The prevalence and persistence of human parvovirus B19 infection in thalassemic patients.

Human parvovirus B19 infection was studied in 60 thalassemic patients in Thailand. Seroprevalence, persistence of parvovirus B19 and their genotypes were identified in blood samples. Prevalence of anti-parvovirus B19 IgG and DNA found in thalassemic patients were 38% and 13%, respectively. Anti-parvovirus B19 IgM could be detected in 4% of these positive anti-parvovirus B19 IgG patients. The seroprevalence and parvovirus B19 DNA in patients with a history of blood transfusion were not significantly higher than those without such a history (44% vs. 34% and 20% vs. 9%, respectively). Phylogenetic analysis of NS1 nucleotide sequences of three parvovirus B19 samples revealed that they were parvovirus B19 genotype 1. They showed low genetic diversity from prototype (Au) strain. We concluded that acute and chronic persistent parvovirus B19 infection were found in the thalassemic Thai patients. Chronic persistence of parvovirus B19 infection might play important clinical role in thalassemic patients because of the high prevalence of parvovirus B19 DNA. Blood transfusion had no significant influence to increase the prevalence of parvovirus B19 infection in thalassemic patients.

Synthesis of von willebrand factor antigen in chlamydophila pneumoniae-infected endothelial cells.

Objective: The main objective of our study was to evaluate the response of endothelial cells infected with Chlamydophila pneumoniae (C. pneumoniae), by using von Willebrand factor (vWf) antigen as a marker for endothelial damage and dysfunction. Another objective was to evaluate the effect of cycloheximide on C. pneumoniae infectivity and vWf secretion from human umbilical vein endothelial cells (HUVECs). Methods: HUVECs were harvested. After first passage, the HUVECs were inoculated with C. pneumoniae in three concentrations of cycloheximide (0, 1, and 2 µg/ml). At 24, 48, and 72 hours post-inoculation, supernatants from each HUVEC culture well were collected and measured for vWf antigen by sandwich ELISA as well as non-infected HUVECs were used as controls. C. pneumoniae infectivity was evaluated by indirect immunofluoresce technique and polymerase chain reaction. Results: The cycloheximide-treated HUVECs resulted in greater infection compared to the non-treated HUVECs. Means of vWf antigens from HUVECs infected with C. pneumoniae were not different from those of non-infected HUVECs. However, there was a significant change in vWf secretion when different concentrations of cycloheximide were used in the culture system. Conclusion: From our study, the results of vWf antigen secreted from HUVECs did not support the direct endothelial damage effect caused by C. pneumoniae infection. Therefore, vWf antigen is not a sensitive marker for this event. Furthermore, results from this study supported the infectious ability of C. pneumoniae on HUVECs and the importance of cycloheximide in improving the infectivity of this organism. However, the investigators had to use this substance cautiously, especially in protein synthesis study. Nevertheless, a non-variable dose of C. pneumoniae and the use of only one surrogate endothelial damage marker may limit the interpretation of this study.

Trends of HIV seropositivity at Siriraj Hospital: 13 year's observation from 1992-2004.

OBJECTIVE: The aim of the present report was to observe the trend of seroprevalence rates of HIV seropositivity for routine services at Siriraj Hospital for 13 years. MATERIAL AND METHOD: The prevalence rate of HIV seropositivity was analyzed in three groups of subjects: 1) patients who attended the hospital with HIV related diseases; 2) pregnant women at first visit to the antenatal care clinic; 3) emigrating workers who have applied for employment in foreign countries. RESULTS: Of the 13 year-observation, HIV seroprevalence rates in the groups of patients, pregnant women and emigrating workers was 10.6% (95%CI 8.9-12.3%), 2.0% (95%CI 1.8-2.2%) and 0.6% (95%CI 0.4-0.8%), respectively. CONCLUSION: The low prevalence of HIV seropositivity in the group of emigrating workers may be due to self selection, whereas the prevalence in pregnant women, which was rather consistent at about 2.0%, may represent the infection rate in the general population. The seroprevalence rate measured in the group of pregnant women demonstrates that Thailand should increase efforts to confine the spread of HIV infection in the community.

Adenovirus hemorrhagic cystitis in a stem cell transplant patient: the first reported case in Southeast Asia.

