Cutaneous manifestations in HIV positive patients.

Cutaneous manifestations are common clinical findings among HIV positive patients. The causes may be bacteria, viruses, fungi and other non-infectious agents. This study was conducted at the Pramongkutklao Hospital skin clinic to determine the frequency distribution of cutaneous manifestations in HIV positive patients. A total of 147 patients with HIV seropositivity were recruited and divided into a retrospective group and a prospective study group. For the retrospective study, hospital records of 129 patients who attended from January 1995 to November 1998 were recruited. The prospective study was carried out from November 1998 to January 1999 and 18 patients were recruited. Cutaneous finding among patients in the two studies were evaluated. There were ten common cutaneous manifestations observed in the retrospective and prospective study including pruritic papular eruptions (PPE) (51.2%, 50%), oral candidiasis (16.7%, 21.7%), herpes zoster (10.9%, 5.6%), oral hairy leukoplakia (10%, 5.6%), unclassified eczema (9%, 11.1%), urticaria (5.6%, 3.1%), seborrheic dermatitis (4.7%, 16.7%), folliculitis (4.7%, 5.6%), prurigo simplex (4.7%, 5.6%), and Steven-Johnson syndrome (3.9%, 0%). However, the distribution of cutaneous manifestations in the two studies were not significantly different. These findings may be useful as baseline data for common cutaneous manifestations in HIV positive patients.

Risk factors for chronic diseases among road sweepers in Bangkok.

The nutritional and health status of road sweepers in Bangkok was investigated. Fifty-seven males and one hundred thirty-four females from 10 districts were selected for the study. The districts were sampled as cluster at random. From each district selected about 50% of road sweepers volunteered to participate in the investigation. Through questionnaires the age, marital status, place of origin, drinking and smoking habits were assessed. Anthropometric measurements, blood pressure and the lipid profile of these subjects were determined. According to a physical check-up and X-rays taken, all individuals investigated were apparently healthy. The age of the study group varied between 26 and 57 years. The median for the males was 47 years and for the females 37.5 years. Almost all the road sweepers were married. Smoking and alcohol drinking was widespread. Over- and undernutrition was found among the group investigated. 26.3% of the males and 1.5% of the females were undernourished. According to their systolic values, 15.8% of the males and 6.7% of the females were suffering from hypertension, and 38.6% of the males and 15.7% of the females had hypertension according to their diastolic values. 58.2% of the females and 29.3% of the males were overnourished. 57.9% of the males and 59.7% of the females had cholesterol levels above 200 mg/dl. Pathological values of LDL cholesterol were determined in 26.3% of the males and 28.4% of the females. The habit of consuming tonic drinks was widespread among the workers. The study concluded that behavior risk factors are highly prevalent in the group of workers belonging to the lower socio-economic class. Further investigations are presently being undertaken to study the after-effects of air pollution among this group of workers. The results will be subsequently reported in future publications.

A randomized comparative study of albendazole and thiabendazole in chronic strongyloidiasis.

An open randomized study for comparing the efficacy of albendazole and thiabendazole in chronic strongyloidiasis was done in 1990-1992. All 35 patients with positive stool examinations for Strongyloides stercoralis were divided randomly into two groups. 23 patients (group A) received albendazole (400 mg twice daily for 5 days) and 12 patients (group B) received thiabendazole (1 g twice daily for 5 days). All patients except four patients in group A were admitted in the Hospital for Tropical Diseases for 21 days for monitoring side effects (D0-7) and stool examination (D0, D7, 8, 9, D21, 22, 23). Methods of stool examination included: direct microscopy of saline smear, formalin ether concentration, culture (Harada and Mori method) and larva count (Stool and Sasa method). Cure was defined as negative stool examination done at 21 days after medication by all above methods. The cure rate for group A was 95% (only one failed to clear the parasite at D21) and the cure rate for group B was 100%. But there was no statistical difference between the two. Mild changes of transminases observed in 5/23 patients who received albendazole, but none developed clinical hepatitis.

alpha 1-antitrypsin phenotype PiMZ, a risk factor for liver cirrhosis but not for liver cancers in Thailand.

