Chronic meningitis in Thailand. Clinical characteristics, laboratory data and outcome in patients with specific reference to tuberculosis and cryptococcosis.

The charts of 114 consecutive patients with chronic meningitis admitted to a general hospital in Bangkok, Thailand, between 1993 and 1999 were retrospectively reviewed. The most common causative agents were Cryptococcus neoformans (54%) and Mycobacterium tuberculosis (37%). HIV and other underlying diseases had a major impact on the presentation of chronic cryptococcal meningitis patients. Compared to HIV-negative cryptococcal meningitis patients (21%), HIV-positives (79%) had a significantly lower incidence of focal signs (p = 0.02), hydrocephalus (p = 0.03) and seizures (p = 0.001) during hospital stay, furthermore, a lower leucocyte level, a significantly higher glucose level (p = 0.02) and a lower protein level (p = 0.03) in the first cerebrospinal fluid examination. Of the 43 patients with chronic tuberculous meningitis, only 3 were HIV positive. Focal neurologic deficits were found more frequently in tuberculous meningitis patients (p = 0.001) when compared to cryptococcal meningitis patients without HIV. Cerebral infarction on cerebral CT was indicative of tuberculous meningitis. Cryptococcal meningitis patients with HIV infection had a worse outcome compared to non-AIDS patients. Advanced stage of the disease on admission, decreased level of consciousness prior to and on the admission day and raised intracranial pressure above 40 cm H(2)O at any given time were predictive of a poor outcome in tuberculous meningitis patients.

Different reticulocyte volume in diabetes mellitus patients with and without hypercholesterolemia and/or hypertriglyceridemia.

Red cells and reticulocytes from patients with diabetes mellitus (DM) were analysed using laser and computer technology of H*3 hematology analyzer. Four groups of diabetes mellitus patients: diabetes with normolipemia (DM) (n = 12) and DM patients with excess triglyceride (DM-T) (n = 7) or cholesterol (DM-C) (n = 21) or both (DM-TC) (n = 21) were studied. Mean corpuscular volume of mature red cells (Mean +/- SD = 93.6 +/- 5.5 fl) and reticulocyte (119.1 +/- 12.3 fl) of patients with DM-T was not significantly increased from normal (red cell, 90.0 +/- 3.5 fl; reticulocyte, 115.2 +/- 7.3 fl). Plasma triglyceride levels had no significant correlation with red cell MCV, reticulocyte MCV and %Hb A1c. This suggests that high triglyceride levels in DM are not dose-dependent in producing increased MCV of red cells and reticulocytes. Comparing between DM-T and DM-C, red cells and reticulocytes from DM-C patients had significantly decreased MCV (red cell, 85.5 +/- 6.1 fL; reticulocyte, 103.8 +/- 7.4 fL). Plasma cholesterol levels were inversely correlated with MCV of red cells (r = -0.377, p = 0.003) and also MCV of reticulocytes (r = -0.418, p = 0.001). In addition, cholesterol levels showed considerable correlation with Hb A1c (r = 0.572, p = 0.004). The red cell volume change in DM-C patients may be partly due to the shift in balance of cholesterol exchange between red cell membranes and serum lipoproteins.

Cytometric analysis of blood cells from malaria-infected patients and in vitro infected blood.

Blood samples from malaria-infected patients and from in vitro culture were analyzed using the H*1 hematology analyzer. An attempt to find a hematologic parameter for detecting the malaria infection and to characterize the pathophysiological changes of red cells was made. The study included 18 malaria-infected patients (10 with Plasmodium falciparum and 8 with Plasmodium vivax) and 52 normal, healthy volunteers. Increased young large lymphocyte or large unstained cell count (LUC over 3%) in the peripheral blood of malaria-infected patients was evidence for malaria infection. Increased population dispersions of red cell volume (red cell distribution width: RDW) and intraerythrocytic hemoglobin concentration (hemoglobin distribution width: HDW) were demonstrated both in clinical samples and cultured blood. The increased RDW correlated with an increased percentage of macrocytes (r = 0.64, P = 0.004). Comparison of HDW and percentage of hypochromic red cells between the clinical specimen and the cultured blood supports the finding that changes in red cell hemoglobin concentration were mainly due to the response of the patient to malaria infection and partly due to the effect of malaria parasites on the red cells.

