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Init Ithoi

Department of Parasitology, Faculty of Medicine Building, University of Malaya, 50603 Kuala Lumpur, MALAYSIA
init@um.edu.my

Journal articles

2013
Awatif M Abdulsalam, Init Ithoi, Hesham M Al-Mekhlafi, Abdul Hafeez Khan, Abdulhamid Ahmed, Johari Surin, Joon Wah Mak (2013)  Prevalence, predictors and clinical significance of Blastocystis sp. in Sebha, Libya.   Parasites & vectors 6: 04  
Abstract: Blastocystis sp. has a worldwide distribution and is often the most common human intestinal protozoan reported in children and adults in developing countries. The clinical relevance of Blastocystis sp. remains controversial. This study was undertaken to determine the prevalence of Blastocystis infection and its association with gastrointestinal symptoms among outpatients in Sebha city, Libya.
Notes:
I Ithoi, R Mahmud, M H Abdul Basher, A Jali, A M Abdulsalam, J Ibrahim, J W Mak (2013)  Acanthamoeba genotype T4 detected in naturally-infected feline corneas found to be in homology with those causing human keratitis.   Tropical biomedicine 30: 1. 131-140 Mar  
Abstract: A total of 10 out of 65 cornea swab samples from cats with eye symptoms showed Acanthamoeba-like morphology after cultivation. By PCR and DNA sequencing of Acanthamoeba diagnostic fragment 3 (DF3), all 10 isolates from the positive samples were categorized into two homologous groups of AfC1 (PM1, PM2, PM3, PF6, KM7, KF8, KMK9) and AfC2 (PM4, PM5, KFK10) due to the presence of bases A(354) and G(354), respectively. Furthermore, DF3 of AfC1 and AfC2 showed 100% similarity with Genbank reference isolates with the accession numbers DQ087314, EU146073 and U07401, GU808323, which were Acanthamoeba castellanii strains genotype T4 originating from human keratitis. This finding suggests that A. castellani strains have the capability to infect cats and human under favorable conditions.
Notes:
2012
A Ahmed, H M Al-Mekhlafi, M N Azam, I Ithoi, A H Al-Adhroey, A M Abdulsalam, J Surin (2012)  Soil-transmitted helminthiasis : a critical but neglected factor influencing school participation of Aboriginal children in rural Malaysia   Parasitology 139: 6. 802-808  
Abstract: Soil-transmitted helminthiasis (STH), among the most common neglected tropical diseases, is a major public health problem in Malaysia with a possible impact on the nutritional status and school participation of rural children. This study was carried out among Aboriginal schoolchildren, living in an endemic area for STH in Malaysia, to determine the possible relationship between intestinal helminthiasis and school absenteeism. We also evaluated whether successful treatment of the infection will affect school attendance among the subjects. Stool analysis revealed that more than 90% of the subjects were infected with at least 1 helminth species, with Ascaris lumbricoides and Trichuris trichiura infections being most prevalent. Infection of moderate-to-heavy worm burdens, low level of fathers’ education and anaemia were identified as the significant predictors of high absenteeism among the subjects (P<0.05). Following treatment of the infected children, it was found that school absenteeism was reduced significantly (P<0.01). In conclusion, STH continues to have significant impacts on public health, particularly in rural communities with a negatively significant effect on the school participation of Aboriginal children. A school-based de-worming programme should be introduced and incorporated in the current educational assistance targeted towards the Aboriginal communities, under the auspices of the government.
Notes: Ahmed, Abdulhamid Al-Mekhlafi, Hesham M Azam, Mohammad Nurul Ithoi, Init Al-Adhroey, Abdulelah H Abdulsalam, Awatif M Surin, Johari eng Research Support, Non-U.S. Gov’t England 2012/02/09 06:00 Parasitology. 2012 May;139(6):802-8. Epub 2012 Feb 6.
A M Abdulsalam, I Ithoi, H M Al-Mekhlafi, A Ahmed, J Surin, J W Mak (2012)  Drinking water is a significant predictor of Blastocystis infection among rural Malaysian primary schoolchildren   Parasitology 139: 8. 1014-1020  
Abstract: Blastocystis infection has a worldwide distribution especially among the disadvantaged population and immunocompromised subjects. This study was carried out to determine the prevalence and the association of Blastocystis infection with the socio-economic characteristics among 300 primary schoolchildren, living in rural communities in Lipis and Raub districts of Pahang state, Malaysia. Stool samples were collected and examined for the presence of Blastocystis using direct smear microscopy after in vitro cultivation in Jones’ medium. The overall prevalence of Blastocystis infection was found to be as high as 25.7%. The prevalence was significantly higher among children with gastrointestinal symptoms as compared to asymptomatic children (x(2)=4.246; P=0.039). Univariate and multivariate analyses showed that absence of a piped water supply (OR = 3.13; 95% CI=1.78, 5.46; P < 0.001) and low levels of mothers’ education (OR = 3.41; 95% CI = 1.62, 7.18; P < 0.01) were the significant predictors of Blastocystis infection. In conclusion, Blastocystis is prevalent among rural children and the important factors that determine the infection were the sources of drinking water and mothers’ educational level. Interventions with provision of clean water supply and health education especially to mothers are required.
