Role of Der p 1–specific B cells in immune tolerance during 2 years of house dust mite–specific immunotherapy

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Hemophagocytic syndrome and Burkholderia cepacia splenic microabscesses in a child with chronic granulomatous disease

Hemophagocytic syndrome, splenic microabscesses and pulmonary cavitary lesions were presented in a 17-month-old boy with prolonged fever, hepatosplenomegaly and a history of tuberculous lymphadenitis. Clinical course mimicked tuberculosis. Blood cultures were negative. Ultrasound-guided, percutaneous aspiration from splenic microabscesses grew Burkholderia cepacia. He was treated successfully with trimethoprim-sulfamethoxazole. This child with chronic granulomatous disease had an unusual clinical manifestation of B. cepacia infection.     

Use of Heparin Alone in Treating Pulmonary Emboli Found in Association with In-Transit Right-Heart Thrombi in a Nonagenarian

In patients who present with pulmonary embolism, right-heart thrombus is a rare condition that is associated with increased mortality rates, compared with pulmonary embolism alone. Thrombolytic therapy has been associated with a survival benefit in previous studies of pulmonary embolism arising from right-heart thrombus. However, older patients have been excluded from such studies because thrombolysis places them at excessively high risk of bleeding. We present a case, in a 92-year-old woman, of pulmonary embolism arising from right-heart thrombi that we successfully treated with heparin.Key words: Aged, 80 and over; anticoagulant drugs; coronary thrombosis/therapy; female; heparin; pulmonary embolism/etiology/ultrasonography; respiratory insufficiency/etiology; thrombolytic therapyThe initial treatment of hemodynamically significant pulmonary emboli often requires thrombolytic therapy and, in some cases, pulmonary embolectomy. However, these therapies are inappropriate for frail, elderly patients because of the increased risk of bleeding. In this communication, we report the successful treatment with intravenous heparin of a nonagenarian with pulmonary emboli in association with right-heart thrombi—a condition that is a marker for hemodynamic instability.     

Hemoglobin E levels in double heterozygotes of hemoglobin E and SEA-type alpha-thalassemia

Coinheritance of alpha-thalassemia and hemoglobin E (Hb E) is prevalent in Thailand, where the gene frequencies of thalassemia and hemoglobinopathies are high. Hb E carriers with, concomitant inheritance of alpha-thalassemia 1 are known to have a lower level of Hb E. In this study, we reviewed the Hb E levels in Hb E carriers, who either had or did not have Southeast Asian (SEA)-type alpha-thalassemia, in order to seek a Hb E level that may be used as a predictor for concomitant alpha-thalassemia carrier status. The Hb E levels as measured by microcolumn chromatography in 844 Hb E carriers detected during a prenatal screening program for severe thalassemia at Chiang Mai University Hospital were reviewed. Hb E levels ranged from 12.3-35.0% (23.3 +/- 3.1%) in 751 Hb E carriers without SEA-type alpha-thalassemia and from 11.6-32.0% (17.0 +/- 3.7%) in 93 concomitant Hb E and SEA-type alpha-thalassemia carriers. The difference was significant (p < 0.01). However, the absence of SEA-type alpha-thalassemia could not be predicted by the higher Hb E level alone, as 3% of double heterozygotes demonstrated a level of more than 25%. Our study confirms a lower Hb E level in double heterozygotes with Hb E and SEA-type alpha-thalassemia. Nevertheless, the difference does not provide sufficient discriminatory power for the reliable exclusion of alpha-thalassemia status.     

The Association of PNPLA3, COX-2 and DHCR7 Polymorphisms with Advanced Liver Fibrosis in Patients with HCV Mono-Infection and HCV/HIV Co-Infection

There is increasing evidence that host genetic variations may influence the natural history of chronic hepatitis C virus(HCV) infection. The aim of this study was to determine the association between single nucleotide polymorphisms (SNPs)of PNPLA3 (rs738409), COX-2 (rs689465) and DHCR7 (rs12785878) and advanced liver fibrosis in Thai patients. Atotal of 220 patients with HCV mono-infection, 200 patients with HCV/HIV co-infection and 200 healthy controls wereenrolled. The SNPs were detected by allelic discrimination using real-time PCR with TaqMan probes. Liver stiffnessmeasurement (LSM) was assessed by transient elastography. Our results showed that the distribution of the studiedSNPs were not significantly different between the HCV mono- and co-infected groups. The frequencies AG and GGgenotypes of rs689465 and GG genotype of rs12785878 were less commonly found in the HCV mono- and co-infectedgroups compare with healthy controls (P<0.01). Among patients with HCV infection, older age, HIV co-infection,GG genotype of rs738409 and GG genotype of rs689465 were independently associated with advanced liver fibrosis(LSM≥9.5 kPa) in multivariate analysis. Moreover, the percentage of patients with advanced liver fibrosis increasedsignificantly along with the accumulated numbers of these risk genotypes. In conclusion, PNPLA3 (rs738409) andCOX-2 (rs689465) polymorphisms were associated with advanced liver fibrosis in patients with HCV mono- andco-infection, suggesting that these variants might play an important role in progressive liver fibrosis in these patients.     

Impact of particulate air pollutants on allergic diseases,allergic skin reactivity and lung function

Elevated levels of particulate matter can exacerbate existing asthma and atopy, while evidence that it can promote the induction of atopy and asthma is limited. A cross sectional study was taken to compare the prevalence of eye, nose, ear and airway allergic symptoms, allergic skin sensitivity and lung function in 290 high school students with a history of high 24 hour average exposure to particulate matter less than 10 microm in diameter (PM10) = 170 microg/m3 versus low PM10 of 36 microg/m3 in central Bangkok. Multivariate analysis revealed an increased risk of eye and airway symptoms in groups exposed to higher PM10 levels (p = 0.003, and 0.05, respectively). Positive skin prick tests and a history of having a lawn at home were associated with nasal symptoms (p = 0.008 and 0.04, respectively). Mean FEF(25-75%) (forced expiratory flow that occurs during the middle 50% of the forced expiratory effort) was significantly lower in those who were exposed to higher PM10 levels (3.89 +/- 1 vs 4.42 +/- 0.9 l/sec, p < 0.001). A significant increase in days of school absence and medical expenses was associated with high PM10 exposure. It is concluded that chronic exposure to high PM 10 levels was significantly associated with increased prevalence of eye and airway symptoms and a decrement of FEF(25-75%) resulting in increase of school absence and medical expense.     

Occurrence of Chlamydia spp.in wild birds in Thailand

Objective: To determine the occurrence of Chlamydia spp.in wild birds in Thailand.Methods: Cloacal and tracheal swabs of 313 wild birds from 11 orders, 27 families, and 51 species were tested to determine the occurrence of Chlamydia infection.The outer membrane protein A(ompA) gene was amplified from positive samples to construct a phylogenetic tree.Results: At the time of sample collection, none of the birds showed clinical signs of any disease.Of 313 wild birds, two Asian openbill stork(Anastomus oscitans) were positive for Chlamydia spp., representing 0.64%(2/313) and 4.9%(2/41) occurrence for birds overall and for the Asian openbill stork, respectively.Phylogram analysis based on deduced amino acid of the ompA gene showed that Chlamydia spp.in Asian openbill storks was closely related to that in wildfowl(Pica pica and Cygnus olor) from Poland in a different branch with a 95% bootstrap value and had a shorter evolutionary distance to Chlamydia abortus.Conclusions: Asymptomatic Asian openbill storks could be a potential source of Chlamydia infection in domestic animals, poultry, and humans who share their habitat.     

Invasive Chromobacterium violaceum infection in children: case report and review

A 3.3-year-old boy developed Chromobacterium violaceum abscesses of lungs, liver and spleen and was successfully treated. He had chronic granulomatous disease (CGD). Twenty-five episodes of invasive C. violaceum infection in 24 children were reviewed. All 9 CGD and 10 nonbacteremic cases survived, but 12 of 16 (75%) non-CGD and 12 of 15 (80%) bacteremic patients died.