14 research outputs found
Appropriate Time to Start Antiretroviral Therapy in HIV-infected Patients with Penicilliosis marneffei
No full text<i>Nocardia beijingensis</i>pericarditis presenting with cardiac tamponade: A case report
No full textWe report the first case of Nocardia beijingensis pericarditis in a 32-year-old HIV-infected patient. He presented with cardiac tamponade after failing to respond to treatment for smear-negative pulmonary and pericardial tuberculosis (TB). The pericardial fluid was examined several times before it eventually revealed filamentous branching organisms in Gram and modified acid-fast bacilli stain. The culture grew Nocardia spp. and was identified by 16s rRNA sequencing as N. beijingensis. Eight previously reported cases of Nocardia pericarditis in HIV-infected patients were caused by Nocardia asteroides. All patients had low CD4 cell count (range: 17–239 cells/mm3) and 50% of patients were treated for tuberculous pericarditis prior to making the correct diagnosis of Nocardia pericarditis. This report revisits the issue of nocardiosis as a great TB mimicker. It should always be considered in the differential diagnosis among HIV-infected patients suspected of having pericardial TB that is failing treatment.</jats:p
Anti-interferon-gamma autoantibody and salmonellosis: Case report and literature review
No full textAdult-onset immunodeficiency syndrome is characterized by the presence of anti-interferon-gamma (IFN-γ) autoantibody and the distribution of infections. Here, we describe Salmonella enterica bacteremia in a Thai woman who also had anti-IFN-γ autoantibody. The patient was also suffering from Salmonella osteomyelitis and a peri-orbital abscess. Her symptoms were completely eradicated after surgical intervention and the administration of appropriate antibiotics
Clinical Features and Treatment Outcomes of Bone-Joint Infection Between Bacteria and Mycobacterium Tuberculosis
No full textAbstract
Background
Bone-joint infection is an emergency condition that requires immediate management. Delayed in treatment or improper management can lead to a significant morbidity and mortality.
Methods
The medical records of patients with bone-joint infection seen at Maharaj Nakorn Chiang Mai Hospital between 1 November 2010 and 30 September 2015 were reviewed. The diagnosis of bone-joint infection was confirmed by pathogen identification or pathohistological report. Only those with adequate clinical features and treatment outcomes were included for analysis.
Results
Of 125 bone-joint infected patients seen during the study period, 92 patients were caused by bacterial infection and 33 from tuberculous infection. Their mean ± standard deviation age was 55.3 ± 17.7 years, and had total disease duration of 7.1 ± 8.2 months. Sixty-four percent were men. Of 33 TB cases, 24 (72.7%) had spinal involvement. Among 92 cases with bacterial infection, 52 (56.5%) had non-spinal joint involvement, and 38 (41.3%) had non-spinal bone involvement. Regarding clinical features, TB cases had mean duration of symptom of 5.3 ± 6.1 months. Multivariate logistic regression analyses showed that neurological manifestations (adjusted OR = 314.1, 95% CI 14.4–6831, P &lt; 0.001), pulmonary symptoms (AOR = 222.1, 95% CI 3.0–16,560, P = 0.014), symptom duration over 1 month (AOR = 67.4, 95% CI 4.2–1070, P = 0.003), afebrile illness (AOR = 24.1, 95%CI 1.2–493.7, P = 0.039), ESR &lt;70 mm/hour (AOR = 4.7, 95% CI 1.1–19.9, P = 0.039), and CRP &lt;30 mg/l (AOR = 7.0, 95% CI 1.6–31.2, P = 0.010) were risk factor of TB bone-joint infection. There were 120 (96.0%) patients with clinical improvement, and five (4.0%) died patients. There were no significant differences among the clinical improvement, recurrent infection, and mortality between the two groups.
Conclusion
Distinguish of bone-joint infection between bacteria and mycobacterium tuberculosis is difficult. However, patients with TB bone-joint infections significantly had more symptom duration over 1 month, the presence of paraplegia, the presence of pulmonary symptoms, and the presence of afebrile illness than those with bacterial infection. There were no significant differences among treatment outcomes and mortality between the two groups.
Disclosures
All authors: No reported disclosures.
