Visceral organ abscesses in melioidosis: sonographic findings.

PURPOSE: We describe the sonographic appearances of extrapulmonary visceral organ abscesses in melioidosis and examine the role of sonography in early detection and follow-up of this elusive disease. METHODS: The sonograms and records of 80 patients with melioidosis were retrospectively reviewed. The number, size, sonographic appearances, and distribution of abscesses in the abdominal visceral organs were analyzed. RESULTS: The most common suspected diagnoses upon hospital admission were septicemia and pyrexia of unknown origin (39%). Abdominal visceral organ abscess was suspected in only 28% of patients. Fifty-seven patients (71%) had single organ involvement, and 23 (29%) had multiple organ involvement. There were lesions in the spleen in 59 patients (74%), liver in 37 (46%), and kidney in 10 (12%). Multiple abscesses were much more common than a solitary abscess in each organ and were demonstrated in 83%, 68%, and 75% of patients with spleen, liver, and kidney involvement, respectively. The sonographic findings of multiple small abscesses with a "target-like" appearance and larger multiloculated abscesses were common in every organ. CONCLUSIONS: The findings of multiple small, discrete abscesses in visceral organs, particularly the spleen, should raise the suspicion of this disease. In endemic areas, screening sonography should be done in every patient presenting with septicemia or fever of unknown origin.

Failure of carbazochrome sodium sulfonate (AC-17) to prevent dengue vascular permeability or shock: a randomized, controlled trial.

OBJECTIVE: We studied the ability of carbazochrome sodium sulfonate (AC-17) to prevent capillary permeability in dengue hemorrhagic fever/dengue shock syndrome. METHOD: A randomized, placebo-controlled trial in 95 children stratified by age and sex was conducted in two hospitals during 1992. AC-17 (n = 45 cases) or B vitamins as placebo (n = 50) were given as a bolus infusion and then as a continuous drip for 24 hours; a total of 300 mg of AC-17 was administered on the first 2 days and 150 mg on the third day. RESULTS: The two groups were comparable in age, sex, duration of illness, and clinical manifestations. No significant difference in shock or pleural effusion was noted between the two groups. Shock developed in 8.9% (4/45) of patients in the AC-17 group and 6% (3/50) in the placebo group (p = 0.44). Pleural effusion was found at 0, 24, 48, and 72 hours after admission in 4.4%, 20%, 31.1%, and 20% in the AC-17 group and 2%, 14%, 28%, and 14% in the placebo group, respectively. CONCLUSION: Administration of AC-17 does not prevent plasma leakage or shock in dengue hemorrhagic fever/dengue shock syndrome.

Visceral abscess in melioidosis.

A retrospective analysis was done in 81 patients with visceral abscess due to melioidosis treated at Khon Kaen Hospital, northeastern Thailand from 1985 to 1993. The clinical presentations were fever 100 per cent, abdominal pain 39 per cent, cough 34.8 per cent, abdominal tenderness 27.5 per cent and palpable mass 24.6 per cent. The laboratory findings were not diagnostic of the etiology. The abscesses were detected by ultrasonography in 97.25 per cent and computed tomography 2.25 per cent. The lesions were found in the spleen 72.8 per cent, liver 45.7 per cent, kidney 12.3 per cent and prostate gland 2.5 per cent. Seventy-six per cent of the patients had diseases in multiple organs (viscera, lungs and others). The preliminary diagnoses were fever of unknown origin, septicemia and urinary tract diseases in one-half of the cases. Patients presenting with fever of unknown origin from an endemic area, like northeastern Thailand, should arouse suspicion of melioidosis and search for the organism is advised. Diagnostic imaging methods, ultrasonography and computed tomography are valuable tools for detection of a solid internal organ abscess.

Peripheral cholangiocarcinoma: sonographic evaluation.

One hundred and seven patients who had intrahepatic tumor that demonstrated by sonography, and proved histologically, to be cholangiocarcinoma (CC), were reviewed retrospectively. Two main tumor patterns were found, namely the nodular form (N = 101) and the infiltrative form (N = 6); 33 of 101 patients with nodular lesions had solitary masses and 18 had multiple masses. The echogenicity of primary tumors were hyperechoic (N = 56), hypoechoic (N = 15), isoechoic (N = 10), and mixed-echoic (N = 20). A peripheral hypoechoic rim was present in 35 primary tumors (34.7%). Peripheral bile duct dilatation was seen in 33 patients (30.8%). Extrahepatic extension was found at operation in 46 of 52 patients (88.5%), while it was demonstrable by ultrasonography in only 16 (30.8%). Five of 6 small lesions (3 cm and less) already had an extrahepatic extension.

Cholangiocarcinoma in north east Thailand. A hospital-based study.

