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Biomedical subjects

M Riganti

Publications and source records attributed to M Riganti.

At least 19 recordsLinked to original sources
PubMed2004

Cryptococcal meningitis in human immunodeficiency virus (HIV)-positive and HIV-negative patients.

This study compared clinical manifestations, blood biochemistry and cerebrospinal fluid (CSF) results of HIV-positive and HIV-negative patients with cryptococcal meningitis. We collected 57 cases of cryptococcal meningitis from cytological specimens submitted to the Department of Tropical Pathology, Faculty of Tropical Medicine. Pertinent clinical data were analyzed retrospectively in 47 cases for clinical manifestations, laboratory features and outcomes of 38 HIV-positive and 9 HIV-negative patients. Headache was the most common symptom seen in all cases, of which 70.2% occurred with fever. CSF examination of both groups revealed elevated opening pressure. Increased CSF protein and depressed CSF glucose levels were seen in HIV-negative cases, which differed from HIV-positive cases, where a slight change was noted. CSF pleocytosis in HIV-positive patients was variable. Forty-eight percent of HIV-positive patients had CSF leukocyte counts below 20 cells/ mm3. None was found in the HIV-negative patients. Specific treatments with amphotericin B and fluconazole were given. Five fatal cases of cryptococcal meningitis were noted, all of which were HIV-positive. There were statistically significant differences in blood neutrophils, blood eosinophils, CSF leukocyte counts, CSF neutrophils, CSF lymphocytes, CSF glucose, and CSF total protein, in HIV-positive and HIV-negative patients (p = 0.050, p = 0.022, p = 0.002, p = 0.016, p = 0.047, p = 0.031, p = 0.009, respectively).

Adolescent↗
PubMed2001

Cerebrospinal fluid analysis in eosinophilic meningoencephalitis.

Eosinophilic meningoencephalitis (EME) remains an important neurological disease and is widely distributed in Thailand. We analyzed the cytological specimens of 56 EME cases. Pertinent clinical data were analyzed retrospectively and correlated with the cerebrospinal fluid (CSF)analysis. Headache was the commonest symptom seen in all EME cases. History of raw or partially cooked Pila snail ingestion was elicited from most patients. There was a marked seasonal occurrence between July to January. Patients received specific treatment as supportive therapy, which included spinal taps, analgesics and corticosteroids, was adequate. No fatal cases were seen. The CSF specimens were sorted into two categories: fresh CSF and hematoxylin and eosin (H&E) stained centrifuged CSF sediment. There was a statistically significant difference between the number of eosinophils and lymphocytes of fresh CSF and the H&E stained centrifuged CSF sediment (p = 0.001 and 0.001 respectively). The CSF glucose and the number of eosinophils in both methods were significantly correlated (p = 0.000, p = 0.008 for fresh CSF and the H&E stained centrifuged CSF sediment respectively). Moreover, the number of eosinophils was statistically significant with the protein in the CSF (p = 0.013), and intracranial pressure (ICP) (p = 0.025). Higher yields of eosinophils, especially in the early course of the disease, can readily be detected in the H&E stained centrifuged CSF sediment, whereas fresh specimens were negative. Further tests may increase the sensitivity and specificity of EME diagnostic results.

Adrenal Cortex Hormones↗
PubMed2000

Prognostic significance of skin and subcutaneous fat sequestration of parasites in severe falciparum malaria.

Intradermal blood smear, histopathologic and immunohistologic studies were performed in severe malaria (n=10) and uncomplicated malaria (n=10) patients during positive parasitemia and within 6 hours after negative parasitemia by finger prick smears. Intradermal blood smears showed asexual forms and intraleukocytic pigments when finger prick blood smears showed negative results; however intradermal blood smear did not indicate disease severity within 6 hours after negative parasitemia by finger prick. Histopathologic findings showed 15 fold higher parasitized red blood cells sequestered in vessels of subcutaneous fatty tissue in severe malaria than in uncomplicated malaria (p<0.001) and may indicate disease severity. A panel of polyclonal antibodies against cytokines applied to skin biopsies clearly detected a higher titer against tumor necrosis factor-alpha (TNFalpha) and interleukin-10 (IL-10) in dermal vessels and stratum granulosum respectively, in severe malaria compared with uncomplicated malaria. Results of the study suggest that histopathology and immunohistology of skin and subcutaneous fatty tissue may indicate prognostic severity of malaria and may be associated with focal accumulation of cytokines.

Adipose Tissue↗
PubMed2000

Opportunistic infections in the liver of HIV-infected patients in Thailand: a necropsy study.

