Multicentric anaplastic astrocytoma in a child.

We report a rare case of anaplastic astrocytoma with multicentric central nervous system lesions in a 10-year-old girl presenting with a 1-month history of progressive headache and paraparesis. Neurological examination upon admission revealed papilloedema of both eyes and grade 2/5 weakness of both legs. Cranial and spinal magnetic resonance imaging revealed multiple tumour foci within the suprasellar region, cerebellar hemisphere, cervical and thoracic cords. After an uneventful laminectomy and excision of the tumour at the T8-9 level, a significant improvement of motor function was observed. The histological diagnosis was anaplastic astrocytoma based on the WHO classification. The patient received postoperative radiotherapy and chemotherapy, and was able to walk with the aid of auxiliary crutches. Despite being an uncommon disease in children and being associated with an unfavourable long-term outcome, early diagnosis and appropriate management of this condition may contribute to reduced patient morbidity.     

Prospective population-based incidence of Haemophilus influenzae type b meningitis in Thailand

There are limited prospective data for Haemophilus influenzae type b (Hib) disease in Asia, where some countries are considering vaccine introduction. A prospective population-based study was conducted to measure the incidence of Hib meningitis in children in two northern provinces of Thailand. Children <5 years with symptoms consistent with bacterial meningitis were enrolled in the study if inclusion criteria were met. The study enrolled 598 children with clinical meningitis, 76% of whom received lumbar puncture. The rate of probable bacterial meningitis was 26.6/100,000 children <5 years per year. There were four cases of laboratory confirmed Hib meningitis (rate 3.8/100,000 children <5 years per year). These findings suggest a relatively low incidence of Hib meningitis. However, additional data from studies of pneumonia are needed to define the Hib disease burden in Thailand.     

Comparative assessment of an Og4C3 ELISA and an ICT filariasis test: a study of Myanmar migrants in Thailand

Detection of circulating filarial antigen has now emerged as an alternative method for the diagnosis of bancroftian filariasis. We compared two antigen detection assays, an Og4C3 ELISA and an ICT (immunochromatography) Filariasis test, for the diagnosis of Wuchereria bancrofti infections in migrant Myanmar workers in Tak province, Western Thailand. A total of 337 Myanmars participated in this study. The microfilarial rate was 3.3%. The Og4C3 ELISA could detect 19.1% of bancroftian filariasis while the ICT test detected 12.7%. Both antigen assays could detect all microfilaremics. The Og4C3 ELISA detected 14.8% of amicrofilaremics while the ICT test identified 8.1%. Those who were positive for the ICT test were also positive by the Og4C3 ELISA. Those Og4C3 positive cases, that were ICT negative (ICT-ve/Og4C3+ve) had statistically significant (p < 0.05, unpaired t-test) lower Og4C3 antigen levels (409.5 units, range 117-2,389) than those that were ICT positive (ICT+ve/Og4C3+ve) (5,252.0 units, range 130-28,062). Our results emphasize the problem of bancroftian filariasis in Myanmar migrants working in Thailand. Close monitoring and control of this disease in Myanmar migrants are of public health importance. Antigen detection systems are promising tools for the surveillance of bancroftian filariasis.     

Endometrial sampling in patients with trophoblastic disease after suction curettage

OBJECTIVE: To determine intrauterine pathology in patients with postmolar gestational trophoblastic neoplasia (GTN) and hydatidiform mole after suction curettage. Safety profiles of endometrial sampling in this setting are also evaluated. STUDY DESIGN: In this prospective study, 24 cases with persistent GTN or postevacuation hydatidiform mole were recruited. Endometrial pathology was evaluated by Endocell. Clinical characteristics, safety of the instrument and pathology results were analyzed. RESULTS: During August 2006 to July 2007, 15 cases with postmolar GTN and 9 cases of postevacuation mole were recruited. Of 15 cases of postmolar GTN, 2 (13%) showed molar tissue. All 9 cases of postevacuation hydatidiform mole showed benign endometrial tissue or normal trophoblast in endometrial sampling pathology. No patients in this study had severe vaginal bleeding or infection after endometrial sampling. Analysis of endometrial sampling pathology as a diagnostic test for GTN showed a sensitivity of 0.133 (95% CI 0.037-0.379). CONCLUSION: Endometrial sampling by Endocell is safe in patients with gestational trophoblastic disease. Although the pathology findings from endometrial sampling had low sensitivity in diagnosing GTN, we encourage a larger prospective trial to confirm this result.     

Predictors of mortality among patients with community-onset infection due to extended-spectrum beta-lactamase-producing Escherichia coli in Thailand .

A matched case-control study was performed to identify predictors of mortality among patients (n = 46) with community-onset infections due to extended-spectrum beta-lactamase-producing Escherichia coli in Thailand. The crude mortality rate was 30%. By multivariable analysis, community-onset bloodstream infection due to extended-spectrum beta-lactamase-producing E. coli was the sole predictor of mortality (adjusted odds ratio, 41.3 [95% confidence interval, 4.3-69.4]; [P= .001).     

