Asian Pacific Journal of Tropical Medicine

51-57

Authors: Xingyi Fang, Yi Gong, Yanlin Ma, Yuanhua Huang

Objective: To evaluate the value of next-generation sequencing (NGS) in the prevention and management of thalassemia. Methods: A systematic search was performed in eight databases including China Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journals Database, Wanfang database, PubMed, EMBASE, Web of Science, and Cochrane Library from the inception to 1 June 2022. Stata 17.0 and Review Manager 5.4 were used for the meta-analysis. Results: Nine studies containing 14 794 participants were included in the meta-analysis. Compared with the routine genetic testing (including Gap-PCR and reverse dot blot), NGS had higher detection rates in screening thalassemia (RR 1.22, 95% CI 1.13-1.31, P<0.01), particularly for the α-thalassaemia mutation carriers (RR 1.24, 95% CI 1.07-1.44, P<0.01). However, no significant difference was found in the screening of β-thalassemia (RR 1.10, 95% CI 0.99-1.23, P>0.05). Conclusions: Compared with routine genetic testing, NGS had a higher detection rate in general, particularly in the detection of α-thalassemia.

65-71

Authors: Govind R. Patel, Indu Thanvi, Mohammad Nadeem, Rahul Kanwaria

Objective: To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue. Methods: This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022. Coagulation tests including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer were performed. Patients were monitored for bleeding manifestations. Results: Coagulation abnormalities were reported in 42.8% of the patients. Overall, prolonged aPTT was the most common coagulation abnormality (40.8%), followed by low fibrinogen (38.7%), raised D-dimer (31.2%), raised INR (26.0%) and prolonged PT (19.2%). Bleeding manifestations were present in 19.9% patients. PT, INR, aPTT and D-dimer levels were significantly higher (P<0.01) and fibrinogen level was significantly lower (P<0.001) in patients with bleeding compared to patients without bleeding. Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding (P<0.01). Conclusions: Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding. Patients with dengue should be assessed for coagulation abnormalities.

80-88

Authors: Nurul Diana Dzaraly, Mohd Nasir Mohd Desa, AbdulRahman Muthanna, Siti Norbaya Masri, Niazlin Mohd Taib, Nurul Hana Zainal Baharin, Nurshahira Sulaiman, Nurul Asyikin Abdul Rahman, Navindra Kumari Palanisamy, Zarizal Suhaili, Semiat Opeyemi Yusuff, Nor Iza A. Rahman, Tuan Suhaila Tuan Soh, Fatimah Haslina Abdullah

Objective: To characterise a collection of pili-carrying and none pili-carrying pneumococcal isolates of clinical origin for serotypes, antibiotic resistance and genotype. Methods: In total, 42 clinical isolates were collected between October 2017 and December 2019. Those isolates were analysed for antimicrobial susceptibility, serotype distribution, detection of pneumococcal virulence and pilus genes. Multilocus sequence typing was performed only for piliated isolates, followed by phylogenetic analysis. Results: The common isolation sites among the pneumococcal isolates were tracheal aspirate (28.6%), blood (26.2%), and sputum (23.8%). Fifty percent isolates were resistant to erythromycin, tetracycline (50.0%) and trimethoprim-sulfamethoxazole (43.0%). The most frequent were serotypes 19F (28.6%), 6A/B (23.8%) and 19A (14.3%). Piliated isolates were detected in a small proportion (33.3%); 64.3% were multidrug-resistant. ST320 was the prevalent sequence type among the piliated isolates and genetically related to the Pneumococcal Molecular Epidemiology Network clones Taiwan19F-14 (CC271). In the phylogenetic analysis, some piliated isolates showed a close association having similar ST320, carrying serotype 19A and both pilus genes indicating their clonal spread. Conclusions: Pneumococcal lineages of piliated isolates have been globally disseminated and pili could have played a role in the spread of antibiotic resistant clones.

92-94

Authors: Shilpa Barthwal, Bennet Angel, Annette Angel, Vinod Joshi, BM Shareef, Nuzhat M Peer, Poorna Khaneja, Ambreen S Khan, Bhawna Sharma, Neha Singh, Ramesh Joshi, Komal Tomar, Kiran Yadav, Satendra P Singh

None.