Notes: Abdulsalam, Awatif M Ithoi, Init Al-Mekhlafi, Hesham M Ahmed, Abdulhamid Surin, Johari Mak, Joon-Wah eng Research Support, Non-U.S. Gov’t England 2012/03/27 06:00 Parasitology. 2012 Jul;139(8):1014-20. Epub 2012 Mar 23.
A Ahmed, H M Al-Mekhlafi, A H Al-Adhroey, I Ithoi, A M Abdulsalam, J Surin (2012)  The nutritional impacts of soil-transmitted helminths infections among Orang Asli schoolchildren in rural Malaysia   Parasites & Vectors 5:  
Abstract: Background: Soil-transmitted helminths (STH) infections, anaemia and malnutrition are major public health problems in school-age children in developing countries. This study was conducted on 289 Orang Asli (aboriginal) schoolchildren in order to assess the current prevalence and predictors of anaemia and malnutrition, as well as the nutritional impacts of STH infections among these children. Methods: A cross-sectional study was combined with a longitudinal follow-up three months after treatment with anthelminthic drugs. Blood samples were collected from the children to measure haemoglobin (Hb) level. Anthropometric and socioeconomic data were also collected and the children were screened for STH. Results: The baseline findings revealed that the prevalence of anaemia, significant stunting, underweight and wasting among the children were 41.0%, 28.0%, 29.2% and 12.5%, respectively. Overall, the prevalence of trichuriasis, ascariasis and hookworm infections were 84.6%, 47.6% and 3.9%, respectively. Haemoglobin level was significantly lower among the moderate-to-heavy infected children compared to the negative-to-light infected children. Age < 10years and moderate-to-heavy ascariasis were the predictors of anaemia. Stunting was associated with gender, age, moderate-to-heavy ascariasis and trichuriasis. Three months post-treatment assessment showed that the moderate-to-heavy infected children gained significant increment in their mean Hb level compared to the negative-to-light infected children (0.44 g/dL compared to 0.08 g/dL). However, no difference was found in the mean increments in growth indices between the groups. Conclusion: STH infections, anaemia and malnutrition are still prevalent and a matter of public health concern in Orang Asli communities in Malaysia. Sustainable deworming programme at school and community levels among these populations will help to improve their health and nutritional status.
Notes: Ahmed, Abdulhamid Al-Mekhlafi, Hesham M Al-Adhroey, Abdulelah H Ithoi, Init Abdulsalam, Awatif M Surin, Johari eng Research Support, Non-U.S. Gov’t England 2012/06/19 06:00 Parasit Vectors. 2012 Jun 15;5:119. doi: 10.1186/1756-3305-5-119.
2011
L L Chan, J W Mak, Y T Low, T T Koh, I Ithoi, S M Mohamed (2011)  Isolation and characterization of Acanthamoeba spp. from air-conditioners in Kuala Lumpur, Malaysia   Acta Tropica 117: 1. 23-30 Jan  
Abstract: During a study on the quality of the indoor environment, Acanthamoeba spp. were detected in 20 out of 87 dust samples collected from air-conditioners installed in a four-story campus building located in Kuala Lumpur, Malaysia. Twenty-one cloned Acanthamoeba isolates designated as IMU1 to IMU21 were established from the positive primary cultures. Five species were identified from the 16 isolates according to the morphological criteria of Pussard and Pons; i.e. A. castellanii, A. culbertsoni, A. griffini, A. hatchetti and A. polyphaga. Species identities for the remaining five isolates (IMU4, IMU5, IMU15, IMU20 and IMU21), however, could not be determined morphologically. At genotypic characterization, these isolates were placed into T3 (IMU14); 15 (IMU16 and IMU17)and T4 (all the remaining isolates). To predict the potential pathogenicity of these Acanthamoeba isolates, thermo- and osmotolerance tests were employed; many isolates were predicted as potential human pathogens based on the outcome of these tests. This is the first time potentially pathogenic Acanthamoeba have been isolated from air-conditioners in Malaysia. (C) 2010 Elsevier B.V. All rights reserved.
Notes: Chan, Li-Li Mak, Joon-Wah Low, Yoon-Tong Koh, Thuan-Tzen Ithoi, Init Mohamed, Shar Mariam eng Research Support, Non-U.S. Gov’t Netherlands 2010/09/23 06:00 Acta Trop. 2011 Jan;117(1):23-30. Epub 2010 Sep 19.
A Ahmed, H M Al-Mekhlafi, S H Choy, I Ithoi, A H Al-Adhroey, A M Abdulsalam, J Surin (2011)  The burden of moderate-to-heavy soil-transmitted helminth infections among rural malaysian aborigines : an urgent need for an integrated control programme   Parasites & Vectors 4: 242 Dec  
Abstract: Background: Soil-transmitted helminth (STH) infections, among the most common neglected tropical diseases, continue to be a major threat to the health and socioeconomic wellbeing of infected people especially children in developing countries. Methods: A cross-sectional study among 254 aboriginal schoolchildren was conducted in order to determine the current prevalence and intensity of infections and to investigate the potential risk factors associated with moderate-to-heavy burden of STH infections among these children. Results: Overall, 93.7% of children were found to be infected with one or more STH species. The prevalence of trichuriasis, ascariasis and hookworm infections were 84.6%, 47.6% and 3.9%, respectively. Almost half of the participants had heavy trichuriasis, one-quarter had heavy ascariasis whereas all hookworm infections were light infections. Overall, moderate-to-heavy STH infections accounted for 56.7% of the total infections. Univariate analysis revealed that those using untreated water supply (P = 0.013), living in houses without toilets (P = 0.027) and having domestic animals in the houses (P = 0.044) had significantly higher prevalence of moderate-to-heavy infections than others. Logistic regression analysis confirmed using untreated water for drinking (P = 0.001) and the absence of a toilet in the house (P = 0.003) as significant risk factors of moderate-to-heavy STH infections among these children. Conclusion: The high proportion of moderate-to-heavy STH infections further confirms the need for serious attention towards these devastating diseases that has put lives and the future of aboriginal children in jeopardy. Introduction of more poverty alleviation schemes, proper sanitation, provision of clean and safe drinking water, health education, as well as the introduction of periodic school-based deworming programmes are imperative among these communities in order to curtail the transmission and morbidity caused by STH.
