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The rising prevalence of Parkinson's disease (PD) globally presents a significant public health challenge for national healthcare systems, particularly in low-to-middle income countries, such as Thailand, which may have insufficient resources to meet these escalating healthcare needs. There are also many undiagnosed cases of early-stage PD, a period when therapeutic interventions would have the most value and least cost. The traditional "passive" approach, whereby clinicians wait for patients with symptomatic PD to seek treatment, is inadequate. Proactive, early identification of PD will allow timely therapeutic interventions, and digital health technologies can be scaled up in the identification and early diagnosis of cases. The Parkinson's disease risk survey (TCTR20231025005) aims to evaluate a digital population screening platform to identify undiagnosed PD cases in the Thai population. Recognizing the long prodromal phase of PD, the target demographic for screening is people aged ≥ 40 years, approximately 20 years before the usual emergence of motor symptoms. Thailand has a highly rated healthcare system with an established universal healthcare program for citizens, making it ideal for deploying a national screening program using digital technology. Designed by a multidisciplinary group of PD experts, the digital platform comprises a 20-item questionnaire about PD symptoms along with objective tests of eight digital markers: voice vowel, voice sentences, resting and postural tremor, alternate finger tapping, a "pinch-to-size" test, gait and balance, with performance recorded using a mobile application and smartphone's sensors. Machine learning tools use the collected data to identify subjects at risk of developing, or with early signs of, PD. This article describes the selection and validation of questionnaire items and digital markers, with results showing the chosen parameters and data analysis methods to be robust, reliable, and reproducible. This digital platform could serve as a model for similar screening strategies for other non-communicable diseases in Thailand., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Bhidayasiri, Sringean, Phumphid, Anan, Thanawattano, Deoisres, Panyakaew, Phokaewvarangkul, Maytharakcheep, Buranasrikul, Prasertpan, Khontong, Jagota, Chaisongkram, Jankate, Meesri, Chantadunga, Rattanajun, Sutaphan, Jitpugdee, Chokpatcharavate, Avihingsanon, Sittipunt, Sittitrai, Boonrach, Phonsrithong, Suvanprakorn, Vichitcholchai and Bunnag.)

Background: Autosomal recessive congenital ichthyosis (ARCI) is a heterogenous group of rare keratinization disorders. To date, more than 13 causative genes have been identified. However, data on clinical and molecular characteristics including genotype-phenotype correlation are lacking in Thailand., Objective: We collected cases diagnosed with non-syndromic ARCI and syndromic recessive congenital ichthyosis at the Institute of Dermatology from 2011 to 2021 and performed genetic testing with next-generation sequencing and assessed clinical details., Methods: Baseline demographic data, birth history, family history, skin manifestations at birth, current cutaneous manifestations, comorbidities, and response to treatments were assessed. DNA was screened for mutations using targeted gene sequencing of 45 genes related to congenital ichthyosis., Results: A total of 33 patients were analyzed with an average age of 23.8 ± 13.9 years. Congenital ichthyosiform erythroderma (CIE) was most common (60.6%), followed by lamellar ichthyosis (18.2%), self-improving congenital ichthyosis (6.1%), Netherton syndrome (6.1%), ichthyosis prematurity syndrome (3%), Sjögren-Larsson syndrome (3%) and bathing suit ichthyosis (3%). Eight genes were found with pathogenic variants in our cohort as follows: ABCA12 42.4% (14/33), NIPAL4 24.2% (8/33), TGM1 15.2% (5/33), SPINK5 6.1% (2/33), ALDH3A2 3% (1/33), SLC27A4 3% (1/33), CYP4F22 3% (1/33), and ST14 3% (1/33). Clinically, 79% of patients with ABCA12 pathogenic variants in this study had CIE, 79% of w had novel biallelic pathogenic compound heterozygous variants, whereas 21% had homozygous missense variants., Conclusions: This is the first study to describe clinical and molecular findings of ARCI in a cohort from Thailand. Our findings demonstrate the clinical spectrum of the diseases and expand the molecular findings in a Southeast Asian population., (© 2022 Wiley Periodicals LLC.)

