Roongnapa Pracharktam | Khon Kaen University (original) (raw)
Papers by Roongnapa Pracharktam
Candiduria is a common infection of the urinary tract. Evaluation of the susceptibility to antifu... more Candiduria is a common infection of the urinary tract. Evaluation of the susceptibility to antifungal drugs could be used for treatment and control of infection. Background: Candiduria is one of the most common symptoms of urinary tract infections caused by several species of Candida spp.. Several antifungals are available to treat such candidal infections. During the last decades, resistance to antifungal especially to non-albicans species has increased. Objectives: The present study aimed to evaluate the susceptibility to antifungal drugs of Candida species isolated from candiduria in Ahvaz. Materials and Methods: Ninety three species of yeasts and yeast like organisms isolated from urine samples [Candida albicans (58), C. glabrata (25), C. tropicalis (4), C. krusei (1), unknown Candida species (4) and Geotrichum species (1)] were used for susceptibility tests. All species were re-identified based on standard mycological methods. Then a suspension of each isolate of overnight cultures was prepared in 1ml of sterile PBS and adjusted to 0.5 McFarland turbidity standards. In the present study several antifungal drugs (fluconazole, amphotericine B, ketoconazole, econazole, itraconazole) were used for susceptibility test using disk diffusion method. Results: In the present study all tested isolates were sensitive/dose dependent to amphotericine B and nystatin, whereas only one isolate of C. glabrata was resistant to both antifungals. Resistance against fluconazole (48.4%) and ketoconazole (26.9%) were observed among tested isolates. Resistance against fluconazole was detected among all tested organisms, 34.4% of C. albicans, and 7.5% of C. glabrata. On the other hand, all isolates were sensitive to econazole (93.5% sensitive, 6.5% dose dependent). Conclusions: It was concluded that Candida species isolated from candiduria in hospitalized patients had excellent in vitro sensitivity against econazole. Other suitable antifungal drugs were amphotericine B and nystatin, itraconazole. Whereas, resistance against ketoconazole (26.9%) and especially fluconazole (48.4%) was significant.
Scandinavian Journal of Infectious Diseases, 2003
Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococ... more Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococci. Both tuberculous and cryptococcal thyroid abscess are even rarer. The incidence of extrapulmonary forms of tuberculosis and cryptococcosis has increased in areas with a high prevalence of human immunodeficiency virus (HIV) infection. A case is reported of dual infection by M. tuberculosis and Cryptococcus neoformans presenting as a thyroid abscess in a 32-y-old woman with symptomatic HIV infection. Atypical presentations of both tuberculosis and cryptococcosis should be considered in areas with a high incidence of these diseases.
Japanese journal of infectious diseases, 2004
Fungal infection of the genitourinary system is a relatively uncommon presentation. Cryptococcuri... more Fungal infection of the genitourinary system is a relatively uncommon presentation. Cryptococcuria has rarely been recognized in clinical practice. Patients with positive urine culture for Cryptococcus neoformans from 1992 to 2003 were retrospectively reviewed. Sixteen patients were identified. Nine (56%) patients were male, with a mean age of 44 +/- 21 (range, 16-88) years. Fifteen (94%) patients had underlying conditions such as HIV infection, diabetes mellitus, hypertension, and/or systemic lupus erythematosus. Thirteen (81%) patients had cryptococcuria as a manifestation of disseminated cryptococcosis, and the rest had only isolated cryptococcuria. Urinary analysis revealed proteinuria (75%), pyuria (31%), and budding yeast (13%). Nine (56%) patients received antifungal therapy. Other patients were misdiagnosed or died before treatment. The mortality rate was 64%. In conclusion, cryptococcuria is not extremely rare and can present as a manifestation of disseminated cryptococcosi...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003
A series of cases infected with rapidly growing mycobacteria were studied to reveal the spectrum ... more A series of cases infected with rapidly growing mycobacteria were studied to reveal the spectrum of disease, antimicrobial susceptibility, pathology, and treatment outcomes. The cases identified as rapidly growing mycobacterial infections in Ramathibodi Hospital from January 1993 to June 1999 were retrospectively studied. There were 20 patients and most of the cases had no underlying disease. Only two cases were HIV-infected patients. The presenting clinical features were lymphadenitis (7), skin and subcutaneous abscess (7), eye infection (4), pulmonary infection (1), and chronic otitis media (1). Four of the seven cases with lymphadenitis had Sweet's syndrome. The organisms were Mycobacterium chelonae/abscessus group (17 cases) and Mycobacteriumfortuitum group (3 cases). The organisms were susceptible to amikacin, netilmicin and imipenem. The M. fortuitum group was susceptible to more antibiotics than the M. chelonaelabscessus group. Pathology of the infected tissue varied from...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2002
A rapid, inexpensive, and reliable antimycobacterial susceptibility assay is needed to effectivel... more A rapid, inexpensive, and reliable antimycobacterial susceptibility assay is needed to effectively deal with the increasing prevalence of resistant strains of M. tuberculosis in Thailand. The microtiter plate Alamar blue assay (MABA) appears to be promising but requires additional data regarding correlation with clinical outcome. The correlation between the susceptibility by MABA and clinical outcomes was studied. There were 123 specimens obtained from extra-pulmonary sites of 108 patients at Ramathibodi Hospital in 1999. The authors found that susceptibility of M. tuberculosis isolates by the MABA correlated with the clinical outcome; patients with isolates sensitive to isoniazid, rifampicin, and ethambutol had a better clinical outcome than patients with isolates resistant to at least one of these drugs (p=0.004). Studies to determine this correlation in pulmonary tuberculosis are still needed.
