External quality assessment scheme for HbA1c assays in Thailand: A 5-year experience.

Background: Thailand National External Quality Assessment Scheme (NEQAS) for HbA1c was established to evaluate the quality of HbA1c assays in Thailand in 2016. Methods: HbA1c results from participating laboratories were compared to the target value assigned by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference system. Results: The pass rates of participating laboratories during 2016-2020 were72-88%. The mean bias ranged between -0.19 and 0.20% of HbA1c. SD ranged from 0.30 to 1.08% of HbA1c. The overall coefficients of variation ranged from 4.46-15.66%. Conclusions: Performance evaluation using IFCC assigned values indicated that different assay methods had an effect on HbA1c results. Participation in external quality assessment programs for HbA1c analysis is essential for improving laboratory quality and benefiting patient management.

SARS-CoV-2 RT-PCR positivity of individuals subsequent to completing quarantine upon entry into a country during a transmission-free period.

BACKGROUND: During the current coronavirus disease 2019 (COVID-19) pandemic, many countries require travellers to undergo a reverse transcription-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before travelling across borders. However, in persons having recovered from COVID-19, RT-PCR positivity can persist for an extended period. MATERIALS AND METHODS: We describe three cases who sought fit-to-fly certificates in Thailand during the period free of local transmission but were tested positive for RT-PCR for SARS-CoV-2. All had returned from a country with an active outbreak of COVID-19. Their clinical courses are described; positive nasopharyngeal swab samples were processed for viral isolation and whole-genome sequencing (WGS); and serology as well as neutralizing antibody were assessed. The contact tracing was carried out for determining evidence of indigenous transmission among close contacts of those three cases. RESULTS: All three cases were completely asymptomatic. Chest computerized tomography was not compatible with COVID-19 pneumonia; cell cultures failed to rescue replication-competent virus; WGS revealed fragmented viral genetic material from nasopharyngeal swab samples; and serological tests demonstrated stable levels of antibodies, together with the presence of neutralizing antibody, suggesting past infection with negligible transmission risk. Contact tracing identified no transmission in high-risk close contact individuals. CONCLUSION: RT-PCR positivity for SARS-CoV-2 might detect fragmented viral genome. Issuance of a travel certificate in these circumstances is problematic. Serology tests can help to define past infection. A practical acceptable set of guidelines for issuance of a COVID-19 safety travel certification is a necessity.

Application of QuantiFERON ELISA for Detection of Interferon-Gamma Autoantibodies in Adult-Onset Immunodeficiency Syndrome.

OBJECTIVE: Patients who develop interferon-gamma autoantibodies (IFN-ɤ autoAbs) in adult-onset immunodeficiency (AOID) syndrome are more likely to develop opportunistic and recurrent intracellular infections. The assay to detect IFN-ɤ autoAbs is essential for the diagnosis and therapeutic monitoring of AOID syndrome. Therefore, this study applied the QuantiFERON assay for the detection of IFN-ɤ autoAbs. METHODS: Serum from patients with AOID syndrome (n = 19) and serum from healthy patients (n = 20) was collected and applied using 2 neutralizing platforms of enzyme-linked immunosorbent assay (ELISA) kits (the BD ELISA and the QuantiFERON ELISA) for IFN-ɤ autoAbs detection. RESULTS: The pooled serum from patients with AOID syndrome showed >50% inhibition at 1:5000 dilution (positive), whereas the pooled serum from healthy patients showed <50% inhibition at 1:5000 dilution (negative) according to the neutralizing QuantiFERON ELISA. Each specimen showed the same result according to both the neutralizing BD ELISA and the neutralizing QuantiFERON ELISA. Moreover, the patient serum showed a variation in titer ranging from 1:5000 to >1:5,000,000 according to the neutralizing QuantiFERON ELISA. CONCLUSION: The QuantiFERON ELISA kit could be applied for the detection of IFN-ɤ autoAbs for the diagnosis and therapeutic monitoring of AOID syndrome.

SARS-CoV-2 neutralizing antibodies decline over one year and patients with severe COVID-19 pneumonia display a unique cytokine profile.