AbstractSeveral case reports of autochthonous leishmaniasis in Thailand have been published since 1996. Most of the previous cases presented with visceral leishmaniasis (VL) and were mostly reported in southern part of Thailand. Recently, it has been evident that Leishmania martiniquensis is the main cause of Leishmania infection in Thailand. However, Leishmania siamensis (PCM2 Trang isolate) was found to be of a separate lineage with restricted distribution in southern Thailand and also a cause of disseminated dermal and visceral leishmaniasis in one published case. Here we report the first patient from central Thailand with human immunodeficiency virus infection presenting with disseminated dermal leishmaniasis. Polymerase chain reaction and DNA sequencing analysis (large subunit of RNA polymerase II and 18S ribosomal RNA internal transcribed spacer 1) from the tissue biopsy sample revealed the pathogen sequences to be highly homologous to PCM2 Trang strain previously reported from southern Thailand.

Background/objectives: Male androgenetic alopecia (AGA) is a common hair problem. Serenoa repens extract has been shown to inhibit both types of 5-α reductase and, when taken orally, has been shown to increase hair growth in AGA patients. The aim of this study was to assess the efficacy of topical products containing S. repens extract for the treatment of male AGA., Methods: This was a pilot, prospective, open, within-subject comparison limited to 24 weeks using no placebo controls. In all, 50 male volunteers aged between 20 and 50 years received topical S. repens products for 24 weeks. The primary end-point was a hair count in an area of 2.54 cm(2) at week 24. Secondary end-points included hair restoration, investigators' photographic assessment, patients' evaluation and discovering adverse events., Results: The average hair count and terminal hair count increased at weeks 12 and 24 compared to baseline. Some of these positive results levelled off at week 24, presumably because the concentrated topical product containing S. repens extract was stopped after 4 weeks. The patients were satisfied with the products and the side-effects were limited., Conclusions: The topical application of S. repens extract could be an alternative treatment in male pattern baldness in male patients who do not want or cannot tolerate the side-effects of standard medications, but the use of a concentrated S. repens product beyond 4 weeks may be necessary for sustained efficacy., (© 2015 The Australasian College of Dermatologists.)

Background: Dengue virus infection is an important mosquito-borne disease with the reported 40,000-100,000 cases per year in Thailand. Shock is one of the common presentations at the emergency room (ER) and dengue shock syndrome (DSS) is among the common causes of shock. Proper and timely management of DSS determines the outcomes and prognosis of DSS patients., Objective: To find the prevalence of DSS at the ER and evaluate the medical management and risk factors associated with the outcome of DSS patients., Material and Method: A retrospective study on patients who presented with shock, including DSS patients at the ER of Queen Sirikit National Institute of Child Health (QSNICH), Bangkok, Thailand, from 1st January 2008 to 31st December 2009 was done. The prevalence of patients who presented with shock at the ER was retrieved from the Statistical and Information Technology Departments. Out-patient cards and In-patient charts of DSS patients were reviewed. Clinical and laboratory data were compared between recovered and death cases. Statistical analysis was done by using SPSS version 14.0., Results: There were 109 shock patients seen at the ER during the present study period with 59 DSS (54.1%), 30 septic shock (27.5%), 13 hypovolemic shock (11.9%), 1 cardiogenic shock (0.9%) and 6 other non-specific shock (5.5%). DSS cases were found all year round with the peak prevalence from June to August which is the rainy season. Twenty-six of DSS (44.1%) were referred cases and 5 of them died, case fatality rate was 8.8%. All death cases had prolonged shock, massive bleeding and liver failure at presentation while these findings were found in 2 (4.4%), 16 (35.6%) and 10 (22.2%) cases of recovered cases. Encephalopathy, renal failure and respiratory failure were found in 80, 60 and 60% of the death cases while in recovered cases they were found in 11.1, 4.4 and 2.2%. Acidosis was found higher in the death group (60%) than in recovered group (8.9%). Other common presenting findings in death and recovered groups were bleeding (35.6 vs 100.0%), fluid over load (31.1 vs. 80%), hyponatremia (40% for both groups) and hypocalcemia (83.3 vs. 80%). Among the 45 recovered cases; 3 cases were misdiagnosed and another 8 cases (17.8%) received no i.v. fluid at the ER. Cross matching was done in 32 cases (64%) and blood was transfused in 16 cases (50% of the cross matching)., Conclusion: DSS is the most common shock found at the ER especially during June to August. ER physicians should be alert for making the correct diagnosis of DSS with proper intravenous fluid resuscitation and correction of the common complications/laboratory abnormalities, i.e. acidosis, hyponatremia, hypocalcemia and cross matching for massive bleeding. A referred case with liver failure together with renal and respiratory failure was likely associated with mortality while fluid overload and significant bleeding do not if they are managed properly. Early signs of shock should be detected in walk in cases to prevent later shock after admission.

