Measles seroprevalence in Thailand: are adolescents and young adults at risk of measles?

INTRODUCTION: During the last decade, measles has become an important re-emerging disease in Thailand. The objective of this study was to measure measles seroprevalence and its influencing factors and to plan for an improved vaccination program. METHODS: A total of 600 participants aged between 9 months and 50 years were divided into seven groups those represent birth cohorts that experienced different measles vaccination policies. Participants' blood samples were obtained to measure measles immunoglobulin G (IgG) levels. RESULTS: None of the participants in the 9-month age group had measles IgG levels beyond a protective level. Participants in the following age groups: 2 ½, 5-15, 16-29, 30-33, 34-40, and 41-50 years had 82% (95% confidence interval [CI] 73.3-90.7), 50% (95% CI 36.1-63.9), 52% (95% CI 42.3-62.7), 70% (95% CI 61.1-78.9), 88.8% (95% CI 84.1-93.5), and 98.8% (95% CI 96.4-100.0) measles seropositivity, respectively. The study did not find any significant factors affecting measles seropositivity. CONCLUSION: Individuals aged 15-34 years are vulnerable to measles infections. Supplementary vaccination in special situations, including post-exposure prophylaxis during an outbreak among young adults or providing for high-risk occupations, such as healthcare personnel, should be encouraged.

A noninferiority cluster-randomized controlled trial on antibiotic postprescription review and authorization by trained general pharmacists and infectious disease clinical fellows.

OBJECTIVE: We compared the effectiveness of antibiotic postprescription review and authorization (PPRA) determined by infectious disease (ID) clinical fellows with that of trained general pharmacists. METHODS: We conducted a noninferiority cluster-randomized controlled trial in 6 general medical wards at Siriraj Hospital in Bangkok, Thailand. Three wards were randomly assigned to the intervention (ie, the pharmacist PPRA group), and another 3 wards were assigned to the control (ie, the fellow PPRA group). We enrolled all patients in the study wards who received 1 or more doses of the targeted antibiotics: piperacillin/tazobactam, imipenem/cilastatin, and meropenem. The noninferiority margin was 10% for the favorable clinical response and 1.5 defined daily doses (DDDs) for the targeted antibiotics. RESULTS: We enrolled 303 patients in the pharmacist PPRA group and 307 patients in the ID fellow PPRA group. The baseline and clinical characteristics were similar in the 2 groups. The difference in the favorable response of patients who received the targeted antibiotics (ie, the pharmacist PPRA group minus the fellow PPRA group) was 5.15% (95% confidence interval [CI], -2.69% to 12.98%); the difference in the DDD of targeted antibiotic use (ie, the pharmacist PPRA group minus the fellow PPRA group) was 0.62 (95% CI, -1.57 to 2.82). We observed no significant difference in the DDD of overall antibiotics, 28-day mortality, 28-day ID-related mortality, favorable microbiological outcome, or antibiotic-associated complications. CONCLUSIONS: We confirmed the noninferiority of pharmacist PPRA in terms of favorable clinical response; however, noninferiority in targeted antibiotic consumption could not be established. Therefore, using trained general pharmacists rather than ID clinical fellows could be an alternative in a resource-limited setting. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov identifier: NCT 01797133.

Thermal Steam Aerosolization Protects Against Lipopolysaccharide-Induced Sepsis in Rats.

