A5065993329- Burkholderia infections and melioidosis
- Mosquito-borne diseases and control
- Leptospirosis research and findings
- Viral Infections and Vectors
- Chemical Looping and Thermochemical Processes
- Malaria Research and Control
- Vector-borne infectious diseases
- Fungal Infections and Studies
- Antifungal resistance and susceptibility
- Brucella: diagnosis, epidemiology, treatment
- Antibiotic Resistance in Bacteria
- Nail Diseases and Treatments
- Plant Pathogenic Bacteria Studies
- Drug-Induced Hepatotoxicity and Protection
- Veterinary medicine and infectious diseases
- Pancreatitis Pathology and Treatment
- Moringa oleifera research and applications
- Cytomegalovirus and herpesvirus research
- Pneumocystis jirovecii pneumonia detection and treatment
- Sepsis Diagnosis and Treatment
- Mycobacterium research and diagnosis
- Vibrio bacteria research studies
- HIV Research and Treatment
- Insect symbiosis and bacterial influences
- Clostridium difficile and Clostridium perfringens research
Mahidol Oxford Tropical Medicine Research Unit
2012-2024
Mahidol University
2013-2024
University of Washington
2017
Bangkok University
2017
Ministry of Public Health
2011-2014
Udon Thani Hospital
2005-2014
University of Oxford
2002-2014
University of Cambridge
2011-2014
Ministère du travail, de l'emploi et de l'insertion
2014
Royal Tropical Institute
2011
Cryptococcal meningitis associated with human immunodeficiency virus (HIV) infection causes more than 600,000 deaths each year worldwide. Treatment has changed little in 20 years, and there are no imminent new anticryptococcal agents. The use of adjuvant glucocorticoids reduces mortality among patients other forms some populations, but their is untested cryptococcal meningitis.
Progress in therapy for cryptococcal meningitis has been slow because of the lack a suitable marker treatment response. Previously, we demonstrated statistical power novel endpoint, rate clearance infection, based on serial quantitative cultures cerebrospinal fluid, to differentiate fungicidal activity alternative antifungal drug regimens. We hypothesized that infection should also be clinically meaningful endpoint.
Background. We observed that some patients with clinical leptospirosis supported by positive results of rapid tests were negative for on the basis our diagnostic gold standard, which involves isolation Leptospira species from blood culture and/or a result microscopic agglutination test (MAT). hypothesized reference standard was imperfect and used statistical modeling to investigate this hypothesis. Methods. Data 1652 suspected recruited during three observational studies one randomized...
Objectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course relationship with neurological findings, CSF fungal burden, immune response, CD4 cell count. Design: Evaluation 163 HIV-positive ART-naive patients enrolled three trials amphotericin B-based therapy for meningitis Thailand South Africa. Methods: Study protocols required four measurements over...
BackgroundA sustained outbreak of leptospirosis occurred in northeast Thailand between 1999 and 2003, the basis for which was unknown.Methods FindingsA prospective study conducted 2000 2005 to identify patients with presenting Udon Thani Hospital Thailand, isolate causative organisms from blood. A multilocus sequence typing scheme developed genotype these pathogenic Leptospira. Additional performed Leptospira isolated human cases other Thai provinces over same period, rodents captured during...
Leptospirosis is an important cause of fever in the rural tropics. Since 1996, there has been a marked increase incidence leptospirosis northeastern Thailand. Although generally susceptible to antibiotics, no consensus regarding optimal treatment for severe leptospirosis.An open-label, randomized comparison parenteral cefotaxime, penicillin G sodium (hereafter known as "penicillin G"), and doxycycline suspected was conducted. The study involved 540 patients admitted 4 hospitals Thailand.A...
ABSTRACT Leptospirosis and scrub typhus are important causes of acute fever in Southeast Asia. Options for empirical therapy include doxycycline azithromycin, but it is unclear whether their efficacies equivalent. We conducted a multicenter, open, randomized controlled trial with adult patients presenting (<15 days), without an obvious focus infection, at four hospitals Thailand between July 2003 January 2005. Patients were randomly allocated to receive either 7-day course or 3-day...
Background Toll-like receptors (TLRs) are essential in host defense against pathogens by virtue of their capacity to detect microbes and initiate the immune response. TLR2 is seen as most important receptor for gram-positive bacteria, while TLR4 regarded gram-negative TLR. Melioidosis a severe infection caused bacterium, Burkholderia pseudomallei, that endemic Southeast Asia. We aimed characterize expression function TLRs septic melioidosis. Methods Findings Patient studies: 34 patients with...
Melioidosis, an infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei, is difficult to cure. Antimicrobial treatment comprises intravenous drugs for at least 10 days, followed oral 12 weeks. The standard regimen based on trial evidence trimethoprim-sulfamethoxaxole (TMP-SMX) plus doxycycline. This used in Thailand but associated with side-effects and poor adherence patients, TMP-SMX alone recommended Australia. We compared efficacy of doxycycline phase melioidosis...
Background Rapid PCR-based tests for the diagnosis of leptospirosis can provide information that contributes towards early patient management, but these have not been adopted in Thailand. Here, we compare diagnostic sensitivity and specificity two real-time PCR assays targeting rrs or lipL32 northeast Methods/Principal Findings A case-control study 266 patients (133 cases 133 controls) was constructed to evaluate (DSe & DSp) both assays. The median duration illness prior admission 4 days...