Background: A novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in Mexico during the spring of 2009. After that, the virus spread globally, resulting in the influenza pandemic., Objective: To observe the clinical manifestations of the 2009 pandemic influenza A (H1N1) and the epidemic waves of hospitalized children for a period of one year., Material and Method: A prospective observational study of children under eighteen years old, confirmed having the 2009 pandemic influenza (H1N1) infection by real-time reverse-transcription-polymerase-chain-reaction (RT-PCR), admitted at Queen Sirikit National Institute of Child Health, Bangkok, Thailand during one year, from 1st June 2009 to 31st May 2010., Results: A total of 83 pandemic influenza infected children were admitted during a one-year period. There were two waves of epidemic outbreak, the first wave from June to August 2009 and the second wave from January to February 2010. There were 47 cases of males (56.6%), with the highest attack rates among children 1-5 years of age (48.2%). The youngest case was a 29-day old girl. The correct provisional diagnosis of pandemic influenza infection are 39.5%, the other initial diagnosis are pneumonia, bronchiolitis, tonsillitis, encephalitis, and dengue infection. Most patients coming for care had typical, influenza-like symptoms with fever (98.8%), cough (92.6%) and rhinorrhea (74.1%). Systemic symptoms are frequent. Gastrointestinal symptoms (including vomiting (46.9%) and diarrhea (24.7%)) occur more commonly than seasonal influenza. Pneumonia is the most common complication (43.2%); other complications include bronchiolitis, hemoptysis, acute respiratory distress syndrome (ARDS) and encephalitis. In one case, a seven year old girl suffered from ARDS, sepsis, multi-organ dysfunction syndrome and ventilator associated pneumonia, but survived with some neurological sequelae. Radiographic findings included diffuse interstitial, alveolar infiltrates and some in lobar distributions. Apart from oseltamivir the other antibiotics included ceftriaxone, cefotaxime, amplicillin and azithromycin, were added for pneumonia. All patients in the present study survived., Conclusion: The burden and character of pandemic influenza infection in developing countries are still incompletely understood. Early therapy with oseltamivir in severely ill patients, without waiting for laboratory confirmation for diagnosis, will save patients from severe complications.

Although Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella spp. are prevalent causes of community-acquired pneumonia, rapid and sensitive diagnosis is difficult. Real-time PCR provides rapid and sensitive diagnosis, however, DNA extraction is still required, which is time-consuming, costly and includes a risk of contamination. Therefore, we aimed to develop triplex real-time PCR without DNA extraction. AmpDirect(R) Plus which inhibits PCR inhibitors was used as the PCR buffer. Melting temperatures of the PCR products for the three bacteria were analyzed by SYBR green triplex real-time PCR and were found to be significantly different. Detection limits of bacteria cells diluted in nasopharyngeal aspirates (NPAs) were comparable with the detection limits of previously reported real-time PCR. Our PCR without DNA extraction and probe real-time PCR with DNA extraction showed identical results for the detection of the three bacteria from 38 respiratory specimens (sputum, endotracheal aspirates, and NPAs) collected from patients with pneumonia. No cross-reaction with other bacteria was observed. Our triplex real-time PCR successfully detected and differentiated the three bacteria. Although further field tests are required, our assay is a promising method for the rapid and cost-effective detection of the three bacteria.

