Brucellosis: the first case of King Chulalongkorn Memorial Hospital and review of the literature.

Brucellosis remains a major zoonotic disease worldwide. It has never been reported at King Chulalongkorn Memorial Hospital (KCMH). The authors describe the first case of brucellosis in KCMH, and also review all previous reports in Thailand. The presented case was a 52-year-old Thai man, living in Phetchabun Province, who was diagnosed with idiopathic pulmonary fibrosis two years prior to admission. He presented with prolonged fever, dry cough, weight loss of eight kg over three months, hepatosplenomegaly, and pancytopenia. Blood and bone marrow cultures grew Brucella melitensis at 72 hours of incubation. A slide agglutination (Rose Bengal) test was also positive for Brucella antibody. He had been exposed to contaminated placenta of his goats that had spontaneous abortion in the past few months before his illness. The patient was successfully treated with gentamicin, doxycycline, and rifampicin. Clinicians should have a high index of suspicion when evaluating patients presenting with prolonged fever and having an exposure risk of brucellosis.

Streptococcus suis meningitis in Thailand.

Streptococcus suis may be the second most common cause of adult streptococcal meningitis. The clinical and epidemiological data of S. suis meningitis are occasionally reviewed. To date, there have been only two large case series from Hong Kong and the Netherlands. We describe twelve cases of S. suis meningitis who were admitted to Chulalongkorn University Hospital, Bangkok, during a 6-year period between 1997 and 2002. A comparative review of case reports of S. suis meningitis in Thailand, Hong Kong, and the Netherlands is presented and revealed no significant differences between the three series. However, the cases from Thailand and Hong Kong had a significantly greater number of associated skin and soft tissue infections. Clinically, S. suis meningitis may appear acute or with a more chronic course.

Comparison of different culture methods on bacterial recovery in hemodialysis fluids.

To examine the culture method that could provide the highest bacterial recovery, 143 reverse osmosis water samples used in hemodialysis were collected for comparison of the media (Tryptic Soy Agar, TSA vs Reasoner's 2A Agar, R2A), the temperature (20 degrees C vs 37 degrees C), the duration of incubation (48-hour vs 7-day), and the culture technique (membrane filtration vs spread plate methods). The European Best Practice Guideline method, R2A at 20 degrees Cfor 7-day incubation provided higher bacterial recovery than the Association for the Advancement of Medical Instrumentation (AAMI) method, TSA at 37 degrees C for 48-hour incubation. The membrane filtration method gave better yield than the spread plate method. As such, the European Best Practice Guideline method in combination with the membrane filtration technique would be the culture method of choice for hemodialysis fluids.

Vancomycin-resistant enterococci in King Chulalongkorn Memorial Hospital: a 5-year study.

The emergence of hospital acquired infections with bacteria resistant to antimicrobials such as vancomycin resistant enterococci (VRE) has become a worldwide concern. The authors studied the prevalence and surveillance of 5 years study of VRE in King Chulalongkon Memorial Hospital and phenotype of these resistance strains. A total of enterococci 1854 isolates were collected from clinical specimens from 1995 to 1999. Screening vancomycin resistance was identified by the agar plated method and minimal inhibitory concentration (MIC) of vancomycin was determined for vancomycin-resistance strains by E-test. The results demonstated that 15 (0.81%) VRE were isolated from 1,854 specimens. Fourteen VRE were identified as Enterococcus faecium and one strain was Enterococcus faecalis. All of these strains, carrying the VanB phenotype, were susceptible to teicoplanin. Similar to other studies, most VRE strains are E. faecium. To the authors' knowledge, this is the first VRE study carried out in King Chulalongkorn Memorial Hospital. The results showed a low prevalence of VRE and surveillance of 5 years study demonstated a gradual increase of VRE. Therefore, it is important to continue periodic surveys of VRE to prevent the spread of VRE in hospitals.

Emm types of invasive group A streptococcal isolates from Thai patients at King Chulalongkorn Memorial Hospital from 1995-1999.