Adenovirus (AdV) infections are prevalent in bone marrow transplant patients, usually associated with significant morbidity and mortality. Hemorrhagic cystitis (HC) is a major complication mainly attributed to this virus. The authors report a case of AdV HC in a myelodysplastic patient undergoing peripheral blood stem cell transplantation. The diagnosis was confirmed by positive urine AdV antigen using indirect immunofluorescence assay. The patient gradually improved after adequate hydration, supportive treatment and reduced dose of cyclosporine, and was discharged on the ninth day of hospitalization. To the authors' knowledge, this is the first case of AdV HC in stem cell transplantation in Southeast Asia.

Prevalence and incidence of Chlamydia pneumoniae antibodies among the healthy elderly and patients with chronic obstructive pulmonary diseases.

Chlamydia pneumoniae is an obligatory intracellular bacteria which can cause both acute and chronic respiratory tract infection. The significance of chronic and recurrent respiratory infection may be of prime importance in chronic obstructive pulmonary diseases (COPD). The purpose of this study was to determine the prevalence and incidence of C. pneumoniae antibodies in elderly COPD patients compared to a healthy elderly control group. C. pneumoniae antibodies were detected by an enzyme-linked immunosorbent assay in serum samples obtained from 127 elderly COPD patients and a 131 healthy elderly control group. The results showed that the seroprevalence of C. pneumoniae infection as determined by the existence of specific IgG or IgA or IgM antibodies was 96.1% in the COPD patients and 75.6% in the control group (p < 0.01). The prevalence of individual C. pneumoniae IgG, IgA and IgM in elderly COPD vs healthy control was 85.8% vs 66.4%, 85.0% vs 51.1% and 3.9% vs 0%, respectively. The incidence or seroconversion rate of C. pneumoniae antibodies after one year follow-up was found to be 33% in the COPD patients and 67.9% in the control group. High prevalence and incidence of C. pneumoniae antibodies indicates that both acute and chronic C. pneumoniae infection play a role in elderly COPD patients. Therefore, antibiotics of choice for C. pneumoniae infection should probably be considered.

Prevalence of rabies virus and Hantaan virus infections in commensal rodents and shrews trapped in Bangkok.

Five hundred rodents and shrews (Rattus norvegicus: 458, Rattus rattus: 28, Rattus exulans: 5, Mus musculus: 4 and Suncus murine: 5) trapped from the fresh food markets around Bangkok area were investigated for rabies virus and Hantaan virus infections. No rabies viral antigens in the animals' brains were detected by direct immunofluorescence. On the other hand, antibodies to Hantaan virus were demonstrated in the sera of 7 (1.53%) R. norvegicus caught in various markets using a particle agglutination technique. Further determination of the viral genome in rat lung tissue was performed by reverse transcriptase-polymerase chain reaction (RT-PCR) and nested PCR, 3 (0.66%) out of 7 were positive. HindIII and HifI restriction enzyme analyses showed the pattern of the Hantaan virus genome in 2 samples and that of the Seoul virus genome in the other. The results of the present study suggest that rodents from Bangkok's fresh food markets did not carry rabies. Thus, getting rid of rabies in dogs or cats in the Bangkok area may be easier than anticipated because there are no sources of asymptomatic reservoirs. This may result in the low incidence of rabies patients observed in Bangkok. On the contrary, the presence of antibodies and the Hantaan virus genome and Seoul virus genome in R. norvegicus will definitely provide evidence for physicians to be aware of hemorrhagic fever with renal syndrome (HFRS) and other clinical settings of Hantaan/Seoul virus disease in patients with a history of having contact with rats or their excreta.

Seroprevalence of rickettsial infection in commensal rodents and shrews trapped in the Bangkok Metropolitan Area.

Murine typhus and scrub typhus are important human rickettsial diseases in Thailand. Small mammals, including many species of rodents and shrews, serve as the reservoir host of rickettsial diseases. Rickettsia typhi can be transmitted to humans by fleas causing murine typhus, while infection with Orientia tsutsugamushi causing scrub typhus in humans is transmitted by chiggers. The prevalence of rickettsial infection depends on the geographic area. The seroprevalence of antibody to R. typhi and O. tsutsugamushi was studied in commensal rodents and shrews trapped in markets in the Bangkok Metropolitan Area (BMA). R. typhi and O. tsutsugamushi antigen prepared in the yolk sac of embryonated eggs were used to determine the specific antibody in trapped animals' sera by using fluorescein isothiocyanate (FITC)-anti rat immunoglobulins as a second antibody. Antibody to R. typhi was found in 25 (5%) of 500 sera tested and no antibody to O. tsutsugamushi was detected. R. typhi antibody titer ranged from 40-1280 and was found in Rattus norvegicus (4.2%), Rattus rattus (0.4%), Rattus exulans (0.2%), and Mus musculus (0.2%) trapped in 8 of 47 markets in the BMA. R. typhi antibody was commonly found in R. norvegicus. The authors concluded that murine typhus is an important rickettsial disease and R. norvegicus is an important reservoir species of rodents found in markets of the BMA.

