Corneal Chromoblastomycosis Caused by Fonsecaea pedrosoi

Purpose

To report 2 unusual cases of fungal keratitis due to Fonsecaea pedrosoi.

Methods

Two patients were diagnosed with Fonsecaea pedrosoi keratitis. Their files were reviewed for predisposing factors, clinical characteristics, microbiological study, treatment, and outcome.

Results

Two consecutive patients presented with brownish pigmented corneal ulcers in their eyes after sustaining eye trauma from vegetative matter. In both cases, corneal scrapings were collected for microscopic examination and culture. Dematiaceous hyphae were seen on the smears, and dark pigmented colonies grew on the culture media, identified as F. pedrosoi. Both patients were treated and cured with combined topical antifungal agents and oral itraconazole. The first patient required an amniotic membrane patch, while the second received an intracameral amphotericin B injection.

Conclusions

Pigmented infiltrates can be an important diagnostic clue, but a microscopic evaluation and culture are required to obtain an accurate diagnosis of Fonsecaea keratitis. The prompt diagnosis and combined antifungal treatment can prevent morbidity associated with this fungal infection.Key Words: Fonsecaea pedrosoi, Dematiaceous fungus, Keratitis, Chromoblastomycosis     

Protective Effect of Crocodile Hemoglobin and Whole Blood Against Hydrogen Peroxide-Induced Oxidative Damage in Human Lung Fibroblasts (MRC-5) and Inflammation in Mice

A putative protective effect of cHb and cWb against H₂O₂-induced oxidative damage was evaluated in detail using MRC-5 cells. In addition, the carrageenan (Carr)-induced mouse paw edema model and the cotton pellet-induced granuloma model were employed to examine the in vivo anti-inflammatory activity of cHb and cWb in mice. It was demonstrated that both cHb and cWb treatments significantly increased cell viability and inhibited morphology alterations in MRC-5 cells exposed to H₂O₂. Orally administered cHb and cWb significantly reduced Carr-induced paw edema volume and cotton pellet-induced granuloma formation. Moreover, cHb and cWb decreased the expression levels of important pro-inflammatory cytokines (IL-6, IL-1β, and TNF-α), while only cWb was found to increase the expression of the anti-inflammatory cytokine IL-10 significantly. Finally, the activity of antioxidant enzymes (SOD, CAT, and GPx) in the liver improved after cHb and cWb treatment under acute and chronic inflammation. Taken collectively, the results of this study suggest that both cHb and cWb protect against hydrogen peroxide-induced damage in fibroblast cells. Moreover, cHb and cWb were found to exhibit anti-inflammatory activity in both the acute and chronic stages of inflammation and appear to enhance antioxidant enzyme activity and decrease lipid peroxidation in the livers of mice. Therefore, this study indicates that cHb and cWb have great potential to be used in the development of dietary supplements for the prevention of oxidative stress related to inflammatory disorders.     

The effect of 5-hydroxytryptamine on the chick biventer cervics muscle

The actions of 5-hydroxytryptamine have been studied in the chick biventer cervics nerve—muscle preparation. At concentrations between 2.5 × 10^?3 and 3.7 × 10^?3 M, 5HT produced a transient increase in responses to indirect stimulation, but not to direct stimulation. At higher concentrations, 5HT produced a reversible depression of twitches, which was much more marked in indirectly than in directly stimulated preparations. In a concentration range of 2.5–3.7 × 10^?3 M, 5HT increased the response to exogenous acetylcholine but reduced the response to carbachol. After pretreatment with neostigmine, 5HT inhibited responses to both acetylcholine and carbachol. It is suggested that the facilitatory effects of 5HT are due to its anticholinesterase activity. The blocking actions of 5HT are thought to be curare-like. In addition, irreversible toxic effects on the muscle preparations were found after repeated exposures to high concentrations of 5HT.     

Early treatment failure in severe malaria resulting from abnormally low plasma quinine concentrations

A patient admitted with severe Plasmodium falciparum malaria in western Thailand had an early treatment failure with quinine, despite full dosing. Plasma quinine concentrations were subtherapeutic. Abnormal quinine pharmacokinetics may explain sporadic reports of quinine treatment failures in severe malaria.     

Effects of Choto-san and its related constituents on endogenous antioxidant systems

We previously reported that Choto-san acts as an antioxidant and cytoprotective agents against H2O2-induced oxidative damage in NG108-15 cells, and the effect is due at least partly to the phenolic compounds. To further investigate the detail mechanisms of this cytoprotection effects of Choto-san and related compounds on enzyme activities of antioxidant systems were examined. Choto-san (5-100 microg/ml) and Chotoko (5-100 mg/ml) stimulated the activity of superoxide dismutase (SOD), catalase and glutathione peroxidase (GPX). These also increased the level of glutathione. Although Choto-san without Chotoko (w/o CKO) did not show the effects on SOD and catalase, GPX activity and glutathion content also, but weakly, stimulated by w/o CKO. The effects of phenolic compounds, epicatechin, caffeic acid and quercetin were also investigated. Epicatechin stimulated catalase, GPX and glutathion content, but not SOD. On the other hand, caffeic acid stimulated SOD activity but had no effects on others. Quercetin stimulated all, although intensities were different among. These results suggest that simultaneous induction of cellular antioxidant defense systems by Choto-sam and its related constituents may be an important mechanisms underlying the protective effects of Choto-san on ischemia-induced neuronal cells injury, and the characteristics of the stimulative effects of phenolic compounds were depend on enzymes.     