Scandinavian Journal of Infectious Diseases, 2003
A 43-y-old woman with underlying cervix carcinoma stage IIIB, status postirradiation, and diabete... more A 43-y-old woman with underlying cervix carcinoma stage IIIB, status postirradiation, and diabetes mellitus with tripathy suffered from chronic diarrhoea for more than 6 months. Stool examination showed few white blood cells and red blood cells. Rectal swab cultures disclosed Cryptococcus neoformans in 2 samples obtained 2 weeks apart. The diarrhoea responded to treatment with oral fluconazole for 4 weeks. Repeated rectal swabs revealed no yeast growth. During follow-up for 4 y, she had no problems with diarrhoea. Chronic diarrhoea caused by C. neoformans is rare and clinical suspicion is needed.
Scandinavian Journal of Infectious Diseases, 2003
Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococ... more Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococci. Both tuberculous and cryptococcal thyroid abscess are even rarer. The incidence of extrapulmonary forms of tuberculosis and cryptococcosis has increased in areas with a high prevalence of human immunodeficiency virus (HIV) infection. A case is reported of dual infection by M. tuberculosis and Cryptococcus neoformans presenting as a thyroid abscess in a 32-y-old woman with symptomatic HIV infection. Atypical presentations of both tuberculosis and cryptococcosis should be considered in areas with a high incidence of these diseases.
International Journal of Infectious Diseases, 2003
International Journal of Infectious Diseases, 2006
To describe the clinical characteristics, treatment, and outcomes of cryptococcosis in HIV-negati... more To describe the clinical characteristics, treatment, and outcomes of cryptococcosis in HIV-negative patients. HIV-negative adult patients with positive culture for Cryptococcus neoformans who attended Ramathibodi Hospital between 1987 and 2003 were retrospectively reviewed. During the 17 year review period, 40 HIV-negative patients with cryptococcosis were identified. Of these, 37 patients had medical records available for study. The mean age was 49+/-18 (range 16-83) years and 73% were female. Twenty-four patients (65%) had associated underlying conditions. The most common associated conditions included immunosuppressive drug treatment (41%), presence of systemic lupus erythematosus (16%), malignancies (16%), and diabetes mellitus (14%). C. neoformans was mainly recovered from cerebrospinal fluid (32%), blood (28%), and sputum/bronchoalveolar lavage/lung tissue (28%). Twenty-three patients (62%) had disseminated cryptococcosis. Six of 14 patients with cryptococcal meningitis were asymptomatic. About half of the patients were treated with amphotericin B and subsequent fluconazole. Five patients (14%) were initially misdiagnosed and treated for tuberculosis or bacterial infection. The overall mortality rate was 27%. Cryptococcosis is not rare in HIV-negative patients. The mortality rate is high. Early recognition of cryptococcosis and use of appropriate antifungal therapy in these patients may improve clinical outcomes.
Clinical Infectious Diseases, 1998
A 14-year-old Thai boy presented because of a history of headache, mandibular swelling, and facia... more A 14-year-old Thai boy presented because of a history of headache, mandibular swelling, and facial nerve palsy. A microorganism identified as Pythium insidiosum was cultured from the mandibular abscesses. Despite treatment with amphotericin B, iodides, ketoconazole, and surgery, the infection progressed. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the neck revealed an aneurysm in the external carotid artery. The aneurysm was removed. MRA performed later showed stenosis of the internal carotid artery. Immunotherapy was recommended as a last resort. One hundred microliters of the P. insidiosum vaccine was subcutaneously injected into the patient's left shoulder, and 14 days later a similar dose was administered. Four weeks following the first vaccination, the patient's headache had disappeared, the facial swellings had dramatically diminished, the cervical lymph node had shrunk, and the proximal left internal carotid artery stenosis had significantly improved. One year after the vaccinations, the boy was considered clinically cured.
