BackgroundMelioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis.ObjectiveWe sought to review case reports of melioidosis from Malaysia.MethodsWe conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome.ResultsOverall, 67 cases were reported with 29 (43%) deaths; the median age was 44 years, and a male preponderance (84%) was noted. Forty-one cases (61%) were bacteremic, and fatal septic shock occurred in 13 (19%) within 24–48 hours of admission; nine of the 13 cases were not specifically treated for melioidosis as confirmatory evidence was available only after death. Diabetes mellitus (n = 36, 54%) was the most common risk factor. Twenty-six cases (39%) had a history of exposure to contaminated soil/water or employment in high-risk occupations. Pneumonia (n = 24, 36%) was the most common primary clinical presentation followed by soft tissue abscess (n = 22, 33%). Other types of clinical presentations were less common—genitourinary (n = 5), neurological (n = 5), osteomyelitis/septic arthritis (n = 4) and skin (n = 2); five cases had no evidence of a focus of infection. With regard to internal foci of infection, abscesses of the subcutaneous tissue (n = 14, 21%) was the most common followed by liver (18%); abscesses of the spleen and lung were the third most common (12% each). Seven of 56 males were reported to have prostatic abscesses. Mycotic pseudoaneurysm occurred in five cases. Only one case of parotid abscess was reported in an adult. Of the 67 cases, 13 were children (≤ 18 years of age) with seven deaths; five of the 13 were neonates presenting primarily with bronchopneumonia, four of whom died. Older children had a similar presentation as adults; no case of parotid abscess was reported among children.ConclusionsThe clinical patterns of cases reported from Malaysia are consistent for the most part from previous case reports from South and Southeast Asia with regard to common primary presentations of pneumonia and soft tissue abscesses, and diabetes as a major risk factor. Bacteremic melioidosis carried a poor prognosis and septic shock was strong predictor of mortality. Differences included the occurrence of: primary neurological infection was higher in Malaysia compared to reports outside Malaysia; internal foci of infection such as abscesses of the liver, spleen, prostate, and mycotic pseudoaneurysms were higher than previously reported in the region. No parotid abscess was reported among children. Early recognition of the disease is the cornerstone of management. In clinical situations of community-acquired sepsis and/or pneumonia, where laboratory bacteriological confirmation is not possible, empirical treatment with antimicrobials for B. pseudomallei is recommended.

Noise-induced hearing loss (NIHL) is a high frequency sensory-neural hearing loss and exposure to traffic noise by traffic policemen makes them susceptible to develop NIHL. The objective of this study was to determine the prevalence and correlates of NIHL among traffic policemen in the city of Colombo, Sri Lanka. A cross sectional study was carried out using 350 traffic policemen who are working in the city at least six months of duration. Pure-tone audiometry test and interviewer-administered questionnaire were used to assess hearing and correlates of NIHL, respectively. The chi-square test and logistic regression was used to analyze the relationship between risk factors and NIHL.287 policemen attended pure-tone audiometry test to check their hearing. Of 287 subjects, the prevalence of NIHL was found in 118 policemen (41%; 95% CI: 36%-47%). Of those with any type of NIHL, 33% (39/118) had major NIHL while 67% (79/118) had minor NIHL. In bivariate analysis 23 variables showed statistically significant association with mild and major NIHL. Multivariate logistic regression modelling found statistically significant association between "duration of employment as a policeman" and any type of NIHL (OR = 1.007; 95% CI = 1.005-1.009), adjusted for 23 variables including age. The prevalence of NIHL among traffic policemen in the city was high. Of those with any type of NIHL, one-third had major NIHL. Traffic policemen should undergo periodic hearing assessment. The police department should explore the feasibility of reducing the number of hours per day spent on the road by traffic policemen.

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Traffic noise levels in most cities of the world are higher than the recommended levels. Exposure to high levels of noise may cause adverse health effects such as ischemic heart diseases and noise induced hearing loss. We conducted a cross-sectional study to determine road traffic noise levels at 60 selected locations in the city of Colombo, Sri Lanka. On randomly selected days we measured equivalent continuous sound pressure level (LA eq ) for six hours during the day. From these measurements LA eq for eight hours were calculated and used as the average noise level of a particular location. LA eq (8 hrs) within Colombo ranged 76.6 to 84.0 dB; well above the Sri Lankan recommendation of 63.0 dB (an increase of 13.3 to 21.0 dB), and the WHO recommendation of 55.0 dB (an increase of 21.6 to 29.0 dB). These levels translate into increase of sound pressure level by 21.4 to 794.3 times above the recommendations on the logarithmic scale of dB. Thirty-eight of 60 locations recorded levels more than 80.0 dB. Road traffic noise levels in Colombo were well above the recommended levels. Though the increase in measured decibels might not appear to be too high, in reality this translates into an increase manifold times in the sound pressure level that reaches the ear.

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