A recent modelling study estimated that there are 2800 deaths due to melioidosis in Thailand yearly. The Melioidosis Network (formed 2012) has been working closely with the Ministry of Public Health (MoPH) investigate and reduce burden this disease. Based on updated data, incidence is still high Northeast Thailand. More than 2000 culture-confirmed cases diagnosed general hospitals microbiology laboratories region each year. mortality rate around 35%. endemic throughout Thailand, but it not...
Recurrent melioidosis occurs in approximately 6% of patients the first year following initial presentation. A recent study revealed that 25% with recurrence had reinfection rather than a relapse resulting from failure to cure. The aim this was reevaluate these 2 patient groups define their individual risk factors.All adult who presented Sappasithiprasong Hospital (Ubon Ratchathani, northeast Thailand) culture-confirmed during period 1986-2004 and survived receive oral antimicrobial therapy...
ABSTRACT Melioidosis is a notoriously protracted illness and difficult to cure. We hypothesize that the causative organism, Burkholderia pseudomallei , undergoes process of adaptation involving altered expression surface determinants which facilitates persistence in vivo this reflected by changes colony morphology. A morphotyping scheme typing algorithm were developed using clinical B. isolates. Morphotypes divided into seven types (denoted I VII). Type gave rise other morphotypes (most...
Abstract In animal models, immunity to cryptococcal infection, as in many chronic fungal and bacterial infections, is associated with a granulomatous inflammatory response, intact cell-mediated immunity, Th1 pattern of cytokine release. To examine the correlates human infection vivo, we analyzed immune parameters at site over time assessed rate clearance by serial quantitative cerebrospinal fluid (CSF) cultures 62 patients trial antifungal therapy for HIV-associated meningitis. CSF IL-6,...
ABSTRACT Orientia tsutsugamushi , the cause of scrub typhus, is a major pathogen in Asia-Pacific region. The severity infection ranges from mild features to multiorgan failure and death. aim this prospective study was define O. loads blood samples patients with typhus on day hospital admission determine whether associated disease severity. Quantitation performed using real-time PCR assay targeting 16S rRNA gene . A total 155 confirmed diagnosis had median (interquartile range [IQR], range)...
Patients with diabetes mellitus are more prone to bacterial sepsis, but there conflicting data on whether outcomes worse in diabetics after presentation sepsis. Glyburide is an oral hypoglycemic agent used treat mellitus. This K(ATP)-channel blocker and broad-spectrum ATP-binding cassette (ABC) transporter inhibitor has broad-ranging effects the immune system, including inhibition of inflammasome assembly would be predicted influence host response infection.We studied a cohort 1160 patients...
A prospective study in Thailand identified 106 patients with culture-proven leptospirosis. The accuracy of the microscopic agglutination test (MAT) predicting infecting serovar was evaluated 78/106 (74%) a diagnostic titer. MAT correctly determined 26 cases (33%), indicating that this assay is poor predictor our setting.
Melioidosis is a tropical infectious disease associated with significant mortality. Most deaths occur early and are caused by fulminant sepsis.In this randomized, placebo-controlled trial, we assessed the efficacy of lenograstim (granulocyte colony-stimulating factor [G-CSF], 263 mu g per day administered intravenously) in ceftazidime-treated patients severe sepsis suspected melioidosis Thailand.Over 27-month period, 60 were enrolled to receive either G-CSF (30 patients, 18 whom had...
A 21-year survey conducted in northeast Thailand of antimicrobial resistance to parenteral drugs used treat melioidosis identified 24/4,021 (0.6%) patients with one or more isolates resistant ceftazidime (n = 8), amoxicillin-clavulanic acid 4), both 12). Two cases were at admission, and the remainder detected a median 15 days after starting therapy. Resistance carbapenem was not detected. These findings support current prescribing recommendations for melioidosis.
Background There is an urgent need to develop rapid and accurate point-of-care (POC) technologies for acute scrub typhus diagnosis in low-resource, primary health care settings guide clinical therapy. Methodology/Principal Findings In this study we present the evaluation of loop-mediated isothermal PCR assay (LAMP) context a prospective fever study, including 161 patients from typhus-endemic Chiang Rai, northern Thailand. A robust reference comparator set comprising following ‘scrub...
Tropical infectious diseases like dengue, scrub typhus, murine leptospirosis, and enteric fever continue to contribute substantially the febrile disease burden throughout Southeast Asia while malaria is declining. Recently, there has been increasing focus on biomarkers (i.e. C-reactive protein (CRP) procalcitonin) in delineating bacterial from viral infections.A prospective observational study was performed investigate causes of acute undifferentiated (AUF) adults admitted Chiangrai...
Background The indirect immunofluorescence assay (IFA) is considered a reference test for scrub typhus. Recently, the Scrub Typhus Infection Criteria (STIC; combination of culture, PCR assays and IFA IgM) were proposed as standard evaluating alternative diagnostic tests. Here, we use Bayesian latent class models (LCMs) to estimate true accuracy each test, STIC, diagnosing Methods/Principal Findings Data from 161 patients with undifferentiated fever re-evaluated using LCMs. Every patient was...
We conducted a trial of oral acetazolamide for the treatment cryptococcal meningitis in 22 Thai adults with headache and an opening cerebrospinal fluid pressure ⩾200 mm H20. The was terminated prematurely because patients who received developed significantly lower venous bicarbonate levels higher chloride had more-frequent serious adverse events than did subjects placebo.