Variable endothelial cell function restoration after initiation of two antiretroviral regimens in HIV-infected individuals.

Background: The effect of ART on endothelial cell function is incompletely characterized. Methods: We performed a 24 week prospective, case-control and comparative pilot study of ART-naive HIV-infected patients who started a darunavir- or rilpivirine-based regimen, matched with non-HIV-infected volunteers, to compare changes at week 24 from baseline in levels of circulating endothelial cells (CECs), endothelial progenitor cells (EPCs) and circulating angiogenic cells, as well as changes in immune-activation markers. Results: The study population comprised 24 HIV-infected patients and 24 non-infected volunteers. Both HIV groups completely suppressed viraemia. HIV-infected patients had higher levels of activation markers than the control group in CD8 T cells at baseline; these decreased after 24 weeks of treatment, but without reaching the levels of the control group. No statistical differences in immune activation were seen between the darunavir and rilpivirine groups. Levels of CECs were higher and levels of EPCs and circulating angiogenic cells were lower in HIV-infected patients than in the control group, although these parameters were similar between the darunavir group and the control group, but not the rilpivirine group, at week 24. An unfavourable association was observed between rilpivirine, age and increased number of CECs. Conclusions: Restoration of circulating levels of EPCs and CECs in darunavir-treated patients was greater than in those treated with rilpivirine, suggesting ongoing endothelial repair mechanisms.

Significant improvement in triglyceride levels after switching from ritonavir to cobicistat in suppressed HIV-1-infected subjects with dyslipidaemia.

OBJECTIVES: Cobicistat seems to have a low rate of adverse events compared with ritonavir. METHODS: This restrospective observational study to evaluated changes in lipid parameters and the percentage of subjects with dyslipidemia in virologically suppressed HIV-infected patients who were receiving a regimen containing darunavir/ritonavir and were then switched from ritonavir to cobicistat, carried out from December 2015 to May 2016, included 299 HIV-1-infected patients who were on stable antiretroviral treatment including darunavir/ritonavir (monotherapy, bitherapy or triple therapy for at least 6 months) and were then switched from ritonavir to cobicistat. Lipid parameters, as well as plasma HIV-1 RNA and CD4 cell counts, were recorded at baseline just before the switch, and 24 weeks after the switch. Patients were stratified according to the presence of hypercholesterolaemia [baseline total cholesterol > 200 mg/dL and/or low-density lipoprotein (LDL) cholesterol > 130 mg/dL] or hypertriglyceridaemia (baseline triglyceride levels > 200 mg/dL). RESULTS: Two hundred and ninety-nine patients were enrolled in the study. Fifty-two per cent of the total study population showed dyslipidaemia at baseline. All patients maintained HIV-1 RNA ≤ 50 HIV-1 RNA copies/mL at week 24. No statistically significant changes were seen in CD4 T-cell count from baseline to week 24 [654 (298) to 643 (313) cells/µL; P = 0.173]. When patients were stratified according to the presence of hypercholesterolaemia at baseline (n = 124), significant changes were observed in total cholesterol (P < 0.001), LDL cholesterol (P = 0.047), high-density lipoprotein (HDL) cholesterol (P = 0.002) and triglyceride levels (P = 0.025), and when they were stratified according to the presence of hypertriglyceridaemia at baseline (n = 64), changes from baseline to week 24 in triglyceride level were statistically significant [median (interquartile range) 352 (223, 389) mg/dL at baseline and 229 (131, 279) mg/dL at week 24; P < 0.001]. CONCLUSIONS: Cobicistat as a booster of darunavir in HIV-infected subjects had a beneficial effect on the lipid profile in patients with hypercholesterolaemia or hypertrigliceridaemia at baseline.

Comparison of two different strategies of treatment with zoledronate in HIV-infected patients with low bone mineral density: single dose versus two doses in 2 years.

