Cryptococcal meningoradiculitis: an atypical presentation after initiation of antiretroviral therapy.

Atypical presentations of cryptococcal infection have been described as clinical manifestations of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients following commence of antiretroviral therapy (ART). The authors describe a patient presenting with cryptococcal meningoradiculitis two weeks after initiation of ART. In patients with advanced HIV disease, immune reconstitution induced by ART can precipitate onset of atypical clinical manifestations in those patients with latent cryptococcal infection of the central nervous system.

Incidence and time trend of surgical site infection in Ramathibodi Hospital during the years 2003-2005.

OBJECTIVE: To determine the incidence of surgical site infection (SSI) for high-risk surgical procedures and any changes in the incidence of SSI during the years 2003 to 2005. MATERIAL AND METHOD: SSI surveillance data were obtained from Ramathobodi's Infection Control Committee for analysis. RESULTS: The overall 30-day incidence of SSI for 492 hepato-biliary-pancreas and colon procedures was 7.7% (38 of 492). Of the 38 SSIs, only 35 were analyzed in detail. MosI patients had SSI types I and II, 89% of SSIs were detected within 20 days after operation, and most common organisms isolated were enterococcus species, E.coli, and P. aeruginosa. SSI rate for the year 2005 (11%) was significantly higher than that of the preceding years (4-5%). CONCLUSION: Overall, SSI rates for Ramathibodi Hospital were not significantly different from those of other studies. The increased SSI rate for the year 2005 needed an explanation, but the value of the present report lies in the potential usefulness of the presented results for future prevention of SSIs. years (4-5%). CONCLUSION: Overall, SSI rates for Ramathibodi Hospital were not significantly different from those of other studies. The increased SSI rate for the year 2005 needed an explanation, but the value of the present report lies in the potential usefulness of the presented results for future prevention of SSIs.

Lipodystrophy and dyslipidemia in human immunodeficiency virus-infected Thai patients receiving antiretroviral therapy.

BACKGROUND: Lipodystrophy and dyslipidemia are increasing problems in HIV-infected patients receiving antiretroviral therapy (ART). OBJECTIVE: Determine the prevalence and predicting factors for lipodystrophy and dyslipidemia in these patients. MATERIAL AND METHOD: A cross-sectional study was performed on HIV-infected patients receiving ART in January 2006. Clinical assessment for lipodystrophy and blood tests for lipid profile were obtained. RESULTS: There were 56 patients with a mean age of 42.3 years and 71.4% were male. Lipodystrophy was detected in 66.1%. Baseline characteristics between patients with and without lipodystrophy were similar except for age, history of receiving d4T and undetectable HIV-RNA (p < 0. 05). There was a high prevalence of dyslipidemia (53.6%). By logistic regression, undetectable HIV-RNA (odds ratio (OR) 6.4, p = 0.016) and receiving d4T (OR 7.4, p = 0.022) are predicting factors for lipodystrophy. CONCLUSION: Lipodystrophy and dyslipidemia in HIV-infected Thai patients receiving ART are common. Clinical monitoring for these abnormalities during ART is highly recommended.

Use of HIV Postexposure Prophylaxis in healthcare workers after occupational exposure: a Thai university hospital setting.

BACKGROUND: PostExposure Prophylaxis (PEP) is widely used after exposures to Human Immunodeficiency Virus (HIV) to reduce the risk of infection in the healthcare setting. Few data are available on the safety and tolerability of Anti Retro Viral drugs (ARV) among Health Care Workers (HCWs) who are prescribed prophylaxis. OBJECTIVE: To collect information about the safety and compliance of taking ARV for HIV PEP among HCWs. MATERIAL AND METHOD: Retrospective review on registry data regarding occupational HIV exposures, the PEP regimens used, and the adverse events associated with PEP was performed. RESULTS: During a five year-period, 820 episodes with occupational blood or body fluid exposures were reported Nurses (27%) were the largest group at risk. The most common type of exposure was percutaneous injuries (82%). Only 125 (15%) HCWs had occupational exposures to HIV, 64 HCWs were prescribed HIV PEP and 32 (50%) HCWs did not complete the PEP regimen as initially prescribed. The commonly prescribed ARV was zidovudine (38%), lamivudine (33%), and indinavir (11%). Overall, 18 (28%) HCWs reported symptoms while on PEP such as nausea (89%), vomiting (55%), and dizziness (39%). None of the HCWs had HIV seroconversion. CONCLUSIONS: Adverse effects from HIV PEP were very common. Clinicians prescribing HIV PEP need to discuss with HCWs about PEP efficacy and side effects. Education efforts aimed at occupational exposure prevention are still important issues.

Case report: Brucellosis: a re-emerging disease in Thailand.

Brucellosis is a zoonotic disease prevalent in many countries, but it has been reported only once in Thailand, 36 years ago. We describe here two consecutive cases of brucellosis in Bangkok, Thailand. Both cases presented with prolonged fever and weight loss. Blood cultures taken from 2 patients yielded Brucella melitensis. The slide agglutination test of blood samples were also positive, with a titer of 1:64 for antibodies to Brucella. The first patient responded to a combination of doxycycline, gentamicin, and ciprofloxacin; the other responded to doxycycline and rifampicin. Brucellosis is a potential public health threat, therefore, preventive measures should be actively implemented. This clinical syndrome should be included in the differential diagnosis of patients presenting with prolonged fever, particularly those with contact to animals which could serve as reservoirs.

Utilization of restricted antibiotics in a university hospital in Thailand.

Antibiotic resistance, a major negative consequence of antibiotic overuse, is an important problem worldwide. Various means have been used to control antibiotic usage including the use of an antibiotic order form (AOF), restricted antibiotic formularies and provision of educational information. The present study was designed to evaluate the use of antimicrobials in a 1,000-bed university hospital. Antimicrobial agents, likely to be abused namely ceftazidime, cefepime, cefoperazone/sulbactam, imipenem/cilastatin, meropenem, ciprofloxacin, netilmicin, vancomycin, azithromycin and clarithromycin, were selected for evaluation. A simple AOF with educational information was used as a mean to follow up the treatment. The investigator collected data from the filled AOF and the patient's charts of the Department of Internal Medicine from June to November 2000; all relevant data were assessed. The appropriateness of antibiotic use, assessed according to the criteria specified in the AOF, showed that 74% of these antibiotics were prescribed appropriately; this may prove the effectiveness of the system used in the present study. However, 348 of the 430 prescriptions (80.9%) were prescribed empirically at the initial stage for treatment of nosocomial infections in patients with serious conditions like pneumonia, sepsis and febrile neutropenia. Drugs that were frequently used empirically were ceftazidime (37.9%), imipenem/cilastatin or meropenem (19.3%), and cefoperazone/sulbactam (12.1%) respectively. Ceftazidime and imipenem/cilastatin or meropenem were also frequently used inappropriately among 111 prescriptions that were classified as an inappropriate prescribing. The most common misuses were prescriptions of the drug that did not follow the specified indications (70 prescriptions), no dosage adjustment in patients with renal impairment (39 prescriptions), improper dose (12 prescriptions) and improper dosing interval (9 prescriptions). The results suggested overuse of certain antibiotics remain to be an unsolved problem. Better monitoring and strict controlled use of the problematic antibiotics, ie ceftazidime, imipenem/cilastatin or meropenem and vancomycin are essential to promote rational drug use as well as to reduce the frequency of drug resistance.