Emm (M protein gene) typing was used to analyze group A streptococcal (GAS) clinical isolates in Thailand from in-patients at Chulalongkorn University Hospital (CUH) between January 1, 1995 and December 31, 1999. Forty GAS isolates were recovered from blood and other sterile sites from 40 patients presenting with different types of infections. A variety of emm sequences (24 types) have been reported in this study including the identification of 2 novel emm variants demonstrating the diverse population of invasive GAS isolates in Thailand. The common emm types include emm1 (5 isolates, 12.5%), emm22 (4 isolates, 10%), emm25 (3 isolates, 7.5%), emm61 (3 isolates, 7.5%), and STNS1033 (3 isolates, 7.5%). No particular emm types of GAS tend to be frequently associated with specific clinical presentation, complication, or anatomic site of infection. This report provides epidemiological information from Thailand where streptococcal infections and their sequelae are important public health problems. In addition, the results are useful for the development of a suitable M protein based vaccine in the future.

Streptococcus suis infection in Thailand.

This is a retrospective study of Streptococcus suis infection in humans submitted to the National Streptococcal Referrence Center of Thailand from 1994 to 2001. There were 11 men and 6 women whose mean age was 46.24 years (range 1 month to 75 years). Among the men, two had known occupational and behavioral exposure to pork or meat products. Among the women, one was a butcher and three were housewives. Half of the patients had underlying diseases. One patient had congenital hydrocephalus, three patients had rheumatic heart disease and three were alcoholics. Two of these patients had a history of skin injury before infection. Nine patients had evidence of acute bacterial meningitis, four patients had infective endocarditis, two had the sepsis syndrome and two suffered from pneumonia and spontaneous bacterial peritonitis. The authors suspected that many cases are not reported particularly where pig-rearing or pork consumption are common. In the absence of an effective vaccine, prevention by public health surveillance is important. Prompt treatment of any cuts and wounds among pork-handlers is a sensible precaution. Furthermore, a high index of suspicion and early detection in order to identify and apply effective antimicrobial agents is necessary to successfully treat S. suis infection.

Inhibitory effect of Lactobacillus acidophilus on Helicobacter pylori in peptic ulcer patients: in vitro study.

Lactobacillus acidophilus (L. acidophilus) have been introduced into many fermented dairy products. The presence of L. acidophilus appears to decrease Helicobacter pylori (H. pylori) density in the human stomach and could enhance antibiotic therapy for H. pylori eradication. This study was designed to determine the optimal density of L. acidophilus that has a maximum inhibitory effect on H. pylori in peptic ulcer patients. To determine whether L. acidophilus has an inhibitory effect on H. pylori isolated from peptic ulcer patients and to determine whether the optimal density of L. acidophilus has a maximum inhibitory effect on H. pylori isolated from peptic ulcer patients. H. pylori was isolated from gastric biopsy specimens of peptic ulcer patients. The suspension of pure H. pylori colonies were inoculated into the broth and adjusted to match the density of No.3 MacFarland standard (approximately 9x10(8) cells/ml). Forty microliters of the suspension were equally spread onto each quadrant of the plate and left to dry. L. acidophilus was prepared from LC-1 (Nestle Research Center, Switzerland). They were grown on blood agar and incubated overnight at 37 degrees C. The suspension of L. acidophilus was inoculated into the broth and adjusted to match the density of No.1, No.2, No.3 and No.4 MacFarland standard (approximately 3x10(8), 6x10(8), 9x10(8) and 12x10(8) cells/ml respectively). Ten microliters of each density of L. acidophilus was dropped onto each quadrant of a previously inoculated H. pylori plate and then the plate was kept under microaerophilic conditions for 72 hours. Inhibition clear halo zone of H. pylori around the colonies of L. acidophilus was interpreted as the inhibitory effect. H. pylori were isolated from gastric biopsy specimens of fifteen peptic ulcer patients (eleven patients with gastric ulcer and four patients with duodenal ulcer). A total of sixty tests of inhibitory effect of L. acidophilus on H. pylori were evaluated in the present study. L. acidophilus had inhibitory effect on H. pylori in 13/15 patients (86.67%) and L. acidophilus in the density of No.3 MacFarland standard had a significantly higher inhibitory effect on H. pylori in the density of No.3 MacFarland than that of No.1 (60% vs 20%; p<0.05), No.2 (60% vs 20%; p<0.05) and No.4 (60% vs 20%; p<0.05) MacFarland standard. In conclusion, L. acidophilus has an inhibitory effect on H. pylori isolated from peptic ulcer patients. Approximately an equal density of L. acidophilus on H. pylori has the most favorable effect. This optimal density of L. acidophilus should have maximum effect on H. pylori clearance and could enhance antibiotic therapy for H. pylori eradication in humans.

Duodenal Helicobacter pylori associated duodenal ulcer depend on gastric Helicobacter pylori status.

