Evaluation of a newly developed dipstick test for the rapid diagnosis of scrub typhus in febrile patients.

Scrub typhus is a potentially fatal, febrile disease prevalent in rural Asia. The etiological agent, Orientia tsutsugamushi, is transmitted to humans by the bite of a larval trombiculid mite. No current diagnostic test is sufficiently practical for use by physicians working in rural areas. A new dipstick test using a dot blot immunoassay format has been developed for the serodiagnosis of scrub typhus. We evaluated this test on 83 patients presenting with acute fever of unknown origin at Maharaj Hospital, a tertiary care medical center in Nakhon Ratchasima, Northeast Thailand. The diagnosis of scrub typhus was confirmed in 30 of these patients (36%) by the indirect immunoperoxidase test. The sensitivity of the test was 87% and its specificity was 94%. The dot blot immunoassay dipstick is accurate, rapid, easy to use, and relatively inexpensive. It appears to be the best currently available test for diagnosing scrub typhus in rural areas where this disease predominates.

Scoring systems for predicting outcomes of critically ill patients in northeastern Thailand.

The Acute Physiology and Chronic Health Evaluation System (APACHE) III, the APACHE II, the Simplified Acute Physiology Score (SAPS), and the Therapeutic Intervention Scoring System (TISS), calculated within the first 24 hours of admission, were compared in 209 critically ill patients admitted to the regional hospital in northeastern Thailand. Eighty-five (40.7%) patients subsequently died. The nonsurvivors had significantly higher APACHE III, APACHE II, SAPS and TISS scores than the survivors. ROC curves drawn for each severity index were in a discriminating position. There were no significant differences either among the areas under the ROC curves drawn for APACHE III, APACHE II, SAPS, and TISS, or among the overall accuracies of these indices. All four scoring system correlated well with the short-term prognosis, ie the mortality outcome, of critically ill patients. APACHE III, APACHE II, SAPS, and TISS appeared to be comparable to predictors of severity of critical illness. Selection of a severity indicator will depend on the resources available.

Helicobacter pylori prevalence in northeastern Thailand.

Helicobacter pylori is distributed worldwide and has been demonstrated in Thailand. However, no study has been conducted so far in northeastern Thailand. The objective of this study was to find the prevalence of H. pylori in patients undergoing upper gastrointestinal endoscopy in northeastern part of Thailand. One hundred and twenty-six patients undergoing surgery between November 1992 and January 1993 were studied. Biopsies were done at antrum, corpus, and other positive lesions. Diagnostic tests of H. pylori by using CLO test, microbiological tests (Gram stain and culture), and histological examination (hematoxylin and eosin) were carried out. The prevalence of H. pylori by CLO test, Gram stain, culture, and histology were 49.2%, 61.9%, 22.2%, and 45.2% respectively. The overall prevalence of H. pylori by all diagnostic tests was 73.8% (95% confidence interval = 66.1-81.5%). This study revealed a high prevalence rate of H. pylori in patients which should alert clinicians who practice in this geographical area.