Background: Sepsis is a severe systemic inflammatory state in response to infection. The induction of heat shock protein 70 (HSP70) by heat stress has been reported to protect against lethal effects of sepsis. In clinical situation, inhalation of thermal water has been used empirically in the treatment of chronic diseases of respiratory tract. Thus, thermal steam aerosolization may have beneficial effects on sepsis via HPS70 induction. Objective: The present study tested the hypothesis that thermal steam aerosolization could protect against lipopolysaccharideinduced sepsis in rats. Material and Method: Male Spraque-Dawley rats were subjected to steam aerosolization at 40°C for 1 hour before intraperitoneal injection of 10 mg/kg lipopolysaccharide (LPS). Blood pressure, heart rate and core temperature were recorded in two hours interval. At the end of the study period, vascular response to vasoconstrictor of isolated aortic rings ex vivo was assessed. Serum proinflammatory cytokines, IL-1beta and IL-6, were analyzed using ELISA technique. Plasma nitric oxide was determined using nitrate/nitrite fluorometric assay Kit. HSP70 expression, heat shock factor-1 (HSF-1) mRNA level and nuclear factor-kappa B (NF-kappa B) activity in the lungs of rats were investigated using western blot analysis, real-time quantitative PCR and transcription factor kits for NF-kappa B p65, respectively. Results: Thermal steam aerosolization treatment prevented the fall in systolic, diastolic, mean arterial blood pressures induced by LPS and restored the vascular response to adrenaline. LPS significantly increased plasma nitrate/nitrite concentration, serum IL-1 beta and IL-6 levels, and NF-kappa B activity in rat lung lysate which were reduced by thermal steam aerosolization. Thermal steam aerosolization induced both HSP70 and HSF-1 mRNA expression. Conclusion: The present study suggests that thermal steam aerosolization can delay the stage of shock in LPS-induced septic rats. It shows a beneficial therapeutic effect and may be applied to the clinical approach for septic shock patient.

Mycotic Aneurysm of the Abdominal Aorta due to Group B Streptococcus (GBS) Infection: A Case Report and Review of the Literature.

We present a case report of an extremely rare infected abdominal aortic aneurysm (AAA) caused by group B streptococcus (GBS). A 66 years old, afebrile male patient with hypertension and history of chronic smoking presented with mild abdominal pain and discomfort. Physical examination revealed a pulsatile mass of 5 cm in diameter located at the periumbilical region. A computed tomography (CT) scan of the whole abdomen exhibited an outpouching lesion with intramural hematoma located at the infrarenal abdominal aorta, sized 5.1x3.7 cm in diameter, suggesting an abdominal aortic aneurysm. A transthoracic echocardiography demonstrated normal endocardium without vegetation. Surgical abdominal aortic aneurysm repair (aneurysmorrhaphy) was successfully done and intravenous amoxicillin/clavulanic acid was given. Tissue culture obtained from the aneurysm sac and para-aortic lymph nodes revealed group B streptococcus infection. Intravenous amoxicillin/clavulanic acid was continued for 14 days, and was transitioned to oral amoxicillin 3 grams/day. Currently, the patient has been followed-up for 20 months with neither recurrent infection nor post-operative complication. This is the first case report of infected abdominal aortic aneurysm due to GBS in Thailand.

Human Erysipelothrix rhusiopathiae Infection: Unsolved Issues and Possible Solutions.

Erysipelothrix rhusiopathiae infection in humans may not be as rare as previously thought. In most cases, the disease is acquired from animals through work-related exposure. Human infection has been reported since the early 1900's up to the present. Unsolved issues associated with this organism include inadequate disease control in animals, difficulty in identification and isolation of the bacteria, diagnostic delay due to unawareness of this uncommon disease or unfamiliarity with the increasingly diverse clinical manifestations, and inappropriate antibiotic use due to misdiagnosis, as well as drug resistance. In this review, we attempt to address the unsolved issues related to human Erysipelothrix infection and suggest possible solutions.

Erysipelothrix rhusiopathiae bacteremia without endocarditis associated with psoas abscess: the first case report in Thailand.

The authors report a patient with a rare manifestation of invasive septic Erysipelothrix rhusiopathiae infection without endocardial involvement. Our patient presented with progressive paraparesis and subacute fever for ten days. He had underlying diabetes mellitus and alcoholic cirrhosis. Magnetic resonance imaging (MRI) of the lumbosacral spine showed a psoas abscess with vertebral osteomyelitis and discitis at level of L23 of the lumbar spine. His blood culture grew E. rhusiopathiae. Transthoracic echocardiography demonstrated normal endocardium. Surgical drainage and debridement with concomitant intravenous antibiotics administration resulted in clinical improvement, including neurological status. MRI showed resolution of the psoas abscess and osteomyelitis. Erysipelothrix infection should be considered as a causative pathogen of musculoskeletal infection in immunocompromised patients. To our knowledge, this is the first case report of psoas abscess caused by E. rhusiopathiae in Thailand.