Pharmacokinetic investigation of albendazole and praziquantel in Thai children infected with Giardia intestinalis.

The pharmacokinetics of albendazole/albendazole sulphoxide and praziquantel were investigated in Thai children with Giardia infection. Twenty school-age children were randomly allocated to receive either a single oral dose of albendazole (400 mg/child) or the same dose of albendazole given concurrently with a single oral dose of praziquantel (20 mg/kg). The concentrations of albendazole/albendazole sulphoxide and praziquantel in plasma samples, collected at intervals in the first 24 h post-treatment, were then quantified using HPLC with ultra-violet detection. No significant pharmacokinetic interaction between the albendazole and praziquantel was demonstrated. For albendazole sulphoxide, the active metabolite of albendazole, there was marked inter-individual variation in the maximum plasma concentration and the 'area under the curve'. The pharmacokinetics of albendazole sulphoxide were similar whether albendazole was given alone or in combination with praziquantel.

The effectiveness of 3, 5 or 7 days of albendazole for the treatment of Trichuris trichiura infection.

A randomized clinical trial was carried out to study the relationship between the duration of albendazole therapy, at 400 mg/day, and its effectiveness in the treatment of Trichuris trichiura infection. The 168 patients were treated for three (N=56), five (N=56) or seven (N=56) consecutive days. Compared with both of the shorter regimens, treatment for 7 days resulted in a significantly higher cure 'rate' and significantly greater reductions in the level of egg excretion. The advantage of using the longer (5- or 7-day) regimens was most apparent among the patients who had heavy infections (at least 1000 Trichuris eggs/g faeces) when treated. It is therefore suggested that albendazole be given for at least 3 days to those with light infections and for 5-7 days to patients with heavy infections.

A comparative trial of albendazole alone versus combination of albendazole and praziquantel for treatment of Trichuris trichiura infection.

A randomized clinical trial was conducted to compare the effectiveness of albendazole alone and albendazole combined with praziquantel in the treatment of Trichuris trichiura infection. The drug regimens consisted of single dose of albendazole 400 mg (A1, n=34), 3 days of albendazole 400 mg daily (A3, n=34), 5 days of albendazole 400 mg daily (A5, n=35), single dose of albendazole 400 mg plus praziquantel 40 mg/kg (AIP1, n=34), and 3 days of albendazole 400 mg plus praziquantel 40 mg/kg daily (A3P3, n=36). It was found that treatment with 3 or more consecutive days of albendazole with or without praziquantel resulted in a significant reduction in density of Trichuris eggs in stools while a single dose of such drug did not. Praziquantel was not shown to have synergistic or antagonistic effects with albendazole. A regimen of 400 mg of albendazole daily for 3 days was found to be the most suitable therapy for Trichuris infection.

Plasma retinol and alpha-tocopherol level and growth indices of 7 months old healthy Thai infants in Bangkok.

A cross-sectional study was conducted to measure plasma retinol and alpha-tocopherol status and the growth indices of 66 healthy Thai infants aged about 7 months old. The mean (SD) plasma retinol and alpha-tocopherol level were 1.59(0.31) and 25.40(7.01) micromol/l respectively. For their weight, height, and body mass index, the mean (SD) values were 7.96(0.93) kg, 69.95(2.42) cm, and 16.25(1.43) respectively. There was a remarkable proportion of improper feeding. However there were no correlations between plasma retinol level, plasma alpha-tocopherol level, growth indices and duration of breast milk, formula milk, weaning food feeding except alpha-tocopherol level which positively correlated with duration of breastfeeding.

Effects of rice powder salt solution and milk-rice mixture on acute watery diarrhea in young children.