OBJECTIVES: Given the need for easily managed treatment of osteoporosis in HIV-infected patients, we evaluated the efficacy and tolerability of two doses of zoledronate, by comparing three groups of patients: those with annual administration, those with biennial administration (one dose in 2 years) and a control group with no administration of zoledronate. METHODS: We randomized (2:1) 31 patients on antiretroviral therapy with low bone mineral density (BMD) to zoledronate (5 mg administered intravenously; 21 patients) plus diet counselling and to a control group (diet counselling; 10 patients). At week 48, patients treated with zoledronate were randomized again to receive a second dose (two-dose group; n = 12) or to continue with diet counselling only (single-dose group; n = 9). Changes in lumbar spine and hip BMD and bone turnover markers were compared. RESULTS: The median percentage change from baseline to week 96 in L1-L4 BMD was -1.74% [interquartile range (IQR) -2.56, 3.60%], 7.90% (IQR 4.20, 16.57%) and 5.22% (IQR 2.02, 7.28%) in the control, two-dose and single-dose groups, respectively (P < 0.01, control vs. two doses; P = 0.02, control vs. single dose; P = 0.18, two doses vs. single dose). Hip BMD changed by a median of 2.12% (IQR -0.12, 3.08%), 5.16% (IQR 3.06, 6.74%) and 4.47% (IQR 1, 5.58%), respectively (P = 0.04, control vs. two doses; P = 0.34, two doses vs. single dose). No differences between the two-dose and single-dose groups were detected in bone markers at week 96. CONCLUSIONS: The benefits for BMD of a single dose of zoledronate in 2 years may be comparable to those obtained with two doses of the drug after 96 weeks, although this study is insufficiently powered to exclude a real difference. Future studies should explore whether biennial administration of zoledronate is a useful alternative in the treatment of osteoporosis in HIV-infected patients.

Evaluation of the furcation area permeability of deciduous molars treated by neodymium:yttrium-aluminum-garnet laser or adhesive.

The purpose of this in vitro study was to compare the effects of a self-etch adhesive system and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser application on the dentinal permeability of the furcation area of primary molars. After endodontic access, 39 extracted human deciduous molars were divided into three groups: control group (CG), no treatment; adhesive group (AG), self-etching adhesive was applied to the furcation area; laser group (LG), specimens were irradiated with Nd:YAG laser. To evaluate dentin permeability of the furcation area, we immersed the specimens in 0.5 % methylene blue dye for 4 h. Then, they were longitudinally sectioned into two halves and photographed. The images were analyzed by two qualified evaluators using TpsDig software to calculate the percentage of the dye penetration area in comparison with the total furcation area. Additional analyses by scanning electron microscopy (SEM) were performed. The analysis of variance (ANOVA), complemented by Student's t-test, showed that mean dye penetration in the LG was statistically significant lower than that in all the other groups (P < 0.05). The SEM analysis showed mostly dentinal tubules obliterated by smear layer in the CG; in the AG the smear layer was modified by the adhesive, and, in the LG, melted surfaces were observed. It can be concluded that the Nd:YAG laser was capable of reducing the dentinal permeability of the furcation area of deciduous molars.

Continuous cerebral PtO2 measurements in awake patients as a diagnostic tool in suspected chronic adult hydrocephalus--a retrospective study of 10 cases.

BACKGROUND: During the last decade of the 20th century, continuous invasive PtO(2) recording has become a widely accepted and well-established means of monitoring patients with acute traumatic or spontaneous cerebral lesions. It is considered a safe and reliable tool for the detection of hypoxia in the ICU setting. However, while invasive measurements of intracranial pressure are being used both in the ICU and in standard diagnostic protocols for suspected chronic adult hydrocephalus the same has not yet happened in relation to PtO(2) recordings. METHODS: We report our experience with the first 10 patients who have been evaluated for suspected CAH applying a protocol that includes continuous cerebral PtO(2) measurements. The relationship between PtO(2) and ICP including a characteristic wave pattern (inverse waves) on the PtO(2) curve is analyzed and clinical and outcome data are recorded. RESULTS AND CONCLUSIONS: 1. PtO(2) recording in awake patients is safe and reliable. 2. The combination of classical Lundberg waves in the ICP recording with phases of inverse waves in the PtO(2) recording may predict good outcome after shunting. 3. The effect of concomitant conditions on the brain oxygenation can be estimated for individual patients and used as a negative predictor for surgical outcome. 4. Invasive intracranial monitoring is not free of potentially serious bleeding complications and can only be performed with risk enhancing factors (AVM/haemorrhagic diathesis) excluded.