OBJECTIVES: As coronavirus disease 2019 (COVID-19) rages on worldwide, there is an urgent need to characterize immune correlates of protection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify immune determinants of COVID-19 severity. METHODS: This study examined the longitudinal profiles of neutralizing antibody (NAb) titers in hospitalized COVID-19 patients clinically diagnosed with mild symptoms, pneumonia, or severe pneumonia, up to 12 months after illness onset, using live-virus neutralization. Multiplex, correlation, and network analyses were used to characterize serum-derived inflammatory cytokine profiles in all severity groups. RESULTS: Peak NAb titers correlated with disease severity, and NAb titers declined over the course of 12 months regardless of severity. Multiplex analyses revealed that IP-10, IL-6, IL-7, and VEGF-α were significantly elevated in severe pneumonia cases compared to those with mild symptoms and pneumonia cases. Correlation and network analyses further suggested that cytokine network formation was distinct in different COVID-19 severity groups. CONCLUSIONS: The study findings inform on the long-term kinetics of naturally acquired serological immunity against SARS-CoV-2 and highlight the importance of identifying key cytokine networks for potential therapeutic immunomodulation.

Rh blood phenotyping (D, E, e, C, c) microarrays using multichannel surface plasmon resonance imaging.

The application of Surface Plasmon Resonance Imaging (SPRi) for the detection of transmembrane antigen of the Rhesus (Rh) blood group system is demonstrated. Clinically significant Rh blood group system antigens, including D, C, E, c, and e, can be simultaneously identified via solid phase immobilization assay, which offers significant time savings and assay simplification. Red blood cells (RBCs) flowed through the micro-channel, where a suitable condition for Rh blood group detection was an RBC dilution of 1:10 with a stop-flow condition. Stop flow showed an improvement in specific binding compared to continuous flow. Rh antigens required a longer incubation time to react with the immobilized antibody than A and B antigens due to the difference in antigen type and their location on the RBC. The interaction between the immobilized antibodies and their specific antigenic counterpart on the RBC showed a significant difference in RBC removal behavior using shear flow, measured from the decay of the SPR signal. The strength of the interaction between the immobilized antibody and RBC antigen was determined from the minimum wall shear stress required to start the decay process in the SPR signal. For a given range of immobilized antibody surface densities, the Rh antigen possesses a stronger interaction than A, B, and AB antigens. Identification of 82 samples of ABO and Rh blood groups using SPRi showed good agreement with the standard micro-column agglutination technique. A wider coverage of antigenic recognition for RBC when using the solid phase immobilization assay was demonstrated for the RBC with the antigenic site located on the transmembrane protein of the clinically significant Rh antigen. Given the level of accuracy and precision, the technique showed potential for the detection of the Rh minor blood group system.

Surface plasmon resonance imaging for ABH antigen detection on red blood cells and in saliva: secretor status-related ABO subgroup identification.

Low antigenic expression of ABO subgroup system on red blood cell (RBC) is cause of discrepancy between forward and reverse blood typing in the standard agglutination technique. Neutralization agglutination is employed for verification of the detection of ABH substances in saliva. However, the neutralization technique is complicated, time-consuming and requires expertise. To overcome these drawbacks, surface plasmon resonance (SPR) imaging was developed for ABH antigen detection on RBCs and in saliva. An antibody array was designed to classify the ABO subgroups by anti-A, anti-B, and anti-H antibodies; the array was immobilized on a carboxymethyl-dextran sensor-surface. RBCs and saliva specimens from sixty-four donors were analysed by passing them over the antibody array, where the secretor status and blood group could be simultaneously identified. Consequently, the immobilized antibodies could specifically and quantitatively detect the ABH antigen on RBCs. Using the direct assay, the SPR signal of saliva detection was weaker than that of RBC detection. However, a sandwich assay with a mixture of anti-A, anti-B, and anti-H antibodies could efficiently enhance the signal. The sensor chip provided high specificity (cut-off at 100 to 175 micro refractive index units) and high precision at 0.06%-4.9% CV. The blood group results of the sixty-four donor specimens obtained by SPR agreed with the standard agglutination test with 100% accuracy. SPR could indicate different ABH antigen densities on the RBCs and nearly the same amounts of ABH substances in the saliva of strong and weak subgroups. Finally, we also demonstrated reduced assay time and fewer complications with the SPR imaging platform compared to the neutralization technique.

Comparison of Double RBC Collection by Blood Cell Separators.

