Presumably entomophthoramycosis in an HIV-infected patient: the first in Thailand

The authors reported the case of a symptomatic HIV-infected woman with a slowly progressive infiltrative lesion which invaded in and around the nasal cavity over a 6-month period. Physical examination showed erythematous to violaceous plaques at the nasal and malar areas. Swelling of the inferior turbinate was noted in the right nare. Skin biopsy of the involved area revealed multiple nonseptate, broad, thin-walled hyphae within giant cells and granulomata. Entomophthoramycosis was diagnosed based on clinical features and histopathology. She was treated with intravenous amphotericin B for two weeks, followed by oral itraconazole 400 mg daily. At six months there was complete resolution of all lesions.

Seroprevalence of hepatitis A virus antibody among children and young adults in Bangkok

OBJECTIVE

To determine the prevalence of hepatitis A virus (HAV) antibodies in various age groups of healthy children and young adults who have not received the hepatitis A vaccine.

METHOD

Blood samples were collected from 825 volunteers aged 1-30 years from a well baby clinic and five academic institutions in the Don Mueang area from 1998 to 1999. Serum samples were assayed for specific HAV IgG antibodies using a commercial enzyme-linked immunosorbent assay (ELISA) kit.

RESULTS

The seropositivity rate (12.4% overall) in each age group was as follows: 1-3 years, 7.7 per cent; 4-7 years, 6.6 per cent; 8-11 years, 12.4 per cent; 12-15 years, 10.7 per cent and 16-30 years, 25.9 per cent.

CONCLUSIONS

In the Don Mueang area of Bangkok, the majority of children (< 16 years) do not have natural immunity against HAV. The use of hepatitis A vaccine for this population should be considered. Pre-vaccination serologic screening for HAV IgG in children may not be worthwhile.

What are today's orphaned vaccines?

Development costs for new biological agents are increasing, and the time span from laboratory research to introduction of a product on the world market is becoming ever longer. Complex regulatory requirements add barriers and additional costs to early introduction abroad. This results in reluctance by manufacturers to undertake development of a vaccine that will be used for a tropical disease in only the public sector of a poor country. The chances of recovery of huge investment costs before patents expire are not good, unless such a new vaccine can also be sold at high cost in North America and Europe. These are some of the reasons that we still do not have a modern Japanese encephalitis vaccine or products against malaria and dengue fever. Many tropical countries must find a way to develop their own vaccine production facilities. Innovative help for technology transfer will have to be forthcoming, or many new life-saving products will never bridge the gap between research unit and production.

Venomous snake husbandry in Thailand

A captive breeding program for venomous Thai snakes was established at the Queen Saovabha Memorial Institute at Bangkok, Thailand. This was necessary to secure a stable, healthy, and species-confirmed source of snake venom for antivenom production. In 1994, wild-caught specimens were collected, sexed, quarantined, and housed appropriately. All data in this report, with the exclusion of Table 6, were collected from 1994 to 1997. Two species were bred successfully in captivity to date during this study period. Although captive breeding has not yet been achieved with all species and subspecies, our early success was encouraging.

Non-serogroup O:1 Vibrio cholerae bacteremia and cerebritis

We describe a case of non-serogroup O:1 Vibrio cholerae bacteremia and cerebritis in a 41-year-old Thai man with alcoholism who presented with fever and cellulitis of the right ankle. He was successfully treated with parenteral cefotaxime and then was switched to treatment with oral ciprofloxacin.

A comparison of mutations induced by accelerated iron particles versus those induced by low earth orbit space radiation in the FEM-3 gene of Caenorhabditis elegans

The fem-3 gene of Caenorhabditis elegans was employed to determine the mutation frequency as well as the nature of mutations induced by low earth orbit space radiation ambient to Space Shuttle flight STS-76. Recovered mutations were compared to those induced by accelerated iron ions generated by the AGS synchrotron accelerator at Brookhaven National Laboratory. For logistical reasons, dauer larvae were prepared at TCU, transported to either Kennedy Space Center or Brookhaven National Laboratory, flown in space or irradiated, returned to TCU and screened for mutants. A total of 25 fem-3 mutants were recovered after the shuttle flight and yielded a mutation frequency of 2.1x10(-5), roughly 3.3-fold higher than the spontaneous rate of 6.3x10(-6). Four of the mutations were homozygous inviable, suggesting that they were large deletions encompassing fem-3 as well as neighboring, essential genes. Southern blot analyses revealed that one of the 25 contained a polymorphism in fem-3, further evidence that space radiation can induce deletions. While no polymorphisms were detected among the iron ion-induced mutations, three of the 15 mutants were homozygous inviable, which is in keeping with previous observations that high LET iron particles generate deficiencies. These data provide evidence, albeit indirect, that an important mutagenic component of ambient space radiation is high LET charged particles such as iron ions.

