Visceral leishmaniasis caused by Leishmania infantum in Thailand.

Thailand is considered as a non-endemic area for leishmaniasis. We report the first case of visceral leishmaniasis caused by Leishmania infantum in a Thai man living in Bangkok.

Genetic diversity of Pneumocystis jirovecii in Thailand.

A fungus Pneumocystis jirovecii, which causes a diffuse bilateral pneumonia called Pneumocystis pneumonia (PcP) is one of the most common opportunistic infections in HIV-infected patients in Thailand. Molecular techniques have demonstrated diversity among isolates of P. jirovecii by comparison of DNA-sequence variation at the internal transcribed spacer region 1 (ITS1) and region 2 (ITS2) of the nuclear ribosomal RNA genes. The studies confirm that a high diversity of P. jirovecii ITS types exists in different populations from different geographical areas. Type Eg is found globally from represent countries in Europe, North America, South Africa and Asia. Among the 23 types of P. jirovecii observed in Thailand, type Ir is present at the highest frequency (28.6 %), followed by type Eb (21.4%) and types Eg and Rp (14.3 %), respectively. Ir and Rp are unique types observed in Thailand. Mixed infections of more than one types of P. jirovecii are commonly observed in all studies with prevalence of 25-82 %. Moreover, unique types of P. jirovecii can be found in a specific group of populations. These types may be used as genetic markers to study the evolution of the organism in each geographical area.

Teaching medical ethics: Phramongkutklao College of Medicine's model.

BACKGROUND: Third-year (first preclinical year) Royal Thai Army (RTA) medical cadets were exposed to a rural community in a community medicine field activity. The poor, kind rural people gave good conditions for student's professional development and empathy. OBJECTIVES: To report a community medicine field work activity for professional development of the RTA medical school. MATERIAL AND METHOD: Descriptive analysis on two occasions to evaluate the third-year RTA medical cadets' impressions immediately after the community medicine field activity in a rural area in central Thailand and one year later using baseline scores of cadets' impressions against our institute's objectives. RESULTS: At the end of the field work, 90.9% of the cadets reported they achieved several institute objectives. The four most frequent mentioned were ethical development (70.6%), professionalism (84.3%), human relationship & communication skills (92.2%), and capability to work in the cmmunity (64.7%). Furthermore, RTA medical cadets rated the staff as good role models (51%). CONCLUSION: The community field work course provided a good environment for the third year medical cadets in building morality and professional development to be good doctors.

Pneumocystis jiroveci in HIV/AIDS patients: detection by FTA filter paper together with PCR in noninvasive induced sputum specimens.

OBJECTIVES: To detect P. jiroveci (previously named P. carinii) by PCR using FTA filter paper to extract the DNA, from noninvasive induced sputum samples of HIV/AIDS patients. MATERIAL AND METHOD: Fifty two HIV/AIDS patients suspected of Pneumocystis jiroveci pneumonia (PJP) in King Chulalongkorn Memorial Hospital were recruited. Both cytological method and PCR with FTA filter paper technique were performed to detect P jiroveci from each specimen. RESULTS: The detectability rate of P. jiroveci infection was 21%. The PCR with FTA filter paper method was 4 folds much more sensitive than Giemsa staining technique. P. jiroveci was detected in 18% of the HIV/AIDS patients in spite of receiving standard PJP prophylaxis. CONCLUSION: Detection of P. jiroveci by using FTA filter paper together with PCR in induced sputum samples could detect more cases of P. jiroveci infection than by using cytological method. DNA extraction using the FTA filter paper was more rapid and convenient than other extraction methods. The causes of failure of PJP prophylaxis should be evaluated.