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It is well known that immunopathogenesis play an important role in the development of severe complications in DHF. Since 2006, the authors have experience in giving immunomodulators to save life of many severe complicated adult DHF patients. This experience stimulates our interest on the benefit of adjunctive corticosteroid therapy in adult grade II DHF patients.To find out whether there are some benefits of giving adjunctive corticosteroid therapy in adult grade II DHF patients.Retrospective analysis during January 2008-February 2010.One hundred and forty nine adult grade II DHF patients were admitted at Vichaiyut Hospital. They were divided into 3 groups according to the different therapy designed by the responsible clinicians. Group 1 consisted of 59 cases who received full dose-short course of intravenous dexamethasone (4 milligram every 6 hours for 2-3 days). Group 2 consisted of 61 cases who received intermittent 4 milligrams intravenous dexamethasone only at febrile episode and group 3-29 cases did not received corticosteroid. All the patients were investigated similarly. Age, sex, symptoms and signs including daily hematologic studies (Hct, Wbc, differential count, platelet count) were recorded. Serum SGOT SGPT bilirubin, alkaline phosphatase and albumin BUN, creatinine were performed on admission and repeated as indicated. The parameter to measure the benefit of adjunctive corticosteroid included 1) severity of thrombocytopenia, 2) liver impairment, 3) the days of illness as determined by fever and 4) the length of the hospital days.The clinical severity of all the three groups were quite similar. There was no benefit of using adjunctive corticosteroid therapy in term of changing the severity of thrombocytopenia and liver impairment. However, the days of illness and the length of hospital days were shorter at 4.6 days and 3.7 days respectively in the group who received full dose, continuous-short course of dexamethasone intravenously. This is statistically significant when compared to the other two groups who had the longer total days of fever at 5.8 days and 6.03 days and the longer length of hospital days at 5.19 days and 4.5 days respectively (p0.05).Adjunctive corticosteroid by given full dose, continuous short course in grade II adult DHF reduced the course of illness (days of fever) and the length of hospital days. These findings indicated the benefit of using adjunctive corticosteroid therapy in grade II adult DHF patients.

Serum and cerebrospinal fluid (CSF) from patients with eosinophilic meningoencephalitis were analyzed for changes in the protein profile and for antibodies to an Angiostrongylus cantonensis extract to seek evidence for a local immune response in the central nervous system. The results showed increased serum IgG and increased CSF total protein, albumin, IgG, IgA, and IgM. Although the CSF immunoglobulin levels were much lower than the corresponding serum levels, antibody activity of both fluids to A. cantonensis extract were similar. These findings are compatible with the idea that CSF antibodies may be synthesized locally within the central nervous system in response to antigenic stimulation.

Six hundred and forty-six patients with an eosinophilic pleocytosis were studied in Thailand over a 3-year period ending in March 1968. It was possible to segregate the cases into two clinical entities, which were termed typical eosinophilic meningitis and eosinophilic myeloencephalitis respectively. The clinical and laboratory finding of 484 cases of typical eosinophilic meningitis are reported here. The latter entity was generally benign and self-limited with a case mortality ratio of less than 0.5%. Acute severe headache was the most significant symptom. Fever was uncommon and abnormal neurologic findings were absent in 58% of cases. Sixteen percent of patients had visual impairment and 12% had an abnormal fundus. Impairment of the sensorium of a slowly progressive type and weakness of the extremities without localization were noted in 5% and less than 1% of patients, respectively. These signs occurred only in severely ill patients. Involvement of the cranial nerves was found in 17% of patients. Paralysis of the external rectus muscle of the eye and facial paralysis were found in 3% and 4%, respectively. The cerebrospinal fluid was characteristically turbid with a leucocyte count of more than 500 cells per mm3 in 75% of cases. It appeared that specific treatment of the disease was not indicated and that steroids and antibiotics did not have a definite beneficial effect on the course of the illness.

2 immature adult male nematodes, identified as Gnathostoma spinigerum , were recovered, for the first time, from the brain at the post mortem examination of 2 patients who died of a newly recognized disease, cosinophilic myeloencephalitis. 54 similar cases were recorded in the 5 studied provinces of Thailand during the 2-year period, indicating the significance of this disease.