Chlamydophila (Chlamydia) pneumoniae as a cause of community-acquired pneumonia in Thailand.

Chlamydophila (Chlamydia) pneumoniae infection is increasingly reported worldwide nowadays. We studied twelve Thai adults presenting with the clinical symptoms and signs of community-acquired pneumonia (CAP) due to C. pneumoniae (TWAR) at Pramongkutklao Hospital in Bangkok, Thailand. Their mean age was 38 (range 21-73) years. Six patients lived in Bangkok. Seven patients had comorbid diseases (four cases with allergic asthma, one each with diabetes mellitus, chronic obstructive pulmonary disease and coronary artery disease). C. pneumoniae pneumonia presented as subacute pneumonia in 6 patients. The clinical manifestations were mild (IDSA risk class I-III) except in 4 patients who had preexisting allergic asthma, COPD and coronary heart disease. The diagnosis of C. pneumoniae pneumonia was based on microimmunofluorescence (MIF) antibody technique (IgM titer > or = 1:16, IgG > or = 1:512, IgA > or = 1:256 with or without fourfold rises). The clinical conditions were consistent with the primary infection (IgM titer of 1:16 or higher) in 6 patients and reinfection (IgG titer of 1:512, IgA titer of 1:256 or higher without rises of IgM titer) in the other 6 patients. Minimal bilateral pleural effusion was detected in only one patient. Coinfection was demonstrated in 2 patients (one each with S. pneumoniae and K. pneumoniae). All patients markedly improved after a 2-week course of macrolide, doxycycline or newest fluoroquinolone therapy. All patients had done well at one year of follow-up. C. pneumoniae infection has been recently recognized and a high seroprevalence (37%) in Thai school children and 100 per cent in young male Thai military conscripts has been reported. This report suggests that this infection, C. pneumoniae, may be a common pathogen of CAP in Thailand.

Invasive group A Streptococcal infections at Chulalongkorn University Hospital.

To determine whether the incidence and pattern of group A Streptococcal (GAS) infections in Thailand have paralleled those in the United States and Europe, we conducted a retrospective study of invasive GAS infections at Chulalongkorn University Hospital from 1995 to 1999. A total of 42 cases were identified. There were 18 males and 24 females (median age of 59 and 46 years, respectively). Most patients were in two age groups: 20-39 (33%) and 60-79 (38%). Underlying conditions were present in 34 patients (81%), including mostly chronic system diseases (50%), alcohol abuse (19%), diabetes mellitus (14%), connective tissue diseases (12%), immunosuppressive illnesses (12%), and human immunodeficiency virus infection (10%). The most common clinical presentations were skin and soft-tissue infections (31%), primary bacteremia (29%), and arthritis (14%). Of these, 24 (57%) presented with toxic shock syndrome (TSS). Overall mortality rate was 33 per cent. All GAS but one isolate were susceptible to penicillin.

Streptococcus suis peritonitis: case report.

A 45-year-old Thai man who presented with peritonitis was seen in a tertiary care centre in Thailand. An exploratory laparotomy was done because of peritonitis from abdominal trauma. Postoperatively the patient received intravenous ceftriaxone and metronidazole, but he developed rhabdomyolysis and acute renal failure. Hemodialysis was performed. After 8 days, the peritonitis had relapsed with hypotension. The patient was given vasopressives but clinicaly deteriorated and expired on day 11. The peritoniteal fluid culture grew Streptococcus suis serotype 2 and the organism was resistant to multiple antimicrobial agents including penicillin (MIC > 32 mcg/ml) but was susceptible to vancomycin.

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.

OBJECTIVE: 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. SUBJECTS AND METHODS: In a randomized clinical trial, 40 postmenopausal women with urogenital symptoms were randomly allocated to two treatment groups for 8 weeks. The first group (n = 20) received a combined contraceptive pill by the vaginal route, one tablet per week at bedtime for 8 weeks. Each tablet contained 250 microg levonorgestrel plus 30 microg ethinyl estradiol. The second group (n = 20) was given 1 gm of an intravaginal conjugated estrogen cream at bedtime, three times in the first week, twice in the second week, and then once a week for the next 6 weeks (1 gram of conjugated estrogen cream contained 0.625 mg conjugated equine estrogens). Subjects were questioned about their urogenital symptoms, and vaginal cytologic smears, vaginal bacterial cultures, and urine cultures were performed before treatment and after 2, 4, and 8 weeks of therapy. RESULTS: The vaginal pH and the proportion of the fecal type bacteria decreased in both groups, with no statistically significant difference between the groups. The karyopyknotic index and the maturation index were improved during treatment in both groups. An increase in the proportion of lactobacilli were recorded in both groups after therapy, with no significant difference between the two groups. No significant changes were observed in urinary bacteria. The therapy (combined contraceptive pill and estrogen cream) had a marked effect on urogenital symptoms (vaginal dryness, dyspareunia, urinary frequency, and urinary urgency), with impressive improvement comparably in both groups. CONCLUSIONS: A combined contraceptive tablet administered vaginally once a week can alleviate urogenital symptoms in Thai postmenopausal women as effectively as the vaginal estrogen cream. However, the pills are much less expensive and are easily obtained in developing countries.