Background: Mycoplasma pneumoniae is one of the most common causes of childhood community-acquired pneumonia (CAP), particularly in school-age children. Information regarding this infection in pre-school age children is lacking., Objective: To determine the prevalence of M. pneumoniae in young children aged under 5 years with CAP., Material and Method: This prospective study was conducted at Queen Sirikit National Institute of Child Health (QSNICH), Bangkok, Thailand between December 2001 and November 2002. We enrolled children aged 2 to 5 years with a clinical and radiological diagnosis of CAP. Acute and convalescent sera were collected and measured by using a particle agglutination test. Polymerase chain reaction (PCR) assay for M. pneumoniae was detected from nasopharyngeal secretions. Criteria for diagnosis were defined as > or = 4-found rising of mycoplasma antibody or titer > or = 1:160 with positive PCR., Results: Thirteen out of 113 CAP patients were diagnosed as mycoplasma pneumonia. Three of them were diagnosed by > or = 4-fold rising of mycoplasma antibody while another 10 patients were diagnosed by mycoplasma titer > or = 1:160 with positive PCR for M. pneumoniae. Clinical symptoms and signs of these 13 mycoplasma pneumonia in young patients were fever (85%), cough (92%), dyspnea (85%), diarrhea (15%), rales (85%), wheezing or rhonchi (46%), and skin rash (15%). Leucocytosis (wbc > 15,000/cumm) was found in 46%. Chest x-rays revealed interstitial infiltration (71%), patchy infiltration (29%) and no pleural effusion was detected. Choices of antibiotic were erythromycin (31%), beta lactam antibiotics (61%), and antibiotic was not prescribed in one patient (8%). Sixty-nine percent of the patients improved, while 31% did not, possibly due to the use of beta lactam antibiotics, or non use of antibiotics., Conclusion: Mycopalsma pneumonia is not uncommon in children aged 2-5 years with CAP. Clinical signs, symptoms and radiological findings are non-specific and cannot be differentiated from other causes of CAP.

Introduction: Prevalence of wheezing is increasing, bronchodilators are sub-optimally utilized and antibiotics are over-prescribed. In Thailand, current case management guidelines based on WHO guidelines, recommend two doses of rapid-acting bronchodilator for children with audible wheeze and fast breathing (FB) and/or lower chest indrawing (LCI)., Objective: To document the response of children with wheeze with FB and/or LCI to up to three doses of bronchodilator therapy and followed children whose FB and LCI disappeared for 7 days., Material and Method: We documented response to up to three dose of inhaled salbutamol in consecutively assessed eligible children 1-59 months of age presenting with auscultatory/audible wheeze and FB [WHO defined non-severe pneumonia (NSP)] and/or LCI [WHO defined severe pneumonia (SP)] at the outpatient department of a referral hospital. Data were collected for up to 7 days in responders to bronchodilator therapy., Results: Of 534 children were screened from November 2001 to February 2003, 263 (49.3%) had wheeze and NSP and 271 (50.7%) had wheeze and SP Forty-eight children (9%) had audible wheeze. At screening, 224/263 (85.2%) children in the NSP group and 195/271 (72.0%) in the SP group responded to inhaled salbutamol. 86/419 (20.5%) responded to the third dose of bronchodilator Four hundred and nineteen responders were enrolled and followed up. On follow-up, 14/217 (6.5%) responders among the NSP group and 24/190 (12.6%) among the SP group showed deterioration. Age 1-11 months at screening was identified as an independent predictor of subsequent deterioration. Two seasonal peaks from December to March and from August to October were documented., Conclusion: A third dose of bronchodilator therapy at screening will improve the specificity of case management guidelines and reduce antibiotic use. Physicians should use auscultation for management of wheeze.