A randomized pilot study was carried out to compare the safety and effectiveness of rice powder salt solution (RPSS) in combination with milk-rice mixture (RPSS-MR group, n = 17) with other two regimens, glucose-based oral rehydration solution (ORS) combined with MR (ORS-MR group, n = 17) and ORS combined with formula milk (ORS-milk group, n = 14) in the treatment of acute watery diarrhea with mild to moderate dehydration in 48 boys younger than 2 years. Results showed that in the first 24 hours patients in the RPSS-MR group had significantly smaller amounts of stool weight (32.7 g/kg) than those in the ORS-MR group (67.5 g/kg) and ORS-milk group (59.2 g/kg) (p< 0.05 for both measurements). Patients in the RPSS-MR group also had significantly shorter duration of diarrhea (29.6 hours) than the other two groups (43.8 hours and 49.6 hours, respectively) (p < 0.05 for both measurements). The stool weight and duration of diarrhea between the ORS-MR group and the ORS-milk group were not significantly different. The positive effect of milk rice mixture was not demonstrated in the study due to the significantly more severe diarrhea in the ORS-MR group. The effectiveness of the RPSS-MR is therefore likely due to mainly RPSS.

Hymenolepis nana infection in Thai children.

Stool examination was performed on 2,083 Thai children from orphanages and primary schools. Hymenolepis nana infection was found only in children from orphanages with a prevalence of 13.12 per cent. Males had a statistically significant higher prevalence of infection than females. Most infected children were asymptomatic. In symptomatic infected children, the symptoms were mild and non-specific such as pruritus ani, abdominal pain, diarrhea, anorexia, headache, and dizziness. Praziquantel in a single oral dose of 25 mg/kg body weight was effective and well tolerated in Hymenolepis nana infected Thai children.

Incidence and clinical manifestations of influenza in nurse assistant students.

A prospective study was conducted to find the incidence and clinical manifestations of influenza in 201 nurse assistant students of Faculty of Tropical Medicine during June 1998 to May 1999. There were 106 episodes of influenza-like illness (incidence 52.7%) of which only 33% were proven to be influenza (incidence 17.4%). Main clinical manifestations of influenza included headache, fever, malaise, myalgia, rhinorrhea, cough, and sore throat. We found that influenza could not be diagnosed solely by using clinical manifestations. Respiratory pathogenic bacteria were rarely isolated in patients with influenza-like illness and this led to our suggestion that routine pharyngeal culture and antibiotic therapy would not be helpful. Influenza vaccination of every nurse assistant student would be beneficial.

Prevalence of enterobiasis and its incidence after blanket chemotherapy in a male orphanage.

A prospective observational study was conducted in a male orphanage to find out the prevalence of enterobiasis and its incidence after blanket chemotherapy using mebendazole. We found that the prevalence of enterobiasis was 28.9%. The incidence density of enterobiasis after blanket chemotherapy was 379.82 per 1,000 person-years which was quite high. We suggest that blanket chemotherapy should be repeated at every 6 months interval to control enterobiasis in orphanages.

Pleural effusion in childhood falciparum malaria.

Pulmonary complication is a rare manifestation of childhood malaria and isolated pleural effusion without pulmonary edema has never been reported in children. We report here an 11-year-old boy who suffered from cerebral malaria and massive right pleural effusion. The patient was treated with intravenous artesunate, albumin, and other supportive treatments. He recovered completely after eight days. The clinical and laboratory courses suggested that the plasma leakage played a role in the pathogenesis of pleural effusion.

Dengue infection with unusual manifestations: a case report.

Since 1978, there has been an increasing number of reported cases of dengue infection with unusual manifestations and most of them had dengue shock syndrome. We report here one patient who had dengue hemorrhagic fever grade II with liver failure and hepatic encephalopathy and very high elevation of liver enzymes. She made a complete recovery after conservative therapy. She is the fourth case of reported dengue hemorrhagic fever grade II who had unusual manifestation.

Clinical presentation of childhood malaria in Savannakhet province, Lao PDR.