Immunologic and virologic evaluation of HIV-1-infected children after rabies vaccination

BACKGROUND

One-third of Thai children experience a dog bite by the time they are 15 years old, and HIV-1 infection in children is also not uncommon. Previous study has shown that rabies vaccination of HIV-1-infected children may not result in a satisfactory antibody response when CD4+ T cells are less than 15%. The objective of this prospective clinical study is to evaluate the immunologic response and effect on viral load after rabies vaccination in HIV-infected children.

METHODS

Thirteen HIV-1-infected children were vaccinated with the intramuscular rabies pre-exposure regimen using human diploid cell rabies vaccine (HDCV) on days 0, 7 and 28. CD4+ and CD8+ lymphocyte counts were performed on days 0, 7 and 28. Plasma viral loads were determined on days 0, 7, 14, 60, 90, 180 and 360.

RESULTS

There were no significant change in serial measurements of CD4+/CD8+ lymphocytes during a period of 1 month and in plasma viral load during 1 year. There was no associated clinical deterioration or any adverse reactions attributable to vaccine.

CONCLUSIONS

Rabies vaccination in HIV-1-infected children appears to be safe but did not significantly change the levels of plasma HIV RNA, CD4+ and CD8+ cell counts.

Dog-bite injuries at the Animal Bite Clinic of the Thai Red Cross Society in Bangkok

Canine rabies remains a public health problem in Thailand and other developing countries. This study of animal bites at the Animal Bite Clinic at the Queen Saovabha Memorial Institute revealed that: (1) The majority of patients were bitten by dogs and the time of the attack was mostly during the day. (2) School-aged children are at the highest risk for animal bites. (3) The most common site of injury are the legs and foot (64.2%), with the second most common site being the hands and fingers (21.2%). (4) Only 48 per cent of patients received rabies vaccine 1-2 days after being exposed. There was considerable delay before the rest received treatment. Solving Thailand' s rabies problem depends on control of canine rabies and educational campaigns. Public education must be an integral part of efforts to decrease the incidence of animal bites and assurance that they are managed properly.

N-Glycosidation of D-arabino-hex-2-ulosonic acid

Two approaches to N-functionalized D-arabino-hex-2-ulosonic acid derivatives were established by nucleophilic substitution of methyl (3,4,5-tri-O-acetyl-beta-D-arabino-hex-2-ulopyranosyl)onate bromide (1). Reaction of 1 with amino compounds in the presence of mercury(II) cyanide led to the 2,3-cis configured beta-D-arabino N-glycosides. On the other hand, the reaction of bromide 1 with azide, followed by catalytic hydrogenation led to 2,3-trans alpha-D-arabino glycosyl amine methyl 3,4,5-tri-O-acetyl-2-amino-alpha-D-arabino-hex-2-ulopyranosonate, which was easily rearranged to the thermodynamically more stable beta-D-arabino N-acetyl derivative methyl 4,5-di-O-acetyl-2-acetylamino-3-hydroxy-beta-D-arabino-hex-2-ulopyranosonate. The assignment of configuration of the tertiary anomeric centre and conformation of all products was based on 1H NMR H,H coupling constants and NOE difference experiments.

Diffusion and fate of intramuscularly injected human rabies immune globulin

The importance of rabies immune globulin (RIG) in postexposure rabies treatment is well known and it has been emphasized that the local injection into the animal bite sites is crucial. This preliminary study used a radioisotope tracer that allows following the fate of human rabies immune globulin (HRIG) injected intramuscularly. There was significant retention and local diffusion of the immune globulin at the injection site and significant radiotracer could still be detected at the site 24 h later.

Humanistic learning in medical curriculum

This paper argues for more attention and exposure to humanistic learning in the Thai medical curriculum. Humanistic learning traditionally consists of literature, history and philosophy, and is advantageous for medical education in that it tends to foster sensitivities to feelings, awareness of social traditions, and creating of skills in deliberating complex, ethical issues. These dispositions are necessary for a doctor in the world where there is an ever increasing public demand for communication, accountability and transparency on the part of doctors. It is proposed that the Thai medical curriculum should include more humanistic learning, and that medical students should be given opportunities to interact more with students from other disciplines throughout their studies and later professional life.

Neutralizing antibodies to rabies following injection of rabies immune globulin into gluteal fat or deltoid muscle

BACKGROUND

This experiment was carried out to determine whether there is any difference in circulating rabies antibody when rabies immune globulin is administered into fat or muscle tissue.

METHODS

Blood samples were taken at 24 and 48 hours after administering 40 IU/kg body weight of purified equine rabies immune globulin (ERIG) into deltoid muscle, or fatty gluteal tissue of grossly obese subjects.

RESULTS

Both groups revealed barely detectable antibody levels.

CONCLUSIONS

No conclusion was possible concerning the absorption kinetics of immune globulin from fat or muscle. However, it was evident that circulating antibody levels, using the recommended 40 IU/kg dose of ERIG, were extremely low and probably less than the required protective level at the possible bite site. This study supports current recommendations for local infiltration of virus inoculation sites with human or equine rabies immune globulin.