Background: The prevalence of community-acquired pneumonia (CAP) caused by atypical pathogens in Thai children is unknown., Objective: To examine the prevalence of Mycoplasma pneumoniae and Chlamydophila pneumoniae infections in paediatric patients (aged 2-15 years) with CAP in three academic hospitals using standardised laboratory techniques. The characteristics of atypical pneumonia were also compared with other causes of CAP., Methods: Diagnosis of current infection was based on a four-fold or more rise in antibody serum samples or persistently high antibody titres together with the presence of mycoplasmal or chlamydial DNA in secretions., Results: Of 245 patients with CAP, 17.5% of cases were caused by atypical pathogens (M. pneumoniae 14.3%, C. pneumoniae 2.8% and co-infection 0.4%). We also found atypical pathogens in young children aged 2-5 years. The clinical and laboratory findings did not distinguish atypical pneumonia from other CAPs. Segmental or lobar consolidation on chest X-rays was more common in atypical pneumonia, while dyspnoea was more prominent in other CAPs., Conclusion: Our data show a high prevalence of M. pneumoniae and C. pneumoniae in Thai children with CAP, including in children aged 2-5 years.

Objective: To determine the prevalence and clinical features of mycoplasma pneumoniae in Thai children with community acquired pneumonia (CAP)., Material and Method: Diagnosis of current infection was based on > or = 4 fold rise in antibody sera or persistently high antibody titers together with the presence of mycoplasma DNA in respiratory secretion. The clinical features were compared between children who tested positive for M pneumoniae, and those whose results were negative., Results: Current infection due to M. pneumoniae was diagnosed in 36 (15%) of 245 children with paired sera. The sensitivity and specificity of polymerase chain reaction (PCR) in diagnosing current infection in the present study were 78% and 98% respectively. The mean age of children with mycoplasma pneumoniae was higher than CAP with unspecified etiology. The presenting manifestations and initial laboratory finding were insufficient to predict mycoplasma pneumoniae precisely, the presence of chest pain and lobar consolidation on chest X-ray, however, were significant findings in children with mycoplasma pneumoniae., Conclusion: The present study confirms that M. pneumoniae plays a significant role in CAP in children of all ages. Children with this infection should be identified in order to administer the appropriate antibiotic treatment.

Background: Most human immunodeficiency virus (HIV) infections among children under 5 years are transmitted perinatally. These children require more medical attention and hospitalization than non HIV-infected children. The expenses of HIV-infected children are mostly related to opportunistic infections., Objective: To compare the medical and non-medical expenses of treating babies born to HIV-infected and non-HIV-infected mothers at the Queen Sirikit National Institute of Child Health (QSNICH)., Methodology: Consecutive children of HIV-infected and non HIV-infected mothers born at Rajavithi Hospital, Bangkok, were recruited from 1993 to 1995. All of them were followed at QSNICH for free medical services. The demographic and pregnancy data of mothers and the characteristics of the babies of the two groups were compared as well as the number of the hospital visits and reported medical and non-medical expenses., Results: 58 children of HIV-infected mothers and 119 children of non-HIV-infected mother were recruited during this period. Only 30 (51.7%) children of HIV-infected mothers could complete the 18-month requirement, while 90 (75.6%) of the babies born to non-HIV-infected mothers finished the 18 months follow-up period. The two groups did not differ much in terms of demographic characteristics, except that the infant fathers were younger and serology for syphilis was higher in the HIV-infected mothers. This indicated that the HIV-infected mothers had earlier sexual activity. Babies born to the HIV-infected mothers tended to have a lower birth weight and were small for gestational age (SGA). Nine out of 30 babies (30%) born to the HIV-infected mothers were found to be HIV positive at the 18th month of follow-up. The mean medical, non-medical, and total expenses of the babies of the infected group were 2,525.90 +/- 4,328.75, 1,323.07 +/- 1,452.41, 3,848.97 +/- 5,308.90 baht respectively, or were 2.4, 2.0, and 2.2 times those of the non-infected group. These expenses did not include antiretroviral therapy., Conclusion: The total medical and non-medical expenses excluding antiretroviral therapy of the children of the infected group were 2.2 times those of the non-infected group. Under the limitation of financial resource and fast growing health care expenditures, the preventive measure for HIV infections including public information, education, communication, and condom promotion should be emphasized.

