Cystic fibrosis in three northeast Thai infants is CF really a rare disease in the Thai population?

The authors report on three infants with cystic fibrosis (CF), with different genotypes, presenting with different clinical manifestations, but having similar abnormal serum electrolytes (i.e. hyponatremia, severe hypochloremia and metabolic alkalosis). Despite the diagnostic investigations, the child who presents with severe electrolyte imbalance especially persistent hypochloremia and a family history of early infant death with respiratory or gastrointestinal problems should point to a diagnosis of CF Early identification and treatment remain critical to effective management. The diagnostic tool used, especially the sweat test, is needed for diagnostic investigations in Thailand.

Salmonellosis and the food chain in Khon Kaen, northeastern Thailand.

Non-typhoidal salmonellosis is a major cause of food-borne illness in Thailand. Specific serotyping of Salmonellae, linked with certain foods, can be used to identify outbreaks, transmission, and for surveillance. We aimed to identify the chain of non-typhoidal Salmonella transmission from food to humans in five slums, two open markets, four supermarkets and an abattoir in the municipality of Khon Kaen. During three months representing the cool-dry, hot-dry, and rainy seasons of 2002, culture samples were collected from water, food, pork, and chicken. Stool cultures of food venders, and others in the same area, were performed. Serological typing was done by the WHO National Salmonella and Shigella Center in Thailand. Of the food, drinking water, and stool samples from food handlers and healthy persons, 18, 7, 11, and 5%, respectively, were positive for Salmonella. Nearly all (96-98%) of the fresh pork and chicken, both from the open markets and supermarkets, were positive for Salmonella. The major Salmonella serovars were S. Anatum, S. Rissen, S. Virchow, S. Enteritidis and S. Panama, similar throughout the food chain and to the other reports that year. To reduce the incidence of human salmonellosis, several preventative measures must be taken where animals are produced, slaughtered and processed, and at home and in eateries. Vulnerable groups, such as infants, the elderly and the immuno-compromised, should be made aware of their increased susceptibility to food-borne disease.

Aortoesophageal fistula: a life-threatening cause of upper gastrointestinal hemorrhage in double aortic arch, a case report.

The authors present the case of a 2-month-old infant with double aortic arch that developed massive bright red upper gastrointestinal hemorrhage from aortoesophageal fistula (AEF) after prolonged endotracheal and nasogastric intubation. Emergency thoracotomy with AEF and double aortic arch repaired were done successfully under cardiopulmonary bypass. Due to tracheomalacia and left phrenic nerve injury, tracheal extubation could not be done until 1 month after correction of the vascular ring. The endotracheal and nasogastric tube led to fistula formation by compression of the esophageal wall against an abnormal double aortic arch. When a double aortic arch is suspected, prolonged nasogastric intubation should be avoided.

Flexibility in the administration schedule of varicella vaccination in healthy adolescents and young adults.

A clinical trial to assess the immunogenicity and reactogenicity of two doses of varicella vaccine (live attenuated Oka-strain, GlaxoSmithKline Biologicals), when either given 8 or 4 weeks apart in healthy seronegative adolescents and young adults, was conducted in Khon Kaen and Bangkok, Thailand. Contrary to seroconversion rates generally reported for this age group, in our study all subjects were already seropositive after the first vaccine dose. After the first vaccine dose, geometric mean titers (GMTs) for anti-varicella antibodies were 78.4 (median 64) for the adolescent group and 136.5 (median 128) for the young adult group. Six weeks after administration of the second dose, anti-varicella GMTs reached 331.7 (median 256) and 636.9 (median 512) for the adolescent and young adult groups, respectively, with a 4.2-4.7-fold increase from pre-vaccination titers. The difference in GMTs between post-dose I and dose II was statistically significant for each group. The reactogenicity after the first and second doses of vaccination was low: no varicella rash was seen, in either the shorter or longer schedule. GlaxoSmithKline Biologicals varicella vaccine (Varilix) offered a high flexibility, administration possible at either 4 or 8 weeks interval, whilst eliciting good immunogenicity and good tolerability.