Eosinofilia inducida por Olanzapina: A propósito de un caso / Olanzapine-induced eosinophilia: A case report

Resumen Se han descrito una serie de reacciones adversas asociadas a antipsicóticos, entre las que destacan las reacciones adversas hematológicas propias de algunos antipsicóticos atípicos. Las más renombradas han sido clásicamente las discrasias sanguíneas asociadas al uso de olanzapina. En este trabajo nos enfocamos en una reacción adversa poco común: eosinofilia en un paciente esquizofrénico paranoide usuario de olanzapina, situación documentada en contadas publicaciones a lo largo de la historia de uso de este medicamento. Se trata de una reacción adversa infrecuente, y por lo mismo poco conocida y estudiada.

Many adverse effects of antipsychotic drugs have been described, among which hematologic adverse effects stand out. Classically, blood discrasias have been associated to the use of olanzapine. On this paper we will focus on an uncommon adverse reaction: eosinophilia in a patient diagnosed with a paranoid schitzophrenia, who had been using olanzapine. There have been just a few reported cases of eosinophilia secondary to the use of olanzapine, which makes this an infrequent, rarely known and even less studied adverse reaction.

Hemophilus influenzae b pericarditis in children.

Recent experience in the diagnosis and management of Hemophilus influenzae b pericarditis is described in five children. Anterior pericardectomy appears to be the preferred method of surgical drainage because it was associated with a shorter hospitalization than pericardiocentesis or closed or open pericardotomy and removed the risk of recurrent cardiac tamponade and constrictive pericarditis. Countercurrent immunoelectrophoresis of sera and pericardial fluid was used to rapidly identify the etiology of pericarditis in four of four patients tested. The observation that three children appeared to develop pericarditis in the absence of a contiguous infectious focus suggests that bacteremic seeding of the pericardium may be important in the pathogenesis of this disease.

Analysis of the adjuvant effect of recombinant Leishmania infantum Hsp83 protein as a tool for vaccination.

The properties of Leishmania infantum hsp83 (LiHsp83) to elicit an immune response against a fused reporter antigen, maltose binding protein (MBP), was studied. CF1 mice were immunized with different purified recombinant proteins: MBP, LiHsp83 and MBP fused to LiHsp83 (MBP-LiHsp83). Serum samples were obtained at days 0, 21, 28, 60, 90, 120 and 150 post-immunization. MBP-LiHsp83 fusion protein elicited a strong humoral response against MBP, higher than that one obtained in mice immunized with MBP alone or MBP mixed with LiHsp83, showing the secretion of both anti-MBP IgG2a and IgG1 isotypes (IgG2a/IgG1 ratio: 2:1). This response was specific for recombinant proteins and was maintained for at least 150 days, whereas the reactivity in mice immunized with MBP alone dissapeared at day 90. After in vitro stimulation with MBP, spleen cells from MBP-LiHsp83 immunized mice showed higher proliferation indices and produced higher secretion of IFN-gamma than spleen cells from either control or MBP-immunized mice. In all groups of mice IL-4 was undetectable. Thus we consider that LiHsp83 may be a promising candidate to be used as carrier of fused antigens for adjuvant-free vaccination.

Trimethoprim-resistant Shigella and enterotoxigenic Escherichia coli strains in children in Thailand.