Notes: Ahmed, Abdulhamid Al-Mekhlafi, Hesham M. Choy, Seow Huey Ithoi, Init Al-Adhroey, Abdulelah H. Abdulsalam, Awatif M. Surin, Johari
I Ithoi, A F Ahmad, J W Mak, V Nissapatorn, Y L Lau, R Mahmud (2011)  Morphological Characteristics of Developmental Stages of Acanthamoeba and Naegleria Species before and after Staining by Various Techniques   Southeast Asian Journal of Tropical Medicine and Public Health 42: 6. 1327-1338 Nov  
Abstract: Seven stains were studied to determine the best color and contrast for staining the developmental stages of free living pathogenic Acanthamoeba and Naegleria species. The acid-fast bacilli stain (AFB) produced a blue color without contrast; trichrome-eosin and modified Field’s showed various color contrasts; Giemsa, iron-hematoxylin, modified AFB and Gram produced only one color which distinguished the nucleus, nucleolus, cytoplasm, food- and water-vacuoles. The motile organs (acanthopodia, pseudopodia, lobopodia and flagella) were also clearly differentiated but produced a similar color as the cytoplasm. These motile organelles were first induced by incubating at 37 C for at least 15 minutes and then fixing with methanol in order to preserve the protruding morphology prior to staining. The trichrome-eosin and iron-hematoxylin stains showed good color contrast for detecting all three stages, the trophozoite, cyst and flagellate; Giemsa and Gram stained the trophozoite and flagellate stages; the modified Field’s and modified AFB stains stained only the trophozoite stage. Depending on the purpose, all these stains (except the AFB stain) can be used to identify the developmental stages of Acanthanweba and Naegleria for clinical, epidemiological or public health use.
Notes: Ithoi, Init Ahmad, Arine-Fadzlun Mak, J. W. Nissapatorn, Veeranoot Lau, Yee-Ling Mahmud, Rohela
I Ithoi, A F Ahmad, V Nissapatorn, Y L Lau, R Mahmud, J W Mak (2011)  Detection of Naegleria Species in Environmental Samples from Peninsular Malaysia   Plos One 6: 9. e24327  
Abstract: Background: In Malaysia, researchers and medical practitioners are unfamiliar with Naegleria infections. Thus little is known about the existence of pathogenic Naegleria fowleri, and the resultant primary amoebic meningoencephalitis (PAM) is seldom included in the differential diagnosis of central nervous system infections. This study was conducted to detect the presence of Naegleria species in various environmental samples. Methods/Findings: A total of 41 Naegleria-like isolates were isolated from water and dust samples. All these isolates were subjected to PCR using two primer sets designed from the ITS1-ITS2 regions. The N. fowleri species-specific primer set failed to produce the expected amplicon. The Naegleria genus-specific primers produced amplicons of 408 bp (35), 450 bp (2), 457 bp (2) or 381 bp (2) from all 41 isolates isolated from aquatic (33) and dust (8) samples. Analysis of the sequences from 10 representative isolates revealed that amplicons with fragments 408, 450 and 457 bp showed homology with nonpathogenic Naegleria species, and 381 bp showed homology with Vahlkampfia species. These results concurred with the morphological observation that all 39 isolates which exhibited flagella were Naegleria, while 2 isolates (AC7, JN034055 and AC8, JN034056) that did not exhibit flagella were Vahlkampfia species. Conclusion: To date, pathogenic species of N. fowleri have not been isolated from Malaysia. All 39 isolates that produced amplicons (408, 450 and 457 bp) from the genus-specific primers were identified as being similar to nonpathogenic Naegleria. Amplicon 408 bp from 5 representative isolates showed 100% and 99.7% identity to Naegleria philippinensis isolate RJTM (AM167890) and is thus believed to be the most common species in our environment. Amplicons 450 bp and 457 bp were respectively believed to be from 2 new species of Naegleria, since representative isolates showed lower homology and had a longer base pair length when compared to the reference species in the Genbank, Naegleria schusteri (AJ566626) and Naegleria laresi (AJ566630), respectively.
Notes: Ithoi, Init Ahmad, Arine Fadzlun Nissapatorn, Veeranoot Lau, Yee Ling Mahmud, Rohela Mak, Joon Wah eng Research Support, Non-U.S. Gov’t 2011/09/15 06:00 PLoS One. 2011;6(9):e24327. Epub 2011 Sep 6.