Risk factors for and outcomes of healthcare-associated infection due to extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae in Thailand.

A matched case-control study was performed to evaluate the risk factors for and outcomes of healthcare-associated infection due to extended-spectrum beta-lactamase-producing Escherichia coli or extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in Thailand. By multivariable analysis, prior exposure to third-generation cephalosporins and transfer from another hospital were risk factors associated with infection. Receipt of inadequate antimicrobial therapy was a predictor of mortality.     

First trimester diagnosis of partial mole

Background Partial mole is one of the two distinctive subtypes of hydatidiform mole. It is usually paternally derived triploid conceptions in which embryonal development occurs in association with trophoblastic hyperplasia. The definite diagnosis is confirmed by pathological and cytogenetic studies. Ultrasound might be helpful to diagnose partial mole in the first trimester.Case A 25-year-old woman, gravida 2, para 0-0-1-0, was initially seen for antenatal care at 6 weeks pregnant. Ultrasound was undertaken at 13 weeks pregnancy due to her first fetal anomaly, which demonstrated partial mole and embryonic death. The serum hCG was 190,900 mIU/ml. Suction curettage was performed without complication. Histopathological study confirmed partial mole and cytogenetic study of the placenta revealed an uncommon karyotype, mosaicism of triploid (69,XXX/69,XXY). Serum hCG was declined and negative at 8 weeks. The patient was well and serum hCG remained normal throughout 6 months of follow-up.Conclusion Although the majority of partial mole pregnancies cannot be detected by routine first trimester ultrasound examination, first trimester ultrasound can be helpful in some cases, such as this one. If partial mole is sonographically suspected, it should be confirmed with histopathology and cytogenetic studies. The management is similar to complete mole including prompt evacuation and careful monitoring of hCG.     

Detection of P. vivax antigens in malaria endemic populations of Nepal by ELISA using monoclonal antibodies raised against Thai isolates

An indirect enzyme linked immunosorbent assay (ELISA) using monoclonal antibody (MAb) originated from the native Thai isolates of P. vivax (McPV1) and the polyclonal antibody (PAb) raised against Nepali isolates of P. vivax was developed for detection of P vivax antigens in red cell lysates. The assay was specific (100%) since it was positive only with P. vivax-infected erythrocytes and was negative when erythrocytes from 40 healthy individuals from malaria non-endemic areas and 40 P. falciparum infected erythrocytes were tested. When the assay was applied to 203 vivax blood samples already proven by microscopic examination collected from Dhanusha district of Nepal, and using the cut-off level of the mean optical density (OD) (0.144) of 40 healthy individuals who had been living in malaria-endemic areas (0.073) + 2 SD (0.016), the assay could detect 189/203 samples, indicating the sensitivity of the test was 93.1% with a detection limit of erythrocytes of 240 parasites/10(6) erythrocytes. In addition, the assay was negative when 40 blood samples with fever of unknown origin, collected from the same malaria-endemic areas, were tested. However, there was a significant correlation between OD values and parasitemia (r=0.649; p=0.018). The results indicate that MAb-PAb indirect ELISA using MAb raised against Thai isolates of P. vivax as the coating antibodies, and polyclonal antibodies raised against local Nepali isolates as the detecting antibody, could detect P. vivax antigens with high degrees of sensitivity and specificity. Furthermore, it seems that the McPV1 MAb raised against Thai isolates of P. vivax could recognize the antigens of Nepali isolates in a wide range of blood samples.     

Prevalence and intensity of third stage Gnathostoma spinigerum larvae in swamp eels sold in three large markets in Bangkok,Thailand

Gnathostoma spinigerum is a common human tissue parasite in Thailand. The swamp eel is the major intermediate or paratenic host for this parasite. The high prevalence of the infective third stage larvae (L3) of this parasite in the rainy season has been noted in previous studies. During June 1999 (rainy season), we performed a cross-sectional survey of the prevalence and the intensity of G. spinigerum L3s in the livers of swamp eels that were obtained from three large Bangkok markets (Klong Toey, Pran Nok, and Tevej). Of a total of 785 livers, G. spinigerum L3s were found in 97: an infection rate of 12%. The prevalence rates in Klong Toey, Pran Nok, and Tevej markets were 13%, 10% and 14% respectively. There was no significant difference in the proportion of infected eels between the markets (p > 0.05). The intensity of L3 burden in the livers ranged from 1-17 larvae, with an average of 2.60 +/- 0.24 larvae (mean +/- SE). In this study a high prevalence of G. spinigerum L3s was found; there was no significant difference in the intensity of larvae in swamp eels between markets. These findings emphasize the importance of public health education: people need to be aware of the dangers of consuming raw or undercooked food.