533-545

Authors: Yocyny Surendran, Mahalingam Nandikha, Syafinaz Amin-Nordin, Sandeep Kumar Dhanda, Mohamad Ridhuan Mohd Ali, Narcisse MS Joseph

Objective: To assess the efficacy of various types of vaccines developed for leptospirosis. Methods: A comprehensive search was conducted in three databases: PubMed, Scopus, and Cochrane Library. Two authors (YS and MN) selected the articles based on manual screening. The study eligibility criteria are all Leptospira species regardless of any cluster (pathogenic, intermediate and non-pathogenic). This study recorded articles with positive and negative results and showed a comparison among various membrane proteins as vaccine candidates. The studies on the effectiveness of outer membrane protein as vaccine candidates were also included. The articles obtained in the databases were imported into the WPS spreadsheet, and duplicate documents were removed manually. Results: A total of 24 studies were included in the review, which evaluated various types of leptospirosis vaccines. Multiple vaccines were developed and tested; however, the heterogeneity of Leptospira species pose a challenge. As an effective approach, an epitope based vaccine shows quite a promising result. However, sufficient validation, testing and clinical trials are required. Conclusions: Developing an effective vaccine for leptospirosis remains a global health priority. While significant progress has been made in recent years, there is a need for further research to optimize vaccine development and to ensure that vaccines are accessible and effective for high-risk populations.

558-564

Authors: Frans Dany, Kindi Adam, Sarwo Handayani, Holy Arif Wibowo, Rita Marleta Dewi, Natalie Laurencia Kipuw, Khariri, Widoretno

Objective: To identify circulating HPV types among urban Indonesian women and their specific co-infection patterns in bid to curb HPV infection in the general population and minimize its complications. Methods: Urban Indonesian women from general population were selected as sample framework. Sample size and distribution across regions were determined by the Indonesian Bureau of Statistics (Badan Pusat Statistik, BPS), which represented the national level. Up to 35 408 cervical swab specimens were collected from August to September 2016 in 34 Indonesian provinces, categorized into six regions based on the development criteria set by the Ministry of National Development Planning (Badan Perencanaan Pembangunan Nasional, BAPPENAS). From all 1 874 samples identified as HPV-positive, hybrid capture was implemented to evaluate type-specific HPV. This study analyzed descriptive data to determine the core-cluster of HPV combination. Co-occurrence HPV network was assessed using ‘qgraph’ package version 1.6.3 and computed in R version 3.6.3. Two-HPV association was analyzed in logistic regression using bias-reduction generalized linear model (brglm2) package version 0.5.1 adjusted by age and six main Indonesian regions. Results: The logistic regression analysis demonstrated that HPV type 52 had rare relationship despite its common co-occurrence, cementing its role in single HPV infection. HPV type 16 and 18 tended to form infection cluster and were strongly associated with other types. Conclusions: HPV type 52 was the most frequent HPV type among urban Indonesian women and accounted for most single infection cases. Concurrently, HPV 16 and HPV 18 accounted for most multiple infection cases and had strong tendency to attract other types, which may add further complications. However, due to lack of cytology and histological examination and information for other potential determinants, further in-depth studies are necessary to confirm whether these infection patterns truly connect to certain clinical outcomes.

573-574

Authors: Abdullah, Riaz Muhammad, Aiman Waheed, Sher Ali, Muddasir Khan

None.

490-497

Authors: Yang Yi, Jun Chen, Nan Li, Yue Huang, Jichao Peng, Xiaoran Liu

Acute lung injury is featured as diffuse pulmonary edema and persistent hypoxemia caused by lung or systemic injury. It is believed that these pathological changes are associated with damage to the alveolar epithelium and vascular endothelium, recruitment of inflammatory cells, and inflammatory factor storms. In recent years, the metabolic reprogramming of lung parenchymal cells and immune cells, particularly alterations in glycolysis, has been found to occur in acute lung injury. Inhibition of glycolysis can reduce the severity of acute lung injury. Thus, this review focuses on the interconnection between acute lung injury and glycolysis and the mechanisms of interaction, which may bring hope for the treatment of acute lung injury.

