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Biomedical subjects

K Silpapojakul

Publications and source records attributed to K Silpapojakul.

16 recordsLinked to original sources
PubMed2000

An outbreak of Burkholderia cepacia bacteremia in hemodialysis patients: an epidemiologic and molecular study.

The risk of blood stream infections increases in patients undergoing chronic hemodialysis. Outbreaks of infection are usually caused by contamination of the water supply, water treatment, distribution system, or dialyzer reprocessing. We report an outbreak of subclavian catheter-related Burkholderia cepacia bacteremia in nine patients undergoing hemodialysis. Using randomly amplified polymorphic DNA (RAPD) analysis, the bacterial isolates were clonally identical to Burkholderia cepacia isolated from residue of the diluted chlorhexidine-cetrimide solution used to disinfect the transfer forceps. These forceps were used to pick up cotton balls and gauze for dressing the subclavian catheter. Antibiotic therapy failed to cure the infections, and all patients required catheter removal. Pathology showed numerous bacilli embedded in the biofilm on the inner surface of the removed catheters. In conclusion, our study showed that contaminated chlorhexidine-cetrimide solution was the source of a bacteremic outbreak in nine patients who developed catheter-related Burkholderia cepacia infection.

Adult↗
PubMed1998

Unnecessary hospital infection control practices in Thailand: a survey.

The high prevalence of hospital-acquired infection has a significant impact on the operating cost of hospitals in Thailand. A nationwide questionnaire survey was conducted to determine how frequently unnecessary infection control procedures were performed. Nearly 17% of hospitals routinely cleaned floors with disinfectants; 48% installed ultraviolet lights in the operating room; 57% performed routine environmental cultures; 68% reported fogging of the operating theatres and the isolation rooms; wearing a protective gown in the intensive care units was routine in 57% of the surveyed hospitals; 30% of hospital laundries set temperatures unnecessarily high and sterile gloves were overused in 25% of hospitals. Large cost reduction can be achieved by discontinuing these practices.

Costs and Cost Analysis↗
PubMed1998

Microcapsule agglutination test for the diagnosis of leptospirosis in Thailand.

Sera from 82 cases of leptospirosis (confirmed by micro-agglutination tests or IFAT) and 108 patients with other diseases were investigated using the microcapsule agglutination test (MCAT) for leptospirosis. The overall sensitivity (90.2%), specificity (96.3%), positive predictive value (94.9%), negative predictive value (92.9%), and accuracy of the MCAT (93.7%) were encouraging. MCAT is simple, can be performed by unskilled personnel with minimum laboratory facilities, and produces results in 3 h. MCAT would be a reliable serodiagnostic test for rapidly screening individuals for leptospirosis, in various geographical areas of Thailand.

Agglutination Tests↗
PubMed1997

Scrub typhus in the Western Pacific region.

Scrub typhus is widely endemic in Asia. Man's behaviour and climatic changes greatly influenced the occurrence of the disease. Increasing prevalences of scrub typhus have been reported from some Asian countries and may coincide with the widespread use of beta-lactam antibiotics or to improve diagnostic facilities and/or more urbanisation into rural areas. Many cases acquired in Asia surfaced in Europe and America. The disease probably is overlooked among paediatric patients. Most patients with scrub typhus present with acute fever of unknown origin (acute FUO). Eschars are rare among Southeast Asian patients. Complications usually develop after the first week of illness. The complications include pneumonitis, meningoencephalitis, renal failure and jaundice. Improved serologic and molecular diagnostic tests are now available. Although drug-resistant strain of Orientia tsutsugamushi has been reported, the infection usually responds to simple but unpopular drugs such as doxycycline or chloramphenicol.

Asia, Southeastern↗
PubMed1996

Liver involvement in murine typhus.

Liver involvement was retrospectively evaluated in 137 patients with murine typhus. Fifteen (10.9%) were jaundiced. One patient had been subjected to cholecystectomy after misdiagnosis of acute cholecystitis. Serum aminotransferase levels were abnormal in 48/52 measurements, and there were elevations of > 5-fold in 14 patients. Liver biopsies and/or necropsies from four jaundiced patients showed portal tract and sinusoidal infiltrates, cloudy swelling/and necrosis of the hepatocytes and occasional pseudogranuloma formation. There were striking mitoses even in the early stage, suggesting rapid hepatocellular regeneration. Haemolytic diseases (G6PD deficiency or haemoglobinopathies), alcoholism, and a second infection probably also contributed to the pathogenesis of jaundice in murine typhus. This rickettsiosis should be included among differential diagnoses of acute hepatitis in patients exposed to areas endemic for Rickettsia typhi.

Acute Disease↗
PubMed1995

Evaluation of the immunofluorescent antibody test for the diagnosis of human leptospirosis.