Gastric Helicobacter pylori (H. pylon) plays an important role in the pathogenesis of duodenal ulcer (DU), although not all H. pylori infected persons will develop disease. Duodenal H. pylori was supposed to be one of the factors related with DU. The aim of this study was to investigate whether H. pylori in the duodenum of patients with DU plays a critical role in the pathogenesis of DU regarding the gastric H. pylori status. Furthermore, it was to determine the prevalence of duodenal H. pylori infection in Thailand. Ninety three patients were included in the study. They underwent gastroscopic evaluation for dyspeptic symptoms and none of them had previous H. pylori eradication therapy. An upper gastrointestinal endoscopy was performed and two specimens were collected each form the antrum, midcorpus and duodenal bulb in order to diagnose H. pylori infection. The gold standard for H. pylori detection is a positive specimen culture or polymerase chain reaction (PCR) assay for the vac A gene or positive urease test plus H. pylori seen in the pathology. Ninety three dyspeptic patients (43 males and 50 females; mean age 48.2 years; range 22 to 79 years) were included in the study. Duodenal H. pylori was detected in 31/93 (33.33%) patients which included 15 (48.38%) patients with duodenal ulcer, 2 (6.45%) patients with gastric ulcer and 14 (45.16%) patients with NUD. Five of thirty one (16.21%) patients with duodenal H. pylori infection had negative gastric H. pylori. These five patients included 1 with DU, 1 with DU and 3 with NUD. Duodenal H. pylori was associated with DU dependent of the presence of gastric H. pylori (p<0.05) and there was no association between duodenal H. pylori with negative gastric H. pylori and duodenal ulcer (p>0.05). Duodenal H. pylori is associated with duodenal ulcer dependent on the presence of gastric H. pylori. These results suggest that transmission of gastric H. pylori to the duodenum was prerequisited for the formation of DU.

Detection of antibody in serum and secretion for the diagnosis of Helicobacter pylori infection.

Helicobacter pylori plays a major role in chronic gastritis and peptic ulcer. In addition, it has been shown to be associated with gastric carcinoma. In this study, the authors compared the detection of IgG antibodies specific to H. pylori by enzyme-immunoassay with culture, histology and a CLO test as tools for diagnosis of H. pylori infection. If the criteria that patients will be considered as H. pylori infected only when their samples are positive by culture or CLO test and histology were used, the sensitivity and specificity of detecting IgG in sera were 96.84 and 72.04 per cent respectively. The use of serological test will be useful as a screening test for H. pylori infection without the need of endoscopy. The authors also performed the assay for detecting IgA antibodies in saliva and gastric juice. The sensitivity and specificity of IgA detection in saliva were 26.79 per oent and 75.00 per cent. As for the assay in gastric juice, although the specificity was as high as 91.67 per cent, the sensitivity is very low (22.22%).

Outbreak of uncommon type of group A streptococcal pharyngitis among cadets at the Chulachomklao Royal Military Academy, Nakhon Nayok, Thailand.

A large outbreak of group A Streptococcus (GAS) pharyngitis occurred among 285 cadets at the Chulachomklao Royal Military Academy, Nakhon Nayok between September 22 and 27, 1996. An epidemiologic investigation was conducted to determine the source of infection. It seemed that respiratory droplets were the mechanism of spread, although foodborne transmission could not be excluded. To assess the presence of the outbreak strain in the community, conventional serotyping and molecular typing by emm sequencing were performed. The results demonstrated the advantage of molecular typing compared to serotyping and suggested that the outbreak was caused by the same strain. Interestingly, the involvement of the causative emm79 strain, which is an uncommon type of GAS disease, in a large number of patients may imply the invasive potential of this organism.

Evaluation of inhouse rapid urease test for detection of Helicobacter pylori from gastric biopsy specimens.

Inhouse rapid urease test for detecting Helicobacter pylori was evaluated. Biopsy specimens were taken for inhouse urease test, commercial rapid urease CLO test, culture, gram stain and histology from the antrium or duodenum of patients who had peptic ulcer. The culture and/or histologic examination and CLO test were used as the gold standard. One hundred and twelve specimens were evaluated. The sensitivity and specificity of the inhouse urease test was 100 per cent and 90 per cent respectively. The inhouse urease test was suitable for detecting Helicobacter pylori from gastric antral biopsy specimens. The medium can be kept in a refrigerator for up to 6 months.