Objective: To compare the outcomes of out-patient antibiotics switch therapy with the treatment provided in the hospital among pediatric urinary tract infection (UTI) cases., Material and Method: A comparative study was carried out using the febrile UTI patients of age 1 month-15 years in the observation room (OPD), Queen Sirikit National Institute of Child Health, Bangkok, Thailand, from 1st January 2000 to 31st December 2000 and the admitted pediatric UTI cases during the same period. The treatment at the OPD was started with parenteral antibiotics, then switched to oral form when the patients were clinically improved and defervesence occurred., Results: There were 95 cases of pediatric UTI of which 29 cases were treated in the observation room as out-patient, 66 cases were treated as in patients after admitting them. The success rate of treatment was the same in both groups. The patients in the observation room were fit enough to be discharged but continued oral treatment within 1.93 +/- 0.65 days, compared with 6.24 +/- 2.72 days of the admitted group. Gentamicin and ceftriazone were the two most common parenteral antibiotics and norfloxacin was the most commonly prescribed oral antibiotics in both group. Mean age of the OPD group (6.24 +/- 2.72 years) was higher than the admitted group (0.97 +/- 1.7 year). Escherichia coli (E. coli) was the most commonly found organism in the urine culture and the sensitivity pattern was the same in both groups., Conclusion: The study revealed that some pediatric UTI patients can be treated as out-patients using antibiotics switch therapy in the observation room instead of being admitted.

Efficient transduction of inhibitory genes is a critical requirement in the development of a gene therapy strategy against human immunodeficiency virus type 1 (HIV-1). Commonly used systems based on retrovirus-mediated gene delivery are characterized by low efficiency gene transfer into the target cell. Genes were transduced in the absence of cell selection into 60-90% of human CD4+ cells by using a novel technique that allows high efficiency gene transfer mediated by adenoviruses coupled with DNA-polylysine complexes. Protection of these cells against HIV-1 acute infection was evaluated by transducing them with three different inhibitory genes which interfere with HIV-1 replication at separate levels (polymeric Tat activation response element [TAR] decoy, dominant-negative mutant of the gag gene and antisense sequences of the gag gene) and subsequent challenging with HIV-1. The polymeric TAR decoy inhibited HIV-1 replication over 95%. Both the dominant-negative mutant and the antisense sequence of the gag gene were less potent inhibitors than the polymeric-TAR decoy. Combinations of either polymeric-TAR with dominant-negative mutant or antisense of the gag gene synergistically enhanced the inhibitory effects of the single genes. These data suggest that the combination of a highly efficient transduction technique with effective HIV-1 inhibitory genes confers rapid protection against HIV-1 acute infection in vitro.

The clinical and epidemiological characteristics of 162 patients with eosinophilic myeloencephalitis, believed to be caused by invasion of the central nervous system by Gnathostoma spinigerum, are described. The case mortality rate was at least 12%, and probably higher. Single live young adult G. spinigerum were recovered from the brains of 2 patients at autopsy and from the eye lids of 2 other living patients. The disease caused by this parasite can be distinguished from that caused by Angiostrongylus cantonensis by characteristic acute nerve root pain, signs of spinal cord and cerebral involvement, and the presence of bloody or xanthochromic cerebrospinal fluid. As judged by its prevalence and mortality, central nervous system disease caused by G. spinigerum is the most important parasitic disease of the central nervous system in Thailand. Since invasion of the nervous system by this parasite is a significant cause of intracranial hemorrhage in Thailand, it should be kept in mind by internists, neurologists, neurosurgeons, and pathologists who care for patients residing in, or who have visited, areas where G. spinigerum occurs.