G Thiruvengadam, I Init, M Y Fong, Y L Lau (2011)  Optimization of the expression of surface antigen SAG1/2 of Toxoplasma gondii in the yeast Pichia pastoris   Tropical Biomedicine 28: 3. 506-513  
Abstract: Surface antigens are the most abundant proteins found on the surface of the parasite Toxoplasma gondii. Surface antigen 1 (SAG1) and Surface antigen 2 (SAG2) remain the most important and extensively studied surface proteins. These antigens have been identified to play a role in host cell invasion, immune modulation, virulence attenuation. Recombinant SAG1/2 was cloned and expressed in yeast Pichia pastoris. We describe here optimization of critical parameters involved in high yield expression of the recombinant SAG1/2. Our results suggest that recombinant SAG1/2 were best expressed at 30 masculineC, pH 6 and 1% methanol as the carbon source by X33 Pichia cells. Additional optimizations included the downstream process such as ammonium sulphate precipitation and dialysis. The fusion protein was purified using Ni-NTA purification system with 80% recovery. The purified protein was 100% specific and sensitive in detection of toxoplasmosis.
Notes: Thiruvengadam, G Init, I Fong, M Y Lau, Y L eng Evaluation Studies Research Support, Non-U.S. Gov’t Malaysia 2012/03/22 06:00 Trop Biomed. 2011 Dec;28(3):506-13.
I Ithoi, A Jali, JW Mak, W Sulaiman, W Yusoff, R Mahmud (2011)  Occurrence of Blastocystis in Water of Two Rivers from Recreational Areas in Malaysia   Journal of parasitology research 2011: 123916  
Abstract: This study reports the occurrence of Blastocystis in water from two rivers, Sungai Congkak and Sungai Batu, located in recreational areas in Malaysia. This protozoan was detected in samples from both rivers with an average of 33.3% and 22.1%, respectively. It was detected highest at the downstream (73.8% and 33.8%) followed by midstream (17.5% and 25.0%) and upstream (8.8% and 7.5%) stations, with additionally higher detection during holidays (with average 47.5% and 30.8%) than week days (with average 19.2% and 13.3%), in both rivers, respectively. There was a strong association with the daily activities of locals and visitors, who came for water recreational activities, mainly located between midstream and downstream and was observed to be higher at Sungai Congkak. The detection of Blastocystis in these rivers’ water implies that this protozoan could potentially be transmitted to humans by the waterborne route. Pearson correlation analysis showed that their occurrence was significantly correlated with faecal coliforms count; inconsistent correlation with dissolved oxygen, temperature and turbidity and no correlation with pH, conductivity and rainfall for both rivers. The correlation of coliforms and Blastocystis suggests the source of the Blastocystis in the water body is likely to be faecal.
Notes: Ithoi, Init Jali, Azman Mak, J W Wan Sulaiman, Wan Yusoff Mahmud, Rohela eng 2011/07/21 06:00 J Parasitol Res. 2011;2011:123916. Epub 2011 Jun 6.
V Nissapatorn, T H Leong, R Lee, Init, Ithoi, J Ibrahim, T S Yen (2011)  SEROEPIDEMIOLOGY OF TOXOPLASMOSIS IN RENAL PATIENTS   Southeast Asian Journal of Tropical Medicine and Public Health 42: 2. 237-247  
Abstract: Toxoplasmosis is an important parasitic disease in immunosuppressed patients. This prospective study was conducted to determine the seroprevalence, associated risk factors and the incidence of clinically confirmed toxoplasmosis among renal patients at the University of Malaya Medical Center, Kuala Lumpur, Malaysia. We interviewed 247 renal patients, each of whom answered an epidemiological questionnaire, and collected blood samples for measurement of anti-Toxoplasma IgG and IgM antibodies by ELISA. Overall seroprevalence of latent toxoplasmosis was observed in 126 (51%) renal patients. Race (Malays), marital status (married) and primary level of education, were all factors associated with a greater chance of Toxoplasma infection. A case of clinically confirned toxoplasmosis was diagnosed in a renal transplant recipient as a result of immunosuppression. Based on the findings obtained, this preliminary study shows a high prevalence of latent toxoplasmosis in renal patients. Risk factors may have significantly contributed to Toxoplasma acquisition in these patients. We recommend further studies be carried out to monitor for trends in toxoplasmosis among immunosuppressed patients.
Notes: Nissapatorn, Veeranoot Leong, Teoh Hoe Lee, Rogan Init-Ithoi Ibrahim, Jamaiah Yen, Tan Si eng Research Support, Non-U.S. Gov’t Thailand 2011/06/30 06:00 Southeast Asian J Trop Med Public Health. 2011 Mar;42
2010
Y L Lau, M T Hasan, G Thiruvengadam, M M Idris, I Init (2010)  Cloning and expression of Toxoplasma gondii dense granular protein 4 (GRA4) in Pichia pastoris   Tropical Biomedicine 27: 3. 525-533 Dec  
Abstract: GRA4 of Toxoplasma gondii has been shown to prompt IgG, IgM and IgA responses in previous studies and is thus considered one of the major immunogenic proteins from T. gondii that can be used for both diagnostics purposes and vaccine development. This study seeks to clone and express the GRA4 in Pichia pastoris, which has numerous advantages over other systems for expression of eukaryotic proteins. In order to achieve this, the gene was cloned into the pPICZ alpha A expression vector, which was then incorporated into the P. pastoris genome via insertional integration for expression of the recombinant protein, under the AOX1 promoter. The antigen was expressed along with the prepro sequence of the alpha-factor of yeast so that it could be excreted out of the P pastoris cells and obtained from the medium. Upon SDS-PAGE analysis it was found that the recombinant protein was expressed optimally as a 40 kDa protein after 96 hours of induction with 0.75% of methanol. The expressed GRA4 protein showed discrepancy in size with the calculated molecular mass. This may be attributed to the various posttranslational modifications including glycosylation and phosphorylation. Despite the difference in molecular weight, the recombinant protein was able to detect toxoplasmosis in Western blot format. The recombinant GRA4 was expressed with an intact polyhistidine-tag, which could be used for future purification of the antigen.