BACKGROUND: The problem of red blood cell (RBC) shortage occurs because of the expanding demand for blood utilization and the dfficulties in donor recruitment and retention. Resources can be maximized by using current technology to collect two units of RBC from the same donor during a single collection session. OBJECTIVE: To evaluate the performance, collection efficiency (CE), production cost, and donor satisfactions of two commercially available blood cell separators (BCS) for double dose red cell (DDRC) collection. Donor safety, clinical effectiveness, and patient safety were studied. MATERIAL AND METHOD: Thirty-one repeated male donors from the blood bank, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University were recruited for DDRC collection by two BCSs, the Alyx™, Fresenius Kabi, NC, USA, and the MCS®+, Haemonetics Corporation, Scotland. The donation intervals were at least 16 weeks. The target RBC volume was 360 mL (180 mL x 2 units). Pre- and post-donation hematologic parameters were monitored and quality tests for DDRC were performed. Donor reactions (DR) were observed and donor satisfaction questionnaires were collected after donations. Eighty-six units of RBC were transfused to 33 patients. Transfusion reactions (TR) were observed, and hematocrit (Hct) increments were determined pre-transfusion and 24 hours post-transfusion. RESULTS: The Alyx™ was faster for collecting and filtrating RBC (p<0.001) and had better CE (p<0.001). All DDRC from both BCSs met all the quality standards, required by both the American Association of Blood Banks (AABB) and the Food and Drugs Administration (FDA), which were hemoglobin (Hb) >42.5 g, Hct 50 to 70% and the residual white blood cells (WBC) <5x10(6). The Alyx™ processed less whole blood (WB) volume but provided DDRC with higher RBC yield, Hb content, and RBC volume than that of MCS® + (p<0. 001). However; the MCS®+ had one advantage over the Alyx™ whereby the DDRC collected by the MCS®+ were washed to reduce the risk of plasma associated TR. No serious DR from either BCS was observed. All donors had Hb >10 g/dL and Hct >30% after collection, as required by AABB. Serum ferritin reduction and iron depletion found in DDRC donors were not different from WB donors. All donors were satisfied with the DDRC collection process and would like to donate again. There was no evidence of acute or delayed TR in the patients. Hct increased significantly in 69.70% of the patients. CONCLUSION: DDRC collection can be performed safely and efficiently from both BCS. The quality of DDRC from both BCSs met the AABB and FDA standards. Donor safety, transfusion safety, and effectiveness were observed. Even though the production cost of DDRC was slightly higher than that of whole blood derived filtered RBC, DDRC was better in terms of quality, risk reduction for infectious agents, and RBC alloimmunization. Production of DDRC can also be helpful supplying special RBC such as group O, Rh D negative, and phenotyped RBC.

Colorimetric Detection by Gold Nanoparticle DNA Probes for Miltenberger Series (GP.Mur, GP.Hop, and GP.Bun) Identification.

BACKGROUND: Miltenberger (Mi) series are the collective glycophorin hybrids in the MNS blood group system. Mi series are composed of several subtypes, for examples, GP.Mur, GP.Hop, and GP.Bun. The incompatibility of Mi series blood transfusion poses the risk of hemolysis. Due to the lack of standard antibodies for Mi series blood typing, colorimetric gold nanoparticle (AuNP) DNA probes were therefore explored for Mi series identification. METHODS: AuNPs were synthesized and conjugated to an RvB (test) probe and an RvA2 (control) probe. Each of the AuNP DNA probes was tested against the amplified products of Mi(+) (GP.Mur/Hop/Bun), Mi(-), and the blank (no amplified product). The change in color was observed by visual inspection and UV-Vis spectroscopy. RESULTS: The amplified product of the Mi(+) sample retained the color on both probes (test+/control+). The amplified product of the Mi(-) sample retained the color only on the control probe (test-/control+) and the amplified product of the blank turned clear on both probes (test-/control-). The results by optical density absorbance measurement were concordant with the results by visual inspection. Both probes were validated with the amplified products of the ten Mi(+) and ten Mi(-) samples. All of the samples were correctly identified. CONCLUSION: AuNP DNA probes (RvB and RvA2) could be applied to distinguish the amplified products of Mi(+), Mi(-), and the blank by visual inspection and/or OD absorbance measurement.

Evaluation of agglutination strength by a flow-induced cell movement assay based surface plasmon resonance (SPR) technique.

