COMPARISONS OF THE CLINICAL FEATURES AND OUTCOMES OF CHILDREN PRESENTING WITH INFLUENZA-LIKE ILLNESSES, INCLUDING A (H1N1) PDM09 AND SEASONAL INFLUENZA, IN A UNIVERSITY HOSPITAL, THAILAND.

In Thailand, during the A(H1N1)pdm2009 pandemic, 82% of fatal cases did not received the specific treatment within 48 hours of the onset of symptoms. Specific diagnostic tests, especially RT-PCR, were not available throughout the country. To assist early clinical diagnosis and treatment, this study compared the clinical features and treatment outcomes of children presenting with influenza-like illness (ILIs). These included confirmed cases of A(H1N1)pdm2009, as well as seasonal influenza and cases for which no cause could be specified. The medical records of patients aged less than 15 years with ILIs, who had RT-PCR performed for influenza virus between May 2009 and December 2011 at Srinagarind Hospital, were reviewed. Clinical features, chest radiographs and treatment outcomes were compared between those positive for A(H1N1)pdm2009, and those with seasonal influenza and/or the unspecified causes group. In 179 complete medical records, 27.4% were positive for A(H1N1)pdm2009, 13.4% for seasonal influenza and the cause of illness in the remainder was unspecified. Both A(H1N1)pdm2009 and seasonal influenza viruses infected older children more than did the unspecified group (group median ages 96,48 and 24 months, respectively). Sore throat, headache and myalgia were significantly more frequent in the A(H1N1)pdm2009 group than in the other two groups (p < 0.001). Half of all children had pneumonia but there were no significant differences among groups. There was no mortality in this study. In conclusion, sore throat, headache and myalgia were the significant clinical features suggestive of A(H1N1)pdm2009 infection in children and might be helpful indicators prompting early administration of specific treatments in the settings where definitive laboratory tests are not available.

An Outbreak of Peripheral Neuropathy in a Prison.

Prisoners are at risk for both physical and psychological diseases. Here, we report an outbreak of peripheral neuropathy in a prison in northeast Thailand. Between July and December 2014, there were 88 male prisoners at Bueng Kan Provincial Prison in Bueng Kan, Thailand suffering from peripheral neuropathy out of a total of 1,464 prisoners (6.01%). The common age range was 20-39 years (58 patients; 65.91%). The three most common features were hyporeflexia/areflexia of the lower extremities (36 patients; 83.72%). On laboratory vitamin B1 deficiency was detected in 4/5 patients, positive rhinovirus polymerase chain reaction in 3/4 patients, positive Mycoplasma pneumoniae IgM in 1/12 patients, and positive urinary arsenic in 4/7 patients. A dT vaccination was given on October 14 during the outbreak. This was a large outbreak of peripheral neuropathy in male prisoners. There are several possible causes of this outbreak including vitamin B1 deficiency, dT vaccination, arsenic toxicity, rhinovirus, and Mycoplasma infection.

Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection.

OBJECTIVE: Pandemic H1N1 2009 influenza virus (H1N1) has been spreading globally. Clinical features might be predictive and may be different among countries. Even though the PCR test is a confirmatory test for this viral infection, it is expensive and limited in most Thai health care facilities. We studied predictive factors of PCR positive in H1N1 suspected patients. METHODS: Consecutive patients who had influenza-like illness less than seven days and had been tested for H1N1 by the real-time PCR method between May and July 2009 were enrolled. Clinical data was collected and compared between those who had positive and negative PCR tests. RESULTS: There were 6494 patients had flu-like symptoms. Of those, 166 patients were done PCR test and 75 patients (45·18%) had positive PCR test. There were four predictors for positive PCR test including history of contact with confirmed H1N1 patients, headache, body temperature, and coryza with the adjusted odds ratio (95% confidence interval) of 2·84 (1·09-7·40), 6·25 (1·42-27·49), 1·69 (1·08-2·66), and 0·31 (0·12-0·79), respectively. CONCLUSIONS: Clinical factors can be both suggestive and protective factors for H1N1 infection. These factors may be helpful in clinical practice to assess the possibility of the H1N1 infection in people who are at risk; particularly in resource-limited health care facilities.