Antimicrobial susceptibility of Helicobacter pylori isolated from gastric biopsies in dyspeptic patients.

The objective of this study was to evaluate the prevalence of antimicrobial resistance in Helicobacter pylori isolated from the antrum and corpus of dyspeptic patients in Khon Kaen, Thailand, and to compare the antimicrobial susceptibility patterns of H. pylori isolated from the antrum and corpus in individual patients. Antimicrobial susceptibility was determined by disk diffusion, studying susceptibility to metronidazole, clarithromycin, amoxicillin, erythromycin, ciprofloxacin, and tetracycline. The H. pylori resistant rate to at least one of the six antimicrobial agents tested was 37%. The resistance rates were 30.2% for metronidazole, 9.2% for ciprofloxacin, 5% for clarithromycin, 2.4% for amoxicillin, and 1.7% for erythromycin and tetracycline. Single, double, and more than double antimicrobial resistances were found in 27.7, 6.7 and 2.5%, respectively. Antimicrobial susceptibility testing revealed 11 antibiotypes. The most common antimicrobial susceptibility pattern found was sensitivity to 6 antimicrobial agents (63%). H. pylori antimicrobial resistance in specimens isolated from the antrum and corpus were nearly equivalent, 37.3% (22/59) and 36.7% (22/60), respectively. Most of the H. pylori specimens isolated from the antrum and corpus in individual patients were identical (87.7%).

The endoscopic-pathologic findings in intestinal capillariais: a case report.

A 27-year-old Thai man presented with chronic watery diarrhea for 2 years. The diagnosis of capillariasis was made by enteroscopy after negative repeated stool tests. Here, the authors reported the first case of abnormal endoscopic finding of intestinal capillariasis. It showed segmental erythematous and swelling of proximal jejunal mucosa with an area of superficial erosion covered by exudates. The parasitic eggs were identified in jejunal content and worms were identified in jejunal mucosa. He was successfully treated with albendazole.

Enzyme-linked immunosorbent assay for serodiagnosis of Helicobacter pylori in dyspeptic patients and volunteer blood donors.

Helicobacter pylori, an important etiological agent in the development of gastritis, peptic ulcer and gastric carcinoma, can be detected by the enzyme-linked immunosorbent assay (ELISA). Our objectives were: (1) to evaluate the efficacy of a commercial ELISA kit (Pyloriset EIA-G III) in sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for diagnosis of H. pylori infection in Thai dyspeptic patients in Khon Kaen Thailand; and (2) to examine the seroprevalence of H. pylori among blood donors at Srinagarind Hospital's Blood Bank, Khon Kaen University, by the commercial ELISA. Gastric biopsies obtained from 137 dyspeptic patients were diagnosed by culture, rapid urease test (RUT) and histology. Serum samples from the same dyspeptic patients and 100 healthy blood donors were assayed using the commercial ELISA. H. pylori infection in dyspeptic patients was considered positive when the culture or both RUT and histology were positive. Using a cut-off value at a titer of 20 U/ml (as recommended by the manufacturer), we found the commercial ELISA kit had a sensitivity of 93.3%, specificity of 75.3%, PPV of 74.7%, NPV of 93.5% and accuracy of 83.2%. The overall H. pylori seroprevalence in the healthy blood donors was 57%. Of the 100 healthy blood donors, 39 (60.9%) of the males and 18 (50.0%) of the females were seropositive.

Sensitivity and specificity of an in-house rapid urease test for detecting Helicobacter pylori infection on gastric biopsy.

We developed an in-house rapid urease test (iRUT) and evaluated the efficacy and the agreement of the iRUT and the cRUT compared with culture and histology for the detection of H. pylori infection. Five iRUT media were tested with H. pylori isolates and other bacteria. The most suitable iRUT medium was further evaluated for detection of H. pylori infection. Gastric biopsies from 120 patients were diagnosed by culture, iRUT, cRUT and histology. The results of the iRUT and cRUT were read at 30 minutes, 1 hour and up to 24 hours. A true positive result was either the culture or both the RUT (cRUT or iRUT) and the histological examination being positive. The sensitivity and specificity of the iRUT result at 30 minutes, 1 hour and up to 24 hours were 77.1% and 100%, 77.6% and 100%, and 94.1% and 94.2%, respectively. Values for the same parameters of cRUT were 87.5% and 100%, 89.8% and 100%, and 100% and 94.2%, respectively. The agreement between the iRUT and cRUT was very good (kappa values > or = 0.82). Our results indicate that the iRUT is a-sensitive, specific and cost effective test. It can be appropriately applied for detecting H. pylori infection in gastric biopsy specimens.

Detection of H. pylori in dyspeptic patients and correlation with clinical outcomes.

The objectives of this study were to evaluate the methods used to diagnose Helicobacter pylon infection in gastric biopsies, and to evaluate the correlation between H. pylori infection and clinical outcomes. Gastric biopsies, obtained from 210 patients, were evaluated for H. pylori by culture, a commercial rapid urease test (RUT, Pronto Dry) and histological examination. A true positive result was either the culture or both the RUT and histological examination were positive. The results showed a H. pylori infection rate of 44.3% (93/210). The sensitivities, specificities, positive predictive values and negative predictive values were 88.2, 100, 100, and 91.4 % by the culture; 95.7, 98.3, 97.8, and 96.6% by RUT; and 96.8, 59.8, 59.8, and 65.7% by histological examination, respectively. The prevalences of H. pylori in non-ulcer dyspepsia (NUD), peptic ulcer dyspepsia (PUD) and gastric cancer (GCA) patients were 41.2, 57.9 and 70.6%, respectively. The chi-squared-test showed that GCA patients were significantly more frequent infected with H. pylori than NUD patients (p<0.05). Our study indicates that the RUT method was highly sensitive, specific and appropriate for routine clinical use.

Exertional rhabdomyolysis following excessive exercise of university freshman cheer-training.

Exertional rhabdomyolysis is a life threatening condition resulting from lysis of muscle cells after vigorous exercise. It can cause many complications such as renal failure. It occurs most commonly in military personnel but also in civilians who have excessive excercise after work. Two cases of freshmen who had exertional rhabdomyolysis were reported to illustrate the potential risk of cheer-training. Appropriate measures should be arranged to prevent this condition. Diagnosis and treatment should be given promptly to prevent serious complications.

Splenic abscess: clinical features, microbiologic finding, treatment and outcome.

Splenic abscess is a rare clinical entity but may be underreported. A retrospective study at Srinagarind Hospital revealed 60 cases of splenic abscess between 1992 and 2001. The causative organisms were identified in 41 cases (68.3%). Gram negative bacilli were commonly isolated and Burkholderia pseudomallei was the most predominant. Diabetes mellitus and leukemia were common underlying diseases found in 46.3 per cent and 9.7 per cent of culture confirmed cases, respectively. The patients usually presented with fever, left upper quadrant pain, tenderness and splenomegaly. Multiple abscesses were more commonly found in the melioidosis than in the non-melioidosis group (p = 0.032), but a single abscess was more commonly found in the non-melioidosis than in the melioidosis group (p = 0.032). Concurrent liver abscesses, often multiple, were not different in both groups. Antimicrobials alone were given in 66.7 per cent of cases with melioidosis and 64.7 per cent of non-melioidosis group. Splenectomy and percutaneous aspiration were performed only in 29.3 per cent and 4.9 per cent of cases with splenic abscess. The overall mortality rate of splenic abscess was only 4.9 per cent in the present series. In conclusion, splenic abscess is not uncommon. Burkholderia pseudomalleli is the most common causative agent found in the present series. Therefore, it should be targeted in the initial empirical antibiotic therapy before the culture results are available especially when multiple lesions in the spleen and concurrent multiple liver abscesses are seen. Prolonged treatment with appropriate antimicrobials alone is usually effective. Splenectomy and/or aspiration may be useful in selected patients.