Notes: Lau, Y L Hasan, M T Thiruvengadam, G Idris, M M Init, I eng Malaysia 2011/03/15 06:00 Trop Biomed. 2010 Dec;27(3):525-33.
L Y Ling, I Ithoi, M Y Fong (2010)  Optimization for High-Level Expression in Pichia Pastoris and Purification of Truncated and Full Length Recombinant Sag2 of Toxoplasma Gondii for Diagnostic Use   Southeast Asian Journal of Tropical Medicine and Public Health 41: 3. 507-513 May  
Abstract: SAG2 is one of the major surface antigens of the intracellular protozoan parasite Toxoplasma gondii. In the present study, truncated recombinant SAG2(S) and full length recombinant SAG2(T) of T. gondii were optimally produced (similar to 15 mg/liter) in Pichia pus tons expression system using BMMY medium at pH 3, 25 degrees C in 0.5-1% methanol and a time-course of 1-2 days. The recombinant proteins were purified using a commercial gel filtration purification system obtaining similar to 33% recovery. The purified SAG2(S) and SAG2(T) showed molecular masses of 45 and 36 kDa by SDS-PAGE, respectively. The recombinant proteins were evaluated by Western blotting with patients’ sera and demonstrated 90% sensitivity and 100% specificity for detection of toxoplasmosis. This study provided a means for large-scale expression and purification of SAG2, which should be useful for diagnosis of toxoplasmosis.
Notes: Ling, Lau Yee Ithoi, Init Fong, Mun Yik
I Init, Y L Lau, A A Fadzlun, A I Foead, R S Neilson, V Nissapatorn (2010)  Detection of free living amoebae, Acanthamoeba and Naegleria, in swimming pools, Malaysia   Tropical Biomedicine 27: 3. 566-577 Dec  
Abstract: This study reports the detection of Acanthamoeba and Naegleria species in 14 swimming pools around Petaling Jaya and Kuala Lumpur, Malaysia. Sampling was carried out at 4 sites (the platforms (P), wall (W), 1 meter from the wall (1) and middle (2)) of each swimming pool. These free living amoebae (FLA) were detected under light and inverted microscopes after being cultured on the surface of non-nutrient agar lawned with Escherichia coli. Acanthamoeba species were detected in higher number of culture plates from all sampling sites of all the swimming pools. While Naegleria, were detected in fewer culture plates at 3 sampling sites (absent at site P) of 8 swimming pools. This suggested that the thick double-walled cysts of Acanthamoeba were more resistant, thus remaining viable in the dry-hot areas of the platforms and in chlorinated water of the swimming pools whereas Naegleria cysts, that are fragile and susceptible to desiccation, preferred watery or moist areas for growth and proliferation. The prevalence of both FLA was highest at site W (76.2%), followed by site 1 (64.7%), lowest at site 2 (19.4%), and could be detected at all 3 sampling levels (top, middle and bottom) of these 3 sites. The surface of site W might act as a bio-film that accumulated all kinds of microbes providing sufficient requirement for the FLA to develop and undergo many rounds of life cycles as well as moving from top to bottom in order to graze food. Other factors such as human activities, the circulating system which was fixed at all swimming pools, blowing wind which might carry the cysts from surroundings and the swimming flagellate stage of Naegleria, could also contribute to the distribution of the FLA at these sampling sites. Both FLA showed highest growth (80.4%) at room temperature (25-28 degrees C) and lesser (70.0%) at 37 degrees C which might be due to the overgrowth of other microbes (E. coli, fungi, algae, etc). While at 44 degrees C, only Acanthamoeba species could survive thus showing that our swimming pools are free from potentially pathogenic Naegleria species. However, further study is needed in order to confirm the virulence levels of these amoebae isolates.
Notes: Init, I. Lau, Y. L. Fadzlun, Arin A. Foead, A., I Neilson, R. S. Nissapatorn, V
2009
J Azman, I Init, W S Wan Yusoff (2009)  Occurrence of Giardia and Cryptosporidium (oo)cysts in the river water of two recreational areas in Selangor, Malaysia   Tropical Biomedicine 26: 3. 289-302 Dec  
Abstract: This study is the first report on the occurrence of Giardia and Cryptosporidium (oo)cysts in recreational rivers water from Malaysia. It was carried out in water samples at two rivers, ’Sungai Congkak’ and ’Sungai Batu’, located in Selangor State. The occurrence of both Giardia lamblia and Cryptosporidium parvum (oo)cysts was higher in Sungai Congkak (50% or 15/30 and 10% or 3/30 respectively) than Sungai Batu (16% or 5/30 and 3.3% or 1/30 respectively). The mean density of cysts/L was 0.72 in Sungai Congkak and 0.023 in Sungai Batu, and that of oocysts/L was 0.023 in Sungai Congkak and 0.0033 in Sungai Batu, showing that the occurrence of Giardia was higher and more frequent than Cryptosporidium in both rivers. Sungai Congkak also showed higher faecal coliforms count (ranging from 0.48x10(3) to 73x10(3) CFU/100 mL) than Sungai Batu (0.41x10(3) to 16x10(3) CFU/100 mL). On the other hand, the Giardia and Cryptosporidium (oo)cysts and faecal coliforms were more concentrated at the downstream station, followed by midstream and upstream stations which might be due to human factors where settlements and recreation areas were located around and between midstream and downstream stations. The (oo)cysts and faecal coliforms also increased during public holidays due to the significantly higher number of visitors (bathers) compared with the week days. All the parameters (physical, faecal coliforms and rainfall) did not show consistent significant correlation (based on r values of Pearson correlation analysis) with both protozoa, therefore these parameters are not suitable as indicator for the presence of Giardia and Cryptosporidium (oo)cysts in both rivers.
