Infection due to nontuberculous Mycobacterium other than MAC in AIDS patients at Siriraj hospital during 1998-2000: saprophyte vs pathogen.

HIV is a major health problem in Thailand. These patients are vulnerable to opportunistic infections, especially Mycobacterium tuberculosis and MAC infection. However, NTM was considered a rare disease in Thailand before the AIDS era. In this study, there were 38 HIV seropositive patients with NTM (other than MAC) identified from clinical specimens during the 3 year period 1998-2000 at Siriraj Hospital, which has a higher prevalence than the previous report. Among these patients, 29 cases were likely to have had definite infection from NTM, 5 cases possibly had NTM as a pathogen, and 4 cases had NTM as colonization. The most common site of infection was the lung (87%) and most common symptoms were cough (62.2%), fever (34.2%), weight loss (42.1%), and lymphadenopathy (5.3%). The outcome was poor because many NTM are not susceptible to standard medication for tuberculosis which is the empirical treatment for the majority of HIV seropositive patients with a clinical finding suspected of mycobacterial infection. The fatality rate was as high as 58.6 per cent. Awareness of NTM as a potential pathogen in HIV seropositive patientsand adjustment of medications even before the availability of culture results may improve the outcome of treatment of NTM infection in HIV seropositive patients.

Occupational exposure to HIV among healthcare workers: Experience at Siriraj Hospital.

Objective : To evaluate the incidence and epidemiological data concerning occupational exposure to HIV among healthcare workers (HCWs) at Siriraj Hospital. Methods : We prospectively collected data concerning occupational exposure among HCWs at Siriraj Hospital using a self-reporting system from 1994 to 2001. All exposed individuals were followed up for at least 6 months after exposure. Results : During the years 1994-2001, there were 691 incident reports from 670 individuals, 180 males and 490 females. The groups of HCWs exposed to blood and other body fluids consisted of : - 152 (22.0%) nurses, 147 (21.3%) medical students, and 119 (17.2%) externs. Needlestick or sharps injuries accounted for 538 (77.9%) cases, while the number exposed to mucous membranes was 93 (13.5%). The remaining 28 (4.1%) cases were of broken skin and 32 (4.6%) cases of intact skin exposure. Venepuncture was the procedure with highest risk of producing injury (20.7%). The incidents mostly occurred on medical wards 156 (22.6%) cases, operating rooms 121 (17.5%) cases, and in the emergency room 111 (16.1%) cases. The HIV status of the sources was positive in 230 (33.3%) cases, negative in 315 (45.6%) cases, and unknown in 146 (21.1%) cases. Postexposure prophylaxis was given in 206 (29.8%) cases. In terms of HIV seroconversion, only 172 (27.3%) out of 629 cases reported back negative results for anti-HIV at the 6 month follow-up. Conclusion : Occupational exposure to HIV at Siriraj Hospital occurred most frequently among nurses, medical students, and externs as needlestick or sharps injuries on medical wards. According to our data up to this time, no one seroconverted or claimed compensation for work-related HIV infection.