A flow-induced cell movement assay combined with a surface plasmon resonance (SPR) technique was developed to quantify the agglutination strength, derived from the standard tube-agglutination test. Red blood cells (RBCs), based on the ABO blood group system, were specifically captured by anti-A and/or anti-B antibodies immobilized on a sensor surface. The agglutination strength corresponds to the amount of antigen-antibody interactions or the strength of RBC adhesion. Under a shear flow, the adherent RBCs were forced to move out of the region of interest with different average cell velocities (vc) depending upon the adhesion strength and wall shear stress (WSS). That is, a higher adhesion strength (higher agglutination strength) or lower WSS represents a lower vc or vice versa. In this work, the agglutination strength was derived from the vc that was calculated from the time derivative of the relative SPR signal by using a simple model of cell movement response, whose validity was verified. The vc values of different samples were correlated with their agglutination strengths at a given WSS and antibody surface density. The vc decreased as the agglutination strength increased, which can be considered as a linear regression. The coefficient of variation of the calculated vc decreased to 0.1 as vc increased to 30 µm min(-1). The sensitivity of this assay can be controlled by optimizing the antibody surface density or the WSS. This assay has the capability to resolve the antigen density of A1 and B RBCs from that of A1B RBCs.

ABO blood-typing using an antibody array technique based on surface plasmon resonance imaging.

In this study, readily available antibodies that are used in standard agglutination tests were evaluated for their use in ABO blood typing by a surface plasmon resonance imaging (SPR imaging) technique. Five groups of antibodies, including mixed clones of anti-A, anti-B, and anti-AB, and single clones of anti-A and anti-B, were used to construct the five-line detection arrays using a multichannel flow cell in the SPR imager. The red blood cell (RBC) samples were applied to a multichannel flow cell that was orthogonal to the detection line arrays for blood group typing. We found that the blood samples were correctly grouped in less than 12 min by the SPR imaging technique, and the results were consistent with those of the standard agglutination technique for all 60 samples. We found that mixed clones of antibodies provided 33%-68% greater change in the SPR signal than the single-clone antibodies. Applying the SPR imaging technique using readily available antibodies may reduce the costs of the antibodies, shorten the measurement time, and increase the throughput.

HemoglobinA1c level in healthy Thai adults: reference interval and fasting plasma glucose.

AIM: To establish reference interval of HbA1c IFCC in Thai. MATERIALS AND METHODS: 699 whole blood samples were used. Samples had fasting plasma glucose >or=126 mg/dl (7.00 mmol/L), renal problem or hemoglobinopathy was excluded. RESULTS: Reference interval of HbA1c IFCC was 2.90-4.90%. CONCLUSION: Effect of age should be determined.

Fecal alpha1--antitrypsin in healthy and intestinal-disorder Thai children.

OBJECTIVE: Determine the normal FA1-AT level in random wet stool of Thai children using RID and NPL, and to study the correlation between RID and NPL methods for measurement of FA1-AT. MATERIAL AND METHOD: Random stool samples were collected from healthy children and intestinal-disorders patients. Alpha1-antitrypsin (FA1-AT) in wet stool samples was measured by nephelometry (NPL) and radial-immunodiffusion (RID) methods. RESULTS: Newborn infants had the highest FA1-AT level during the first day of life and declined to the same level as older children on day 3-4. Median and geometric mean of FA1-AT levels by NPL from healthy children aged 1 month-15 years was 1.23 and 1.11 mg/dL respectively. FA1-AT levels by NPL from children with severe intestinal disorders, displaying median and geometric mean at 6.77 and 12.39 mg/dL respectively, were much higher than healthy children. The RID and NPL methods showed a correlation of r = 0.87 (p < 0.01) and R2 = 0.75. CONCLUSION: Random FA1-AT assay in wet stool is a non-invasive and simple test for supporting diagnosis of protein-losing enteropathy.

Quorum sensing regulates dpsA and the oxidative stress response in Burkholderia pseudomallei.