Liver necropsy from patients infected with human immunodeficiency virus was analyzed in 117 cases. Wide ranges of opportunistic infections were recorded in 47%. Cryptococcosis (21.4%) was the most outstanding infection, followed by tuberculosis (16.2%), cytomegalovirus (5.1%) and penicillosis (3.4%). Non-specific alterations of the liver tissues included fatty steatosis (49.6%), fibrosis (55.6%), portal inflammation and reactive hepatitis. Cases of chronic active and chronic passive hepatitis and one case of hepatocellular carcinoma were reported. In the infected liver, predominant pathological changes included granuloma and spotty necrosis, which were attributed to tuberculous hepatitis. Infection with Cryptococcus usually showed no associated pathological change. The sensitivity for the clinical diagnosis of Cryptococcus was 88.8% and specificity was 91.7%. For tuberculosis, sensitivity was 20% and specificity was 67.9%.

AIDS-Related Opportunistic Infections↗
PubMed1999

Cytomegalovirus and Cryptosporidium infections in AIDS: a necropsy study.

A case of coinfection of cytomegalovirus (CMV) and Cryptosporidium in an AIDS patient is reported. Chronic diarrhea was the presenting symptom. Etiologic agents were diagnosed only at postmortem evaluation. CMV intranuclear inclusions were seen in the terminal ileum, colon and vermiform appendix. Cryptosporidium oocysts were also present in the intestinal brush border of the colon. Improvement of diagnostic procedures such as colonic biopsy and the use of appropriate staining procedure for AIDS patients with diarrhea can help identify the cause of illness.

AIDS-Related Opportunistic Infections↗
PubMed1998

Electron-microscopic examination of Rickettsia tsutsugamushi-infected human liver.

A 33 year-old Thai woman was diagnosed with scrub typhus infection according to clinical symptoms, eschar lesions compatible with the disease, and specific antibody to Rickettsia tsutsugamushi detected by indirect immunoperoxidase. Percutaneous transhepatic needle biopsies were taken before and 7 days after treatment with tetracycline to study the pathology of the liver. The liver tissue was evaluated by light microscopy, using H & E and Pinkerton's stains, and by transmission electron microscopy (TEM). Before treatment it showed reactive hepatitis. Rickettsia organisms within the hepatocytes and sinusoids detected by Pinkerton's stain appeared as tiny bright-red organisms. By TEM, the rod-shaped double-membrane Rickettsiae appeared intact in the cytoplasm of Kupffer's cells and hepatocytes. After tetracycline treatment, moderate levels of acidophilic and ballooning liver cells were observed. The degree of cytoplasmic organelle damage varied, including fatty metamorphosis, depletion of glycogen granules, loss of the mitochondrial cristae, dilatation of endoplasmic reticulum and cytoplasmic vacuolation. Rickettsia organisms cannot be visualized by Pinkerton's stain but were detected by TEM, in markedly vacuolated hepatocytes, in congested sinusoids and in Kupffer's cells. Intranuclear Rickettsia were discovered in the endothelial nucleus, showing various degrees of injury. Some were mildly degenerated, while others exhibited clumping of nucleoprotein at the cytoplasm periphery and large vacuolation centrally. Many indented organisms were found, and binary fission during Rickettsiae multiplication was always affected. Electron-microscopic examination of hepatic injury associated with scrub typhus is rare. This is the first ultrastructural localization of Rickettsiae in the infected human liver.

Adult↗
PubMed1998

Opportunistic protozoa in stool samples from HIV-infected patients.

A retrospective study of stool samples of HIV-infected patients from January 1994 to December 1995 submitted to the Department of Tropical Pathology was analyzed. There were twenty-two cases, all of which presented with chronic diarrhea. Result showed that 50% were infected with protozoa. These include Microsporidium (27.27%), Cryptosporidium (9.09%), Isospora belli (4.54%) and Giardia intestinalis cysts (9.09%). Other infections were Candida sp, Strongyloides stercoralis larva and Opisthorchis viverrini ova. The data stress the importance of opportunistic protozoa in the HIV-infected patients. Awareness of their existence of the diseases is important areas with increasing number of HIV-infected patients for early detection and proper treatment.

AIDS-Related Opportunistic Infections↗
PubMed1998

Changes of liver functions after albendazole treatment in human gnathostomiasis.

Ninety-eight out-patients of the Hospital for Tropical Diseases, Bangkok with clinical diagnosis of cutaneous gnathostomiasis were studied. All patients were treated with albendazole at a dosage of 400 mg (two tablets) twice daily for 14 days. They were seen periodically on day 0, day 14, day 28, day 195 and 1 year after treatment with laboratory investigations for any side effects of the treatment. There was a statistically significant increase of total protein, albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values when comparing the different periods. The abnormal results are clearly indicated in AST and ALT values (liver enzyme) especially on day 14 both male and female patients had highest levels. No significant association with time was found in ALP value.

