Khachornsakdi Silpapojakul

Viremic profiles in asymptomatic and symptomatic chikungunya fever: a blood transfusion threat?

The presence of a chikungunya virus (CHIKV) outbreak could have an impact on transfusion safety when there are a large number of infected persons during an epidemic. Serosurveys have found that 3% to 28% of infected persons remain asymptomatic and are potential disseminators of transfusion‐associated chikungunya. However, the viremic profiles of asymptomatic chikungunya patients, the major determinant of the transfusion risk, are unknown.

Case Reports of Neuro-Chikungunya in Southern Thailand

There has been a recent increase in reports of neurologic complications as major causes of morbidity and mortality in chikungunya virus infection. As a part of 2004-2009 global outbreaks, an unprecedented large chikungunya epidemic occurred in Southern Thailand during 2008-2009 in which 49,069 cases were reported. During this period, we encountered two patients with meningoencephalitis and another patient with myeloneuropathy among 1,018 cases diagnosed as chikungunya in our hospital. The clinical pictures are presented and the key points are used to recognize and differentiate chikungunya from Japanese encephalitis virus, dengue virus, and herpesvirus infections, which are more common causes of meningoencephalitis and myelitis in this region.

Comparative evaluation of four serodiagnostic tests for scrub typhus in Thailand

The commercial dot-blot enzyme-linked immunosorbent assay Dip-S-Ticks dipstick test was compared with the indirect immunoperoxidase (IIP) and Weil-Felix (WF) tests for the diagnosis of scrub typhus, using the indirect immunofluorescent antibody test (IFA) as the reference standard. With a panel of 117 positive and 75 negative sera, the dipstick test was 94% sensitive and 98.7% specific at a cut-off value of one or more positive dots. The IIP was 90.6% sensitive and 100% specific at a cut-off titre of 1:400, and was more sensitive than the IFA with acute sera (79.6% vs. 68.5% at a titre > or = 1:400). All 3 were superior to the WF, which lacked sensitivity. The dipstick assay was easy to perform and did not require sophisticated electrical equipment, and the results were available within one hour. It is therefore suitable for use in rural Thailand, where scrub typhus is common.

The risk of blood transfusion–associated Chikungunya fever during the 2009 epidemic in Songkhla Province, Thailand

Asymptomatic Chikungunya fever (CHIKF)‐viremic blood donors could be a potential threat of spreading the disease unwittingly through contaminated blood transfusions. The relatively low prevalence of Chikungunya virus antibodies in the population and the records of more than 9000 suspected CHIKF cases raised concern about the potential transfusion‐associated CHIKF during the 2009 epidemic. This study assessed the potential transfusion risk for CHIKF and the implementation of blood safety measures to mitigate this risk.

Consecutive cutaneous and visceral leishmaniasis manifestations involving a novel Leishmania species in two HIV patients in Thailand.

Leishmaniasis is an emerging disease in Thailand. Herein, we report on two human immunodeficiency virus (HIV)-infected patients with leishmaniasis who presented with overlapping manifestations between cutaneous and visceral leishmaniasis. Sequencing analysis of the internal transcribed spacer 1 (ITS1) of the ribosomal RNA gene showed that the species was identical to a new species recently described in Thailand. The detection of DNA of this Leishmania species in saliva may have important implications for transmission and epidemiological studies.

Leptospirosis and its pulmonary complications

Objective:  The aim of this study was to assess the incidence and factors associated with pulmonary complications of leptospirosis.

Outcomes of Patients with Melioidosis Treated with Cotrimoxazole Alone for Eradication Therapy

We retrospectively reviewed a 10-year experience of administration of cotrimoxazole alone in 31 patients compared with 109 patients who received conventional eradication therapy (cotrimoxazole plus doxycycline). The baseline characteristics, the clinical manifestations, the initial intravenous antibiotic treatments, and the mean duration of eradication therapy between the two groups were similar. The culture-confirmed recurrences among the patients who received cotrimoxazole alone and those who received the conventional regimen were not significantly different (1/31 [3.2%] versus 5/109 [4.5% odds ratio = 0.69 [95% confidence interval [CI] = 0.08-6.17]). Gastrointestinal side effects were more common among the conventional regimen group (28/109 [25.7%] versus 2/31 [6.5%], P = 0.02) and the proportion of patients who could complete at least 20 weeks of therapy without having switched to the other regimen was significantly lower (91/109 [83.5%] versus 31/31 [100.0%] P = 0.01). Cotrimoxazole alone is as effective as and better tolerated than cotrimoxazole plus doxycycline for the eradication treatment of melioidosis.

Risk of transfusion-transmitted chikungunya infection and efficacy of blood safety implementation measures: experience from the 2009 epidemic in Songkhla Province, Thailand

To date, neither is there a standard guideline for maintaining a safe blood supply during a chikungunya fever (CHIKF) outbreak nor has a study been performed on actual transfusion‐transmitted CHIKF to recipients. This study estimated the potential incidence of transfusion‐transmitted CHIKF and compared the efficacies of various blood safety intervention strategies to mitigate the transfusion‐transmitted CHIKF risk.

Multiple Cutaneous Nodules in an HIV-Infected Patient

1 Medical Science Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 2 Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand, 3 Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 4 Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 5 Medical Sciences, National Institutes of Health Ministry of Public Health, Nonthaburi, Thailand, 6 Excellence Center for Emerging Infectious Diseases, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand