Etiology of acute lower respiratory tract infection in children at Srinagarind Hospital, Khon Kaen, Thailand.

We investigated the etiology of acute lower respiratory infection (ALRI) in children under 5 admitted to Srinagarind Hospital. The causative bacteria and viruses were determined by hemoculture and viral isolation from blood and nasopharyngeal aspirate samples. Antigens of respiratory syncytial virus (RSV) and Chlamydia trachomatis were detected using EIA. The 74 children less than 5 years of age with ALRI enrolled in our study were diagnosed with pneumonia (75.7%), croup (16.2%), and bronchiolitis (8.1%), respectively. Examination of blood or nasopharyngeal aspirate revealed viral or bacterial infections in 26 and 22 cases, respectively, whereas 5 of the children aged under 1 year (10%) were diagnosed with pneumonia caused by Chlamydia trachomatis. RSV was the most common virus detected (24.3%) and was associated with pneumonia and bronchiolitis, while the parainfluenza virus was the primary cause of croup. In cases of pneumonia, bacterial infections were identified in almost all of the cases: and Streptococcus pneumoniae and Haemophilus influenzae were the most commonly isolated (at 8.9% each). Mixed infections were detected in 8 cases (10.8%). The incidence of RSV infection peaked during the especially warm and cool seasons, whereas the bacterial infections were primarily associated with the relatively cool season. Our study indicates that a combined pneumococcal and Hib vaccine and a RSV vaccine would reduce the high rate of pneumonia in children under 5 years of age in Northeast Thailand.

Survey of the prevalence of asthma, allergic rhinitis and eczema in schoolchildren from Khon Kaen, Northeast Thailand. an ISAAC study. International Study of Asthma and Allergies in Childhood.

This survey of schoolchildren from Khon Kaen, Northeast Thailand used the standardized ISAAC questionnaires to estimate the prevalence of asthma and other allergic diseases and to compare the results with two previous studies. A total of 6,068 questionnaires were analyzed (2,658, 45.6% males from the 6 to 7 years old group and 3,410, 49.5% male from the 13 to 14 years old group). The three predominant cumulative and 12-month conditions discerned from the written questionnaires among the 6 to 7 vs 13 to 14 years old were: wheezing, at 18.6% and 10.2% vs 20.5% and 11.0%; rhinitis at 38.4% and 33.5% vs 59.4% and 42.5%; and eczema at 18.0% and 15.2% vs 9.9% and 7.4%, respectively. The observed prevalences in our study were similar to those found in Bangkok and slightly higher than those in Chiang Mai, except for 'exercise wheezing' in older children which was two times higher in our study than in the two previous studies. Our study showed seasonal variation of the 'nose' symptoms. The peak prevalence was in the relatively cool and dry season (between November and January), which was the same pattern as Chiang Mai but different from Bangkok (which had a perennial pattern and less climatic variation). Our results concurred with the two previous Thai ISAAC studies. There is a high prevalence of asthma and other allergic diseases among Thai children and there has been a four-fold increase in symptoms since the last decade. If the trend persists asthma and allergic disease may become a pressing health concern of the country.

Prediction of idiopathic respiratory distress syndrome by the stable microbubble test on gastric aspirate.

We evaluated the usefulness and accuracy of the stable microbubble test (SMT) performed on gastric aspirates of neonates to predict idiopathic respiratory distress syndrome (IRDS) and compared the results with those of the shake test, using the clinical characteristics of IRDS as the gold standard for the diagnosis of IRDS. One hundred forty paired samples of gastric aspirates, obtained within 1 hour of delivery from neonates with gestational ages between 27 and 42 weeks (mean, 36.6+/-3.5 weeks) and birth weights between 800 and 4,090 grams (mean 2,571+/-826 grams ) were evaluated. The sensitivity and specificity of the SMT with a predefined cut-off value of less than 20 bubbles/mm2 were 94.7% and 95%, respectively, with a positive and negative predictive value of 75% and 99.1%, respectively. The positive predictive value and specificity were increased to 100% in premature neonates. These values, especially the positive predictive value and specificity, were much higher than those obtained with the shake test. We conclude that the SMT on gastric aspirates obtained within 1 hour of delivery is a rapid and simple procedure to identify those neonates who will develop IRDS and who may benefit from prophylactic exogenous surfactant replacement.