Adult↗
PubMed1997

Involvement of cytokines in the histopathology of cerebral malaria.

Histopathologic and immunohistologic studies were performed in two cases of fatal cerebral malaria. On admission, both patients were in unarousable coma with hyperparasitemia. Examination of the tissue sections from various organs showed parasite sequestration in both cases with more extensive area of sequestration in case 1 than in case 2. A panel of monoclonal antibodies against cytokines applied to these tissues clearly detected tumor necrosis factor-alpha (TNF alpha), interferon-gamma (IFN gamma), interleukin-1beta (IL-1beta), and IL-10 in the tissues from brain and liver of case 1. A different cytokine profile, IL-4 and IL-10, was found in the brain tissues of case 2; no TNF alpha nor IFN gamma was detected. There was no cytokine detected in the tissues of other organs in either case. Results of the study suggest that histopathology in the brain of fatal cerebral malaria may be associated with focal accumulation of cytokines. Additionally, the type of cytokines produced locally in a particular tissue during malaria infection may be regulated by the degree of regional parasite sequestration.

Adolescent↗
PubMed1997

Imported cutaneous leishmaniasis in Thailand.

Eleven cases of imported cutaneous leishmaniasis are described based on clinical features such as sex, age, occupation, country visited prior to consultation, sites and numbers of lesions, duration of illness, treatment and outcomes. Ketoconazole was shown to be effective against imported cutaneous leishmaniasis. With the increasing numbers of cutaneous leishmaniasis due to exchange workers going to the endemic areas and the presence of vectors in some localities in Thailand, primary transmission of the disease in this country is possible if feeding habits of the vectors change.

Adult↗
PubMed1994

Monoclonal antibody-based immunohistochemical demonstration of Entamoeba histolytica in liver tissues of experimentally infected hamster (Mesocricetus auratus).

Histopathological changes and the presence of Entamoeba histolytica trophozoites was sequentially followed after intrahepatic inoculation of the parasites in 42 hamsters, 35 of which received no treatment whereas the remaining seven were treated with metronidazole. The liver tissues were examined for amoebic trophozoites by a monoclonal antibody (mAb)-based immunofluorescence assay (IFA), a mAb-based immunoperoxidase (IPx) and H & E staining. The number of hamsters developing abscesses was increased with time and was highest on day 30. Cellular infiltration with inflammatory cells and glycogen depletion were observed as early as day 5, followed thereafter by more intense inflammation of portal canals, periportal fibrosis, bile duct proliferation and hepatocyte degeneration. In 7 metronidazole-treated hamsters, no obvious pathological damage was seen. In a group of seven hamsters each, both IPx and IFA were positive in 3, 3, 4, 5 and 4 hamsters and in 3, 4, 3, 3 and 5 hamsters on days 5, 10, 15, 20 and 30, respectively. In 18 control hamsters, IPx, IFA and H & E were all negative. If the result from H & E was used as a gold standard, agreement between H & E and IFA and H & E and IPx were 91.4%, and 88.6%, respectively. Sensitivity and specificity were 93.8% and 89.5%, respectively for IFA, and 93.8% and 84.2%, respectively for IPx.

Animals↗
PubMed1992

Albendazole stimulates outward migration of Gnathostoma spinigerum to the dermis in man.

Human gnathostomiasis is characterized by space-occupying inflammatory lesions and/or hemorrhage as a result of the migration of, very often, a single larva of Gnathostoma spinigerum. Intermittent cutaneous migratory swellings occurring over years is the most common manifestation and the rare cerebral invasion may be fatal. There are currently no effective anthelminthics for this infection. During a double-blind randomized placebo control trial evaluating the efficacy of albendazole in cutaneous gnathostomiasis at a dosage of 400 mg twice daily for two weeks, it was observed that gnathostome larvae tended to migrate outward as a result of the treatment so that they could be recovered by excisional biopsy or by picking with a needle. In the placebo-treated group (N = 40), no such migration was observed during the 8,470 patient-days of follow-up while in the albendazole-treated group (N = 41) there was one worm in an excisional biopsy done on day 16 and two worms were removed from the skin by the patients themselves on days 8 and 0. Assuming that the period of drug exposure of the gnathostomes was the 14 days of albendazole administration plus another washout period of 7 days (equivalent to 20 half-lives of the active detectable metabolite), the total patient-days of albendazole exposure was 830. The rate of outward migration of gnathostomes in the drug treated group (3 per 830 patient-days) was significantly (p < 0.0001) higher than in the placebo group (0 per 8,470 patient-days).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Dyspepsia in acute falciparum malaria: a clinico-pathological correlation.