The population of Northeast Thailand has one of the highest known rates of cholangiocarcinoma (cancer of the bile ducts). We sought firstly to obtain an estimate of the frequency of hospital-based diagnosis of cholangiocarcinoma in the northeastern province of Khon Kaen. All pathology, ultrasound and in-patient and out-patient records were searched for cases diagnosed in tertiary hospitals in a random calendar month in 1988. A total of 203 persons from various parts of northeastern Thailand were newly-diagnosed in the two hospitals, 75 of whom resided in Khon Kaen province. We estimated the minimal age-standardised annual incidence rate in this province to be 135.4 per 100,000 among males and 43.0 per 100,000 among females (world standard). Truncated standardised incidence rates (ages 35-64 years only) were 334.2 and 104.3 per 100,000 for males and females respectively. Secondly we aimed to assess the feasibility of secondary prevention by early clinical diagnosis. However, the symptoms and signs observed were typically non-specific and associated with advanced disease in patients with cholangiocarcinoma who presented to hospital. Primary preventive measures appear to be the key to decreasing the mortality from this disease.

Pulmonary melioidosis: clinical-radiologic correlation in 183 cases in northeastern Thailand.

The chest radiographs of 183 patients with pulmonary melioidosis seen over a 4-year period were evaluated retrospectively. Disseminated nodular lesions occurred in 46 of 55 patients (84%) with the acute septicemic form of the disease and in 17 of 31 (55%) with the subacute or chronic form and positive blood cultures. Alveolar lesions occurred in 26 of 50 patients (52%) with the acute pneumonic form. There was no typical pattern of pulmonary infiltrates in 16 patients with the subacute pneumonic form, but in the chronic form, 17 of 31 patients (55%) had mixed infiltrates with cavities. The lesions were confluent in the upper lobes but tended to spare the apices in nonsepticemic cases. Rapid progression and early cavitation are distinctive features in acute cases, but in chronic cases the lesions may remain unchanged up to 20 months. Pleural effusion or empyema was seen in 22 of 105 patients (21%) with acute disease and four of 31 (13%) with chronic disease. Six of 105 patients (6%) with acute disease and three of 31 (10%) with subacute or chronic disease and positive blood cultures had pericardial involvement.

Renal failure in melioidosis.

In a restrospective study of 220 patients with melioidosis admitted to the hospital over a period of 3.5 years, acute renal failure was noted in 77 patients. Interesting clinical features included hypercatabolism, hypoalbuminemia, hyponatremia, jaundice and multisystem involvement. Prognosis was poor especially when associated with jaundice, lung involvement and the presence of underlying diseases. Mortality rate was 89.6%. Renal failure is believed to the due to renal ischemia from multiple nonspecific factors. In a limited pathological study renal changes consisted of tubular necrosis, microabscesses, interstitial nephritis and mild tubular degeneration.

Roentgenographically controlled healing of gallbladder lesions in opisthorchiasis after praziquantel treatment.

In a study, gallbladder lesions due to Opisthorchis viverrini infection were controlled roentgenographically after treatment with praziquantel (2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin- 4-one, EMBAY 8440, Biltricide). The place of study was the Khon Kaen Hospital, Northeast Thailand. Included in the study were 20 patients with impairment of gallbladder function; 7 of them were males and 13 females. Their age ranged from 27 to 60 years (mean 47.4), eggs per gram (EPG) ranged from 800 to 30,000 (geometric mean 4321). The laboratory parameters were within normal limits. Praziquantel 3 X 25 mg/kg per kg body weight was given on Day 0 and all patients were parasitologically cured within 60 days. Oral cholecystography was performed to evaluate the function and size of the gallbladder and intravenous cholangiography for the common bile duct on Days 0, 14, 60, 120 and 180. The results were: (a) very large and severe dysfunction of gallbladder seen in three patients returned to normal in 60, 60 and 180 days; (b) moderate dysfunction was present in 13 patients, all but one returned to normal: 6 in 14 days, 1 in 21 days, 2 in 60 days, 1 in 120 days and 2 in 180 days. The only patient who showed no change had diabetes mellitus and moderate dysfunction of the gallbladder for one year prior to treatment; (c) mild dysfunction: all 4 patients were normal in 14 days. The common bile duct was enlarged in 3 patients (1.2, 1.3, 1.5 cm); no significant changes were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal capillariasis from Maha Sarakham Province, northeast Thailand: report of a case.

Intestinal capillariasis cases in Thailand were reported from the areas where people customarily ate raw freshwater fish. The present case came from Maha-Sarakham Province, Northeast of Thailand with the chief complaint of diarrhoea for one month. Eggs, larvae and adult Capillaria philippinensis were found in the faeces. The authors observed that protein-losing enteropathy was an early manifestation on this disease.