Burkholderia pseudomallei is the causative agent of melioidosis, a fatal human tropical disease. The non-specific DNA-binding protein DpsA plays a key role in protecting B. pseudomallei from oxidative stress mediated, for example, by organic hydroperoxides. The regulation of dpsA expression is poorly understood but one possibility is that it is regulated in a cell population density-dependent manner via N-acylhomoserine lactone (AHL)-dependent quorum sensing (QS) since a lux-box motif has been located within the dpsA promoter region. Using liquid chromatography and tandem mass spectrometry, it was first established that B. pseudomallei strain PP844 synthesizes AHLs. These were identified as N-octanoylhomoserine lactone (C8-HSL), N-(3-oxooctanoyl)homoserine lactone (3-oxo-C8-HSL), N-(3-hydroxyoctanoyl)-homoserine lactone (3-hydroxy-C8-HSL), N-decanoylhomoserine lactone (C10-HSL), N-(3-hydroxydecanoyl) homoserine lactone (3-hydroxy-C10-HSL) and N-(3-hydroxydodecanoyl)homoserine lactone (3-hydroxy-C12-HSL). Mutation of the genes encoding the LuxI homologue BpsI or the LuxR homologue BpsR resulted in the loss of C8-HSL and 3-oxo-C8-HSL synthesis, demonstrating that BpsI was responsible for directing the synthesis of these AHLs only and that bpsI expression and hence C8-HSL and 3-oxo-C8-HSL production depends on BpsR. In bpsI, bpsR and bpsIR mutants, dpsA expression was substantially down-regulated. Furthermore, dpsA expression in Escherichia coli required both BpsR and C8-HSL. bpsIR-deficient mutants exhibited hypersensitivity to the organic hydroperoxide tert-butyl hydroperoxide by displaying a reduction in cell viability which was restored by provision of exogenous C8-HSL (bpsI mutant only), by complementation with the bpsIR genes or by overexpression of dpsA. These data indicate that in B. pseudomallei, QS regulates the response to oxidative stress at least in part via the BpsR/C8-HSL-dependent regulation of DpsA.

Prevalence and clinical presentations of atypical pathogens infection in community acquired pneumonia in Thailand.

OBJECTIVES: To determine the prevalence of atypical pneumonia and clinical presentations in patients with community acquired pneumonia (CAP). MATERIAL AND METHOD: A prospective multi-centered study was performed in patients aged > or = 2 years with the diagnosis of CAP who were treated at seven governmental hospitals in Bangkok from December 2001 to November 2002. The diagnosis of current infection was based on > or = 4 fold rise in antibody sera or persistently high antibody titers together with the presence of DNA of M. pneumoniae or C. pneumoniae in respiratory secretion or antigen of L. pneumophila in the urine. Clinical presentations were compared between patients with atypical pneumonia and unspecified pneumonia. RESULTS: Of 292 patients, 18.8% had current infection with atypical respiratory pathogens (M. pneumoniae 14.0%, C. pneumoniae 3.4%, L. pneumophila 0.4% and mixed infection 1.0%). Only age at presentation was significantly associated with atypical pneumonia in adults, while absence of dyspnea, lobar consolidation, and age > or = 5 years were significant findings for atypical pneumonia in children. CONCLUSION: The present study confirms the significance of atypical pathogens in adults and children. Moreover lobar consolidation is likely to predict atypical pneumonia in childhood CAP.

Prevalence and clinical features of mycoplasma pneumoniae in Thai children.

OBJECTIVE: To determine the prevalence and clinical features of mycoplasma pneumoniae in Thai children with community acquired pneumonia (CAP). MATERIAL AND METHOD: Diagnosis of current infection was based on > or = 4 fold rise in antibody sera or persistently high antibody titers together with the presence of mycoplasma DNA in respiratory secretion. The clinical features were compared between children who tested positive for M pneumoniae, and those whose results were negative. RESULTS: Current infection due to M. pneumoniae was diagnosed in 36 (15%) of 245 children with paired sera. The sensitivity and specificity of polymerase chain reaction (PCR) in diagnosing current infection in the present study were 78% and 98% respectively. The mean age of children with mycoplasma pneumoniae was higher than CAP with unspecified etiology. The presenting manifestations and initial laboratory finding were insufficient to predict mycoplasma pneumoniae precisely, the presence of chest pain and lobar consolidation on chest X-ray, however, were significant findings in children with mycoplasma pneumoniae. CONCLUSION: The present study confirms that M. pneumoniae plays a significant role in CAP in children of all ages. Children with this infection should be identified in order to administer the appropriate antibiotic treatment.

Functional genetic analysis reveals a 2-Alkyl-4-quinolone signaling system in the human pathogen Burkholderia pseudomallei and related bacteria.

