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Background: The occurrence of tuberculosis (TB) in prisoners is higher than in the general population. Objective: To determine the incidence of Latent tuberculosis infection (LTBI) in newly incarcerated persons in southern Thailand. Materials and Methods: A prospective cohort study was conducted between January 2020 and December 2020 in all new inmates aged 15 years or older. Within two weeks of imprisonment, chest radiography and the two-step tuberculin skin test (TST) were performed. Participants with a negative TST underwent a repeat one-step TST at six months. A positive TST at six months without evidence of TB indicated new LTBI. Results: Six hundred two male inmates were enrolled. Fifty-one prisoners (8.5%) were excluded due to a history of previous incarceration for 4.1%, history of TB for 0.8%, household contact with TB cases for 2.1%, and refusal to participate for 1.3%. The remaining 551 inmates participated in the study. The average age was 31.1 years. The two-step TST was completed in 507 inmates (92.0%). Two hundred thirteen out of 551 participants (38.7%) initially tested positive. Follow-up was conducted on 290 participants. Only 53 participants (9.6%) completed the study protocol at six months due to COVID-19 pandemic lockdown. Tuberculin conversion was found in five inmates (9.4%). Conclusion: LTBI prevalence and incidence rates among Thai inmates are high. Individuals with negative LTBI test at initial imprisonment were at high risk of acquiring infection and should be followed to detect conversion and offered LTBI treatment. [ABSTRACT FROM AUTHOR]

Chikungunya virus (CHIKV) is responsible for large periodic epidemics in both endemic and nonendemic areas where competent mosquitoes are present. Transmission of CHIKV by transfusion during explosive outbreaks has never been documented, and the true impact of CHIKV infection on blood transfusion during an outbreak is unknown. Considerations include not only transfusions in the active outbreak areas but also returning travelers to nonendemic areas. Because there are no documented cases of transfusion-transmitted CHIKV, there are no standard guidelines regarding transfusion policies during a chikungunya fever outbreak. We review current information from studies during outbreaks with the goal of estimating the potential effect of different blood safety interventions (eg, querying donors for possible CHIKV exposure, chikungunya fever–related symptoms, screening for CHIKV RNA). • Current information regarding viral loads among presymptomatic, asymptomatic, and symptomatic CHIKV infected individuals is presented. • If transfusion is found to be a means of transmitting CHIKV, measures aimed at reducing the rate of transfusion transmission during an outbreak are reviewed. • Strategies regarding the return of traveling donors at risk for CHIKV infection are reviewed. [ABSTRACT FROM AUTHOR]

Background: The impact of the spread of chikungunya virus (CHIKV) by autochthonous transmission and blood transfusion in nonendemic areas via travelers returning from CHIKV-affected locations is a concern.Methods: We analyzed the risks of potential CHIKV importation and transfusion transmission from Thailand to Europe via travelers visiting southern Thailand from 2008 through 2015, using the web-based European Up-front Risk Assessment Tool.Results: The risk of CHIKV importation by European travelers returning from Thailand from 2008 through 2015 varied depending on the year of travel, tourist destination, duration of stay, and time since last possible exposure. Specifically, the risks of acquiring CHIKV among travelers visiting Songkhla and Krabi for 1, 5, or 10-30 days during the highest epidemic activity in 2009 were estimated to be 74.40, 371.99, and 706.77 (Songkhla) and 1.82, 9.08, and 17.25 (Krabi) per 100,000 travelers, respectively. In contrast, such risks were estimated to be fewer than 0.099 per 100,000 travelers in nonepidemic years. The 2009 yearly average rates of expected incidence among 4,059,988 European travelers who stayed for 1 or 10-30 days in all six outbreak activity destinations were calculated to be, respectively, 4.01 × 10-6 or 1.20 × 10-4 cases per day, corresponding to the estimated rates of viremia and transfusion-transmitted CHIKV via traveling blood donations of 3.21 × 10-5 and 0.61, and 9.62 × 10-4 and 3.34, respectively. Additionally, it is probable that 18 (0.0004%) Europeans acquired CHIKV in Thailand, representing a maximum attack rate of 0.0023%.Conclusion: The extent of the expected risks and attack rates of CHIKV infection might reflect the travel preferences for popular destinations rather than the true risks of CHIKV transmission in travelers' home nonendemic countries. Nevertheless, preventive and blood-safety intervention measures may be applied to returning travelers at risk for infection to reduce CHIKV transfusion threats in their home countries. [ABSTRACT FROM AUTHOR]

