Ovarian teratoma with diffused peritoneal reactions mimicking advanced ovarian malignancy

Background Benign cystic teratomas are one of the most common benign ovarian neoplasms. Although its rupture is rare, once occurred it can cause complications such as granulomatous peritonitis, mimicking metastatic ovarian malignancy. Case A 39-year-old woman, Para 0–0-0–0, presented to the hospital with rapid abdominal distention for 3 months. Her physical examination and ultrasonographic findings led to a diagnosis of advanced stage ovarian carcinoma. An exploratory laparotomy was performed and the operative impression was that of stage III ovarian carcinoma. Total hysterectomy with bilateral salpingo-oophorectomy and surgical staging were done. The postoperative pathology revealed a benign cystic teratoma of right ovary with chronic granulomatous peritonitis. She was well at discharge and at her 1-year follow-up. Conclusion Although ruptured a benign cystic teratoma is rare, it can cause granulomatous peritonitis, the clinical findings of which mimic advanced stage ovarian carcinoma. This warrants physicians to be aware of and intraoperative frozen section should be used, its correct management will provide a good outcome with less complication.     

Clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase-producing Escherichia coli infections in Thailand: a case-case-control study

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing organisms, first identified in Germany in 1983, are now widely recognized as clinically relevant causes of infections in community. METHODS: Our objective was to evaluate the clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase (CO-ESBL)-producing Escherichia coli infections. We used a case-case-control study undertaken in a 450-bed, tertiary care hospital. Patients included case group (CG) I, which had confirmed CO-ESBL-producing E coli infections (n=46). Case group (CG) II (n=46) included patients with CO-non-ESBL-producing E coli infections. Controls (n=138) were patients without infections. RESULTS: By multivariate analysis, diabetes (95% confidence interval [CI]: 1.9-13.2, P< .001), prior ESBL E coli colonization (<90 days) (95% CI: 1.2-67.8, P< .001), recent receipt of antibiotics (<90 days) (95% CI: 4.2-44.2, P= .004), and previous exposure to third-generation cephalosporins (95% CI: 2.2-16.4, P= .001) and fluoroquinolones (95% CI: 1.4-18.3; P= .003) were associated risks among CG I. Diabetes (95% CI: 1.6-15.4, P= .005), stroke (95% CI: 1.5-17.1, P= .001), and diarrhea (95% CI: 3.8-65.8, P= .001) were risks among CG II. Patients with CO-ESBL in CG I versus controls were more likely to die (30% vs 0%, respectively; P< .001), had prolonged hospital length of stay (8 vs 5 days, respectively; P< .001), and had higher hospitalization costs (median, US $528 vs $108, respectively; P< .001). The plasmid carrying the CTX-M-15 gene was identified in 13 of 25 (52%) available CO-ESBL-producing E coli isolates. CONCLUSION: CO-ESBL-producing E coli is an emerging multidrug-resistant microorganism in Thailand. Patients with prior ESBL colonization and recent antibiotic exposures, especially to third-generation cephalosporins and fluoroquinolones, were at risk for CO-ESBL-producing E coli infection.     

Genetic speciation of environmental Legionella isolates in Thailand

Legionella-like organisms were isolated during 2003-2007 from various water resources by culturing on selective media of Wadowsky-Yee-Okuda agar. The 256 isolates were identified as belonging to the Legionella genus based on detection of 108bp PCR product of the 5S rRNA gene, while the inclusion as Legionella pneumophila were confirmed by PCR detection of a specific mip gene region of 168bp. The 50 isolates, identified as non-pneumophila, were then subjected to DNA tree analysis, based on mip gene of ～650bp and rnpB genes product ranged from 304 to 354bp. Phylogenetic tree was constructed to predict their species in relative to the available database. The isolates of which their speciation, based on those two genes were inconclusive, were then investigated for the almost full-length of 16S rRNA sequences. The isolates were assigned as 16 known Legionella species, and proposed seven novel species based on their unique 16S rRNA sequence.     

Streptococcus suis Infection in Hospitalized Patients,Nakhon Phanom Province,Thailand

In Nakhon Phanom, Thailand, we identified 38 hospitalized patients with Streptococcus suis infection during 2006–2012. Deafness developed in 12 patients; none died. Thirty-five reported recent exposure to pigs/pork. Annual incidence was 0.1–2.2 cases/100,000 population (0.2–3.2 in persons >20 years of age). Clinicians should consider S. suis infection in areas where pig exposure is common.     

Cyclosporine in chronic inflammatory demyelinating polyradiculoneuropathy

This study demonstrates the efficacy of cyclosporine included in a regimen for the treatment of steroid-resistant chronic inflammatory demyelinating polyradiculoneuropathy in two children. Clinical response was characterized by either decreased frequency of recurrent weakness or normalized motor function. Nerve conduction studies and monitoring of cyclosporine levels were included in the serial follow-up evaluations, and their results were used in formulating a treatment plan. One of the two children, who had been monitored for 56 months since the onset of the disease, was able to maintain normal muscle strength without recurrent weakness for 39 months, with 5 mg/kg daily of cyclosporine. The other child, who had been taking prednisolone 0.3 mg/kg daily and cyclosporine 5 mg/kg daily, regained ambulation without support while demonstrating a reduction of recurrent weakness. None had adverse effects caused by cyclosporine therapy. We conclude that cyclosporine is an effective drug in the treatment of children with steroid-resistant chronic inflammatory demyelinating polyradiculoneuropathy.     

Prevalence of bancroftian filariasis on the Thai-Myanmar border

To achieve the goal of eliminating lymphatic filariasis by the year 2020, close monitoring systems and effective control strategies need to be implemented and the real disease burden needs to be assessed. Bancroftian filariasis is endemic at the Thai-Myanmar border. However, there are only limited data on the prevalence of this disease in Thailand available. We employed microscopic examination, together with ELISA kits to detect W. bancrofti-specific Og4C3 circulating antigen and specific anti-filarial IgG4 antibodies to determine the burden of bancroftian filariasis in an endemic area at the Thai-Myanmar border in Umphang District, Tak province, Thailand. A total of 433 Thai-Karen blood samples were analyzed. The microfilarial rate determined by microscope was 6% and the W. bancrofti-specific Og4C3 antigenemia rate was 22%, while the specific anti-filarial IgG4 antibody rate was 54%. There were statistically significant higher levels of W. bancrofti-specific Og4C3 antigen in the microfilaremic-antigenemic group than in the amicrofilaremic-antigenemic group (unpaired Student's t-test; p < 0.001), similar to the specific anti-filarial IgG4 antibody results (unpaired Student's t-test; p < 0.001). A statistically significant correlation of moderate degree between the presence of W. bancrofti-specific Og4C3 antigen and of specific anti-filarial IgG4 antibody was found in the amicrofilaremic group (r = 0.474, p < 0.001), but not in the microfilaremic group (r = 0.291, p > 0.05). Our study revealed a very high prevalence of bancroftian filariasis in this endemic area and thus emphasized the importance of using highly sensitive and specific diagnostic tools to evaluate the true prevalence of the disease.