Notes: Azman, J. Init, I. Wan Yusoff, W. S.
M Rohela, Jamaiah, T T I Hui, J W Mak, I Ithoi, A Amirah (2009)  Dirofilaria causing eye infection in a patient from Malaysia   Southeast Asian Journal of Tropical Medicine and Public Health 40: 5. 914-918 Sep  
Abstract: Human dirofilariasis caused by Dirofilaria immitis and Dirofilaria repens have been reported in Malaysia. This is the fourth reported case of dirofilariasis caused by D. repens. The patient was a Chinese male from Kuching Sarawak, Malaysia who presented with a one day history of redness and itchiness over the temporal aspect of his left eye. A worm was seen and later removed from beneath the conjunctiva under local anesthesia and based on the morphological characteristics, it was identified as an immature Dirofilaria repens.
Notes: Rohela, M. Jamaiah, I. Hui, T. T. Mak, J. W. Ithoi, I. Amirah, A.
2007
I Init, AL Foead, MY Fong, H Yamazaki, M Rohela, Yong, JW H S Mak (2007)  Restriction enzyme digestion analysis of PCR-amplified DNA of Blastocystis hominis isolates   Southeast Asian J Trop Med Public Health 38: 6. 991-7 Nov  
Abstract: Genomic DNA of Blastocystis isolates released into 0.1% Triton X-100 was suitable for amplification and yielded similar results as the genomic DNA extracted with standard kit. The specific B. hominis primers (BH1: GCT TAT CTG GTT GAT CCT GCC AGT and BH2: TGA TCC TTC CGC AGG TTC ACC TAC A) successfully produced the PCR product of about 1,770 bp with all the 7 Blastocystis isolates tested. The restriction fragment length polymorphism (RFLP) patterns yielded by 13 out of 25 restriction endonucleases showed that the 7 isolates could be grouped into 4 subgroups: subgroup-1 consisted of isolate C; subgroup-2 of isolates H4 and H7; subgroup-3 of isolates KP1, Y51 and M12; and subgroup-4 of isolate 27805. The differences between subgroups manifested as clear-cut RFLP patterns. A common band of 230 bp was revealed by Eco R1 in all the Blastocystis isolates tested. The band of about 180 bp was revealed by Alu I, differentiated symptomatic from asymptomatic isolates of this parasite, and might indicate the pathogenicity of this parasite.
Notes: Init, I Foead, A L Fong, M Y Yamazaki, H Rohela, M Yong, H S Mak, J W eng Research Support, Non-U.S. Gov’t Thailand 2008/07/11 09:00 Southeast Asian J Trop Med Public Health. 2007 Nov;38(6):991-7.
2006
M Rohela, J Surin, I Jamaiah, I Init, S H Lee (2006)  Acute cholecystitis caused by Clonorchis sinensis   Southeast Asian journal of tropical medicine and public health 37: 4. 648-651  
Abstract: We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery.
Notes: Rohela, M Johari, S Jamaiah, I Init, I Lee, S H eng Case Reports Thailand 2006/11/24 09:00 Southeast Asian J Trop Med Public Health. 2006 Jul;37(4):648-51
2003
V Nissapatorn, M A Noor Azmi, S M Cho, M Y Fong, I Init, M Rohela, A Khairul Anuar, K F Quek, H M Latt (2003)  Toxoplasmosis : prevalence and risk factors   Journal of Obstetrics & Gynecology 23: 6. 618-624  
Abstract: A total of 200 pregnant women were recruited in this cross-sectional study. The overall seroprevalence of toxoplasmosis in pregnant women was found to be 49%, in which 39%, 4% and 6% for anti-Toxoplasma IgG, IgM and both anti-Toxoplasma IgG and IgM antibodies, respectively. We found the differences in Toxoplasma seroprevalence rates among the races were significant: the highest rate was in the Malays (55.7%), followed by the Indian (55.3%) and the Chinese (19.4%) (P < 0.05) populations. An increase in Toxoplasma seroprevalence with increasing parity was detected (P < 0.05). Women with no children had a prevalence of 39.7%, while women with one or more than two children had a prevalence of 44.2% and 62.9%, respectively. In this study, there was no significant association between Toxoplasma seroprevalence and various possible risk factors in pregnant women (P > 0.05). When multivariate analysis was performed, no significant association between Toxoplasma seroprevalence and history of contact with cats, consumption of undercooked meat and blood transfusion was found (P > 0.05). We did not find any newly diagnosed cases of acute acquired toxoplasmosis in pregnancy during the study period. Read More: http://informahealthcare.com/doi/abs/10.1080/01443610310001604376
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V Nissapatorn, C Lee, I Ithoi, M Y Fong, K A Abdullah (2003)  Tuberculosis in AIDS patients   Malaysian Journal of Medical Sciences 10: 1. 60-64  
Abstract: Tuberculosis is the top agenda among opportunistic diseases and the most leading cause of death in HIV/AIDS patients. A total of 406 AIDS patients were recruited in this retrospective and descriptive study. 123/406 (30.3%) were diagnosed as AIDS-related tuberculosis (TB). Their age range from 17 to 69 years with a mean (±SD) of 37.2 (±9.51. There were significant association between occupation, or mode of HIV transmission and tuberculosis infection (p< 0.05). Pulmonary tuberculosis 104/123 (84.6%) was the most common disease location among TB patients. We found the significant association between the clinical presentations i.e. fever, cough, sputum or hemoptysis and TB patients (p<0.05), moreover, the level of CD4 cell count plays a significant role in association with the disease (p<0.05) in this study.
