the presence of common bacterial enteropathogens. Vibrio parahaemolyticus, non-agglutinating vibrios, and various serotypes of enteropathogenic E. coli were isolated from a large proportion of them. Salmonella were isolated in two instances. High colony counts with evidence of faecal contamination indicated the strong possibility of pulltion being the cause for the presence of these enteropathogens. Methods of cooking and eating these shellfish enhance their likelihood of acting as vehicles of diarrhoeal disease.

Topics: Animals; Diarrhea; Escherichia coli; Food Microbiology; Humans; Malaysia; Mollusca; Salmonella; Shellfish; Vibrio; Vibrio parahaemolyticus

In the context of this study the ethnic origin of the patients revealed no noteworthy difference in the clinical reaction to the parasite; neither did age or sex of the patients. Any minor differences whcih appeared in length of history before seeking treatment and frequency of repeat attacks were more a reflection of the cultural pattern of response to illness (i.e. resort to traditional medicines) and the distance between the patient's home and the doctor rather than any altered response on the part of the host to the parasite. However, the fact that about 35 per cent of all the episodes had a history of eight or more days (about 10 per cent more than 30 days) suggest that more "malaria consciousness" is called for in what is after all an endemic malaria area. The value (and necessity) of repeated examination of the blood to detect the parasite is confirmed but it is also encouraging to note that in 84% of cases a single careful examination of the blood revealed the parasite. Since in 49% of our malaria episodes the patient was afebrile when the parasite was discovered, it is obvious that in outpatient practice especially blood should be examined when the patient presents for treatment, irrespective of the presence or absence of pyrexia. As always, a prerequisite to the diagnosis of malaria is an awareness of its possible presence.

Topics: Adolescent; Adult; Child; Child, Preschool; Diarrhea; Ethnicity; Female; Fever; Humans; Infant; Malaria; Malaysia; Male; Plasmodium falciparum; Plasmodium vivax; Vomiting

Vibrio parahaemolyticus was isolated from 47 of 2,699 stools examined primarily for the exclusion of cholera. All strains grew well in alkaline peptone water containing 0.5% NaCl and in Monsur's medium. Serotyping showed them to be of various types. Adults were mainly affected. The importance of looking for V. parahaemolyticus in clinical specimens from cases of diarrhea is emphasized.

Topics: Adult; Diarrhea; Female; Humans; Malaysia; Male; Vibrio parahaemolyticus

Children with heavy Trichuris infestation were compared with paediatric amoebic dysentery patients and normal children. Heavy Trichuris infestation was diagnosed by visualization of worms on anoscopy. Patients with heavy Trichuris infection had a longer duration of disease, more frequent hospitalization and a higher rate of rectal prolapse than did patients with amoebiasis. Five Trichuris children also had clubbing. Trichuris patients had lower mean haematrocrits (27%) and serum albumin (3-3 gm%) than did patients with amoebiasis (32% and 3-7 gm% respectively). Coinfection with Shigella and Salmonella was significantly increased in patients with heavy Trichuris infection compared to both amoebic and control group children. Trichuris patients were infected with Entamoeba histolytica more frequently (46%) than normal children. Heavy Trichuris infection is the probable cause of symptoms and signs seen in these patients.

Topics: Bacterial Infections; Blood Proteins; Child; Child, Preschool; Diarrhea; Dysentery, Amebic; Humans; Infant; Malaysia; Rectal Prolapse; Trichuriasis

Topics: Age Factors; Anti-Bacterial Agents; Child; Child, Preschool; Diarrhea; Diarrhea, Infantile; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Ethnicity; Feces; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Malaysia; Male

Topics: Acute Disease; Biopsy; Child, Preschool; Chronic Disease; Diarrhea; Duodenum; Feces; Gastroenteritis; Giardia; Giardiasis; Humans; Infant; Intestinal Diseases, Parasitic; Intestinal Mucosa; Intestinal Secretions; Jejunum; Malabsorption Syndromes; Malaysia; Methods; Prospective Studies

Topics: Age Factors; Animals; Animals, Laboratory; Anti-Bacterial Agents; Chloramphenicol; Diarrhea; Dysentery, Bacillary; Feces; Female; Haplorhini; Indonesia; Japan; Macaca; Malaysia; Male; Monkey Diseases; Philippines; Quarantine; Rifampin; Seasons; Shigella flexneri; Shigella sonnei

Topics: Adult; Aeromonas; Diagnosis, Differential; Diarrhea; Dysentery, Bacillary; Humans; Malaysia; Male; Shigella; Shigella sonnei; Typhoid Fever

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Diarrhea; Drug Resistance, Microbial; Enterobacteriaceae Infections; Escherichia coli; Ethnicity; Humans; Infant; Infant, Newborn; Malaysia; Salmonella; Shigella dysenteriae