PIP: A randomized clinical trial conducted in Bangkok, Thailand, investigated whether intravaginal use of a combined oral contraceptive (OC) is as effective for the treatment of urogenital symptoms in postmenopausal women as the standard regimen of conjugated estrogen cream. 40 postmenopausal women (mean age, 54 years) with urogenital symptoms related to estrogen deficiency were allocated to one of two treatment groups for 8 weeks. The first 20 women received one OC (250 mcg of levonorgestrel and 30 mcg of ethinyl estradiol) per week; the remaining 20 women were given estrogen cream (0.625 mg conjugated equine estrogens) at bedtime 3 times in the 1st week, twice in the 2nd week, and weekly for the last 6 weeks. Vaginal pH and the proportion of fecal-type bacteria decreased, the karyopyknotic and maturation indices improved, and the proportion of vaginal colonization with lactobacilli increased in both groups, with no significant differences between treatments. Also recorded in both groups were impressive improvements in vaginal dryness, dyspareunia, urinary frequency, and urinary urgency. No significant changes were observed in urinary bacteria. Combined OCs are less expensive than vaginal estrogen cream and more readily available in developing countries. Since they are as effective as the cream at alleviating urogenital symptoms in postmenopausal women, their use for this purpose merits consideration.

Psittacosis pneumonia: a case report and review of the literature.

A case of acute, severe pneumonia with respiratory insufficiency due to Chlamydia psittaci is described. Rapid improvement with tetracycline therapy in all symptoms and arterial blood gases is demonstrated. The diagnosis of psittacosis was secured by both cultivation and serological verification. A comprehensive review of the literature is appended. The present report attests to the need for inclusion of C. psittaci as a possible aetiologic agent causing fulminating community-acquired pneumonia.

Chlamydia pneumoniae infection in Thai children: serological diagnosis.

Recent Chlamydia pneumoniae infections were investigated in children with respiratory tract infections and in normal children. Four groups of sera were tested for C. pneumoniae antibody IgG and IgM serum fraction by the method of MIF test. A total of 7 cases of recent infection were detected, 3 of 116 with pneumonia, 3 of 123 with other respiratory tract infections, 1 of 263 normal school children and none in sera from cord blood. The cases with recent C. pneumoniae infection were as young as 24 days and 2 months old.

Risk factors of streptococcal colonization in school age children.

We studied the factors influencing the colonization of Streptococcus in school age children aged 6-11 years from 2 low socioeconomic schools of the Bangkok Metropolitan area. 4,055 throat swab cultures were performed. Beta hemolytic Streptococcus (BHS) and beta hemolytic Streptococcus group A (BHSA) were isolated in 1,747 (43%) and 744 (18%) respectively. 1,547 questionnaires were returned from the children. Of these, 750 and 570 were found to have BHS and BHSA in the throat, respectively. Among the risk factors, considered, teeth brushing of one time or none per day was significant for BHS positive in the throat as compared with the BHS negative group, while personal hygiene such as sharing glass with other, playing in dirty water, poor housing sanitation and low family income was significantly associated with the BHSA positive group. With the combination of certain clinical manifestations, these factors may increase the accuracy of predicting streptococcal infection.

Evaluation the enzyme immunosorbent assay IDEIA test detecting Chlamydia trachomatis in cervix.

A total of 87 cervical specimens of unselected female sex workers in massage parlors were tested by an enzyme amplified immunoassay IDEIA Chlamydia test and cell culture for the presence of Chlamydia trachomatis. The prevalence of C. trachomatis was 28 (32%) cases and 34 (39%) cases by the cell culture and the IDEIA Chlamydia test respectively. The IDEIA Chlamydia test demonstrated the sensitivity and specificity of 85.7% and 83% respectively, positive and negative predictive values of 70.5% and 92.4% respectively.

Group A beta-hemolytic streptococcal type M11 sepsis and empyema: a case report.

A case of serious suppurative disease caused by GABHS in a previously well 2-month-old Thai female presenting with clinical features of sepsis and right pleural effusion was reported. Treatment was initially with cloxacillin and a right side intercostal drainage. When subsequent cultures of blood and pleural fluid grew GABHS; intravenous penicillin was substituted. She made an uneventful recovery. Typing of the GABHS revealed non typable T-antigen and M-protein 11 GABHS, although very sensitive to penicillin, can cause severe and rapidly progressive disease in a very young infant. This is the first case of GABHS type M11 causing pleural effusion and sepsis in an infant ever reported in Thailand. Epidemiologic study might be indicated if an epidemic should occur.

Occurrence of beta-hemolytic streptococcus group G in school children and sick children.

We studied the occurrence of Streptococcus group G in throat cultures obtained from school children of poor socioeconomic status and in sick children brought to our hospital. The results revealed a high occurrence of group G Streptococci (44% and 91.5% respectively) in cases positive for beta-hemolytic Streptococci.

Prevalence of Chlamydia trachomatis among women attending an antenatal clinic in Bangkok.

Cervical swabs from 140 Thai pregnant women were cultured for Chlamydia trachomatis twice during the first and the third trimester. Serum samples for antichlamydial antibodies was also studied from 126 women; 12 of women were culture positive on both occasions. Chlamydia was isolated from 24% of women aged 20-24 years, compared to only 9% of women 25-30 years. Antibody were detected to the genital serotypes (D-K) in 31 (25%) of 126 women who were tested. 70% of women who were culture positive had antibody titer greater than or equal to 1:64 compared to 7% of women who were culture negative.

Rifampicin-erythromycin combination for the treatment of gonococcal urethritis in men.

A total of 184 men with uncomplicated gonococcal urethritis were treated with a single oral dose of rifampicin 900 mg and erythromycin stearate 1 gm. The cure rate on day 3 was 95.1%, 175 were cured and 9 failed (4.9%). Of all the Neisseria gonorrhoeae isolated, 86 were PPNG (46.7%). There was no difference in failure rate among patients with PPNG or with non-PPNG. With the exception of self-limited gastrointestinal disturbance, side effects were minimal. The value of this combination for the treatment of uncomplicated gonococcal urethritis in men is promising and deserves further study.