Asian Pacific Journal of Tropical Medicine

97-109

Authors: Shiza Malik, Khalid Muhammad, Omar Ahsan, Muhammad Tahir Khan, Ranjit Sah, Yasir Waheed

Zika virus (ZIKV) is the causative agent of a viral infection that causes neurological complications in newborns and adults worldwide. Its wide transmission route and alarming spread rates are of great concern to the scientific community. Numerous trials have been conducted to develop treatment options for ZIKV infection. This review highlights the latest developments in the fields of vaccinology and pharmaceuticals developments for ZIKV infection. A systematic and comprehensive approach was used to gather relevant and up-to-date data so that inferences could be made about the gaps in therapeutic development. The results indicate that several therapeutic interventions are being tested against ZIKV infection, such as DNA vaccines, subunit vaccines, live-attenuated vaccines, virus-vector-based vaccines, inactivated vaccines, virus-like particles, and mRNA-based vaccines. In addition, approved anti-ZIKV drugs that can reduce the global burden are discussed. Although many vaccine candidates for ZIKV are at different stages of development, none of them have received Food and Drug Authority approval for use up to now. The issue of side effects associated with these drugs in vulnerable newborns and pregnant women is a major obstacle in the therapeutic pathway.

119-128

Authors: Huynh Ngoc Linh, Nguyen The Tan, Le Thi Minh Thu, Nguyen Tu Loan, Nguyen Thi To Uyen, Le Thanh Thao Trang, Truong Thanh Nam, Doan Hoang Phu

Objective: To investigate the prevalence and risk factors associated with long COVID symptoms among children and adolescents who have recovered from COVID-19. Methods: This study applied a cross-sectional approach within community settings in a southern province of Vietnam. A structured questionnaire featuring socio-demographic information and common long COVID symptoms was employed. Phi correlation coefficients assessed associations among pairs of long COVID symptoms. Additionally, multivariable logistic regression models were performed to investigate the risk factors of long COVID in recovered COVID-19 children and adolescents. Results: Among 422 participants, 39.3% reported long COVID symptoms, with a prevalence of 45.2% (SD=0.5) in children and 22.2% (SD=0.4) in adolescents. Common symptoms reported were cough 34.6% (SD=0.5), fatigue 20.6% (SD=0.4), shortness of breath 10.9% (SD=0.3), and lack of appetite 6.6% (SD=0.3). Concerning risk factors of long COVID, a higher risk was observed among demographic groups, including girls (OR 1.25, 95% CI 1.15-1.37; P<0.001, reference: boys), children compared to adolescents (OR 1.24, 95% CI 1.12-1.37; P<0.001), overweight individuals (OR 1.14, 95% CI 1.02-1.27; P=0.018, reference: healthy weight), and participants without any COVID-19 vaccination (OR 1.36, 95% CI 1.20-1.54; P<0.001), or have received only one single dose (OR 1.35, 95% CI 1.10-1.64; P=0.004) compared to those who have received two doses. Besides, patients with a COVID-19 treatment duration exceeding two weeks also had a higher risk of long COVID (OR 1.32, 95% CI 1.09-1.60; P=0.003) than those who recovered less than seven days. Conclusions: The insights from this study provide crucial guidance for predicting the factors associated with the occurrence of long COVID in pediatric patients, contributing to strategic interventions aimed at mitigating the long COVID risks among children and adolescents in Vietnam.

136-138

Authors: Boudhayan Bhattacharjee, Hardik Patel, Rucha Karad, Vasireddy Teja, Agnibho Mondal, Soumendra Nath Haldar, Bibhuti Saha

Rationale: Acute pain is a medical emergency that requires prompt abdominal evaluation and management. Dengue, a mosquito- borne arboviral infection, can lead to complications such as acute abdominal pain. Patient concerns: A 72-year-old hypertensive female presented with high-grade intermittent fever with chills and rigors for four days. She was diagnosed with dengue fever (NS1Ag-reactive) the day before admission. A contrast-enhanced computed tomography of the abdomen showed a hematoma along the rectus sheath which was managed conservatively as per surgical opinion. Diagnosis: Dengue hemorrhagic fever with rectus sheath hematoma. Interventions: Blood transfusion and fluid therapy. Outcomes: Ten days after discharge, the patient reproted no pain in the right iliac fossa and the size of the hematoma was significantly reduced. Lessons: Although it is rarely seen as a cause of acute abdomen, complaints of adnominal pain should never be ignored in critical or convalescent phase of dengue fever. Radiological investigations should be promptly conducted as hematoma is often difficult to be diagnosed clinically. Delay in diagnosis of rectus sheath hematoma can be fatal.