Background: To date, neither is there a standard guideline for maintaining a safe blood supply during a chikungunya fever (CHIKF) outbreak nor has a study been performed on actual transfusion-transmitted CHIKF to recipients. This study estimated the potential incidence of transfusion-transmitted CHIKF and compared the efficacies of various blood safety intervention strategies to mitigate the transfusion-transmitted CHIKF risk.Study Design and Methods: A Web-based tool named the European Up-Front Risk Assessment Tool (EUFRAT) was used to estimate the risk of transfusion-transmitted CHIKF using data inputs from the 2009 Songkhla epidemic in Thailand.Results: The mean and maximal risks of viremic donations during the entire epidemic period were estimated to be 0.9 (95% confidence interval [CI], 0.0-2.7) and 4.8 (95% CI, 0.5-9.1), respectively. This meant that the potential risk of transfusion-transmitted CHIKF to recipients receiving all infective end products in the absence of blood safety measures was from 10.9 (95% CI, 1.8-20.4) to 57.6 (95% CI, 36.4-79.5). Based on experience from the 2009 Thai epidemic, the proportion of 10% asymptomatic cases, for instance, with predonation screening for CHIKF-related symptoms and follow-up observation in donors at risk was estimated to be 88.4% (95% CI, 69.9%-100.0%) to 99.1% (95% CI, 79.6%-100.0%) effective in reducing this transfusion risk compared to 83.7% (95% CI, 65.8%-100.0%) to 90.7% (95% CI, 72.1%-100.0%) by predonation screening for donors at risk of chikungunya virus infection alone.Conclusion: This study suggests that prompt blood screening measures can reduce the risk of transfusion-transmitted CHIKF and maintain a safe blood supply during an outbreak. [ABSTRACT FROM AUTHOR]

Background: Leishmaniasis caused by two new species of Leishmania; L. siamensis and L. martiniquensis have been recently described in Thailand. The disease has mainly been documented in AIDS patients from southern Thailand. In this study, polymerase chain reaction (PCR) was used to determine HIV-Leishmania co-infection in southern Thailand.Methods: One ml of saliva and 3 ml of EDTA blood were collected from HIV-infected patients for PCR detection of Leishmania DNA, cloning and sequencing. The positive PCR samples were then cultured on Schneider's insect medium.Results: Three out of 316 saliva samples collected from HIV-infected patients were found to be positive for Leishmania DNA (0.95%). Among the positive samples, one patient was observed with disseminated cutaneous lesions and also tested positive via saliva, whole blood and buffy coat in PCR. The second case presenting with nodular lesions also gave a positive saliva test via PCR two months prior to buffy coat. This diagnosis was confirmed by microscopic examination and a culture of biopsy samples from a nodule. The last case was an asymptomatic Leishmania infection which tested PCR positive only in saliva with a consecutive sample collection conducted for three months.Conclusions: The prevalence of Leishmania infection in HIV infected patients within this study is 0.95%. Leishmania DNA was detected in saliva by PCR prior to blood and buffy coat of two HIV infected patients. Early detection of Leishmania DNA in saliva would be beneficial for the follow up of asymptomatic Leishmania infected patients, the early treatment of leishmaniasis and for surveillance survey purpose. However, full evaluation of sensitivity and specificity of this technique with a large cohort of patients is required before deployment. [ABSTRACT FROM AUTHOR]

This article discusses a case of an HIV-infected patient in Thailand who developed multiple cutaneous nodules due to a relapsed Leishmania siamensis infection. The patient was diagnosed through microscopic examination, culture, and polymerase chain reaction (PCR). Treatment involved intravenous amphotericin B deoxylate followed by oral itraconazole. Leishmaniasis is a parasitic disease transmitted by infected sand flies and is a significant cause of morbidity and mortality globally. The article also highlights the emergence of L. siamensis infections in Thailand and Myanmar, as well as the diagnostic methods and treatment options available. [Extracted from the article]

Leishmania siamensis is newly described as the causative pathogen of autochthonous leishmaniasis in Thailand. Potential vectors and animal reservoirs of L. siamensis are not thoroughly studied. An environmental survey was carried out in the affected area in two provinces in southern Thailand: Songkhla and Nakhon Si Thammarat. Ninety-nine villagers, 378 sandflies, and potential animal reservoirs were examined. Leishmania DNA amplicon was identified in two species of female sandflies, Sergentomyia (Neophlebotomus) and Sergentomyia (Parrotomyia) barraudi. The DNA amplicon was also identified in black rats (Rattus rattus). A phylogenetic tree of confirmed patients, sandflies and black rats fell into a single clade and separate from other Leishmania species. This study showed the potential involvement of R. rattus and Sergentomyia (Neophlebotomus and Parrotomyia) sandflies in transmission of L. siamensis.

