Measles in Thai adults: three case reports and management of contact cases.

We report on three adults (one nurse and two medical students) diagnosed as having measles. All the patients presented with fever, cough, conjunctival injection and rash. They contracted measles from pediatric patients who had been treated at Chulalongkorn Hospital in the previous two weeks. Physical examination revealed Koplik's spots on the oral mucosa and typical maculopapular rash. The diagnosis was confirmed by viral isolation. Measles IgG antibodies were measured in 36 medical students who were in close contact with patient 2 and measles vaccines were given. Thirty-three specimens had positive measles IgG, two had equivocal results and one had negative result. The student with negative measles IgG eventually developed measles (patient 3). Except for patient 2 and 3, no further cases of measles were seen among the contacts.

Parvovirus B19 antibodies in immunocompromized children in Thailand.

Parvovirus B19, a non-enveloped single stranded DNA virus is distributed worldwide. Sero-prevalence in adult populations amounts to approximately 50%. Clinical manifestations vary depending on the Immune status of the infected individuals and may include mild childhood Infection as well as hydrops fetalis due to intrauterine infection. To determine the prevalence of this infection among the immunocompromized individuals in Thailand, we determined, by indirect ELISA, levels of IgM and IgG antibodies to the parvovirus B19 in 106 immunocompromized children. These included 49 children who were on chemotherapy for treatment of malignancies, 18 who were receiving immunosuppressive drugs after organ transplantations, 14 who were under a regimen of corticosteroids and 25 who were positive for antibodies to HIV. The average prevalence of IgG antibodies in 106 children was 16.0%; the prevalence of antibodies was 33.3% in post-transplanted group, 16% in children positive for HIV, 12.2% in the group receiving chemotherapy for malignancies and 7.6% in the group treated with corticosteroids. All children were negative for IgM antibodies to parvovirus B19.

Cytomegalovirus infection in immunocompromised children in Thailand.

Cytomegalovirus (CMV) constitutes the most widespread cause of congenital and perinatal viral infections on a global scale, exceeding a 90%-prevalence among blood donors in Thailand. The present study was aimed at determining the prevalence of CMV in the sera of 113 immunocompromised children by means of serology, as well as polymerase chain reaction using nested primers. Our results showed anti-CMV IgG, i.e. latent infection, prevalent in an age-dependent manner irrespective of the disorder underlying the children's immunocompromised condition, whereas anti-CMV IgM was equally prevalent throughout all age groups and disease patterns and, therefore, unreliable as a marker. Detection of serum CMV DNA by PCR represented the most exact diagnostic parameter by far, indicating active infection long before clinical symptoms may appear. In conclusion, based on the high prevalence of latent CMV infection among the general population in Thailand, we recommend especially the sera of immunocompromised patients be examined for the presence of viral DNA by means of PCR in order to provide clinical guidelines for their proper management.

Chlamydia pneumoniae infection in Thai children: serological diagnosis.

Recent Chlamydia pneumoniae infections were investigated in children with respiratory tract infections and in normal children. Four groups of sera were tested for C. pneumoniae antibody IgG and IgM serum fraction by the method of MIF test. A total of 7 cases of recent infection were detected, 3 of 116 with pneumonia, 3 of 123 with other respiratory tract infections, 1 of 263 normal school children and none in sera from cord blood. The cases with recent C. pneumoniae infection were as young as 24 days and 2 months old.

Risk factors of streptococcal colonization in school age children.

We studied the factors influencing the colonization of Streptococcus in school age children aged 6-11 years from 2 low socioeconomic schools of the Bangkok Metropolitan area. 4,055 throat swab cultures were performed. Beta hemolytic Streptococcus (BHS) and beta hemolytic Streptococcus group A (BHSA) were isolated in 1,747 (43%) and 744 (18%) respectively. 1,547 questionnaires were returned from the children. Of these, 750 and 570 were found to have BHS and BHSA in the throat, respectively. Among the risk factors, considered, teeth brushing of one time or none per day was significant for BHS positive in the throat as compared with the BHS negative group, while personal hygiene such as sharing glass with other, playing in dirty water, poor housing sanitation and low family income was significantly associated with the BHSA positive group. With the combination of certain clinical manifestations, these factors may increase the accuracy of predicting streptococcal infection.