Clinical Infectious Diseases, 2006
Pythiosis is an emerging and life-threatening infectious disease in humans and animals that is ca... more Pythiosis is an emerging and life-threatening infectious disease in humans and animals that is caused by the pathogenic oomycete Pythium insidiosum. Human pythiosis is found mostly in Thailand, although disease in animals has been increasingly reported worldwide. Clinical information on human pythiosis is limited, and health care professionals are unfamiliar with the disease, leading to underdiagnosis, delayed treatment, and poor prognosis. To retrospectively study the clinical and epidemiological features of human pythiosis, we analyzed clinical data from patients with pythiosis diagnosed during the period of January 1985 through June 2003 at 9 tertiary care hospitals throughout Thailand. A total of 102 cases of human pythiosis were documented nationwide. A substantial proportion (40%) of cases occurred in the last 4 years of the 18-year study interval. Clinical presentations fell into 4 groups: cutaneous/subcutaneous cases (5% of cases), vascular cases (59%), ocular cases (33%), and disseminated cases (3%). Almost all patients with cutaneous/subcutaneous, vascular, and disseminated pythiosis (85%) had underlying thalassemia-hemoglobinopathy syndrome. Most ocular cases (84%) were associated with no underlying disease. A majority of the patients were male (71%), were aged 20-60 years (86%), and reported an agricultural occupation (75%). Regarding treatment outcomes, all patients with disseminated infection died; 78% of patients with vascular disease required limb amputation, and 40% of these patients died; and 79% of patients with ocular pythiosis required enucleation/evisceration. Here, we report, to our knowledge, the largest case study of human pythiosis. The disease has high rates of morbidity and mortality. Early diagnosis and effective treatment are urgently needed to improve clinical outcomes. Because P. insidiosum is distributed worldwide and can infect healthy individuals, an awareness of human pythiosis should be promoted in Thailand and in other countries.
Clinical and Vaccine Immunology, 2002
Human pythiosis is an emerging, fatal, infectious disease caused by Pythium insidiosum and occurs... more Human pythiosis is an emerging, fatal, infectious disease caused by Pythium insidiosum and occurs in both tropical and subtropical countries. Thalassemic patients, farmers, and aquatic-habitat residents are predisposed to this disease. Delayed treatment due to the long time required for isolation and identification of the causative organism, as well as the difficulty in obtaining internal organ specimens, results in high morbidity and mortality. To facilitate rapid diagnosis, an in-house enzyme-linked immunosorbent assay (ELISA) for the detection of immunoglobulin G antibodies against P. insidiosum was developed and evaluated for the diagnosis and monitoring of human pythiosis. Sixteen sera were collected from seven culture-proven human pythiosis cases. A total of 142 sera from thalassemic patients, from patients with other infectious diseases, and from healthy blood donors served as controls. All sera were tested in duplicate. By choosing a suitable cutoff point to maximize sensitivity and specificity, sera from pythiosis cases were all determined to be positive, whereas sera from control groups were all determined to be negative. ELISA signals from serial samples of sera taken from treated patients showed gradually declining levels of antibodies to P. insidiosum. The ELISA test was highly sensitive (100%) and specific (100%) and was useful for early diagnosis and for monitoring the treatment for pythiosis.
Journal of Clinical Microbiology, 2006
The oomycetous, fungus-like, aquatic organism Pythium insidiosum is the etiologic agent of pythio... more The oomycetous, fungus-like, aquatic organism Pythium insidiosum is the etiologic agent of pythiosis, a life-threatening infectious disease of humans and animals that has been increasingly reported from tropical, subtropical, and temperate countries. Human pythiosis is endemic in Thailand, and most patients present with arteritis, leading to limb amputation and/or death, or cornea ulcer, leading to enucleation. Diagnosis of pythiosis is time-consuming and difficult. Radical surgery is the main treatment for pythiosis because conventional antifungal drugs are ineffective. The aims of this study were to evaluate the use of Western blotting for diagnosis of human pythiosis, to identify specific immunodominant antigens of P. insidiosum, and to increase understanding of humoral immune responses against the pathogen. We performed Western blot analysis on 16 P. insidiosum isolates using 12 pythiosis serum samples. These specimens were derived from human patients with pythiosis who had different forms of infection and lived in different geographic areas throughout Thailand. We have identified a 74-kDa immunodominant antigen in all P. insidiosum isolates tested. The 74-kDa antigen was also recognized by sera from all patients with pythiosis but not by control sera from healthy individuals, patients with thalassemia, and patients with various infectious diseases, indicating that Western blot analysis could facilitate diagnosis of pythiosis. Therefore, the 74-kDa antigen is a potential target for developing rapid serodiagnostic tests as well as a therapeutic vaccine for pythiosis. These advances could lead to early diagnosis and effective treatment, crucial factors for better prognosis for patients with pythiosis.
Candiduria is a common infection of the urinary tract. