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Article ; Online: Bacterial Coinfection in Adults With Severe Malaria.

Aung, Ne Myo / Nyein, Phyo Pyae / Kyi, Mar Mar / Hanson, Josh

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2021 Volume 72, Issue 3, Page(s) 535–536

MeSH term(s)	Adult ; Bacteremia ; Bacteria ; Coinfection ; Humans ; Malaria/complications
Language	English
Publishing date	2021-02-01
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciaa732
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Article ; Online: Time for pragmatic, prospective clinical trials to determine the role of empirical antibacterial therapy in critically ill adults hospitalized with malaria.

Hanson, Josh / Nyein, Phyo Pyae / Aung, Ne Myo / Kyi, Mar Mar

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2020 Volume 102, Page(s) 28–31

Abstract: Background: Children with severe falciparum malaria in malaria-endemic regions are predisposed to developing life-threatening bacterial co-infection. International guidelines therefore recommend empirical broad-spectrum antibacterial therapy in these ... ...

Abstract	Background: Children with severe falciparum malaria in malaria-endemic regions are predisposed to developing life-threatening bacterial co-infection. International guidelines therefore recommend empirical broad-spectrum antibacterial therapy in these children. Few studies have examined co-infection in adults, although it has been believed to be relatively rare; antibacterial therapy is therefore not routinely recommended in adults with falciparum malaria. Discussion: However, the fundamental pathophysiology of falciparum malaria in adults and children is the same; it is therefore unclear why adults would not also be predisposed to bacterial infection. Indeed, recent studies have identified bacteraemia in >10% of adults hospitalized with malaria. Some have suggested that these adults probably had bacterial sepsis, with the parasitaemia an incidental finding. However, it is usually impossible in resource-limited settings to determine-at presentation-whether critically ill, parasitaemic adults have severe malaria, bacterial sepsis, or both. Given the significant case-fatality rates of severe malaria and bacterial sepsis, the pragmatic initial approach would be to cover both possibilities. Conclusions: Life-threatening bacterial co-infection may be more common in critically ill adults with malaria than previously believed. While further prospective data are awaited to confirm these findings, it might be more appropriate to provide empirical aantibacterial cover in these patients than current guidelines suggest.
MeSH term(s)	Adult ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/complications ; Bacteremia/drug therapy ; Bacterial Infections/complications ; Bacterial Infections/drug therapy ; Child ; Coinfection ; Critical Illness ; Humans ; Malaria/complications ; Malaria, Falciparum/complications ; Parasitemia/complications ; Sepsis/complications ; Sepsis/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-10-02
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2020.09.1472
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Article ; Online: The impact of gender and the social determinants of health on the clinical course of people living with HIV in Myanmar: an observational study.

Nyein, Phyo Pyae / Aung, Eithandee / Aung, Ne Myo / Kyi, Mar Mar / Boyd, Mark / Lin, Kyaw Swar / Hanson, Josh

AIDS research and therapy

2021 Volume 18, Issue 1, Page(s) 50

Abstract: Background: There is a growing recognition of the impact of gender and the social determinants of health on the clinical course of people living with HIV (PLHIV). However, the relative contribution of these factors to clinical outcomes of PLHIV is ... ...

Abstract	Background: There is a growing recognition of the impact of gender and the social determinants of health on the clinical course of people living with HIV (PLHIV). However, the relative contribution of these factors to clinical outcomes of PLHIV is incompletely defined in many countries. This study was performed to gain a greater understanding of the non-clinical determinants of prognosis of PLHIV in Myanmar. Methods: Selected demographic, behavioural and socioeconomic characteristics of outpatients at two specialist HIV hospitals and one general hospital in Yangon, Myanmar were correlated with their subsequent clinical course; a poor outcome was defined as death, hospitalisation, loss to follow-up or a detectable viral load at 6 months of follow-up. Results: 221 consecutive individuals with advanced HIV commencing anti-retroviral therapy (ART) were enrolled in the study; their median CD4 T-cell count was 92 (44-158) cells/mm Conclusions: Men starting ART in Myanmar have a poorer prognosis than women. Expanded implementation of gender-specific management strategies is likely to be necessary to improve outcomes.
MeSH term(s)	CD4 Lymphocyte Count ; Cohort Studies ; Female ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Humans ; Male ; Myanmar/epidemiology ; Social Determinants of Health ; Viral Load
Language	English
Publishing date	2021-08-09
Publishing country	England
Document type	Journal Article ; Observational Study
ISSN	1742-6405
ISSN (online)	1742-6405
DOI	10.1186/s12981-021-00364-w
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Article ; Online: Investigating potential transmission of antimicrobial resistance in an open-plan hospital ward: a cross-sectional metagenomic study of resistome dispersion in a lower middle-income setting.

Ashokan, Anushia / Hanson, Josh / Aung, Ne Myo / Kyi, Mar Mar / Taylor, Steven L / Choo, Jocelyn M / Flynn, Erin / Mobegi, Fredrick / Warner, Morgyn S / Wesselingh, Steve L / Boyd, Mark A / Rogers, Geraint B

Antimicrobial resistance and infection control

2021 Volume 10, Issue 1, Page(s) 56

Abstract: Background: Antimicrobial resistance (AMR) represents a profound global health threat. Reducing AMR spread requires the identification of transmission pathways. The extent to which hospital wards represent a venue for substantial AMR transmission in low- ...

Abstract	Background: Antimicrobial resistance (AMR) represents a profound global health threat. Reducing AMR spread requires the identification of transmission pathways. The extent to which hospital wards represent a venue for substantial AMR transmission in low- and middle-income countries settings is poorly understood. Methods: Rectal swabs were obtained from adult male inpatients in a "Nightingale" model general medicine ward in Yangon, Myanmar. Resistome characteristics were characterised by metagenomic sequencing. AMR gene carriage was related to inter-patient distance (representing inter-patient interaction) using distance-based linear models. Clinical predictors of AMR patterns were identified through univariate and multivariate regression. Results: Resistome similarity showed a weak but significant positive correlation with inter-patient distance (r = 0.12, p = 0.04). Nineteen AMR determinants contributed significantly to this relationship, including those encoding β-lactamase activity (OXA-1, NDM-7; adjusted p < 0.003), trimethoprim resistance (dfrA14, adjusted p = 0.0495), and chloramphenicol resistance (catB3, adjusted p = 0.002). Clinical traits of co-located patients carrying specific AMR genes were not random. Specifically, AMR genes that contributed to distance-resistome relationships (OXA-1, catB3, dfrA14) mapped to tuberculosis patients, who were placed together according to ward policy. In contrast, patients with sepsis were not placed together, and carried AMR genes that were not spatially significant or consistent with shared antibiotic exposure. Conclusions: AMR dispersion patterns primarily reflect the placement of particular patients by their condition, rather than AMR transmission. The proportion of AMR determinants that varied with inter-patient distance was limited, suggesting that nosocomial transmission is a relatively minor contributor to population-level carriage.
MeSH term(s)	Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/pharmacology ; Cross-Sectional Studies ; Developing Countries ; Drug Resistance, Multiple, Bacterial/genetics ; Hospitals ; Hospitals, Public ; Hospitals, Teaching ; Humans ; Infection Control ; Inpatients ; Male ; Metagenomics ; Middle Aged ; Myanmar ; Patients' Rooms ; Sepsis/microbiology ; Spatial Analysis ; Tertiary Care Centers ; Tuberculosis/microbiology ; Young Adult
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-03-18
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2666706-X
ISSN	2047-2994 ; 2047-2994
ISSN (online)	2047-2994
ISSN	2047-2994
DOI	10.1186/s13756-021-00915-w
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Article ; Online: Antibiotic Therapy in Adults with Malaria (ANTHEM): High Rate of Clinically Significant Bacteremia in Hospitalized Adults Diagnosed with Falciparum Malaria.

Aung, Ne Myo / Nyein, Phyo Pyae / Htut, Thu Ya / Htet, Zaw Win / Kyi, Tint Tint / Anstey, Nicholas M / Kyi, Mar Mar / Hanson, Josh

The American journal of tropical medicine and hygiene

2018 Volume 99, Issue 3, Page(s) 688–696

Abstract: It has been believed that concomitant bacteremia is uncommon in adults hospitalized with falciparum malaria. Accordingly, the World Health Organization treatment guidelines presently only recommended additional antibacterial therapy in these patients if ... ...

Abstract	It has been believed that concomitant bacteremia is uncommon in adults hospitalized with falciparum malaria. Accordingly, the World Health Organization treatment guidelines presently only recommended additional antibacterial therapy in these patients if they have a clinical syndrome compatible with serious bacterial infection. Admission blood cultures were collected from 20 consecutive adults in Myanmar, hospitalized with a positive immunochromatographic test and blood film, suggesting a diagnosis of falciparum malaria; four (20%) had bacteremia with a clinically significant pathogen. These case series' data were pooled with a previously published multicenter study from Myanmar which had also collected blood cultures in adults hospitalized with a diagnosis of falciparum malaria. Among 87 patients in the two studies, 13 (15%) had clinically significant bacteremia on admission, with Gram-negative organisms in 10 (77%) and
MeSH term(s)	Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Antimalarials ; Bacteremia/drug therapy ; Bacterial Infections/drug therapy ; Cohort Studies ; Coinfection ; Female ; Humans ; Malaria, Falciparum/complications ; Malaria, Falciparum/drug therapy ; Malaria, Falciparum/parasitology ; Male ; Middle Aged ; Prospective Studies ; Young Adult
Chemical Substances	Anti-Bacterial Agents ; Antimalarials
Language	English
Publishing date	2018-07-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.18-0378
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Article ; Online: The Influence of HIV Status on the Burden and Clinical Manifestations of Gastrointestinal Pathogens in Yangon, Myanmar.

Pa Pa Aung, Win / Myint, Nan Phyu Sin Toe / Zaw, Thet Tun / Cooper, David A / Aung, Ne Myo / Kyi, Mar Mar / Lwin, Mya Mya / Hanson, Josh

The American journal of tropical medicine and hygiene

2020 Volume 102, Issue 4, Page(s) 884–888

Abstract: The impact of HIV infection on the burden of gastrointestinal pathogens in Myanmar is poorly defined. Stools of 103 HIV-infected and 105 HIV-uninfected adult outpatients at a tertiary referral hospital in Yangon were examined microscopically. Stool ... ...

Abstract	The impact of HIV infection on the burden of gastrointestinal pathogens in Myanmar is poorly defined. Stools of 103 HIV-infected and 105 HIV-uninfected adult outpatients at a tertiary referral hospital in Yangon were examined microscopically. Stool antigen tests for
MeSH term(s)	Adult ; Feces/parasitology ; Female ; Gastrointestinal Diseases/complications ; Gastrointestinal Diseases/epidemiology ; HIV Infections/complications ; HIV Infections/epidemiology ; Humans ; Male ; Middle Aged ; Myanmar/epidemiology ; Parasitic Diseases/complications ; Parasitic Diseases/epidemiology ; Parasitic Diseases/parasitology
Language	English
Publishing date	2020-02-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.19-0725
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Article ; Online: The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar.

Mar Minn, Mar / Aung, Ne Myo / Kyaw, De Zin / Zaw, Thet Tun / Chann, Pyae Nyein / Khine, Hnin Ei / McLoughlin, Steven / Kelleher, Anthony D / Tun, Ne Lin / Oo, Thin Zar Cho / Myint, Nan Phyu Sin Toe / Law, Matthew / Mar Kyi, Mar / Hanson, Josh

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2021 Volume 104, Page(s) 543–550

Abstract: Objectives: To determine the comparative prognostic utility of commonly used disease prediction scores in adults with presumed community-acquired sepsis in a resource-limited tropical setting.: Methods: This prospective, observational study was ... ...

Abstract	Objectives: To determine the comparative prognostic utility of commonly used disease prediction scores in adults with presumed community-acquired sepsis in a resource-limited tropical setting. Methods: This prospective, observational study was performed on the medical ward of a tertiary-referral hospital in Yangon, Myanmar. The ability of the National Early Warning Score 2 (NEWS2), quick NEWS (qNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, Universal Vital Assessment (UVA) and Sequential Organ Failure Assessment (SOFA) scores to predict a complicated inpatient course (death or requirement for intensive care unit (ICU) support) in patients with two or more systemic inflammatory response syndrome criteria was determined. Results: Among the 509 patients, 30 (6%) were HIV-seropositive. The most commonly confirmed diagnoses were tuberculosis (30/509, 5.9%) and measles (26/509, 5.1%). Overall, 75/509 (14.7%) died or required ICU support. All the scores except the qSOFA score, which was inferior, had a similar ability to predict a complicated inpatient course. Conclusions: In this resource-limited tropical setting, disease severity scores calculated at presentation using only vital signs-such as the NEWS2 score-identified high-risk sepsis patient as well as the SOFA score, which is calculated at 24 h and which also requires laboratory data. Use of these simple clinical scores can be used to facilitate recognition of the high-risk patient and to optimise the use of finite resources.
MeSH term(s)	Adult ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Myanmar ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; ROC Curve ; Sepsis/diagnosis ; Sepsis/mortality ; Sepsis/therapy ; Severity of Illness Index ; Tertiary Care Centers
Language	English
Publishing date	2021-01-23
Publishing country	Canada
Document type	Journal Article ; Observational Study
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2021.01.047
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Article ; Online: HIV care in Yangon, Myanmar; successes, challenges and implications for policy.

Aung, Ne Myo / Hanson, Josh / Kyi, Tint Tint / Htet, Zaw Win / Cooper, David A / Boyd, Mark A / Kyi, Mar Mar / Saw, Htin Aung

AIDS research and therapy

2017 Volume 14, Issue 1, Page(s) 10

Abstract: Background: Approximately 0.8% of adults aged 18-49 in Myanmar are seropositive for Human Immunodeficiency Virus (HIV). Identifying the demographic, epidemiological and clinical characteristics of people living with HIV (PLHIV) is essential to inform ... ...

Abstract	Background: Approximately 0.8% of adults aged 18-49 in Myanmar are seropositive for Human Immunodeficiency Virus (HIV). Identifying the demographic, epidemiological and clinical characteristics of people living with HIV (PLHIV) is essential to inform optimal management strategies in this resource-limited country. Methods: To create a "snapshot" of the PLHIV seeking anti-retroviral therapy (ART) in Myanmar, data were collected from the registration cards of all patients who had been prescribed ART at two large referral hospitals in Yangon, prior to March 18, 2016. Results and discussion: Anti-retroviral therapy had been prescribed to 2643 patients at the two hospitals. The patients' median [interquartile range (IQR)] age was 37 (31-44) years; 1494 (57%) were male. At registration, injecting drug use was reported in 22 (0.8%), male-to-male sexual contact in eleven (0.4%) and female sex work in eleven (0.4%), suggesting that patients under-report these risk behaviours, that health care workers are uncomfortable enquiring about them or that the two hospitals are under-servicing these populations. All three explanations appear likely. Most patients were symptomatic at registration with 2027 (77%) presenting with WHO stage 3 or 4 disease. In the 2442 patients with a CD4+ T cell count recorded at registration, the median (IQR) count was 169 (59-328) cells/mm Conclusions: People living with HIV in Yangon, Myanmar are generally presenting late in their disease course, increasing their risk of death, disease and transmitting the virus. A centralised model of ART prescription struggles to deliver care to the key affected populations. TB co-infection is very common in Myanmar, but despite the proven efficacy of IPT, it is frequently not prescribed.
MeSH term(s)	Adult ; Antiretroviral Therapy, Highly Active ; Antitubercular Agents/therapeutic use ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes/immunology ; Coinfection/drug therapy ; Coinfection/virology ; Female ; HIV/isolation & purification ; HIV Infections/epidemiology ; HIV Infections/immunology ; HIV Infections/therapy ; HIV Infections/transmission ; Humans ; Isoniazid/therapeutic use ; Lost to Follow-Up ; Male ; Middle Aged ; Myanmar/epidemiology ; Risk Factors ; Sex Work ; Sexual Behavior ; Substance-Related Disorders/virology ; Tuberculosis/drug therapy ; Tuberculosis/virology
Chemical Substances	Antitubercular Agents ; Isoniazid (V83O1VOZ8L)
Language	English
Publishing date	2017-03-04
Publishing country	England
Document type	Journal Article
ISSN	1742-6405
ISSN (online)	1742-6405
DOI	10.1186/s12981-017-0137-z
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Article ; Online: Sequential Helicobacter pylori eradication therapy in Myanmar; a randomized clinical trial of efficacy and tolerability.

Myint, Nan Phyu Sin Toe / Zaw, Thet Tun / Sain, Kyauk / Waiyan, Soe / Danta, Mark / Cooper, David / Aung, Ne Myo / Kyi, Mar Mar / Hanson, Josh

Journal of gastroenterology and hepatology

2019 Volume 35, Issue 4, Page(s) 617–623

Abstract: Background and aim: There is little published research to examine the best approach to the management of Helicobacter pylori in Myanmar. This study aimed to determine the relative efficacy and tolerability of sequential eradication therapy compared to ... ...

Abstract	Background and aim: There is little published research to examine the best approach to the management of Helicobacter pylori in Myanmar. This study aimed to determine the relative efficacy and tolerability of sequential eradication therapy compared to Myanmar's current recommendation of a concomitant four drug regimen. Methods: Patients were screened for H. pylori using monoclonal Stool Antigen Testing (SAT). Those testing positive were randomized 1:1 to receive receive Myanmar's first-line regimen of 14 days of concomitant rabeprazole, clarithromycin, amoxycillin and tinidazole (140 pills, cost US$23) or 10 days of sequential rabeprazole, clarithromycin, amoxycillin and tinidazole (60 pills, cost US$10). Adherence and adverse effects were recorded, and the efficacy of the regimens assessed with repeat SAT. Results: Of the 1011 patients screened for H. pylori infection, 313 (31%) tested positive. There was no statistical difference in the cure rates of the two regimens in either intention-to-treat: 128/157 (82%; 95% confidence interval (CI): 75-87%) receiving sequential therapy versus 123/156 (79%; 95% CI: 72-85%) receiving concomitant therapy (P = 0.55) or per-protocol analysis: 125/131 (95%; 95% CI: 90-98) receiving sequential therapy versus 121/130 (93%; 95% CI: 87-96) receiving concomitant therapy (P = 0.42). Side effects of therapy were reported in 54/157 (47%) patients taking sequential therapy compared with 62/156 (53%) taking concomitant therapy, but this difference did not reach statistical significance (P = 0.33). Conclusions: In this high-burden, resource-poor setting, less expensive sequential therapy was as effective and as well tolerated as the currently recommended concomitant four drug regimen for eradication of H. pylori.
MeSH term(s)	Amoxicillin/administration & dosage ; Amoxicillin/adverse effects ; Amoxicillin/economics ; Clarithromycin/administration & dosage ; Clarithromycin/adverse effects ; Clarithromycin/economics ; Drug Costs ; Drug Therapy, Combination/economics ; Gastritis/drug therapy ; Gastritis/microbiology ; Helicobacter Infections ; Helicobacter pylori ; Myanmar ; Rabeprazole/administration & dosage ; Rabeprazole/adverse effects ; Rabeprazole/economics ; Tinidazole/administration & dosage ; Tinidazole/adverse effects ; Tinidazole/economics ; Treatment Outcome
Chemical Substances	Tinidazole (033KF7V46H) ; Rabeprazole (32828355LL) ; Amoxicillin (804826J2HU) ; Clarithromycin (H1250JIK0A)
Language	English
Publishing date	2019-12-05
Publishing country	Australia
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	632882-9
ISSN	1440-1746 ; 0815-9319
ISSN (online)	1440-1746
ISSN	0815-9319
DOI	10.1111/jgh.14942
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Article: High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria.

Nyein, Phyo Pyae / Aung, Ne Myo / Kyi, Tint Tint / Htet, Zaw Win / Anstey, Nicholas M / Kyi, Mar Mar / Hanson, Josh

Open forum infectious diseases

2016 Volume 3, Issue 1, Page(s) ofw028

Abstract: Background. African children with severe falciparum malaria commonly have concomitant Gram-negative bacteremia, but co-infection has been thought to be relatively rare in adult malaria. Methods. Adults with a diagnosis of falciparum malaria ... ...

Abstract	Background. African children with severe falciparum malaria commonly have concomitant Gram-negative bacteremia, but co-infection has been thought to be relatively rare in adult malaria. Methods. Adults with a diagnosis of falciparum malaria hospitalized at 4 tertiary referral hospitals in Myanmar had blood cultures collected at admission. The frequency of concomitant bacteremia and the clinical characteristics of the patients, with and without bacteremia, were explored. Results. Of 67 adults hospitalized with falciparum malaria, 9 (13% [95% confidence interval, 5.3%-21.6%]) were also bacteremic on admission, 7 (78%) with Gram-negative enteric organisms (Escherichia coli [n = 3], typhoidal Salmonella species [n = 3], nontyphoidal Salmonella [n = 1]). Bacteremic adults had more severe disease (median Respiratory Coma Acidosis Malaria [RCAM] score 3; interquartile range [IQR], 1-4) than those without bacteremia (median RCAM score 1; IQR, 1-2) and had a higher frequency of acute kidney injury (50% vs 16%, P = .03). Although 35 (52%) were at high risk of death (RCAM score ≥2), all 67 patients in the study survived, 51 (76%) of whom received empirical antibiotics on admission. Conclusions. Bacteremia was relatively frequent in adults hospitalized with falciparum malaria in Myanmar. Like children in high transmission settings, bacteremic adults in this low transmission setting were sicker than nonbacteremic adults, and were often difficult to identify at presentation. Empirical antibiotics may also be appropriate in adults hospitalized with falciparum malaria in low transmission settings, until bacterial infection is excluded.
Language	English
Publishing date	2016-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofw028
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