Outbreak of Occupational Brucellosis in a Laboratory Technician at Her Royal Highness Princess Sirindhorn Medical Center, Srinakharinwirot University, Thailand.

Objective: To document laboratory transmission of brucellosis and identify the likely mechanism of transmission of brucellosis at Her Royal Highness (HRH) Princess Sirindhorn Medical Center, Thailand. Material and Method: Using small subunit ribosomal RNA (rRNA) sequencing technique to analyze Brucella melitensis cultured from the first 2 patients of the hospital and an infected laboratory technician, and using brucellosis serologic test to rule out infections in all other involved technicians. Results: We had encountered the first 2 cases of brucellosis. Both had infected from community exposure with goat. The first case had pancreatic abscess and spinal bone involvement with a positive blood culture. The second case presented with fever of unknown origin and had a positive blood culture. A few weeks later, 1 of our laboratory technicians presented with fever, myalgia and fatigue. Blood culture grew B. melitensis. He never had any associated community-acquired risk factors for brucellosis. The presumed mechanism of transmission was an inhalation while taking photographs of the bacterial plate of the first patient. B. melitensis identified from our laboratory technician and both patients were analyzed based on 16S-23S rRNA intergenic transcribed spacer (ITS) region. Results of 16S-23S rRNA ITS sequence testing confirmed a match from all patients and laboratory technician's isolate. All other 10 potentially exposed laboratory technicians were asymptomatic. A brucellosis serologic test was negative in all non-infected technicians but was only positive in the 1 infected technician. Conclusion: This is the first report in Thailand of occupational brucellosis transmitted in microbiologic laboratory. The most likely mechanism is air-borne inhalation of bacterial organisms on culture media in the absence of adequate precautions. Laboratory technicians should handle Brucella cultivation with caution utilizing appropriate measures to prevent inhalation.

Factors associated with seropositive antibodies to Brucella melitensis in the Nakhon Nayok, Thailand.

BACKGROUND: Human brucellosis is a re-emerging disease in Thailand. In 2006, Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center Nakorn Nayok province had diagnosed three cases of brucellosis which have never been reported in this area. OBJECTIVE: To conduct an epidemiologic study with the aim of evaluating the sero-prevalence and factors associated with seropositive antibodies to Brucella melitensis among residents who live in the same sub-district of the first index case. MATERIAL AND METHOD: In 2007, a study was conducted in Chumpon sub-district, Ongkharak district, Nakhon Nayok province, Thailand where the outbreak took place in the previous year. The 86 subjects were selected from three villages in the present study area. Blood specimens were collected and tested for antibodies for Brucella melitensis using a serum agglutination test. A structural interview questionnaire was used to detect any possible risk factors. A binary logistic regression was utilized for analyzing the statistical data. RESULTS: Of all participants in the present study, 45.35% (95% CI; 34.61-56.08%) had seropositive antibodies to Brucella melitensis. Multivariate analysis indicated that factors associated with seropositive titers were highly related to contact with labored or aborted goats, adjusted odds ratio = 27.16 (95% CI = 1.02-721.53) and the consumption of raw goat products, adjusted odds ratio = 6.27 (95% CI = 1.25-31.36). CONCLUSION: High seropositive prevalence of Brucella melitenis after the 2006 outbreak was found in the present study. The associated factors of infection are direct contact with infected animals and this is similar with the other outbreak areas in Thailand and the endemic countries. Therefore, local authorities should not only provide the communities with health education, but also conduct continued surveillance in order to help control and prevent the epidemic.

Long-term study of Escherichia coli and Klebsiella pneumoniae isolates producing extended-spectrum beta-lactamases.

OBJECTIVE: To evaluate the prevalence and susceptibility pattern of Escherichia coli and Klebsiella pneumoniae isolates producing extended-spectrum beta-lactamases (ESBLs) in Thailand from 2000 to 2005. MATERIAL AND METHOD: Data on the WHONET, from 28 hospitals participated in the National Antimicrobial Resistance Surveillance, Thailand surveillance program, were reviewed and analyzed for the prevalence and susceptibility pattern. RESULTS: During the five-year surveillance from 2000 to 2005, the prevalence of ESBL-producing E. coli detected by ceftazidime screening test was 17%, 21.3%, 23.2%, 20.4%, 23.1%, and 25.0%; as well as detected by cefotaxime screening test was 20.8%, 65.9%, 69.3%, 69.3%, 68.3%, and 33.8%, respectively. The prevalence of ESBL-producing K. pneumoniae detected by ceftazidime screening test was 30.9%, 34.7%, 32.5%, 34.4%, 372%, and 39.2%; as well as detected by cefotaxime screening test 38.4%, 39.3%, 40.1%, 41.0%, 42.8%, and 40.4%, respectively. CONCLUSION: From 2000 to 2005, the prevalence of ESBL-producing organisms in Thailand was high. ESBL-producing E. coli was most commonly isolated from sputum, followed by blood and urine specimens. ESBL-producing K. pneumoniae had not been increasingly isolated from sputum, blood and urine.

Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents: the recommendations of the Thai AIDS Society (TAS) 2008.

BACKGROUND: More than 100,000 patients have been treated, since the implementation of the National Universal Coverage for antiretroviral therapy (ART) in Thailand Although there are several comprehensive guidelines available internationally, there is a need to have guidelines that can be implemented in Thailand. MATERIAL AND METHOD: The guidelines were developed by a panel of 17 members who are the experts on HIV research and/or HIV patient care and appointed without incentive by the Thai AIDS Society (TAS). The recommendations were based on evidences from the published studies and availability of antiretroviral agents. Published studies that are relevant and applicable to Thailand in particular have been taken into consideration. RESULTS: The recommendations include: when to start ART; what to start; how to monitor the therapy; adverse effects and its management; diagnosis of treatment failure; and antiretroviral treatment options in patients with treatment failure. ART in special circumstances, i.e., patients with co-infection of tuberculosis or hepatitis B virus, is also included Appropriate level of CD4+ T-cell count to start ART among Thai patients has been considered carefully. The authors recommend to start ART at CD4+ T-cell count < 200 cells/mm3. CONCLUSION: ART should be initiated in adults and adolescents HIV-1 infected patients with a history of HIV-related illness or AIDS or with a CD4+ T-cell count <200 cells/mm3. For treatment-naive patients, the preferred initial therapy is a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. CD4' T-cell count and viral load should be monitored for at least twice and once a year, respectively. Proper management of antiretroviral-related toxicity and enhancement of adherence are crucial for the long-term success of ART.