506-514

Authors: Made Agus Nurjana, Agung Dwi Laksono, I Kadek Wartana, Vidyanto, Gunawan, Afi Nursafingi, Samarang, Hayani Anastasia, Kristina Tobing, Anis Nurwidayati, Octaviani

Objective: To assess the prevalence of Mycobacterium (M.) tubercu¬losis infection and its associated risks in children under fifteen years of age. Methods: Based on secondary data from the 2018 Indonesian Basic Health Survey (RISKESDAS 2018), this cross-sectional study employed M. tuberculosis infection in children as a dependent variable and age level, sex, region, location, family case positive, and smoking as independent variables. Geospatial analysis was applied to show the prevalence of M. tuberculosis infection and multivariate regression was performed to analyze the risk factors of getting the infection among children under 15 years of age. Results: Prevalence ranges of M. tuberculosis infection among children aged 0-14 years, babies (age <12 months), toddlers (age 12-59 months), and children aged between 5 and 14 years were 0.03% to 0.57%, 0% to 0.64%, 0% to 0.78%, and 0.01% to 0.53%, respectively in Indonesia. A high prevalence of M. tuberculosis in¬fection among children under 15 years of age was found in Papua and other provinces, such as Kalimantan and Java. Contacting with tuberculosis family members was positively associated with M. tuberculosis infection in children as shown by multivariate logistic regression (OR 8.94; 95% CI 5.4-14.6, P<0.05). Conclusions: Contacting with family member who has tuberculosis is related with M. tuberculosis infection among children in Indonesia. Therefore, screening the household for contact with tuberculosis patients is a preventive treatment for children.

522-523

Authors: Lakshmi Krishnasamy

None.

434-445

Authors: Sabar Nurul-Nastasea, Ke-Xin Yu, Ahmad Rohani, Mohamed Nor Zurainee, Tengku Idzzan Nadzirah Tengku-Idris, Roza Dianita, Masse Rezki Sabrina, Wan Mohamad Ali Wan Najdah

This review aimed to determine the prevalence of the insecticide resistance status of the field-collected Aedes (Ae.) aegypti and Ae. albopictus in Malaysia from 2010 to 2022 towards carbamates, organochlorines, organophosphates and pyrethroids. Biological and environmental controls were summarized with an emphasis on the mosquito vector control strategies in Malaysia. The information in this review was extracted from several databases such as PubMed (MEDLINE), Science Direct and Scopus by using keywords including “insecticide resistance”, “carbamate resistance”, “organochlorine resistance”, “organophosphate resistance”, “pyrethroid resistance”, “Aedes” and “Malaysia”, between January 2022 and December 2022. Distribution of resistant Ae. aegypti and Ae. albopictus in Malaysia was mapped using QGIS software. Insecticide resistance in both Ae. aegypti and Ae. albopictus is widespread in Malaysia, although the rates vary by states. The most notable was the steep increase in permethrin resistance of Ae. aegypti in Selangor, Malaysia, over the past decade. Ae. albopictus also displayed moderate resistance to permethrin, though not as widespread as Ae. aegypti in Selangor, but showed sign of resistance in Sarawak, East Malaysia. Resistance towards four main classes of insecticides have been widely documented in Malaysia. The extensive resistance towards permethrin in Malaysia which is one of the current insecticides used in Malaysia suggested that policies supporting the widespread use of permethrin fogging needs further evaluation.