Studies were conducted on the pathogenicity and the route of migration to the central nervous system by the immature larval stage of G.spinigerum in experimental animals. Five mice and one rat showed signs of nervous tissue damage and CNS involvement. The significant findings were massive haemorrhagic areas and blood clot around large lower nerve trunk and spinal cord invasion by the worm. The possible roles of the immature larval stages of G.spinigerum in human was discussed.

A case of human schistosomiasis from Phichit Province is presented. Schistosome eggs were found in the ileo-caecal mass of a 44-year old woman, native of Sak-Lek, Muang District. Histologic pictures revealed an early acute granulomatous lesion which consisted of predominantly eosinophils without multinucleated giant cells and fibrotic change suggesting a recent infection. On the basis of the shape and microscopic appearance of the eggs, they are smaller than those described previously for Schistosoma japonicum, probably those of S. mekongi, a related species. This is the third histologic-confirmed case of schistosomiasis in this locality. Addendum: At the time of the manuscript preparation, another case of schistosomiasis was diagnosed. A 55-year old man who lives entirely in the very close adjacent village to the present case was admitted to the Ramathibodi Hospital, Bangkok with chronic hepatosplenomegaly in January 1986. Amyloidosis was suspected and rectal biopsy revealed schistosome eggs, some contained miracidia with varying degrees of degeneration, some were empty and/or fragmented shells and were surrounded with fibrotic changes and chronic cellular infiltration (Fig. 5). They were identical to those of Schistosoma japonicum. Several fecal examinations, miracidium hatching and COPT yielded negative results. This finding showed significantly that all schistosomiasis cases reported from this locality, except the second one, were in the old age group of 40 and above. Further epidemiologic investigation is in progress to delineate this locality as a potential endemic area for this infection.

Schistosome ova were found in the serosa of colon mass of a 65-year old Thai woman from Dokkhumtai District, Phayao Province. On the basis of the shape and microscopic appearance of the ova, they probably belonged to those of Schistosoma mansoni complex. In follow-up study, no ova were found by faecal examinations and rectal biopsy. There are evidences suggesting the presence of two distinct mammalian strains in Thailand: Orientobilhorzia harinasutai, a schistosome of water buffalo in Southern region and Tricula bollingi schistosome, a rodent schistosome in Northern region. This case is believed to be the first human schistosome infection with mammalian strain of S. mansoni complex in Thailand.

A study on Schistosoma incognitum, a blood fluke of a variety of mammals, was conducted in different ecological conditions in Phitsanulok and Phichit, northern Thailand. The intermediate host of S. incognitum in permanent water habitats studied, i.e; swamps and ditches is Radix (Lymnaea) auricularia rubiginosa. Of 44,412 mollusks representing 13 different species collected from 24 water habitats studied, 7,186 were R. a. rubiginosa. S. incognitum infection rate in the snails was 2.1%. 483 Rattus rattus, 8 R. argentiventer, 280 Bandicota indica and 65 B. savilei were found infected with S. incognitum with an overall infection rate of 41.7%. R. argentiventer and B. savilei are reported as new mammalian hosts of the parasite. Also, 3.9% of dogs in the study area were found excreting S. incognitum eggs in their stools for the first time. The possibility of S. incognitum as a zoonotic potentiality to humans is discussed and is still an equivocal issue deserving further study.

Laboratory experiments were conducted to evaluate the role of the guppy, Lebistes reticulatus (Peters, 1859), as an active predator on Schistosoma mansoni miracidia. When five guppies were introduced into 3.5 liters of water containing 500 and 1200 miracidia on two corresponding tests, a dramatic reduction in number of miracidia was observed. In one experiment, no miracidia could be found after 60 minutes of exposure. The infection rates of vector snails, Biomphalaria glabrata, exposed to approximately 3000 miracidia in the presence of guppies were also greatly reduced. The results obtained suggest that L. reticulatus is a probable predator of S. mansoni miracidia and may, under field conditions, play an important role as a limiting or interfering factor in the transmission of S. mansoni.