The risk of developing liver cirrhosis, hepatoma (HCC) and bile duct carcinoma (BDC) have been associated with homozygous alpha 1-antitrypsin (AT) deficiency especially linked to the Z allele. While the association between liver cancers and AT deficiency remains debatable, the risk of adult AT deficiency carriers to develop liver cirrhosis has not been assessed quantitatively. Liver cancers and liver diseases with subsequent liver cirrhosis are highly prevalent in tropical countries such as Thailand and heterozygous AT phenotypes are rather common in this country as well. The aim of this study was to assess the risk of developing liver cirrhosis, HCC and BDC by means of case-control studies with Thai patients and controls in connection with AT deficiency. For hepatitis, HCC and BDC to association with AT deficiency was detected. Carriers of PiMZ phenotype in Thailand have a high risk to develop liver cirrhosis (odds. ratio of 10.8, 95% confidence interval = 1.3-88.1). Patients with predisposing diseases should be screened for Pi phenotypes so that rigorous measures to combat the occurrence of liver cirrhosis can be implemented.

Pasteur oral cholera vaccine: studies of reactogenicity, clinical acceptability and immunogenicity in human volunteers.

Pasteur cholera vaccine consists of isolated antigenic fractions from V. cholerae El Tor Ogawa and Inaba. Enteric coated microgranules were prepared from antigen lyophilisate. Three doses of this vaccine were administered orally to 19 healthy young Thai adults at one week intervals. None of the volunteers experienced untowards reactions. The vibriocidal antibody responses manifested a significant antibody rise (> or = 4 fold) to serovar Inaba in 8 vaccinees (42.1%) and Ogawa in 4 (21.1%). Five and 6 vaccinees (26.3% and 31.6%) showed a > or = 4 fold rise of IgG and IgA anti-LPS, respectively.

Health status of Thai volunteers in a cholera vaccine trial.

One hundred and seventy-one male adults were screened in recruitment of volunteers for a cholera vaccine trial. A full medical history and a physical examination were performed on each subject. The percentages of subjects vaccinated against cholera and typhoid within twelve months were 4 and 1 per cent respectively, while 88 and 15 per cent respectively had been vaccinated more than a year. Biochemical screening revealed abnormal liver function tests in 40.7 per cent, specifically alkaline phosphatase (8%), glutamic oxaloacetic transaminase (8%), glutamic pyruvic transaminase (4.7%), total bilirubin (10%) and globulin (34%). Ten (6%) of the volunteers were positive for hepatitis B surface antigen (HBs-Ag). The total white cell count was elevated in 13.5 and 81.9 per cent had eosinophilia. Stool examination revealed infection with Hookworm (54.9%), Opisthorchis viverrini (29.8%), Strongyloides stercoralis (5.3%), Endolimax nana (3.5%), Giardia lamblia (5.3%) and Taenia saginata (2.9%). Few volunteers (13.4%) had abnormal microscopic examination of urine sediment. Only 57 subjects were considered suitable to be volunteers. Each of these subjects had no significant past medical, surgical or psychological illness. None had been vaccinated against cholera within the previous 12 months and no subject had abnormalities on physical examination or routine biochemical and haematological screening. The large number of subjects excluded from recruitment (67%) emphasized the importance of proper screening of volunteers for any vaccine trial.

Immune responses following killed whole vibrio-B subunit oral cholera vaccine in human volunteers.

Immunogenicity of killed whole vibrio and B subunit oral cholera vaccines in American and Thai volunteers were analysed in terms of significant rise of antibody titre. Three doses of 2 x 10(11) killed vibrios and 5 mg of cholera toxin B subunit were given at two-week intervals. There were no differences in the percent of volunteers with significant rise of serum immunoglobulin G and secretory immunoglobulin A (sIgA) to cholera toxin. However, the percent with significant rises of serum antibody to whole cell V. cholerae Inaba measured by vibriocidal titre and serum immunoglobulin G, and secretory immunoglobulin A to lipopolysaccharide (LPS) measured by ELISA in American volunteers were significantly different from those in Thai volunteers (89% VS 45%, 68% VS 9% and 53% VS 0%, respectively) (p less than 0.05).

Lack of interferon induction in man by two rabies tissue culture vaccines.

Both neutralising antibody and interferon play a part in protection of animals against death from rabies virus infection. Interferon induction was therefore sought in 53 volunteers within 24 hours of receiving human diploid cell strain vaccine or fetal bovine kidney cell vaccine given either intramuscularly or intradermally. Repeat observations were made in 18 subjects following a second dose of vaccine seven days later. No interferon was detected in any sample tested although no subject had any detectable rabies neutralising antibody on day 0. The sensitivity of the interferon assay, and comparison with other studies are discussed. An interferon inducer suitable for human use should be sought as an alternative to, or a replacement for, passive rabies immunization.