141-142

Authors: Raman Sharma, Sruti Sharma

None.

61-70

Authors: Siew-Keah Lee, Ang-Lim Chua, Clement Heng Yew Fong, Ban Hao Brian Cong, Wen Ling Ng, Jing Feng Kong, Yik-Ling Chew, Kai Bin Liew, Yang Shao

Objective: To investigate the interrelationship between cardiovascular health awareness, risk perception, behavioural intention, and INTERHEART risk stratification in a middle-aged adult population in Malaysia. Methods: A cross-sectional survey with convenience sampling was conducted during November 2022 and January 2023. Participants completed validated questionnaires assessing cardiovascular health awareness, risk perception of cardiovascular diseases, behavioural intention towards adopting healthy habits, and INTERHEART risk stratification score (IHRS) based on established risk factors. A total of 602 respondents were included in the final analysis. Data were analysed with independent t-test/one-way ANOVA or Mann- Whitney/Kruskal-Wallis to test the differences, Pearson correlation or linear regression test to analyze the association of independent and dependent variables. Results: There was a significant positive correlation between medical knowledge related to cardiovascular disease (CVD) and knowledge related to CVD risk prevention, risk perception, behavioural intention and IHRS (P<0.05, Pearson correlation). Notably, individuals with higher IHRS tended to have lower knowledge related to CVD and CVD risk prevention, risk perception, and behavioural intention. Males, laborers, active/former smokers, individuals with lower household income and educational levels, those involved in occupations not related to the healthcare sector, and those who did not receive the CVD health brochure or are unaware of health self-assessment tools are likely to have lower levels of knowledge, risk perception, and poorer behavioural intention regarding cardiovascular health (P<0.05, one-way ANOVA). While educational level, smoking status, awareness about CVD poster, self-assessment tools were repeatedly significantly associated with knowledge related to CVD and CVD risk prevention, risk perception, behavioral intention and/or IHRS (P<0.05, linear regression). Conclusions: These findings underscore the importance of promoting cardiovascular health awareness and risk perception among middle-aged adults to foster positive BI and reduce CVD risk. Tailored interventions targeting specific risk factors identified by INTERHEART may enhance risk stratification accuracy and facilitate targeted preventive strategies.

84-90

Authors: Eric Tzyy Jiann Chong, Joveen Wan Fen Neoh, Tiek Ying Lau, Kek Heng Chua, Yvonne Ai-Lian Lim, Ping-Chin Lee

Objective: To determine the genetic diversity of Plasmodium (P.) knowlesi isolates from Sabah, Malaysian Borneo and Peninsular Malaysia, targeting the S-type SSU rRNA gene and including aspects of natural selection and haplotype. Methods: Thirty-nine blood samples infected with P. knowlesi were collected in Sabah, Malaysian Borneo and Peninsular Malaysia. The S-type SSU rRNA gene was amplified using polymerase chain reaction, cloned into a vector, and sequenced. The natural selection and haplotype of the S-type SSU rRNA gene sequences were determined using DnaSP v6 and illustrated using NETWORK v10. This study's 39 S-type SSU rRNA sequences and eight sequences from the Genbank database were subjected to phylogenetic analysis using MEGA 11. Results: Overall, the phylogenetic analysis showed no evidence of a geographical cluster of P. knowlesi isolates from different areas in Malaysia based on the S-type SSU rRNA gene sequences. The S-type SSU rRNA gene sequences were relatively conserved and with a purifying effect. Haplotype sharing of the S-type SSU rRNA gene was observed between the P. knowlesi isolates in Sabah, Malaysian Borneo, but not between Sabah, Malaysian Borneo and Peninsular Malaysia. Conclusions: This study suggests that the S-type SSU rRNA gene of P. knowlesi isolates in Sabah, Malaysian Borneo, and Peninsular Malaysia has fewer polymorphic sites, representing the conservation of the gene. These features make the S-type SSU rRNA gene suitable for comparative studies, such as determining the evolutionary relationships and common ancestry among P. knowlesi species.