Identification of a novel 74-kiloDalton immunodominant antigen of Pythium insidiosum recognized by sera from human patients with pythiosis

The oomycetous, fungus-like, aquatic organism Pythium insidiosum is the etiologic agent of pythiosis, a life-threatening infectious disease of humans and animals that has been increasingly reported from tropical, subtropical, and temperate countries. Human pythiosis is endemic in Thailand, and most patients present with arteritis, leading to limb amputation and/or death, or cornea ulcer, leading to enucleation. Diagnosis of pythiosis is time-consuming and difficult. Radical surgery is the main treatment for pythiosis because conventional antifungal drugs are ineffective. The aims of this study were to evaluate the use of Western blotting for diagnosis of human pythiosis, to identify specific immunodominant antigens of P. insidiosum, and to increase understanding of humoral immune responses against the pathogen. We performed Western blot analysis on 16 P. insidiosum isolates using 12 pythiosis serum samples. These specimens were derived from human patients with pythiosis who had different forms of infection and lived in different geographic areas throughout Thailand. We have identified a 74-kDa immunodominant antigen in all P. insidiosum isolates tested. The 74-kDa antigen was also recognized by sera from all patients with pythiosis but not by control sera from healthy individuals, patients with thalassemia, and patients with various infectious diseases, indicating that Western blot analysis could facilitate diagnosis of pythiosis. Therefore, the 74-kDa antigen is a potential target for developing rapid serodiagnostic tests as well as a therapeutic vaccine for pythiosis. These advances could lead to early diagnosis and effective treatment, crucial factors for better prognosis for patients with pythiosis.     

The characteristics of ABO antibodies in group O Thai blood donors

This study aimed to characterize anti-A and anti-B hemolysins, IgM, and IgG titers in Thai blood donors. Altogether, 300 serum samples from group O donors at the National Blood Centre, Thai Red Cross Society, were screened for anti-A and anti-B hemolysins and treated with 0.01 M dithiothreitol to characterize IgM and IgG titers by standard tube technique. Antibody titers were compared with hemolysis grade. Male and female ratio = 1:1.3 and ages ranged from 17 to 60 years. The overall prevalence of anti-A and anti-B hemolysins was 69%. Anti-A and anti-B hemolysins comprised 18.3% and 16.7%, respectively and 34% had both antibodies. High titers of anti-A hemolysins were associated with females (P< 0.05), and only anti-B IgM titers were associated with age (P< 0.05). Interestingly, the association of anti-A IgM titers, anti-A IgG titers, and hemolysin grade was demonstrated (P< 0.05). A significant association between hemolysin grade and anti-B IgM titers was found (P< 0.05). The prevalence of anti-A and anti-B hemolysins and high titers of IgM and IgG in Thais are high. Hemolysin grade showed significant associations with IgM titers; therefore, when providing ABO-incompatible platelet transfusion, especially for female plateletpheresis donors, IgM high titers of anti-A and anti-B screening is suggested.     

Under-registration of deaths in Thailand in 2005-2006: results of cross-matching data from two sources

Objective

To estimate the magnitude of under-registration of deaths, by age and sex, in Thailand.

Methods

The data in this study were derived from two sources: the Thai Survey of Population Changes (SPC) 2005–2006, a consecutive multi-round household survey conducted over a 12-month period, and Thailand’s vital registration records. SPC death entries for people of all ages were matched to 2005–2006 death records from vital registration. The principles of a dual records system were applied to estimate the magnitude of under-registration of deaths, classified by age and sex, using the Chandrasekaran-Deming formula.

Findings

Overall under-registration of deaths during 2005–2006 was 9.00% (95% confidence interval, CI: 8.95–9.05) for males and 8.36% (95% CI: 8.31–8.41) for females. For both males and females, under-registration decreased as age increased. Under-registration was greatest among people of either sex aged 1–4 years, whereas it was < 10% among people 60 years of age and older, both males and females.

Conclusion

These findings provided correction factors that can be used for adjusting mortality data from the registration system.     

Myanmar mortality registration: an assessment for system improvement

Background

The vital registration system in Myanmar has a long history and geographical coverage is currently high. However, a recent assessment of vital registration systems of 148 countries showed poor performance of the death registration system in Myanmar, suggesting the need for improvement. This study assessed the quality of mortality data generated from the vital registration system with regard to mortality levels and patterns, quality of cause of death data, and completeness of death registration in order to identify areas for improvement.

Methods

The study used registered deaths in 2013 from the vital registration system, data from the 2014 Myanmar Population and Housing Census, and mortality indicators and COD information for the country estimated by international organizations. The study applied the guidelines recommended by AbouZahr et al. 2010 to assess mortality levels and patterns and quality of cause of death data. The completeness of death registration was assessed by a simple calculation based on the estimated number of deaths.

Results

Findings suggested that the completeness of death registration was critically low (less than 60%). The under-registration was more severe in rural areas, in states and regions with difficult transportation and poor accessibility to health centers and for infant and child deaths. The quality of cause of death information was poor, with possible over-reporting of non-communicable disease codes and a high proportion of ill-defined causes of death (22.3% of total deaths).

Conclusion

The results indicated that the vital registration system in Myanmar does not produce reliable mortality statistics. In response to monitoring mortalities as mandated by the Sustainable Development Goals, a significant and sustained government commitment and investment in strengthening the vital registration system in Myanmar is recommended.