453-462

Authors: Jie Liu, Wanqing Zheng, Zhen Liu, Xiujing Jiang

Objective: To determine the impact of major disease epidemics on pharmaceutical manufacturing firms' Research & Development (R&D) investments and economic consequences. Methods: The sample consists of 1 582 firm-year observations from 2009 to 2022 in China, of which, 26.6% of pharmaceutical companies are involved in the diagnosis and treatment of prevalent diseases. Linear models using R&D investments, patent applications, operating performances and stock returns as dependent variables are constructed separately to examine the response of pharmaceutical companies to disease epidemics and the resulting economic consequences. Results: The prevalence of five major diseases led to a 17.5% increase in the amount of R&D investment and an 87.8% rise in the ratio of R&D investment to total assets by disease-related pharmaceutical companies, compared to unrelated pharmaceutical companies. Further evidence indicated that the patent applications for disease-related firms increased by 44.3% relative to unrelated firms after the epidemics. Though the impacts of the epidemics on firms’ operating performances were insignificant in the short term, a major disease epidemic was associated with an increase in stock returns of 67.4% and 44.6%, respectively, as measured by the capital asset pricing model and Fama-French five-factor model. Additional analysis revealed that the impacts of the epidemics on R&D investments and patent applications were more pronounced for non- state-owned enterprises than state-owned enterprises. Conclusions: This study demonstrates that disease-related pharmaceutical firms respond to the disease epidemics through increasing R&D investment. More patent applications and higher market value are the main gains from the firms’ increased investments in R&D following the epidemic, rather than the improvements of short-term operating performances.

472-475

Authors: Rui He, Siqi Zhong, Jinghua Fan

Rationale: Aeromonas hydrophila, a bacterium commonly found in a variety of soils, aquatic habitats, and other natural environments, is known for causing infections and hemorrhagic diseases in both aquatic and terrestrial animals. Patients with leukemia, when infected by Aeromonas hydrophila following chemotherapy, face an increased risk of developing necrotizing fasciitis. Patient concerns: A 48-year-old male with a history of acute myeloid leukemia presented with swelling and pain in his right hand after being stabbed by a grass carp two days ago. The injury occurred on the fifth day after his last chemotherapy session when he was accidentally punctured in the right thumb and ring finger by a carp while fishing. Two days following the injury, the skin isurrounding the wound turned black immediately, while the rest of his hand was reddened, swollen, and bleeding. Diagnosis: Aeromonas hydrophila infection in the soft tissue of the right hand. Interventions: Intravenous antibiotics and local debridement. Outcomes: The patient experienced an alleviation of systemic poisoning symptoms, effective control of the local wound infection. Lessons: It is important for physicians to appreciate the potential for highly unusual and life-threatening infections in patients with acute myeloid leukemia. Early diagnosis and prompt treatment can prevent the development of necrotizing fasciitis and save patients’ lives.

3-8

Authors: Alireza Malektojari, Sara Ghazizadeh, Mohammad Hamed Ersi, Elham Brahimi, Soheil Hassanipour, Mohammad Fathalipour, Mehdi Hassaniazad

Objective: To evaluate the effectiveness and safety of ivermectin in patients with mild and moderate COVID-19. Methods: This study was a single-center, randomized, open-label, controlled trial with a 2-arm parallel-group design on 68 patients with COVID-19. According to the 1:1 ratio between the study groups (ivermectin group and standard treatment group), patients were randomly admitted to each intervention arm. Results: The mean age of the participants in the ivermectin group was (48.37±13.32) years. Eighteen of them were males (54.5%) and the participants in the control group had a mean age of (46.28±14.47) years, with nineteen of them being males (59.4%). As a primary outcome, after 5 days of randomization, there was no significant difference between the ivermectin group and the control group in the length of stay in the hospital (P=0.168). ICU admission (P=0.764), length of stay in ICU (P=0.622), in-hospital mortality (P=0.427), adverse drug reactions, and changes in the mean difference of laboratory data had not any significant difference between the two groups (except for urea change). In addition, the radiologic findings of the two groups of patients were not significantly different. Linear regression analysis showed that for every 10 years increase of age, 0.6 day of hospitalization duration was increased. There was no statistically significant association between other variables and clinical outcomes. Conclusions: Among adult hospitalized patients with moderate to severe COVID-19, there was no significant relationship between the administration of ivermectin single dose in a five-day course and clinical improvement, and mortality of the participants.