4-11

Authors: Ni Wayan Anantika Riani, I Gde Raka Widiana, Yenny Kandarini

Objective: To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19. Methods: We conducted a systematic search across four databases following the PRISMA statement guidelines. Studies reporting ferritin levels and mortality of regular hemodialysis patients with COVID-19 were included. Employing the random-effects model, we performed a meta-analysis to determine the mean difference in serum ferritin levels between the studied groups, along with their corresponding 95% confidence intervals. The meta-analysis was carried out using Review Manager 5.4 and Stata 16. Results: A total of 1 013 patients from seven studies were included in this study. Our meta-analysis showed higher mean serum ferritin in the deceased compared to surviving regular hemodialysis patients with COVID-19, with a mean difference of 449.43 ng/mL [95% CI (244.07, 654.80), P<0.000 1; I2=58%, P=0.003]. Conclusions: Our study found a higher mean of serum ferritin levels in the deceased compared to surviving regular hemodialysis patients with COVID-19.

21-29

Authors: Ahlam Sundus, Renukha Sellappans, Tan Maw Pin

Objective: To explore existing practices and challenges in the delivery of geriatric home medication review (HMR). The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR. Methods: This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals. The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR. Results: Based on the emerging themes from the qualitative data, the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits, encompassing a diverse patient population with various healthcare needs. However, it faces challenges such as the lack of outcome monitoring, formal training, and workforce constraints. Despite these hurdles, there is a pressing need for the expansion of this service to better serve the community, and collaboration with community pharmacists holds potential to broaden its scope. Ultimately, the findings suggest that pharmacistled HMR is both warranted and feasible within the Malaysian healthcare context. In order to optimize medicine-use among older people living in the community, approaches for expanding geriatric HMR services in Malaysia must be developed. Conclusions: This study holds profound implications as it attempts to illuminate policy makers in developing countries, enabling them to formulate effective HMR plans. By considering the challenges highlighted within this research, policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.

39-42

Authors: Hekmatollah Khoubfekr, Mohammad Jokar, Vahid Rahmanian, Hasan Blouch, Mohammad Reza Shirzadi, Rouzbeh Bashar

Rationale: Rabies is a zoonotic disease with a high mortality, primarily transmitted through the bite of infected mammals, particularly dogs and cats. Despite being a well-known disease since ancient times, it continues to cause a significant number of human deaths worldwide, with approximately 65 000 fatalities reported annually. Patient concerns: We present two fatal cases of rabies in a 12-yearold immigrant boy and a 7-year-old boy. The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff, leading to the administration of wound dressing only. The second case received timely rabies immunoglobulin administration; however, there was a 4-day delay in administering the fourth dose of the rabies vaccine, despite presenting evident symptoms of rabies. Diagnosis: Postmortem examination of brain samples from both patients confirmed the presence of rabies virus. Interventions: Post-exposure prophylaxis for rabies. Outcomes: Both patients were admitted to the hospital after the manifestation of rabies-related symptoms, with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure. Finally, the first patient died after 27 days and the second patient died after 40 days of hospitalization. Lessons: There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure. Timely recognition and initiation of postexposure prophylaxis are pivotal in preventing the progression of the disease. Strengthening surveillance and reporting systems, coupled with continuous training for healthcare professionals, can contribute to early detection and management of rabies cases.

45-46

Authors: Sheikh Mohd Saleem, Shah Sumaya Jan

None.

