Pongpun Nunthapisud

Analysis of eight different methods for the detection of Helicobacter pylori infection in patients with dyspepsia

Background:  The present study was designed to compare the accuracy of eight different methods for the detection of Helicobacter pylori (H. pylori) infection in patients with dyspepsia. These tests included culture, histology, rapid urease test (CLO test), serology, saliva IgA, gastric juice IgA, and two in‐house methods, namely in‐house urease test and Gram stain.

The use of two estrogen preparations (a combined contraceptive pill versus conjugated estrogen cream) intravaginally to treat urogenital symptoms in postmenopausal Thai women: a comparative study.

To determine whether the combined contraceptive pill used intravaginally was as effective as the standard conjugated estrogen cream for the treatment of urogenital symptoms in postmenopausal Thai women.

Spontaneous bacterial peritonitis caused by Streptococcus bovis: case series and review of the literature

Streptococcus bovis is the rare cause of spontaneous bacterial peritonitis in decompensated cirrhosis. S. bovis bacteremia has long been known to be associated with colon cancer. We describe seven patients and review the seven previous reports of spontaneous bacterial peritonitis patients with S. bovis infection. Most of the patients had cirrhosis and presented with fever, abdominal pain, abdominal distention, and jaundice. Colonic adenomatous polyps with dysplastic change were found in 18.2% of the patients. The approach to this group of patients requires diagnostic paracentesis, blood cultures, ascitic fluid culture, and treatment with antimicrobial agents. Intravenous penicillin is still the antimicrobial agent of first choice (mean minimum inhibitory concentration for penicillin = 0.05 μg/ml). S. bovis is an infrequent cause of spontaneous bacterial peritonitis. The physician could make a case that colonoscopy is not needed because the patient is very sick and the possibility of GI pathology, especially colonic lesions, has been low. However, it may be that colonoscopy should be done if there are clinical suggestions to do so or the patient is well enough to withstand surgery.

Serotype coverage of pneumococcal conjugate vaccine and drug susceptibility of Streptococcus pneumoniae isolated from invasive or non-invasive diseases in central Thailand, 2006-2009.

The serotype of 172 S. pneumoniae isolates obtained from normally sterile sites from January 2006 to February 2009 in Thai patients was evaluated. The most common serotypes were 6B, 23F, 14, 19F, and 19A in patients <5 year-old, and 6B, 19A, 23F, 4, 9V in patients >65-year old. Seven-valent pneumococcal conjugated vaccine (PCV-7) covered 70.3%, 43.6%, and 43.5% of patients <5, 5-64 and > or = 65 years of age, respectively, while PCV-13 covered 81.2%, 59.7%, and 60.9%, respectively. PCV-9, PCV-10, PCV-11 had very similar coverage as PCV-7. The antibiotic susceptibility rates of the isolates from sterile sites were 88.7-95.7% for penicillin, 90.6-98.4% for cefotaxime, 92.2-100% for ofloxacin and 100% for ciprofloxacin. PCV-7 covered 83% and 100%, respectively, of penicillin and cefotaxime non-susceptible isolates in patients <5-year old.

Appendicitis-like syndrome owing to mesenteric adenitis caused by Salmonella typhi

Abstract We report a 14-year-old girl who presented with signs of appendicitis and had her appendix removed. She subsequently proved to have mesenteric adenitis owing to Salmonella typhi which responded to treatment with ceftriaxone.

Tetanus after white-lipped green pit viper (Trimeresurus albolabris) bite.

Snakebite is a common medical emergency in Thailand. The fatality rate due to snakebites, however, has declined from more than 200 cases per year in the 1940s1 to fewer than 20 cases per year in the 1980s.2 The green pit vipers (Trimeresurus spp) are responsible for the great majority of venomous snakebites in Thailand.3–5 Severe coagulation abnormalities from green pit viper bites are uncommon and, if present, respond readily to the administration of fresh frozen plasma, platelets, and antivenom.6 Almost all patients survive and some eventually develop secondary bacterial infection at bite sites. There have been a few reports of tetanus complicating snakebite.7–9 But no tetanus has been reported after green pit viper bites. Tetanus prophylaxis is not routinely recommended in Thailand during the early period after bites from hematotoxic snakes because there is a risk of bleeding at the injection site. We report the first case of tetanus in a patient with white-lipped green pit viper (Trimeresurus albolabris) bite. We also investigated whether Clostridium tetani, the causative agent of tetanus, are present in the oral cavity of T albolabris.

Changing trends in serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae causing invasive diseases in Central Thailand, 2009-2012.

To describe the trends in serotype distribution and antimicrobial susceptibility of S. pneumoniae causing invasive pneumococcal diseases (IPD) we tested 238 pneumococci isolates from normally sterile sites between 2009 and 2012 and compared these findings with previous data collected within our network. Serotyping was performed for 15 serotypes contained in the 7-,10-, 13-, and experimental 15-valent pneumococcal conjugate vaccines (PCV). The most common serotypes found were 6B (13.9%), 19A (12.6%), 14 (8.0%), 18C (5.9%), and 6A (3.8%); and 39.9% were non-PCV15 serotypes. One of 81 patients with available data had breakthrough infection with vaccine serotype (19F). There was a significant increase of serotype 19A among children ≤5 years (5.6% in 2000–2009 vs 18.3% in 2009–2012, P = 0.003). The all-age serotype coverage was 36.4%, 41.5%, 59.3%, and 59.7% for PCV7, PCV10, PCV13, and PCV 15, respectively. The corresponding coverage in children ≤5 years were 46.4%, 48.8%, 73.2%, and 73.2% respectively. High susceptibilities to penicillin (89.7%), cefotaxime (95.7%), cefditoren (90.2% by Spanish breakpoints), ofloxacin (97.9%), and levofloxacin (100%), but low to cefdinir (50.0%), cefditoren (45.1% by US-FDA breakpoints), macrolides (<50%), clindamycin (67.7%), tetracycline (41.4%), and trimethoprim-sulfamethoxazole (32.4%) were observed. Serotype 19A was less susceptible to penicillin (80.0 vs 91.2%, P = 0.046), cefditoren (66.7 vs 95.5% by Spanish breakpoints, P = 0.004), and tetracycline (9.1 vs 45.5%, P = 0.024) than non-19A isolates. These data emphasize the need for continued surveillance to monitor changes in serotypes as well as antimicrobial susceptibilities in order to guide strategies for prevention and treatment.

Prevalence of Chlamydia pneumoniae infection in Thai children with community-acquired pneumonia.

The prevalence of Chlamydia pneumoniae infection in children with community-acquired pneumonia was investigated at Chulalongkorn Hospital, Bangkok from 1999 through 2001. Serologic evidence of acute C. pneumoniae infection was found in 149 of 333 (44.7%) children, of whom 132 of 149 (88%) were <5 years of age. The findings provide further evidence that C. pneumoniae infection is common in very young children.

Detection of the erythrogenic toxin A, B, and C genes in group A streptococci isolated from clinical specimens.

Erythrogenic toxins are also known as streptococcal pyrogenic exotoxins (spe) which cause a skin rash in scarlet fever (3). They also appear to be involved in the pathogenesis of severe infection (1). We investigated the detection of speA, speB, speC genes in group A streptococci (GAS) isolated from clinical specimens and in throat of school children.