Intestinal microsporidiosis in HIV infected patients with chronic diarrhea in Thailand.

Microsporidia have been recognized as emerging opportunistic agents affecting multiple organs. Intestinal microsporidiosis caused by Enterocytozoon bieneusi and Encephalitozoon intestinalis is a common disease which is associated with gastrointestinal symptoms, particularly in AIDS patients. So far, information on the frequency of this enteric disease in Thailand is not available. Therefore, the present study was undertaken to investigate the prevalence of intestinal microsporidiosis in HIV infected persons with chronic diarrhea. From 1995 to 1996, multiple diarrheal stool specimens were received and examined for the presence of the organism using Weber's modified trichrome staining method and transmission electron microscopy for confirmation. Twenty-two of 66 patients (33.3%) were positive for microsporidia which appeared as pink-red spores of 0.8-1.2 x 0.7-0.9 microm with the characteristic transverse or oblique band representing the coiled polar filament. Clinical features of these patients included chronic diarrhea (100%), weight loss (100%), abdominal pain (77%), fever (36%), vomiting (36%) and anorexia (18%). Transmission electron microscopic examination of fecal specimens from the 22 patients with positive staining results revealed E. bieneusi in 18 cases.

The rapid detection of microsporidia in stool using a new trichrome-methylene blue stain: A preliminary report.

The increasing number of HIV-infected patients with intestinal microsporidiosis promt the physician to look for appropriate diagnostic techniques to identify microsporidia. The Weber’s modified trichrome stain has been established as a standard method for detection of microsporidia spores in fecal apecimens. This staninng is practical for routinely diagnosis. However, the original method requires approximately two hours to be completed. The new rapid trichrome-methylene blue technique was therefore developed to reduce the processing time from 120 to 15 minutes. Twenty-two formalinized stool samples known to be positive for microsporidia by transmission electron microscopy and 22 negative control specimens were stained by both original and new modified methods. With these two techniques, the parasitic morphology showed the same characteristic staining pattern, but the trichrome-methylene blue method provided a greater background contrast. The sensitivity and specificity of this modified technique were similar to the Weber’s method and the specificity was equal. This new less time-consuming procedure will be helpful in clinical management.

Survey of naegleria fowleri the causative agent of Primary Amoebic Meningoencephalitis (PAM) in stagnant waters around factory area in Thailand.

Naegleria fowleri a free-living amoeba commonly found in moist soil and fresh water, enters the body via the nasal mucosa and migrates along the olfactory nerve to the brain, where it causes fulminant meningoencephalitis that is generally fatal. From 1988 to 1992, a survey of pathogenic Naegleria sp. was carried out in the industrial areas of three provinces. Water samples from warm and fresh ponds were collected from Pathumthani (34 samples), Samutprakan (150 samples) and Lopburi (162 samples). AII specimens were cultured in non-nutrient agar Escherichia coli media (NNE) AT 37oC. The amoebae obtained from water samples were in amoeboid, flagellate and cyst form. The amoeboflagellate transformation was occurred in distilled water and amoebae saline. The amoebae from water samples in Pathumthain (70.59 per cent) and Samutprakan (69.30 per cent) were cultured in Chang’s axenic media (SCGYEM) at 37oC. Non-pathogenic and pathogenic Naeglenia sp were distinguished by the characteristics of growth properties since the pathogenic form can grow only in the SCGYEM axenic media. The percentage of amoebae from Pathumthani and Samutprakan in SCGYEM axenic media at 37oC. were 11.46% and 12.00% respectively. The amoebae from Lopburi cultured in NNE 45oC (10.49 per cent) was inoculated through nasal cavity of Rattus rattus. The result was 10.49 per cent of the amoebae also determined for the virulence and the rats were died in 5-7 days. The histological studies of mouse brain tissue sections revealed the large central karysome and halo around the nucleus of the organisms, the amount of amoebae were accumulated around perivascular space. The characteristics, pathogenicity and pathology of pathogenic Naegleria sp. are the same as Naegleria fowleri.

Intestinal parasitosis in the monks and novices at kanmphaeng saen district, nakhon pathom province.

In September 1988, the authors examined 173 fecal specimens of the monks and novides at Kamphaeng Saen Mong College, Kamphaeng Saen District, Nakhon Pathom Province, central Thailand, 56 km from Bangkok. The presence of parasites was found in 48.56% of apecimens examined. These were hookworm Opisthorchis viverrini, Strongyloides stercoralis Echinostome eggs, Tania eggs, Trichuris trichiura, Blastocystis hominis, Entamoeba coli, Giardia lamblia, Trichomonas hominids, and Fntamoeba histolytic encountered in 12.39%, 17.34%, 8.6%, 2.31%, 1.16%, 0.58%, 7.51, 4.62%, 4.05%, 1.16 and 0.58% restively. Praziquantel 40 mg/lg and niclosamide 2 gm were given in single dose orally for the fluke infections and taeniasis respectively. Metronidazole 400 mg and 700 mg thrice daily for 7 and 10 days were also given for fiardiasis and amoebiasis respectively.

Primary amoebic meningoencephalitis in Thailand: report of a case and review literatures.

Primary amoebic meningoencephalitis (PAM) which is caused by free-living amoeba, Naegleria fowleri, is a rare disease. We report the fifth case in Thailand in order to add more information. The patient was a previously healthy 4 1/2-year-old girl from Nakhon Pathom province. For several weeks before this illness she had swum in a water supply canal. She developed high fever with change in consciousness. Her cerebrospinal fluid contained numerous Naegleria fowleri which grew in culture media and mice inoculation. She did not respond to treatment with intravenous and intraventricular amphotericin B, and oral rifampicin. She died on the fifth day of illness. Water sample from the canal also grew N. fowleri. All five reported cases in Thailand were reviewed. It was found that none of them had been exposed to a common source. Four of the five cases were male, and four cases occurred during the summer months, March to May. These findings agree with worldwide information.