Respiratory syncytial virus-associated lower respiratory tract infection in under-5-year-old children in a rural community of central Thailand, a population-based study.

The population-based cohort study on the epidemiology of respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRI) (RSV-LRI) was conducted in Takhli district from November 1998 to February 2001. The incidence of RSV-LRI was 12.6/1,000 child-year and 5.8/ 1,000 child-year during the first and second year, respectively. RSV accounted for 35.8 per cent of all LRI cases during the first year and significantly decreased to 17.5 per cent during the second year. Three-quarters of RSV-LRI occurred among children under 2 years old (76.6% during the first year and 62.2% during the second year). Most of RSV-LRI in both years occurred from July to October. Risk factor for morbidity of RSV infections were age less than or equal to 2 years (OR = 2.38, 95% CI = 1.22-4.67 p = 0.009) and sleeping with more than 3 persons in the patient's bedroom (OR = 2.92,95% CI = 1.42-6.00, p = 0.002). Most RSV-LRI (63.9%) were clinically diagnosed as having pneumonia. No RSV-LRI deaths were detected. During the first year, RSV subtype B was predominate, in contrast to the second year when subtype A was more predominate. Further research to determine the annual change in subtype of RSV-LRI and correlation of severity of disease with specific subtypes needs to conducted in order to prepare for the future introduction of a vaccine.

Acute viral lower respiratory infections in children in a rural community in Thailand.

The present study was conducted as a population based cohort in a rural community of Amphoe Takhli, Nakhon Sawan province for the determination of the prevalence of acute viral lower respiratory infection (ALRI) in pediatric cases under 5 years of age from November 1998 to February 2001. There were 472 ALRI episodes during the study period; and there were 5 cases who contracted ALRI twice. The etiologic agents were determined by indirect immunofluorescence (IIF) test using specific monoclonal antibodies for the staining of exfoliated cells in nasopharyngeal aspirate (NPA) samples. The slides of fixed cells were prepared by Takhli Hospital and posted in ambient temperature to the Virology Laboratory, Siriraj Hospital where they were stained and examined. Among 472 episodes of ALRI, 170 (36.0%) viral agents were found. Viral agents were associated with 41.4 per cent of all pneumonic cases. Respiratory syncytial virus (RSV) was the most common virus observed in the present study; and it was also the most common virus associated with pneumonia and bronchitis. RSV subgrouping was performed directly in NPA samples by IIF test using a panel of subgroup specific monoclonal antibodies. RSV subgroup B predominated over subgroup A in the first study year, and it was vice versa in the second year. Overall, more cases of subgroup B were found which was in contrast to what the authors had reported in the previous study. Prevalence of RSV was seasonal dependent, the epidemic was seen during the rainy season with peaks in August or September of each year. As the method of viral identification was limited to IIF only, therefore, fewer viruses were detected. Parainfluenza viruses were detected as the second most common viral agent, the viruses spread during early summer with peaks in February or March of each year. However, its association with croup could not be demonstrated which may be due to the insensitivity of IIF in the diagnosis of non-RSV infection. Nevertheless, in terms of feasibility to investigate the disease in a rural area, IIF is economic, convenient and rapid; and gives enough information for the nationwide plan of a health care development system.

Detection of anti-human papillomavirus antibodies in patients with cervical neoplasia and in normal population.

Because of the relative simplicity of specimen collection comparing to HPV-DNA detection from cervical specimens, HPV serology might have a role in screening and prediction of cervical cancer risk. Serprevalences to HPV proteins in Thai population has not been assessed. The prevelences of antibodies to HPV-16 E6,E7 oncoproteins-derived peptides in peptides in patients with cervical intraepithelial neoplasia (CIN) and invasive cervical cancer, and in control group with normal cervical cytology were studied. The selected peptides were previously shown to contain immunodominant epitopes. The seroprevalences of antibodies to the peptides in the control group were 4.7% - 11.5%. The antibody to an E6 peptide (E6 aa 1-23) was found in 75.5% of patients with invasive cervical cancer, associated with cervical neoplasia. Eighty-five percent of patients with invasive cervical cancer and 17% of the control group had antibodies to at least one of the three peptides.