The percentage of Shigella and enterotoxigenic Escherichia coli (ETEC) strains resistant to trimethoprim (TMP)-sulfamethoxazole isolated from children with diarrhea at the outpatient department of the Children's Hospital in Bangkok increased from 3 and 0%, respectively, in 1982 to 29% and 25% in 1986. One hundred thirty-nine Shigella and 22 ETEC strains resistant to greater than 1024 micrograms/ml of trimethoprim (TMPr) isolated from children with diarrhea in Bangkok in 1984 and 1985 were analyzed for the presence of type I, II and III plasmid-specific dihydrofolate reductase (DHFR) genes. Thirty-two percent (45 of 139) of TMPR Shigella had genes encoding type II and 9% (13 of 139) had genes encoding type I DHFR genes. Fifty percent (11 of 22) of TMPR ETEC had type II and 14% (3 of 22) had type I DHFR genes. Plasmids encoding DHFR were identified by the Southern technique in 24% (14 of 58) of Shigella and 1 of 14 ETEC that contained genes encoding DHFR. Plasmids coding for type II DHFR were transferred to E. coli K12 by conjugation from 13 of 14 Shigella and a plasmid coding for type I DHFR was transferred from the single ETEC containing a plasmid coding for type I DHFR. Genes coding for DHFR were presumably situated on the chromosome in 76% (44 of 58) of Shigella and 93% (13 of 14) of ETEC that contained genes encoding DHFR. Since 58% (81 of 139) of TMPR Shigella and 36% (8 of 22) of TMPR ETEC strains examined did not contain genes encoding type I, II or III DHFR, high level TMP resistance was presumably caused by other types of DHFR genes.(ABSTRACT TRUNCATED AT 250 WORDS)

Two new Escherichia coli O groups: O172 from "Shiga-like" toxin II-producing strains (EHEC) and O173 from enteroinvasive E. coli (EIEC).

Two Escherichia coli strains were established as antigenic test strains for two new O groups, O172 and O173. The O172 strain (EHEC) which produces "Shiga-like" toxin II (verocytotoxin 2) was isolated from a case of haemorrhagic colitis while the enteroinvasive O173 strain (EIEC) originated from a child with diarrhoea.

Emergence of nalidixic acid resistant Shigella dysenteriae type 1 in Thailand: an outbreak associated with consumption of a coconut milk dessert.

BACKGROUND: Although Shigella dysenteriae type 1 has been responsible for large outbreaks of severe dysentery in many parts of Asia, relatively few cases of this disease have been reported from Thailand and have generally not involved nalidixic acid resistant strains. METHODS: Beginning March 1991, all patients with diarrhoea seen at the hospital outpatient department (OPD) in Suan Phung, Thailand (a western district near the Burmese border) were cultured for enteric pathogens. Shigella dysenteriae 1 was first recognized in July 1992, and an OPD-based case-control study was conducted to pinpoint the source of the outbreak in the community. For each case of culture confirmed S. dysenteriae 1, one control person without diarrhoea, matched by age and date of visit, was randomly selected from the OPD registry. RESULTS: Of 197 patients treated for diarrhoea at the hospital OPD in July and August 1992, 79 (40%) had bloody diarrhoea, compared with 86/561 (15%) patients seen during 16 months of previous surveillance (P < 0.0001). Shigella dysenteriae 1 was isolated from 33/197 (17%) patients. Compared to matched controls, patients with S. dysenteriae 1 were more likely to attend one of the local elementary schools (odds ratio = 6.74, P = 0.025), or live in the community surrounding this school (odds ratio for non-school age people = 18.0, P = 0.008). A cross-sectional study conducted at the school indicated that 50 (10%) of 485 students had dysentery in July. A coconut milk dessert prepared at the school was identified as the vehicle of transmission (relative risk = 24.9, P < 0.0001). CONCLUSIONS: Nalidixic acid resistant S. dysenteriae 1 emerged in a community in Thailand, and was traced to a point source outbreak at a local school.