A serological survey was conducted in the villages of Phichit Province, Northern region and in the urban slum communities in Bangkok to determine whether amoebiasis was endemic in the areas and to determine the prevalence rates. Six rural villages, ethnically and culturally alike with a population of 3,019 and two urban slums with a population of 1,510 were surveyed. Sera were tested for indirect hemagglutination antibody (IHA) to Entamoeba histolytica and the stools examined for the parasite by direct smear method. Positive IHA titres (greater than or equal to 1:128) were detected in 482 (11%) and 176 (20%) sera, and E. histolytica found in 639 (2%) and 208 (3%) stool specimens of rural and urban slum populations respectively. Out of a total of 88 persons who showed significant levels of IHA antibodies to E. histolytica antigen, 5 had E. histolytica cysts in their stool specimens. The survey confirmed, serologically and parasitologically, that amoebiasis is endemic in the lower socio-economic areas. Substandard living and sanitary conditions within the areas were considered responsible for the transmission of the disease.

The "facultative" sewage-stabilization pond was investigated with respect to transmission of S. mansoni. The results of field and laboratory experiments suggest that the ecologic factors i.e., physical and chemical play important roles in a combined interplay affecting the hatchability of S. mansoni eggs, infectivity of miracidia of S. mansioni and the potential existence of the planorbid snails host, B. glabrata. The results seem to indicate the successful reduction of S. mansoni transmission in the pond itself. If the pond is designed properly in terms of depth, detention time, etc., it will serve as an efficient barrier for transmission of S. mansoni. It is expected that the same would be true for other human schistosomes.

A health survey was carried out among residents of 33 villages under the Phitsanulok Irrigation Project Area, Nan River Basin, Northern Thailand, whereby general health conditions were examined including intradermal tests for schistosomiasis japonica, stools for intestinal parasites and sera tested by circumoval precipitin test for antibodies to S. japonicum and by agglutination test for leptospiral infection. Health investigations revealed that 913 (60.9%) of 1,499 people examined had experienced gastro-intestinal disorders, 254 (17%) had poor oral hygiene and a few had mild anemia. 799 (62%) of 1,298 examined had intestinal parasites. Hookworm (45%) was most common, followed by Opisthorchis viverrini (20%), Entamoeba coli (10%), Ascaris lumbricoides (6%), intestinal flukes (2%), Enterobius vermicularis (1%) and Giardia lamblia (1%). 149 (10%) of 1,422 people gave positive skin reaction to crude S. japonicum antigen. Circumoval precipitin test was strongly positive in 7 (1.6%) persons out of 449 tested for schistosome infection and 6 (4.0%) out of 1,358 people were positive for leptospiral infection. The significant endemic diseases as potential health problems in this water resources development are discussed.

Provisional nidal base regions have veen delineated for Thailand. The nidal base regions so derived were compared by computing the percentages of species common to pairs of provinces (coefficient of community, CC). The results provided a CC matrix and dendrogram showing the relationship between regions, combined with the general geographic and climatologic conditions. Six ecological regions have been designated, of which five are classified as super provinces (Northeast, Central, East, South and Far South), while only one is a subregion (North). Problems of error in the data are discussed and the need for further accurate analysis to further the goal of control of disease.

A seroepidemiological study of leptospirosis in man and rodents in the North and Northeast Thailand revealed that 0.27% of the rural people from three different ecologic areas were positive. The positivity rate has dropped dramatically when compared to a previous survey (28%). Of 1,135 wild rodents studied, 42 of 365 (11.5%) B. indica and 50 of 676 (7.4%) R. rattus were serologically positive. Others were negative. Only two of 157 R. rattus had positive cultures in which L. javanica and L. autumnalis were isolated. The study shows that wild rats are naturally implicated in human disease as a common reservoir and that the yearly rat eradication campaigns attributed as one of the effective factors in a major reduction of disease to a level of non significant public health hazard.

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.