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I Init, Mak, S J W Top, Z Zulhainan, Prummongkol, V S Nissapatorn, WS Wan-Yusoff, A K Anuar (2003)  Polypeptides associated with in vitro cyst formation of Blastocystis hominis   Southeast Asian J Trop Med Public Health 34: 4. 727-32 Dec  
Abstract: The objective of this study was to characterize the polypeptides associated with cysts of Blastocystis hominis. This form is believed to be infective and plays a role in parasite resistance to anti-B. hominis drugs currently used for treatment of Blastocystis associated diarrhea. Cysts were induced through in vitro culture of the parasite in complete medium supplemented with bacterial extract with trypticase, metronidazole or doxycycline. SDS-PAGE analysis showed almost similar polypeptide patterns of parasite extracts obtained from in vitro cultured parasites before and after exposure with the three supplements. Polypeptide bands at 76, 58.5, 48, 45, 40, 38, 32, 25 and 22 kDa were constantly seen in all antigenic preparations and no specific cyst-associated polypeptide was present. However, on immunoblot analysis, 3 out of 16 blastocystosis human sera identified a cyst-associated polypeptide at 60 kDa in all parasite extracts prepared from cultures with the three supplements. In addition, there were associated morphological changes detected in these parasites stained with acridine orange and observed under fluorescence microscopy. Metronidazole induced cyst forms (reddish cells) as early as 12 hours post-exposure; more cyst production (with stronger immunoblot bands) occurred after 24 hours exposure. However, cysts rupture with release and destruction of B. hominis daughters cells occurred after 48 hours exposure. Doxycycline induced less cyst-like forms at 24 hours (weaker 60 kDa band) and less destruction of the cysts (60 kDa band still present at 72 hours post exposure). Bacterial extract and trypticase also induced cysts at 12 hours with increasing numbers up to 72 hours exposure (corresponding increase in intensity of 60 kDa band from samples harvested at 12 to 72 hours post exposure) without any sign of deleterious effect on the parasite.
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M Y Fong, Y L Lau, I Init, I Jamaiah, A K Anuar, N Rahmah (2003)  Recombinant expression of Toxocara canis excretory-secretory antigen TES-120 in Escherichia coli   The Southeast Asian journal of tropical medicine and public health 34: 4. 723-726 Dec  
Abstract: The gene encoding the excretory-secretory antigen TES-120 of dog ascarid worm Toxocara canis was cloned into the bacterium Escherichia coli. The specificity of the recombinant TES-120 antigen produced by the bacterium was investigated. A total of 45 human serum samples from patients infected with differenthelminthes and protozoa, including 8 cases of toxocariasis, were tested against the recombinant antigens in immunoblot assays. The results from the assays revealed that the recombinant TES-120 antigen reacted with sera from toxocariasis patients only. This highly specific recombinant TES-120 antigen can potentially be used for the development of an inexpensive serodiagnostic assay for human toxocariasis.
Notes: Fong, Mun-Yik Lau, Yee-Ling Init, Ithoi Jamaiah, I Anuar, A Khairul Rahmah, N eng Evaluation Studies Research Support, Non-U.S. Gov’t Thailand 2004/04/30 05:00 Southeast Asian J Trop Med Public Health. 2003 Dec;34(4):723-6.
2002
V Nissapatorn, A Kamarulzaman, I Init, L H Tan, M Rohela, A Norliza, L L Chan, H M Latt, A K Anuar, K F Quek (2002)  Seroepidemiology of toxoplasmosis among HIV-infected patients and healthy blood donors   The Medical journal of Malaysia 57: 3.  
Abstract: A cross-sectional study was carried out in University of Malaya Medical Centre, Kuala Lumpur. Blood samples from 100 HIV-infected patients and 203 Healthy Blood Donors (HBD) were collected and anti-Toxoplasma antibodies were detected by using conventional ELISA. The seroprevalence of toxoplasmosis in HIV/AIDS and Healthy Blood Donors were found to be 21% and 28.1% respectively. There was no significant association between the seroprevalence of toxoplasmosis and various possible risk factors i.e. contact with cat, consumption of undercooked meat and history of blood transfusion in both groups. No significant differences between Toxoplasma seroprevalence in HIV/AIDS and Healthy Blood Donors in association with presence of single or multiple risk factors were found. The mean CD4 count among HIV/AIDS patients in this study was 202.23 cell/cumm. There was no significant association between CD4 count and seropositivity for Toxoplasma antibodies in HIV/AIDS patients.