PIP: Shigella dysenteriae type 1 has been responsible for large outbreaks of severe dysentery in many parts of Asia, but relatively few cases of the disease have been reported from Thailand and have generally not involved nalidixic acid resistant strains. Nalidixic acid resistant Shigella dysenteriae type 1, however, emerged in a community in Thailand and was traced to a point source outbreak at a local school. Beginning March 1991, as part of prospective surveillance for diarrheal disease in Suan Phung, all patients with diarrhea seen at the hospital outpatient department (OPD) in Suan Phung, Thailand, were cultured for enteric pathogens. 79 of the 197 patients treated for diarrhea at the hospital OPD in July and August 1992 had bloody diarrhea compared with 86/561 patients seen during 16 months of previous surveillance. Shigella dysenteriae type 1 was isolated from 33 of these 197 patients. Compared to matched controls, patients with Shigella dysenteriae type 1 were more likely to attend one of the local elementary schools or live in the community surrounding that school. A cross-sectional study conducted at the school found that 50 of 485 students had dysentery in July. A coconut milk dessert prepared at the school was identified as the vehicle of transmission.

Viruses and bacteria in pediatric diarrhea in Thailand: a study of multiple antibiotic-resistant enteric pathogens.

Children with diarrhea admitted to a rehydration ward of a children's hospital in Bangkok were investigated to determine the prevalence of enteric pathogens, the extent of children's previous antibiotic therapy, and the frequency of plasmid-mediated antibiotic resistance among infecting bacteria. Rotavirus (36%), enterotoxigenic Escherichia coli (18%), Shigella (9%), Salmonella (6%), Campylobacter jejuni/coli (4%), and Vibrio cholerae (2%) infections were among 105 children with diarrhea. Antibiotics were detected in 29% of urines collected from children on admission. All Shigella, 83% of enterotoxigenic E. coli, and 40% of Salmonella were resistant to more than one antibiotic. Sixty-two percent of 24 antibiotic-resistant enteric pathogens transferred R factors to E. coli K12 by conjugation. Four of four multiresistant E. coli that produced heat-labile and heat-stable toxin transferred resistance and the ability to produce heat-labile toxin. An analysis of plasmids by agarose gel electrophoresis indicated enterotoxigenicity and antibiotic resistance were associated with separate plasmids in transconjugants from these six matings. Antibiotics are used frequently in the treatment of pediatric diarrhea in Bangkok, which has undoubtedly contributed to the high frequency of plasmid-mediated resistance among enteric pathogens.

Short report: impact of traveler's diarrhea on United States troops deployed to Thailand.

Among a United States military unit of 170 personnel deployed to Utapao, Thailand for a three-week training exercise, 40% experienced diarrheal disease, and 12% sought medical treatment for diarrhea. Most illness clustered within the first two weeks of arrival and individuals were ill an average of 3.6 days. Fifty-five percent of cases lost two days of work and 15% required treatment with intravenous fluids. Bacterial pathogens were recovered from 38% of 16 stools submitted, with Campylobacter jejuni the most common. Four (12.5%) of 32 persons who voluntarily submitted paired sera exhibited a four-fold increase in IgG antibody titer to C. jejuni. Traveler's diarrhea continues to be an important problem with a serious potential to impact the mission readiness of even small military units deployed overseas.

Short report: case report of Cyclospora infection acquired in Indonesia and treated with cotrimoxazole.

A detailed chronology of unsuccessful efforts to diagnose and treat a sudden-onset case of chronic diarrhea acquired in Jakarta Indonesia, and ultimately attributed to Cyclospora is presented. A modified Kato technique was used to quantify Cyclospora oocysts during successive days prior to, during, and after successful cotrimoxazole therapy (160 mg of trimethoprim, 800 mg sulfamethoxazole twice a day for seven days) for this infection. Cyclospora was associated with 6.4% of the gastrointestinal illness and/or diarrhea cases that presented during a seven-month period to a Jakarta clinic that serves a small population of expatriates. Cyclospora and Giardia lamblia were identified with equal frequency during this period and were the dominant pathogenic intestinal parasite species found in this community.

A comparative study of enterotoxigenic Escherichia coli, Shigella, Aeromonas, and Vibrio as etiologies of diarrhea in northeastern Thailand.