385-399

Authors: Aashna Sinha, Sudhashekhar Kumar, Deen Dayal, Vaishali Yadav, Atreyi Pramanik, Kundan Kumar Chaubey, Sanjay Kumar

Lymphatic filariasis (LF), an asymptomatic, acute, and chronic condition in human beings, is the second most common vector-borne disease after malaria. According to the World Health Organization, there are 120 million LF cases detected in 81 tropical and subtropical countries, and one billion people are at risk. Therefore, the Global Program to Eliminate Lymphatic Filariasis was launched in 2000, with the primary objective of stopping LF transmission among all at-risk groups using mass drug administration (MDA), managing morbidities, and preventing LF-related impairments using a minimum treatment package. Additionally, other programs such as epidemiological assessment including National Filaria Control Program and World Health Organization recommended routine and pre-MDA microfilaremia surveys also implemented to stop the LF transmission. The routine filaria surveys were also carried out in around 2 000-4 000 individuals/month throughout the year whereas pre-MDA surveys were also conducted every year in approximately 4 000 individuals in four fixed and four random sites. Furthermore, the Transmission Assessment Survey was also conducted to check the risk of LF among primary school children. Moreover, potential diagnostic methods, systematic surveillance regimes, the Direct Network Report system, and regular trainings and awareness may be also effective in preventing the recurrence of LF. Hence, this review emphasizes the potential advocacy tools and various strategies as well as procedures for monitoring, which could be impactful in eliminating LF.

409-417

Authors: Zainul Khaqiqi Nantabah, Rofingatul Mubasyiroh, Antonius Yudi Kristanto, Lely Indrawati, Astridya Paramita,Dwi Hapsari Tjandrarini, Agung Dwi Laksono

Objective: To investigate individual characteristics related to satisfaction with the quality of First Health Facility Services (FHFS) in Indonesia. Methods: This cross-sectional study analyzes national representation data. Meanwhile, the study involved 9 846 representative respondents in 2019. Respondent’s satisfaction with FHFS based on the five dimensions of service quality (SERVQUAL) is a dependent variable. Independent variables consist of sex, marital status, age, education, employment, insurance ownership, and economics. The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality. Results: 77.3% Respondents were satisfied with FHFS, with the highest order of satisfaction dimensions being assurance (59.4%), empathy (57.3%), reliability (53.6%), responsiveness (52.7%), and then tangibility (49.1%). Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied (95% CI 1.17-1.87). Employees were 0.77 less likely than the unemployed to get satisfied (95% CI 0.70-0.86). Respondents with higher education was 0.82 less likely than those with primary education to be satisfied (95% CI 0.67-0.99). Meanwhile, respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied (95% CI 1.42-1.80). Moreover, the rich were 0.82 less likely than the poor to get satisfied (95% CI 0.73-0.92). Conclusions: Community satisfaction with FHFS is generally high, though some areas could be improved. Demographic factors are still strongly related to satisfaction ratings. The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society, ensuring that service satisfaction is rated as good by all groups.

425-427

Authors: Harpreet Singh Pawar, Itu Singh, Harish Kumar Sagar

Rationale: Leprosy, a chronic granulomatous disease often present clinically as erythema nodosum leprosum, a type 2 reaction. The involvement of cochlear part of audiovestibular system is a rarity. Patient concerns: A 26-year-old male patient with lepromatous leprosy developed bilateral sensorineural hearing loss (SNHL) during type 2 reactional episode. Diagnosis: Recurrent erythema nodosum leprosum in rifampicin- resistant lepromatous leprosy. Interventions: Corticosteroids and second-line multidrug therapy. Outcomes: The patient improved significantly and was further referred for management of psychosocial impact due to sensorineural hearing loss. Lessons: The hearing impairment is a rare complication of type 2 reaction. Any patient with suspected cranial nerve involvement should essentially be screened by tuning fork tests for early detection of hearing impairment and offer timely intervention as required. All high bacteriological index cases should be investigated for antimicrobial resistance in high endemic areas.