Measurements of cell volume and hemoglobin concentration of erythrocytes from hereditary ovalocytosis and hereditary spherocytosis.

Red cell analysis using the laser technique was done on erythrocytes from 11 cases of hereditary ovalocytosis (HV) and one case of hereditary spherocytosis (HS). Heterogeneity in red cell volume measured as red cell distribution width (RDW) and heterogeneity of hemoglobin concentration in the red cells as measured by hemoglobin concentration distribution width (HDW) were analyzed. All of the studied cases showed abnormal increase in both RDW and HDW. The patient with HS had decreased MCV 77.4 fL (normal range = 80-99 fL). The HS patient had microcytes 14.7 per cent with markedly increased RDW 22.3 per cent (normal range = 11.5-14.5%). Increased hemoglobin concentration was demonstrated in HS red cells as shown by increased CHCM 39.2 g/dl (normal range = 33-37) with 5.86 g/dl of HDW (normal range = 2.2-3.3 g/dl). The HV patients had slightly decreased cell volume, MCV = 84.1 +/- 11.8 fL, with 9.2 +/- 10.1 per cent microcytes and 17.5 +/- 5.7 per cent RDW. Decreased hemoglobin concentration was shown in HV red cells as shown by decreased CHCM (31.7 +/- 1.9 g/dl) with slightly increased HDW (3.3 +/- 0.9 g/dl). The HV patients had increased per cent hypochromic red cells (14.8 +/- 18.6%). The ovalocytic red cells in HV patients had obviously reduced hemoglobin concentration compared to the spherical red cells of HS patients.

Effect of vegetable oil intake on erythrocyte physical properties and hemorheology.

Effects of vegetable oil intake on red cell physical properties and blood flow condition were evaluated. The study was done on two groups of volunteers taking either soybean oil (6 volunteers) or palm oil (another 6 subjects) for a period of eight weeks. The continuous effects were followed up after continuing the vegetable oil intake for another four weeks. Significant reduction in red cell deformability was demonstrated by laser diffractometry in both groups. The palm oil had greater extent in causing reduced red cell deformability as early as four weeks after the oil intake, whereas, such effect was shown in eight weeks after the soybean oil intake. The reducing effect of red cell deformability by palm oil intake was more obvious than that by the soybean oil intake as indicated by the fall of deformability index from the control by 47.6 per cent in palm oil and 21.9 per cent in the soybean oil group. The decrease still persisted and could be investigated on the four weeks' followup. The hematologic parameters measured by the laser-based instrument, the H*1 analyser were all within the normal ranges in both groups. However, the group taking soybean oil showed decreasing hemoglobin levels, which may be a physiological response to facilitate blood flow condition. The platelet volume was increased in both groups, indicating the possibility of adjustment of thrombopoiesis in the subjects although no clinical indication related to this finding was shown. In conclusion, intake of vegetable oil had an effect on red cell deformability. Soybean oil had an advantage over palm oil in having less effect on reducing the red cell deformability.

Increased ovalocytic red cells and their low parasitemia in malaria infected subjects.

Ovalocytic red blood cells were significantly increased in the peripheral blood films of patients infected with P. falciparum (mean +/- S.D. = 6.3 +/- 8.4%) and P. vivax (8.3 +/- 14.0%), whereas, there was only 0.6 +/- 0.4 per cent ovalocytes in normal individuals. Per cent parasitemia of ovalocytes counted at least 100 ovalocytes of the blood films of malaria infected individuals was significantly reduced when compared with that of discocytes which revealed at least 100 discocytes in the same blood smears. Relative increase in ovalocyte and their low parasitemia might be the response of malaria infected individuals to cope with malaria multiplication in their circulation.