The incidence of enterotoxigenic Escherichia coli (ETEC), Shigella, Aeromonas, and Vibrio was determined in patients with diarrhea seen at a hospital in northeastern Thailand, and compared with the incidence of these bacteria in household contacts and their neighbors. ETEC was identified in 17%, Shigella in 9%, Aeromonas in 9%, V. parahaemolyticus in 5%, and non-01 V. cholerae in 2% of 299 patients with diarrhea. These five species of bacteria were isolated more often from patients with diarrhea than persons without diarrhea (P less than 0.001). ETEC was found more often in household contacts (22/141) and neighbors (18/147) of index cases than in persons living in homes not associated with ETEC infections (32/1,318; P less than 0.001). While Shigella was isolated less often in family contacts (3/76) and neighbors (4/93) of patients with shigellosis, this enteric pathogen was also isolated more often from contacts than persons not associated with Shigella infection (13/1,437; P less than 0.001). Both Aeromonas and non-01 V. cholerae can also be enteric pathogens; further efforts should be made to define the enteropathogenicity of these bacteria.

Foods as a source of enteropathogens causing childhood diarrhea in Thailand.

Foods obtained in markets in Bangkok were cultured for bacterial enteric pathogens and examined for their similarity to strains isolated from children under 5 years of age in Bangkok in 1986. Salmonella was isolated from 17%, Campylobacter from 12%, and enterotoxigenic Escherichia coli (ETEC) from 3% of 510 foods examined. Campylobacter was isolated from 13.5%, ETEC from 13%, and Salmonella from 12% of 1,230 children under 5 years of age with diarrhea. Eighty-eight percent of children infected with Salmonella were infected with serotypes isolated from foods of animal origin. Six percent of children with Salmonella were infected with the same serotype containing plasmids with identical endonuclease restriction patterns as isolates from food. Eighty-seven percent of children with Campylobacter were infected with the same serotypes and biotypes found in food of animal origin. Thirty-one percent of heat-labile enterotoxin (LT) producing ETEC from foods containing genes coding for LT II, but LT II ETEC was not isolated from children. Twenty-one percent of ETEC isolated from foods vs. 53% isolated from children were resistant to 2 or more antibiotics (P less than 0.01). Salmonella and Campylobacter, but not ETEC, isolated from foods were similar to strains isolated from children. Foods of animal origin are an important source of Salmonella and Campylobacter in Thailand.

An epidemic of Vibrio cholerae el tor Inaba resistant to several antibiotics with a conjugative group C plasmid coding for type II dihydrofolate reductase in Thailand.

Between June and October 1982, Vibrio cholerae el tor Inaba phage type Russian 13, resistant to ampicillin (Ap), chloramphenicol (Cm), colistin, neomycin (Nm), kanamycin (Km), gentamicin (Gm), trimethoprim sulfamethoxazole (TMP-SMZ), and tetracycline (Tc), was isolated from 31 children with diarrhea at a hospital in Samutsakorn, Thailand. Thirty of these children were less than 2 years of age and were admitted to a single pediatric ward. Seventeen of the cases, infected with V. cholerae (MARV) resistant to several antibiotics, were admitted to the hospital for non-gastrointestinal illnesses; these children developed diarrhea and positive cultures for MARV 1-greater than 10 days after admission. The majority of cases occurred in September, when the attack rate in the patient population in 1 pediatric ward was 11.5%. During this period, MARV with the same characteristics was isolated from water used for bathing in a reservoir on the pediatric ward where most of the cases occurred. MARV was not isolated from adults with diarrhea at the hospital. No further MARV infections occurred at the hospital after the water reservoir had been drained and disinfected. V. cholerae isolates from children and water contained a conjugative incompatibility group C plasmid of 100 megadaltons (mDa) encoding resistance to Ap, Cm, Nm, Km, Gm, TMP-SMZ, and Tc. This plasmid hybridized with a DNA probe for genes encoding Type II dihydrofolate reductase (DHFR). As far as we know, this is the first report of MARV with V. cholerae that contained genes coding for Type II DHFR.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective study of the incidence of diarrheal disease and Helicobacter pylori infection among children in an orphanage in Thailand.