16-25

Authors: Mohammad Mehdi Sedaghat, Faramarz Bozorg Omid, Mohammad Karimi, Sajjad Haghi, Ahmad Ali Hanafi- Bojd

Objective: To determine the suitable ecological habitats of Aedes (Ae.) aegypti and Ae. albopictus in Iran due to climate change by the 2070s. Methods: All data relating to the spatial distribution of Ae. aegypti and Ae. albopictus worldwide, which indicated the geographical coordinates of the collection sites of these mosquitoes, were extracted from online scientific websites and entered into an Excel file. The effect of climatic and environmental variables on these mosquitoes was evaluated using the MaxEnt model in the current and future climatic conditions in the 2030s, 2050s, and 2070s. Results: The most suitable areas for the establishment of Ae. aegypti are located in the southern and northern coastal areas of Iran, based on the model outputs. The modelling result for suitable ecological niches of Ae. albopictus shows that in the current climatic conditions, the southern half of Iran from east to west, and parts of the northern coasts are prone to the presence of this species. In the future, some regions, such as Gilan and Golestan provinces, will have more potential to exist/establish Ae. albopictus. Also, according to the different climate change scenarios, suitable habitats for this species will gradually change to the northwest and west of the country. The temperature of the wettest season of the year (Bio8) and average annual temperature (Bio1) were the most effective factors in predicting the model for Ae. aegypti and Ae. albopictus, respectively. Conclusions: It is required to focus on entomological studies using different collection methods in the vulnerable areas of Iran. The future modelling results can also be used for long-term planning to prevent the entry and establishment of these invasive Aedes vectors in the country.

33-38

Authors: Hewa Babarandage Chathurika Harshani, Ruvini Tharuka Wijewickrama, Gayan Wimalarathne, Chrishan Jude S Jayamaha, Janaki I Abeynayake

Objective: To analyze data on socio-demographic and clinical characteristics of SARS-CoV-2 infected population whose samples were received from Medical Research Institute, Sri Lanka. Methods: Laboratory based retrospective study was done on patient samples which were tested positive for SARS-CoV-2 by National Reference Virology Laboratory at the Medical Research Institute, Sri Lanka, from November, 2020 to November, 2021. Data on socio-demographic characteristics and clinical presentation of 13 126 patients were examined. Results: The mean age of the study population was (36.0±7.2) years and the majority were men (64.0%). The highest number of positive cases were found in the 21-30 years-of-age group. Two distinct peaks were noted in the incidence of SARS-CoV-2 positive individuals. In addition, 42.5% of the positive samples tested positive (42.5%) were from Medical Officer of Health collection centres. Furthermore, 60.6% (7 951) of the infected subjects were asymptomatic whereas the remaining were symptomatic. The highest percentage of symptomatic patients were observed in the 91-100 years-of-age group while the highest asymptomatic subjects were found in the 31-40 years-of-age group. The percentage of asymptomatic children (65.3%) was significantly (P<0.05) higher than that of adults (43.4%). Conclusions: The findings of this study aid decision makers to focus on the vulnerable groups, and geographic and temporal distribution of patients in the public health strategies that aim at preventing the spread of the disease and reducinig its mortalities.

45-48

Authors: Hartantyo Kusuma, Dwiyanti Puspitasari, Dominicus Husada, Leny Kartina, Parwati Setiono Basuki, Ismoedijanto

Rationale: Pompholyx refers to pruritic vesicles or bullous rash that mainly distribute on the palms and lateral surfaces of the fingers. It is less common among Asians, and in a severe condition, secondary bacterial infection of pompholyx can happen and result in pain, swelling and pustules. Patient concerns: A 15-year-old girl complained of progressive wound and small bumps containing yellowish pus and crusts on her hands and feet for over 6 months and worsened in the last month before admission. She also had Ebstein anomaly. Diagnosis: Atypical pompholyx with secondary Staphylococcus and Klebsiella infections. Interventions: Wound care with wet dressing and applying moisturizer on crusts, application of antibiotics for Gram positive and negative bacteria and giving nutritional support with reckoning of proper calories. Outcomes: Skin lesions were completely healed and the patient was discharged after 10 days of hospitalization. Lessons: Atypical manifestation of pompholyx makes it hard to diagnose. The diagnosis can be confirmed with meticulous history-taking and physical examination. Wound caring and controlling of the infection should be done to earn an optimal outcome.