Sera from 175 patients with clinically suspected leptospirosis were tested with the immunofluorescent antibody (IFA) assay and compared with the microscopic agglutination (MA) method. Overall, the IFA test recognized all 58 MA-positive patients with leptospirosis. On acute sera testing, the IFA titer > or = 1:100 was 0.97 specific and more sensitive than the conventional MA method (sensitivities = 0.48 versus 0.17, respectively). None of the 117 MA-negative patients, 101 healthy blood donors, and 93 patients with five diseases commonly confused with leptospirosis had IFA titers > or = 1:400. However, cross-reactivity was seen with sera from patients with syphilis. On serial testing, the IFA antibody first appeared during the first week of illness, peaked by the fourth week, and generally decreased below 1:400 after the fourth month. The IFA test appears to be moderately sensitive and specific for the initial diagnosis of leptospirosis. It could replace the more complicated and less sensitive MA assay.

Adult↗
PubMed1993

Murine typhus in Thailand: clinical features, diagnosis and treatment.

One hundred and thirty-seven patients with murine typhus were reviewed. A history of direct contact with rats was rare, and none gave a history of flea bite. No seasonal trend was observed. Clinical presentations included fever (100%), hepatomegaly (24%), rash (20%) and non-specific signs. Complications were uncommon but included jaundice, pneumonia, renal insufficiency and meningitis. Only two patients died. A single 200 mg dose of doxycycline significantly shortened the duration of fever: 79% were afebrile in 48 h, compared to 15% of the untreated group.

Adolescent↗
PubMed1991

Scrub and murine typhus in children with obscure fever in the tropics.

Between October, 1985, and February, 1987, 28 (8.7%) cases of scrub and murine typhus were diagnosed among 320 children with greater than or equal to 1 week history of obscure fever. Scrub typhus is a rural disease and characterized by fever, tachypnea and hepatosplenomegaly. Skin rash was rare and eschar was absent. Four patients had pneumonia and two had meningitis. Murine typhus, more an urban disease, was milder and half the patients presented exclusively because of night fever. Slightly enlarged liver and skin rash were the only significant physical signs. Lacking the classical textbook presentations, both rickettsioses often were missed or diagnosed as enteric fever. Recognition is important because patients with either disease respond well to treatment with chloramphenicol or doxycycline.

Child↗
PubMed1991

Rickettsial meningitis and encephalitis.

Nine of 72 patients with scrub typhus and three of 137 with murine typhus presented with meningitis and/or encephalitis syndromes. Focal neurologic signs were rare, and cerebrospinal fluid profiles were similar to those of leptospirosis and viral and tuberculous meningitis. One patient had papilledema, and another had cerebellitis. Other major organ involvement (renal, liver, or lungs) occurred in five patients. One patient died and four spontaneously recovered, while the conditions of the rest responded well to either chloramphenicol or doxycycline. Scrub and murine typhus should be included in the differential diagnoses of aseptic meningitis and encephalitis in patients exposed to endemic areas, especially when accompanied by renal insufficiency and/or jaundice. They are treatable forms of virallike meningoencephalitis.

Adolescent↗
PubMed1988

Scrub typhus pneumonitis: an entity which is frequently missed.

Four cases of scrub typhus pneumonitis are reported. Diagnosis was confirmed by positive Weil-Felix OX-K reaction and immunofluorescent antibody test for Rickettsia tsutsugamushi. Two patients presented with atypical pneumonia and two had overwhelming pneumonia resembling adult respiratory distress syndrome. All patients made a full recovery after appropriate treatment.

Adult↗
PubMedDate not supplied

Rapid, simple serodiagnosis of murine typhus.

The dot-blot enzyme-linked immunosorbent assay (dot-ELISA) was compared to latex agglutination (LA) and the Weil-Felix OX-19 test for the diagnosis of murine typhus using the indirect immunofluorescent antibody (IFA) test as the 'gold standard'. With a panel of 74 positive and 47 negative sera, the dot-ELISA was 98% specific and 74% sensitive at a cut-off value of the second dot. With acute sera, latex agglutination was 100% specific and 74% sensitive at a cut-off titre of > or = 1:64. Both tests were more sensitive than the OX-19 test, which was 98% specific and 56% sensitive at a titre of > or = 1:320. Both dot-ELISA and latex agglutination were comparable and the results were available within one hour of testing. The rapidity, ease in performance and minimal requirement for electrical instruments made these 2 tests suitable for the diagnosis of murine typhus in countries where sophisticated laboratory facilities are lacking.

Acute Disease↗
PubMedDate not supplied

Comparative evaluation of four serodiagnostic tests for scrub typhus in Thailand.

The commercial dot-blot enzyme-linked immunosorbent assay Dip-S-Ticks dipstick test was compared with the indirect immunoperoxidase (IIP) and Weil-Felix (WF) tests for the diagnosis of scrub typhus, using the indirect immunofluorescent antibody test (IFA) as the reference standard. With a panel of 117 positive and 75 negative sera, the dipstick test was 94% sensitive and 98.7% specific at a cut-off value of one or more positive dots. The IIP was 90.6% sensitive and 100% specific at a cut-off titre of 1:400, and was more sensitive than the IFA with acute sera (79.6% vs. 68.5% at a titre > or = 1:400). All 3 were superior to the WF, which lacked sensitivity. The dipstick assay was easy to perform and did not require sophisticated electrical equipment, and the results were available within one hour. It is therefore suitable for use in rural Thailand, where scrub typhus is common.

Agglutination Tests↗