337-346

Authors: Yasser Ali Kamal, Seham Abdelwakeel Abdel-Gaber

Objective: To explore the clinical features, diagnosis, etiology, treatment, and outcomes of COVID-19 related empyema. Methods: Using PRISMA statement, a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases. The collected data included demographics, clinical manifestations, diagnostic findings, treatment, and outcomes. Results: Thirty-six case reports were identified with 43 cases of empyema. The included cases had a median age of 55 years (range: 12-78 years) and 79.1% (34/43) were males. The majority of cases presented during hospitalization for management of acute COVID-19 infection (29/43, 67.4%) and Charlson comorbidity index <3 (40/43, 93.0%). Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid (9/43, 20.9%) and 16.3% of the cases (7/43) had polymicrobial infections. Chest drainage was performed in all cases while surgery was indicated in 24 cases (55.8%). The most common complication of COVID-19-related empyema was broncho-pleural fistula (2/43, 4.7%). The mortality rate was 23.3% (10/43). Sepsis and/or multi-organ failure were the most commonly reported causes of death. On univariate analysis, no statistically significant risk factor for mortality was identified. Conclusions: COVID-19-associated empyema has a variety of predisposing factors, time of presentation, clinical features, and causative organisms. Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage. Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.

354-362

Authors: Nurhayat Yakut, Zeynep Ergenc, Sevgi Aslan Tuncay, Sezin Bayraktar, Elvan Sayin, Arzu Ilki, Eda Kepenekli

Objective: To describe clinical and epidemiological characteristics, antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections (HCAIs) caused by Staphylococcus (S.) aureus in children. Methods: We conducted a retrospective, single-centre study of pediatric HCAIs caused by S. aureus from a tertiary care hospital in Turkey between February 2014 and December 2019. The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) isolates was evaluated. Results: A total of 310 pediatric patients were examined. Overall, 225 (72.6%) isolates were MSSA and 85 (27.4%) were MRSA. All S. aureus isolates were susceptible to teicoplanin, vancomycin, linezolid, tigecycline, mupirocin, and daptomycin. Penicillin resistance rates were high (89.0%), while fosfomycin, gentamicin, and clindamycin resistance rates were low (1.3%, 1.0%, and 2.3%, respectively). Except susceptibility to fosfomycin, which was significantly lower in 2014 compared to 2018 and 2019, no significant difference was found in the antimicrobial susceptibility of S. aureus isolates between the years. Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs. The mortality rate of HCAIs caused by S. aureus was 6.5% (20 patients). Malignancy was an independent risk factor associated with mortality in the multivariate analysis (OR 5.446, 95% CI 1.573- 18.849). Conclusions: Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S. aureus. The mortality rate was 6.5%, the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children. These findings could help improve the management of HCAIs caused by S. aureus in children.

371-378

Authors: J. Y. Kumari, L.D. Amarasinghe, H.A.K. Ranasinghe

Objective: To determine the prevalence of tick-borne pathogens with a particular focus on Rickettsia spp. in ticks collected from cattle in Gauteng and Limpopo Provinces, South Africa. Methods: A total of 200 ticks were collected from cattle within the Madala livestock, Pretoria, Gauteng Province and in Mankweng Township, Polokwane, Limpopo Province in 2019. The ticks were morphologically identified and processed individually for a total genomic DNA extraction. Specific primers targetting ompA, ompB, and the 17KDa genes were used for a molecular screening and delineation of Rickettsia from the extracted genetic materials using polymerase chain reaction (PCR) technique. PCR amplicons of positive samples were sequenced bidirectionally using the Sanger sequencing method. Sequences generated were processed and analysed using appropriate bioinformatics software. Results: The ticks were morphologically identified as Amblyomma spp. PCR profiling of the genomic DNA samples revealed the presence of the Rickettsia pathogen in 42 (21%) of the ticks collected from both Provinces. Out of the genes profiled, 14 (7%) were positive for 17KDa, 42 (21%) for ompA and 32 (16%) were positive for ompB genes respectively. The nucleotide blast of the sequenced genomes showed high similarity, as high as 100% with other reference Rickettsia (R.) africae in the GenBank. The phylogenetic analysis of the sequences further validated them as R. africae with their characteristic clustering pattern with related reference sequences. Conclusions: There is an abundance of R. africae in Amblyomma ticks collected from cattle in the study areas. This has serious public health implications as individuals who accidentally get infested with the ticks could acquire R. africae. Hence, adequate precautions in terms of sensitization of farmers about the risk and mass mobilization drive to control the vectors in the areas are highly recommended to safeguard public health.