To evaluate the hypothesis that gastric infection with Helicobacter pylori increases risk for diarrheal disease in children, we conducted a yearlong prospective study among 160 orphanage children < 5 years of age in Nonthaburi, Thailand. Serum samples collected at six-month intervals were examined by ELISA for antibodies to H. pylori, and children were followed daily for the development of diarrhea. Seven percent of children were seropositive on enrollment, 59% were seronegative, and 34% were indeterminate. Among the seronegative children, seroconversion occurred at a rate of 7% per six months. Forty-six percent of children developed 214 total episodes of diarrhea. By age group, children < 18 months, 18-24 months and > 24 months of age experienced 2.6, 1.1, and 0.2 mean diarrhea episodes per six months. The incidence of diarrhea was not significantly different between children by H. pylori serostatus. We conclude that H. pylori infection was not associated with an increased risk of diarrheal disease.

A comparative study of gastrointestinal infections in United States soldiers receiving doxycycline or mefloquine for malaria prophylaxis.

A double blind study of daily doxycycline (100 mg) vs. weekly mefloquine (250 mg) was performed on United States soldiers training in Thailand to assess the effect of doxycycline malaria prophylaxis on the incidence of gastrointestinal infections. During a 5 week period, 49% (58/119) of soldiers receiving doxycycline and 48% (64/134) of soldiers receiving mefloquine reported an episode of diarrhea. Infection with bacterial enteric pathogens was identified in 39% (47/119) of soldiers taking doxycycline and 46% (62/134) of soldiers taking mefloquine. Forty-four percent (59/134) of soldiers receiving mefloquine and 36% (43/119) of soldiers receiving doxycycline were infected with enterotoxigenic Escherichia coli (ETEC), while 9% (12/134) of soldiers receiving mefloquine and 4% of soldiers receiving doxycycline were infected with Campylobacter. Side effects from either medication were minimal. After 5 weeks in Thailand, the percent of non-ETEC strains resistant to greater than or equal to 2 antibiotics increased from 65% (77/119) to 86% (95/111) in soldiers on mefloquine and from 79% (84/106) to 93% (88/95) in soldiers on doxycycline. Doxycycline prophylaxis did not prevent or increase diarrheal disease in soldiers deployed to Thailand where ETEC and other bacterial pathogens are often resistant to tetracyclines.

Molecular characterization of Vibrio cholerae O139 isolates from Asia.

In 1992, a serologically novel clone of Vibrio cholerae, designated O139, caused large epidemics of diarrhea in India and Bangladesh. To determine the extent of the spread of V. cholerae O139 worldwide, 484 V. cholerae non-O1 strains isolated from different patients with diarrhea in Thailand, Indonesia, the Philippines, and Peru in 1993 were tested for agglutination in O139 antisera. One hundred fifty-one of these 484 isolates were examined for genes encoding cholera toxin, zonula occlulans toxin, the repetitive sequence 1, and the toxin coregulated pilin A (the V. cholerae virulence gene complex). Thirty-three percent (122 of 364) of V. cholerae non-O1 strains isolated from different patients with diarrhea in Thailand agglutinated in O139 antisera. Ninety-eight percent (120 of 122) of V. cholerae O139 contained the V. cholerae virulence gene complex. None of the 104 V. cholerae non-O1 strains isolated from patients with diarrhea in Indonesia or the 14 strains from patients with diarrhea in the Philippines were serotype O139. Four different ribotypes were found in V. cholerae O139 isolated in Asia. Twenty-three (47%) of 49 Thai O139 strains examined were of different ribotypes than isolates from India and Bangladesh; V. cholerae strains that were not O1 or O139 that were isolated from flies and water in Thailand 11 years previously in 1981 contained the same V. cholerae virulence gene complex found in V. cholerae O1 and O139. This suggests that other unidentified virulence determinants are involved in V. cholerae O139 pathogenesis.