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1999
I Init, J W Mak, S L Hakim, H S Yong (1999)  Strain differences in Blastocystis isolates as detected by a single set of polymerase chain reaction primers   Parasitology Research 85: 2. 131-134 Feb  
Abstract: A total of 20 isolates of Blastocystis were characterized using a single set of polymerase chain reaction (PCR) primers. The amplification product revealed five types of pattern. All four isolates from Singapore yielded PCR products quite different from those of the local isolates. However, most of the local isolates showed a major product at either 280 or 500 bp, or both. We also suspected that the amplification product detected at 280 bp might be an indicator of the pathogenicity of this parasite. One isolate (M12) obtained from a monkey showed patterns similar to those of human isolates (10203 and KP1) and probably belongs to the same strain. The results indicate that the intraspecific or interstrain variations in these 20 Blastocystis isolates belong to 5 different patterns. The differences among isolates of the same strain revealed by the presence or absence of certain amplification products showed further intrastrain variations in this parasite.
Notes: Init, I Mak, JW Hakim, SL Yong, HS
H R Salim, G S Kumar, S Vellayan, J W Mak, A K Anuar, Init, I Vennila, G D Saminathan, K R Ramakrishnan (1999)  Blastocystis in animal handlers   Parasitology Research 85: 12. 1032-1033 Dec  
Abstract: The present study investigated whether people working closely with animals were at higher risk of getting infected with Blastocystis hominis. The prevalence of the parasite was determined in two population groups, i.e., animal handlers and normal healthy individuals who did not work with animals. In all, 105 stool samples were collected from animal handlers from 2 local research institutions, a local zoo, and a local abattoir and 163 stool samples were collected from normal healthy individuals residing in high-rise hats in the city. The in vitro culture method used in the study detected that 41% of 105 animal handlers and 17% of 163 flat-dwellers in the city were positive for Blastocystis. This statistically significant finding (P = 0.0000313) shows that people who work closely with animals do stand at risk of acquiring Blastocystis infection.
Notes: Salim, HR Kumar, GS Vellayan, S Mak, JW Anuar, AK Init, I Vennila, GD Saminathan, R Ramakrishnan, K
1998
1997
Hashimoto, T KWatanobe, C X Liu, I Init, D Blair, S Ohnishi, T Agatsuma (1997)  Mitochondrial DNA and nuclear DNA indicate that the Japanese Fasciola species is F-gigantica   Parasitology Research 83: 3. 220-225 Mar  
Abstract: For elucidation of the taxonomic status of the Japanese Fasciola species, whole mitochondrial DNA of Fasciola hepatica from Australia, F. gigantica from Malaysia, and Fasciola sp. from Japan was digested with three four-base-cutting endonucleases: HinfI, MspI, and RsaI. The resulting digestion patterns showed that for each enzyme there were some bands specific for each geographical isolate and that the Japanese Fasciola sp, shared more bands with F. gigantica than with F. hepatica. Nucleotide sequences of two regions, the second internal transcribed spacer (ITS2) of the nuclear ribosomal RNA cluster and mitochondrial cytochrome c oxidase subunit I (COI), were also compared among them. The ITS2 sequence was highly conserved among the three isolates. F. gigantica and the Japanese Fasciola sp. were identical, but they differed from the Australian F. hepatica at six sites, one of which was a deletion. The COI sequence was less conserved but implied a similar relationship between the isolates. There seems no reason to regard the Japanese Fasciola sp. as anything other than a strain of F. gigantica.
Notes: Hashimoto, K Watanobe, T Liu, CX Init, I Blair, D Ohnishi, S Agatsuma, T
K Suresh, JW Mak, LS Chuong, T Ragunathan, I Init (1997)  Sac-like pouches in Blastocystis from the house lizard Cosymbotus platyurus   Parasitology research 83: 6. 523-525  
Abstract:
Notes: Suresh, K Mak, J W Chuong, L S Ragunathan, T Init, I eng Research Support, Non-U.S. Gov’t GERMANY 1997/01/01 Parasitol Res. 1997;83(6):523-5.

Conference papers

A Khairul Anuar, M Y Fong, I Init  Parasitic Infections in Malaysia-Review of the Last Millennium   Edited by:Federation of Parasitologist. 59-70  
Abstract: As Malaysia marches into the new millenium with aspirations to be a fully developed nation, the health and well being of its people remains a top priority in the agenda. Among others, control or eradication of infectious diseases that affects large segments of the population has been given much attention. Significant manpower and finance have been channeled into these efforts. Diseases caused by parasitic infections have always been a major concern among health providers and managers in Malaysia. Historically, when the Institute for Medical Research (IMR) was established in Kuala Lumpur in 1899, the institute’s top priorities were to conduct research into parasitology, diagnosis, treatment and control of malaria. Since then, many other parasites and related diseases have been investigated. In fact, some of the pioneer researches such as on filariasis, malaria, helminthiasis and scrub typhus have been conducted in Malaysia and their contribution in the control of these diseases have been immense.This paper presents a review on the epidemiology and status of the major parasitic infections in the country. It is hoped that the data and views presented in this review will be useful as a guide for the future planning of measures in the combating of parasitic infections in Malaysia.
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