Pseudomonas aeruginosa synthesizes diverse 2-alkyl-4(1H)-quinolones (AHQs), including the signaling molecule 2-heptyl-3-hydroxy-4(1H)-quinolone (PQS), via the pqsABCDE locus. By examining the genome databases, homologs of the pqs genes were identified in other bacteria. However, apart from P. aeruginosa, only Burkholderia pseudomallei and B. thailandensis contained a complete pqsA-E operon (termed hhqA-E). By introducing the B. pseudomallei hhqA and hhqE genes into P. aeruginosa pqsA and pqsE mutants, we show that they are functionally conserved and restore virulence factor and PQS production. B. pseudomallei, B. thailandensis, B. cenocepacia, and P. putida each produced 2-heptyl-4(1H)-quinolone (HHQ), but not PQS. Mutation of hhqA in B. pseudomallei resulted in the loss of AHQ production, altered colony morphology, and enhanced elastase production, which was reduced to parental levels by exogenous HHQ. These data reveal a role for AHQs in bacterial cell-to-cell communication beyond that seen in P. aeruginosa.

Identification of a novel 74-kiloDalton immunodominant antigen of Pythium insidiosum recognized by sera from human patients with pythiosis.

The oomycetous, fungus-like, aquatic organism Pythium insidiosum is the etiologic agent of pythiosis, a life-threatening infectious disease of humans and animals that has been increasingly reported from tropical, subtropical, and temperate countries. Human pythiosis is endemic in Thailand, and most patients present with arteritis, leading to limb amputation and/or death, or cornea ulcer, leading to enucleation. Diagnosis of pythiosis is time-consuming and difficult. Radical surgery is the main treatment for pythiosis because conventional antifungal drugs are ineffective. The aims of this study were to evaluate the use of Western blotting for diagnosis of human pythiosis, to identify specific immunodominant antigens of P. insidiosum, and to increase understanding of humoral immune responses against the pathogen. We performed Western blot analysis on 16 P. insidiosum isolates using 12 pythiosis serum samples. These specimens were derived from human patients with pythiosis who had different forms of infection and lived in different geographic areas throughout Thailand. We have identified a 74-kDa immunodominant antigen in all P. insidiosum isolates tested. The 74-kDa antigen was also recognized by sera from all patients with pythiosis but not by control sera from healthy individuals, patients with thalassemia, and patients with various infectious diseases, indicating that Western blot analysis could facilitate diagnosis of pythiosis. Therefore, the 74-kDa antigen is a potential target for developing rapid serodiagnostic tests as well as a therapeutic vaccine for pythiosis. These advances could lead to early diagnosis and effective treatment, crucial factors for better prognosis for patients with pythiosis.

Raising rheumatoid factor cutoff helps distinguish rheumatoid arthritis.

The presence of rheumatoid factor (RF) is one of the clinical criteria for the diagnosis of rheumatoid arthritis (RA). The cutoff point of RF assays is usually based on a reference level obtained from normal subjects in the same population as the patients. We evaluated 63 rheumatoid arthritis (RA), 25 other arthritis patients and 110 blood donors. Their rheumatoid factors (RF) ranged from < 9.9 to 2,264, < 9.9 to 262, and < 9.9 to 66 mIU/ml, respectively. The sensitivity at different cutoff points of 15, 20, and 25 mIU/ml was 92.1%, 90.5%, and 88.9%, respectively. The specificity at the same cutoff points was 81.5%, 84.4%, and 85.2%, respectively. Having minimally sacrificed the sensitivity, we recommend using a higher RF cutoff to increase specificity.

Ocular pythiosis: is it under-diagnosed?

PURPOSE: To increase awareness of ocular pythiosis by presenting a typical case and summarizing clinical data of 11 ocular pythiosis cases in Ramathibodi Hospital. DESIGN: Interventional case report. METHODS: A 48-year-old healthy woman with a history of 3-week painful corneal ulcer of left eye was treated with enucleation. RESULTS: The histopathology of enucleated eye revealed endophthalmitis and ulcerative keratitis with numerous hyphae in full-thickness of corneal stroma. The culture identification of the causative organism was Pythium insidiosum. The final diagnosis was ocular pythiosis. CONCLUSIONS: Pythium insidiosum is a causative agent of pythiosis and is distributed worldwide. Ocular pythiosis may not be uncommon, as it may be underdiagnosed due to unfamiliarity among clinicians and microbiologists. Diagnosis of pythiosis is difficult. The disease has high morbidity, as evidenced by nearly evisceration or enucleation among all patients at Ramathibodi Hospital. Early detection and effective treatment are needed for possible cure.