A descriptive study on the clinical presentation of childhood malaria was conducted in Savannakhet Province, Lao People's Democratic Republic. It is aimed to describe the clinical features and to determine the association between the severity of malaria and the initiation or delay of treatment. A total number of 92 children 1-14 years of age with confirmed malaria diseases were enrolled in this study. Fifty-six cases (60.9%) had illness for less than 3 days before hospitalized and 36 cases (39.1%) for more than 3 days. Twenty-nine cases (31.5%) had self antimalarial medication before admission (9 cases of chloroquine, 16 cases of quinine and 4 cases of artesunate). Ten cases (10.9%) had abnormal consciousness of which 7 cases (7.6%) had confusion but responded to verbal command and 3 cases (3.3%) were in coma not respond to painful stimuli but had reflex. Two cases 2.2%) had convsulsions, 11 cases (12.0%) had dehydration, 47 cases (51.1%) had vomiting, 18 cases (19.6%) had hepatomegaly and 19 cases (20.7%) had splenomegaly. There was a statistically significant association between consciousness levels and the duration of illness before admission < or = 3 days and > 3 days (p = 0.01) while there is no significant difference between parasitemia density and the duration of illness before admission (p > 0.05).

A new Vero cell rabies vaccine: results of a comparative trial with human diploid cell rabies vaccine in children.

We evaluated the immunogenicity and safety of a chromatographically purified rabies vaccine (CPRV) compared with human diploid cell rabies vaccine (HDCV) after pre-exposure immunizations (both primary and booster). Intramuscular doses of either 0.5 mL of CPRV or 1.0 mL of HDCV were given to 400 schoolchildren on days 0, 7, 28, and 365 (booster). Adequate titers of antibody (> or = 0.15 IU/mL, as defined by the Centers for Disease Control and Prevention) were observed in serum samples from all children 14 days after primary immunization with CPRV and HDCV; the antibodies persisted in all but one child up until 1 year. Fourteen days after the primary immunization series (day 42) and 7 days after booster immunization (day 372), all children had antibody titers of > or = 0.5 IU/mL. Local and systemic reactions after primary and booster immunizations occurred significantly less frequently in the CPRV group. A severe allergic reaction (angioedema) was reported in only one child after booster immunization with HDCV. CPRV has adequate immunogenicity for primary and booster pre-exposure immunizations in children and has a better safety profile than does HDCV.

Albendazole treatment for Giardia intestinalis infections in school children.

A randomized controlled trial, 113 school children with Giardia intestinalis infection were treated with albendazole or tinidazole. Albendazole 400 mg once a day x 3 days and tinidazole 50 mg/kg single dose were given orally to 62 and 51 children, respectively. Parasitological cure was documented when there were > or = 2 times negative stool examination for G. intestinalis at 1-2 weeks after therapy. Thirty-one of 62 (50%) children treated with albendazole and 49 of 51 (96.1%) children treated with tinidazole had parasitological cure (p < 0.001). No major side effects were observed except one case in tinidazole group had severe headache for 30 hours. Albendazole appears to be safe and produced a moderate cure rate for G. intestinalis infection when a 3 day anthelmintic regimen is given.

Severe shigellosis in childhood.

A prospective study was performed on 20 bacteriologically proven pediatric cases of severe shigellosis admitted to the Department of Pediatrics, Chulalongkorn Hospital during March 1989 to March 1990. Fourteen patients were male and six were female. Shigella B was found in 85% and Shigella D in 15% of cases. The major indications for admission were convulsions and dehydration. Fifteen per cent of cases had underlying malignancies and 42.1% had malnutrition. Most patients had a peak of fever between 39.5 and 40.5 degrees C, serum sodium between 128-144 mEq/l. Mild acidosis was detected in 45% and moderate acidosis in 30% of cases. There were no statistical differences in peak of fever and serum sodium between patients who had convulsion and who did not. Shigellemia was found in one case who also had underlying neuroblastoma. One patient died due to necrotizing enterocolitis, septic shock and renal failure. Most of the organisms found resisted to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX). However, TMP-SMX was prescribed in most immunocompetent patients and they recovered well. All of three patients with underlying malignancy responded well to ceftriaxone.