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Efficacy and safety of Saccharomyces boulardii as adjunct therapy with Vancomycin in treating Clostridioides difficile infection: A randomized controlled trial
No full textAbstract Clostridioides difficile infection (CDI) is a significant cause of hospital-acquired diarrhea, leading to high morbidity, recurrence, and healthcare costs. Probiotics like Saccharomyces boulardii show potential as an adjunct therapy to standard CDI treatment, but further trials are needed to confirm their efficacy. This study assessed the efficacy and safety of S. boulardii combined with vancomycin for treating mild to moderate CDI. 120 CDI patients diagnosed with positive stool toxin test were randomly assigned to receive two capsules of 250 mg of S. boulardii or a placebo every 12 h alongside 125 mg of vancomycin every 6 h for 10 days. The primary endpoint was the clinical cure rate, with secondary endpoints including recurrence, global cure rate, and diarrheal outcomes. Clinical cure rates were similar between groups (98.4% vs. 98.3%), but the combination group had a significantly higher global cure rate (96.6% vs. 85.3%, p = 0.044) and lower recurrence rate (1.7% vs. 13.1%, p = 0.032). No significant differences were found in diarrheal outcomes, functional ability, or adverse events. No patients discontinued treatment due to intolerance. In conclusion, adding S. boulardii to vancomycin reduced CDI recurrence without affecting functional recovery or increasing adverse events
Left-turn Phasing Decisions Based on Conflict Analysis
No full textAbstractThe need to balance safety and operational efficiency at intersections requires special attention for accommodating left turn movements. Signalized intersections epitomise this need because unnecessary protection of left turns can significantly increase operational delay. Left turn protection however, increases safety and there is a need for proper balancing between the conflicting goals of safety and operations. The long time required to collect crash data to evaluate the use of existing warrants render them frequently ineffective and the need for a preliminary design tool to assist in left turn phasing decisions is needed. This research developed a quantitative safety assessment tool that predicts left turn related conflicts and uses them to determine the appropriate phasing scheme for left turns. The model was developed based on VISSIM micro-simulation software in conjunction with the Surrogate Safety Assessment Model
A comparison of Rv0559c and Rv0560c expression in drug-resistant Mycobacterium tuberculosis in response to first-line antituberculosis drugs
No full textPythiosis presenting with chronic swelling and painful subcutaneous lesion at right deltoid
No full textPythiosis is a fatal disease which has high incidence in tropical regions. In contrast with vascular pythiosis, cutaneous and subcutaneous pythiosis are both uncommon. Here, we report a case of subcutaneous pythiosis in a pregnant farmer manifested with a progressively larger and more painful mass at right deltoid. The tissue culture and molecular test were negative for fungi. The diagnosis was supported by the positivity of serum immunochromatographic test (ICT) for pythiosis. Patients responded well to the combination therapy of itraconazole, terbinafine and azithromycin
Sequential testing with Xpert MTB/RIF assay for diagnosis of tuberculous meningitis in Maharaj Nakorn Chiang Mai University Hospital
No full textAbstract Early diagnosis and appropriate treatment are essential for reducing morbidity and mortality in tuberculous meningitis (TBM). This study aimed to evaluate the diagnostic performance of the Xpert MTB/RIF assay for the diagnosis of TBM in patients with subacute lymphocytic meningitis. This cross-sectional study included 65 cerebrospinal fluid (CSF) specimens from patients at Maharaj Nakorn Chiang Mai University Hospital, Thailand, between January 2015 and March 2016. Mycobacteria growth indicator tube (MGIT) culture was used as the reference standard. Sensitivity, specificity, and agreement between Xpert MTB/RIF and MGIT culture were calculated. Sequential testing using a TBM score, followed by Xpert MTB/RIF was also analyzed. Xpert MTB/RIF demonstrated 83.33% sensitivity (95% CI 57.19–98.22) and 96.23% specificity (95% CI 87.02–99.54). Agreement between Xpert MTB/RIF and MGIT culture was 93.85% (p < 0.001), with a kappa score of 0.80 (95% CI 0.60–0.99). Sequential testing with a TBM score cut-off of 6, followed by Xpert MTB/RIF improved specificity from 96.23 to 97.15%. The Xpert MTB/RIF assay is a rapid and valuable tool for detecting Mycobacterium tuberculosis in centrifuged CSF specimens. A diagnostic algorithm incorporating the TBM score enhances performance, balancing sensitivity and specificity, and could improve patient outcomes in resource-limited settings
Limitations to coral recovery along an environmental stress gradient
No full textPositive feedbacks driving habitat-forming species recovery and population growth are often lost as ecosystems degrade. For such systems, identifying mechanisms that limit the re-establishment of critical positive feedbacks is key to facilitating recovery. Theory predicts the primary drivers limiting system recovery shift from biological to physical as abiotic stress increases, but recent work has demonstrated that this seldom happens. We combined field and laboratory experiments to identify variation in limitations to coral recovery along an environmental stress gradient at Ningaloo Reef and Exmouth Gulf in northwest Australia. Many reefs in the region are coral depauperate due to recent cyclones and thermal stress. In general, recovery trajectories are prolonged due to limited coral recruitment. Consistent with theory, clearer water reefs under low thermal stress appear limited by biological interactions: competition with turf algae caused high mortality of newly settled corals and upright macroalgal stands drove mortality in transplanted juvenile corals. Laboratory experiments showed a positive relationship between crustose coralline algae cover and coral settlement, but only in the absence of sedimentation. Contrary to expectation, coral recovery does not appear limited by the survival or growth of recruits on turbid reefs under higher thermal stress, but to exceptionally low larval supply. Laboratory experiments showed that larval survival and settlement are unaffected by seawater quality across the study region. Rather, connectivity models predicted that many of the more turbid reefs in the Gulf are predominantly self seeded, receiving limited supply under degraded reef states. Overall, we find that the influence of oceanography can overwhelm the influences of physical and biological interactions on recovery potential at locations where environmental stressors are high, whereas populations in relatively benign physical conditions are predominantly structured by local ecological drivers. Such context-dependent information can help guide expectations and assist managers in optimizing strategies for spatial conservation planning for system recovery.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Rivers, Ports, Waterways and Dredging Engineerin