Systemic Haemophilus influenzae disease in Thai children.

Fifty patients with systemic Haemophilus influenzae disease were indentified by hospital chart review between 1980-1992. The age distribution varied from 8 days to 14 years; the mean age of the patients was 12.7 months. The peak incidence was between 4 and 6 months of age. There were 27 male patients and 23 female patients for a male:female ratio of 1.17:1. The relative frequencies of 79 clinical entities encountered in 50 patients are as follows: meningitis 55.7%, bacteremia 13.9%, pneumonia 25.3%, cellulitis 2.5% arthritis 1.3%, septic shock 1.3%. There were 23 patients (46%) who had more than one disease entity. Most of the patients were anemic (Hb < 10 gm%) when hospitalization. Sixty-four percent of the patients had early complications. The mortality rate was 8%. Although serotyping was not done from the isolates, at least 33 cerebrospinal fluid samples were positive for H. influenzae type b capsular antigen by counterimmunoelectrophoresis. The percentage of susceptible H. influenzae to penicillin, ampicillin, chloramphenicol, co-trimoxazole were 57.1%, 76.4%, 87.5% and 54.2%, respectively. There was no strain resistant to third generation cephalosporin. Our data indicate that H. influenzae is a serious and life threatening infection. Early diagnosis and proper treatment will reduce the morbidity and mortality rates. For prevention of infection, an appropriate strategy for vaccination is required.

Prevalence of complement fixing antibody to Mycoplasma pneumoniae in Thai children.

The prevalence of antibodies to Mycoplasma pneumoniae was determined in normal Thai children by means of complement fixation. There were 445 children (243 boys and 202 girls) of different ages, ranging from newborn to 15 years. The lowest frequency of complement-fixing antibody was found in children age 1-3 months, and highest in children age 6-10 years which corresponds to the age distribution of symptomatic M. pneumoniae infection. The lowest and highest titers measured were less than 1:8 and 1:512 respectively. The prevalence of complement fixing antibody of titers more than or equal to 1:8, 1:32, 1:64 and 1:128 were 61.3, 31.7, 25.4 and 10.3 per cent of total children, respectively. Among children less than one month old, the frequency of complement fixing antibody of titers greater than or equal to 1:32 was 12.2 per cent and decreased to 1.3 per cent among children from the age 1-3 months. This decrease probably represented the disappearance of maternal antibody over this period. An increase in both the frequency and the geometric mean titer was seen thereafter. The peak frequency of high titers (greater than or equal to 1:32), 81.1 per cent, occurred in children 6-10 year of age. Paired sera were obtained from 72 children with high titers of greater than or equal to 1:64, 9.7 per cent had four fold changes of titer which indicated recent infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Group A beta-hemolytic streptococcal type M11 sepsis and empyema: a case report.

A case of serious suppurative disease caused by GABHS in a previously well 2-month-old Thai female presenting with clinical features of sepsis and right pleural effusion was reported. Treatment was initially with cloxacillin and a right side intercostal drainage. When subsequent cultures of blood and pleural fluid grew GABHS; intravenous penicillin was substituted. She made an uneventful recovery. Typing of the GABHS revealed non typable T-antigen and M-protein 11 GABHS, although very sensitive to penicillin, can cause severe and rapidly progressive disease in a very young infant. This is the first case of GABHS type M11 causing pleural effusion and sepsis in an infant ever reported in Thailand. Epidemiologic study might be indicated if an epidemic should occur.

Concomitant disseminated varicella and generalized staphylococcal scalded skin syndrome in a leukemic patient.

We report a case of nosocomial fatal varicella infection in a 13-year-old boy with acute lymphoblastic leukemia complicated with staphylococcal scalded skin syndrome. His underlying leukemia, immunosuppressive drugs, disseminated varicella, S. aureus colonization, and acute renal insufficiency were all contributing factors that were pathogenetically linked in the development of his generalized SSSS.