Leishmaniasis is an emerging disease in Thailand. Herein, we report on two human immunodeficiency virus (HIV)-infected patients with leishmaniasis who presented with overlapping manifestations between cutaneous and visceral leishmaniasis. Sequencing analysis of the internal transcribed spacer 1 (ITS1) of the ribosomal RNA gene showed that the species was identical to a new species recently described in Thailand. The detection of DNA of this Leishmania species in saliva may have important implications for transmission and epidemiological studies.

Objective: To study the factors influencing delayed pulmonary tuberculosis suspicion and isolation among hospitalized patients in Songklanagarind Hospital., Material and Method: A prospective study examining the microbiologically confirmed pulmonary tuberculosis patients who were admitted in the hospital. The data collected included demographic data, HIV status, initial symptoms, and chest radiographs., Results: Sixty inpatients were identified. Forty-five percent and 30% of patients were admitted. There was delay in suspicion of pulmonary tuberculosis and delay in isolation in 18 (30%) and 24 (40%) patients, respectively. There was no statistical significance among delayed and non-delayed groups of pulmonary tuberculosis suspicion and isolation., Conclusion: The pulmonary tuberculosis suspicion and isolation should concern patients for whom TB is an etiologic implication.

Objective: To determine epidemiology, microbiology, outcome, and factor influencing mortality in nosocomial bloodstream infection in Songklanagarind Hospital., Material and Method: Retrospective study in adult patients who were hospitalized at Songklanagarind Hospital with positive blood culture after 48 hours of admission was conducted. The present study duration was between 1 August and 30 November 2008., Results: There were 138 episodes of nosocomial blood stream infection in 117 patients, the prevalence of 11.6/1,000 admissions. The mean age of patients was 54.8 years (range 12 to 88 years) and males comprised of 60.9%. Hematologic malignancy was the most common underlying condition of the patients (27.5%) while 30.4% of patients had no underlying disease. The three common primary infections were lower respiratory tract (13.9%), urinary tract (12.4%) and skin and soft tissue (6.5%), whereas the unknown site of infection had accounted for 80 episodes (62.0%). The leading pathogens of nosocomial bacteremia were E. coli 17.4%, S. aureus 15.2%, K. pneumoniae 12.3% and P. aeruginosa 10.3%. Vanocomycin was dominantly sensitive to gram positive cocci, while about half (52.4%) of S. aureus had methicillin resistance. The variety of resistance had encountered for example P. aeruginosa (7.1%) to imipenem and majority of A. baumannii to aminoglycosides, fluoroquinolones and carbapenems. Overall mortality was 28.3% but mortality due directly to bacteremia was 13.8%. Univariate and multivariate analyses showed liver cirrhosis and lower respiratory tract infection to be associated with increased mortality., Conclusion: The prevalence of nosocomial blood stream infection had slightly sideway down, while the mortality was stable, compared with several reports in the last two decades. The gram negative bacteria had a high proportion of antibiotic resistance.

There has been a recent increase in reports of neurologic complications as major causes of morbidity and mortality in chikungunya virus infection. As a part of 2004-2009 global outbreaks, an unprecedented large chikungunya epidemic occurred in Southern Thailand during 2008-2009 in which 49,069 cases were reported. During this period, we encountered two patients with meningoencephalitis and another patient with myeloneuropathy among 1,018 cases diagnosed as chikungunya in our hospital. The clinical pictures are presented and the key points are used to recognize and differentiate chikungunya from Japanese encephalitis virus, dengue virus, and herpesvirus infections, which are more common causes of meningoencephalitis and myelitis in this region.

A multi-test strip dotblot immunoassay for the diagnosis of typhoid fever, scrub typhus, murine typhus, dengue virus infection and leptospirosis was evaluated in Thai adults presenting to hospital with acute, undifferentiated fever. The kit gave multiple positive test results in 33 of 36 patients with defined infections and was therefore not a useful admission diagnostic tool.