Dengue infection-associated brachial plexopathy: Report of the fi rst case and review of the literature

Brachial plexopathy is an uncommon neurologic disease which is associated with many conditions including infectious and non-infectious conditions. Many viral infections have been reported to be associated with brachial plexopathy. To the best of our knowledge, dengue infection-associated brachial plexopathy has never been reported in the literature. We report here a case of dengue infection complicated by bilateral brachial plexopathy, and also review all reported cases of viral infectionassociated brachial plexopathy in the English literature.

Risk factors for nosocomial infections caused by extended-spectrum β-lactamase producing Escherichia coli or Klebsiella pneumoniae in Thailand

Background and objective: Extended-spectrum β-lactamase (ESBL)-producing organisms have been reported among nosocomial pathogens. The objective of this study is to determine the risk factors for nosocomial infections in adults caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E-coli) or Klebsiella pneumoniae (K. pneumoniae) in regional and provincial government hospitals in Thailand.Methods: A nested case-control study was conducted, and the patients were enrolled between July 1 and December 31, 2007. We compared 288 patients with nosocomial infections caused by ESBL-producing E. coli or K. pneumoniae to 288 hospital-matched controls with nosocomial infections caused by non ESBL-producing E. coli or K. pneumoniae.Results: The independent risk factors associated with nosocomial infections caused by ESBL producing strains included Charlson comorbidity index (Odds ratio=1.18, 95% confidence interval (CI) =1.06-1.31, p-value=0.001) and previous third generation cephalosporin use (OR=4.82, 95% CI=3.23-7.21, p-value \< 0.001).Conclusion: This is the first nested case-control study regarding the risk factors of nosocomial infections caused by ESBL-producing organisms. The Charlson comorbidity index and previous third-generation cephalosporin use were the contributing factors of nosocomial infections caused by these organisms. An emphasis on appropriate use of the third-generation cephalosporins as well as effective infection control measures in patients with high comorbidity index are needed to reduce the incidence of nosocomial infections caused by these organisms.

Successful treatment of polyomavirus infection in kidney allograft recipients: case reports and literature review

Background: Polyomavirus nephropathy, also termed BK virus nephropathy, is an infectious complication after kidney transplantation, causing allograft failure. The state of immunosuppression of the patient is the principal risk for the infection. Most cases of BK virus nephropathy were associated with the use of potent immunosuppressive regimens like tacrolimus and mycophenolate mofetil. To the best of our knowledge, no patient with BK virus nephropathy has been reported in Southeast Asia.Objective: We report two cases of BK virus nephropathy in patients who received the immunosuppressive regimen of sirolimus with cyclosporine. We also review the literature regarding the pathogenesis, clinical manifestations, and treatment strategies.