Outbreak of oral-oropharyngeal anthrax: an unusual manifestation of human infection with Bacillus anthracis.

An oral-oropharyngeal form of human anthrax is described in 24 individuals. The cases occurred as an epidemic in northern Thailand, concurrent with an epidemic of the common cutaneous form. This syndrome is a potentially fatal, febrile illness, characterized by a mucosal lesion in the oral cavity and/or oropharynx which can progress to pseudomembranous necrosis, and to cervical adenopathy and edema. Cattle and water buffaloes, recently arrived from Burma and eaten raw or undercooked, were the probable source of the infection. Determination of etiology was based on both microbiologic and epidemiologic evidence. The clinical syndrome and epidemiology are discussed.

Epidemiology of Burkholderia pseudomallei in Thailand.

The distribution of Burkholderia pseudomallei in soil collected from four regions of Thailand and the frequency of B. pseudomallei infections in patients attending government hospitals throughout Thailand in 1997 were surveyed. A total of 3,585 soil samples collected from 896 sites in four regions of Thailand were cultured for B. pseudomallei using selective enrichment broth and modified Ashdown's agar. The organism was recovered in 4.4%, 6.1%, 20.4%, and 5.9% of the soil samples collected from the northern, central, northeastern, and southern regions, respectively, of Thailand (P < 0.0001). Burkholderia pseudomallei was cultured from 50.1% of the sites in the northeastern region compared with 13.8%, 24.5%, and 18.4% in the northern, central, and southern regions, respectively (P < 0.0001). The infection rate in patients attending government hospitals in the northeastern region (137.9 per 100,000 inpatients) was significantly higher than those in the northern (18 per 100,000 inpatients), central (13.4 per 100,000 inpatients), and southern (14.4 per 100,000 inpatients) regions, respectively (P < 0.0001). It is suggested that melioidosis, which is endemic in Thailand, is associated with the presence of B. pseudomallei in soil.

Epidemiology of arabinose assimilation in burkholderia pseudomallei isolated from patients and soil in Thailand.

Burkholderia pseudomallei is an environmental saprophyte that has been isolated widely from soil in Southeast Asia and the relationship between environmental contamination and clinical melioidosis has been established. It has been shown that the arabinose assimilation property of B. pseudonrallei is probably one of the determinants indicating virulence of this organism. Therefore, the distribution of arabinose assimilation biotypes of B. pseudomallei collected from four geographic regions of Thailand was studied in order to determine an association between arabinose assimilation of B. pseudomallei and the uneven distribution of melioidosis found among these four areas. A total of 830 isolates of B. pseudomallei (412 patient isolates and 418 soil isolates) collected from the patients and soil in four regions of Thailand in 1997 were tested for an ability to grow on a minimal agar medium supplemented with L-arabinose. All patient isolates except one could not utilise arabinose (Ara-). For 418 soil isolates, 232 (55.5%) isolates were identified as Ara type. They comprised 180 (62.5%), 36 (46.8%), 6 (35.3%) and 10 (27.8%) isolates derived from northeastern, southern, northern and central regions respectively. The ratios of Ara- to Ara, were 1.7, 0.9. 0.5 and 0.4 among isolates collected from northeastern, southern, northern and central regions respectively. The prevalence of Ara- in soil isolates in northeast is significantly higher than those in other regions. This observation suggests that in addition to the presence of B. pseudomallei in soil which is one of the factors contributing to a burden of melioidosis in northeastern Thailand, the distribution of more virulent biotype (Ara-) soil isolates is a factor contributing to a high prevalence of melioidosis in northeastern Thailand as well.

Streptococcus suis infection in northern Thailand.

A ten-case report of Streptococcus suis infection was reported in Lamphun, northern Thailand from 1999 to 2000. Ten patients were admitted to Lampoon Provincial Hospital with a history of high fever, watery diarrhea, severe myalgia and ecchymosis rashes. The disease progressed rapidly and all patients died within 24-48 hours after admission from complications such as disseminated intravascular coagulation (DIC), acute renal failure (ARF) or acute respiratory distress syndrome (ARDS). Epidemiological data revealed that all cases were healthy men aged between 40-49, residing in the same geographical area and had a history of raw pork or uncooked pig's blood consumption prior to their illnesses. Blood culture and genetic investigation (16 s rRNA polymerase chain reaction with restriction enzyme PstII) confirmed diagnoses of the same species of Streptococcus suis infections.

Ofloxacin otic solution as treatment of chronic suppurative otitis media and diffuse bacterial otitis externa.

Pseudomonas aeruginosa, Diphtheroid bacilli, Staphylococcus aureus were the major causes of diffuse bacteria otitis externa and chronic suppurative otitis media. This study showed that 0.3 per cent ofloxacin used for 2 weeks gave good clinical and bacteriological control of chronic suppurative otitis media and diffuse bacterial otitis externa without significant side effects.

Pulmonary infection caused by Rhodococcus equi in HIV-infected patients: report of four patients from northern Thailand.

We report four human immunodeficiency virus (HIV)-infected patients (3 men and one woman, average age, 34.3 years) with pulmonary infection (two with pneumonia and two with lung abscess) caused by Rhodococcus equi. These patients, who presented with fever and productive cough, were admitted to Nakornping Hospital in northern Thailand. Chest roentgenograms showed pulmonary infiltration and/or cavitary lesions. Their conditions were poor because of severe anemia, and transfusion was necessary in three of the four patients. Before culture results were available, the etiologic microorganisms identified in sputum smears were gram-positive and acid-fast coccobacilli. One of the four patients had a mixed infection with R. equi and Salmonella enteritidis. The mean CD4 lymphocyte count in the three tested patients was 10/mm3 (CD4/CD8 ratio = 0.057). Four isolates of R. equi were sensitive to imipenem, minocycline, erythromycin, vancomycin, and ciprofloxacin (minimum inhibitory concentrations; MICs, 100 microg/ml) to rifampicin. Two patients were treated with erythromycin plus rifampicin, while the other two were treated with anti-tuberculous drugs. However, treatment was ineffective; three patients subsequently died because of respiratory failure, and one patient did not improve and was transferred to another hospital in her hometown.