In 2012, IHCM initiated a new research area focusing on viral respiratory disease. The research targets children under 5 years old that have been admitted to the intensive care unit with severe lower respiratory disease. Samples are recruited from three major public hospitals located Kuching, Sibu and Miri respectively.
The goals of this project is to determine what are the major viruses involved in severe respiratory disease in young children in Sarawak and if there is a seasonality pattern associated with these viruses. This information would eventually be used to develop a “clinical diagnostic key” that would hopefully be able to associate observed clinical symptoms with virus type. Such a tool would be useful to clinicians to aide in diagnosis.
Hand, Foot and Mouth Disease
HFMD is a disease that primarily affects infants and young children. The disease is caused by many different types of viruses from the genus Enterovirus. Infection typically results in a mild, self-limiting febrile illness but can sometimes lead to more serious forms that include neurologic complications. The former more serious outcomes are often associated with Enterovirus 71 (EV-A71).
Here at IHCM, our research interest in HFMD includes molecular epidemiology of viruses causing HFMD with particular interest in EV-A71, viral-host interactions, molecular diagnostics and pathogenesis. Through a ten year surveillance program initiated in 1998, and involving several different hospitals and clinics throughout Sarawak, we have accumulated a collection of viruses from annual outbreaks of HFMD in Sarawak that serves as material for the various research programs undertaken at IHCM.
Dengue is endemic to Malaysia with yearly reported cases. The disease is caused by one of four types of dengue viruses (DENV1-4). Infection with one type confers immunity to that type but not to the other three. Subsequent infection with a different type increases the risk of contacting dengue hemorrhagic fever. DENV is transmitted by the Aedes mosquito particularly with A. aegypti but may also include A. albopictus, A. polynesiensis and A. scutellaris.
Here at IHCM, our research interest in dengue includes molecular epidemiology of DENV, molecular diagnostics for DENV detection, viral-host interactions, mosquito vectors of DENV and sylvatic spillover of DENV into endemic cycles. To achieve this, researchers at IHCM work collaboratively with Sarawak public health personnel from various public hospitals and clinics, and with other research groups both within and outside Malaysia.
Melioidosis is a potentially fatal disease caused by Burkholderia pseudomallei, which is endemic in northern Australia and Southeast Asia including Malaysian Borneo. Infections occur due to exposures to water or soil containing the bacteria through skin inoculation, ingestion and inhalation. Clinical presentations of melioidosis are highly variable and can manifest as asymptomatic infections, localized skin abscess formation, acute or chronic pneumonia, genitourinary, bone, and joint infections, or severe systemic sepsis, with or without foci of multiple abscesses in internal organs, with a mortality of 90% in septic shock cases.
Due in part to the high virulence of this organism and increased concerns for transmission by aerosolization, B. pseudomallei was upgraded to a tier 1 select agent by the U.S. Centers for Disease Control and Prevention in 2012. Our research activities thus far include investigation on the molecular epidemiology, biogeography and antibiotics susceptibility profiles of B. pseudomalleithrough collaborations with local and foreign institutions. We are also interested in identifying factors that affect the distribution of B. pseudomallei in the environment in Sabah and Sarawak.
Chikungunya virus (CHIKV), a mosquito borne arbovirus that causes chikungunya fever. Considerable attention has been focused upon CHIKV in the last few years due to re-emergence of massive outbreaks of CHIKV reported especially in countries around the Indian Ocean, Asia, southern Europe, and most recently in the Caribbean. CHIKV infection causes a range of clinical manifestations including fever, headache and photophobia, may additionally include maculopapular or petechial rashes, myalgia, gastrointestinal complaints and edema of the extremities. A long-lasting polyalthralgia which may persist for months or even years is a hallmark of CHIKV infection and serves to discriminate it from the clinically similar dengue fever.
Although normally a relatively self-limiting disease, more severe complications including encephalopathy and occasional deaths have been reported over the last decade. Malaysia first reported outbreak of CHIKV in the late 1998 to 1999 and the re-emergence of the endemic CHIKV was reported in 2007. In 2009, Sarawak experienced an outbreak of CHKIV. During the initial onset of the outbreak, IHCM was invited by the Sarawak Public Health authorities to help investigate the etiologic cause of the outbreak. IHCM’s current research interest in CHIK focuses on the molecular epidemiology and molecular diagnostics for use in differential diagnosis of CHIK and DENV.