Gastrointestinal symptoms are common in acute falciparum malaria. Dyspepsia often occurs in such patients and sometimes it is exceptionally severe. However, the pathogenesis of the dyspeptic symptoms in malaria has not been clearly defined. Upper gastrointestinal endoscopy was performed in 40 patients with acute falciparum malaria in order to correlate the dyspeptic symptoms with the macroscopic (endoscopic) and microscopic (histologic) pathology of stomach and duodenum. The patients were divided into a dyspeptic group (n = 20, male/female ratio = 17/3, age range 18-50 years, mean age = 28.85 + 9.14 years), and a non-dyspeptic group (n = 20, male/female ratio = 16/4, age range 15-47, mean age 26.05 + 9.98 years). The findings revealed that dyspepsia correlated with topographic endoscopic pangastritis (p = 0.0014), the category of endoscopic antral gastritis (p = 0.013), and the histologic severity of antral gastritis (p = 0.0434). The results suggested that gastritis should be considered in acute falciparum malaria patients presenting with dyspepsia.

Adolescent↗
PubMed1991

Microvascular sequestration of parasitized erythrocytes in human falciparum malaria: a pathological study.

Thirty-nine falciparum malaria autopsy cases from the Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand were divided into two groups that had had either cerebral malaria (CM) or non-cerebral malaria (NCM). We then studied significant pathological differences between these groups in order to investigate the correlation between parasitized erythrocyte (PRBC) sequestration in small blood vessels in the brain, heart, lungs and small intestines. We found that the percentage of PRBC sequestration in the organs which we studied was higher in the CM patients than in the NCM patients. The difference of PRBC sequestration among the organs of two groups was significant (P less than 0.05). In the CM group, the average percentage of PRBC sequestration in the brain was significantly higher than in the heart, lungs and small intestines (P less than 0.05). No statistically significant difference was found between PRBC sequestration in the brains, hearts, lungs and small intestines in the NCM group (P greater than 0.05). Our study indicates that severity of malaria in the CM patients depends on PRBC sequestration, especially in the brain. A combination of functional disturbances of the other organs, in addition to the cerebral pathology, may augment the severity of the disease.

Animals↗
PubMed1991

The treatment of neurocysticercosis with praziquantel.

Twenty-five patients with cerebral cysticercosis admitted to the Bangkok Hospital for Tropical Diseases from March 1987 to November 1989 were studied. The patients had a mean age of 41 +/- 5 years with a mean body weight of 57 +/- 4 kgs. Male to female ratio was 1.5:1. Eight patients (32%) gave a history of having taeniasis with a mean duration of 3.6 years before having symptoms of cerebral cysticercosis. Six patients (24%) also had subcutaneous cysticercosis with a duration of 20 +/- 8 months. The important clinical symptoms were headache, focal seizure, epilepsy and dementia. Fourteen patients (56%) had headache, 12 patients (48%) had focal seizure and four patients (16%) had a mild degree of dementia. Baseline study included routine blood examination, biochemical tests, cerebrospinal fluid for routine examinations and immunological study. Biopsy of subcutaneous cysts, plain films of soft tissue and computerized tomography of brain. Praziquantel was given orally at a dosage of 45 mg/kg/day in 3 divided doses at 4-5 hour interval for 15 days. Patients who were taking anti-epileptic drugs before were permitted to continue their medications. The evaluation of results of treatment was done a year post treatment, ten patients (40%) were asymptomatic, 12 patients (48%) had much clinical improvement, their epileptic attack was controlled by 1-2 tablets of phenobarbital (1/2 g) at bedtime. Two patients (8%) had mild headache. One patient (4%) was not improved. Those patients with dementia were not improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Human cerebral malaria in Thailand: a clinico-pathological correlation.

Based on the cerebral malaria coma scale, 39 falciparum malaria autopsy cases from the Hospital for Tropical Diseases, Mahidol University, Bangkok, Thailand were divided into two groups of patients that had either cerebral malaria or non-cerebral malaria. We then studied significant pathological differences, such as parasitized erythrocyte (PRBC) sequestration, ring hemorrhages and cerebral edema, between these two groups in order to investigate the correlation between the clinical coma scale and pathological findings. Patients with a coma grade of 2 and higher were designated as having cerebral malaria, and had erythrocyte PRBC sequestration in cerebral microvessels. Ninety four percent (94%) of cerebral microvessels showed PRBC sequestration when quantitatively analyzed. On the other hand, only 13% of cerebral microvessels showed sequestration in non-cerebral malaria patients with a coma grade of 1 and lower, although some degree of PRBC sequestration was found in 50% of these patients. Our study, therefore, clearly demonstrated that the degree of the PRBC sequestration in cerebral microvessels appeared to correlate closely with the clinical coma scale.

Adolescent↗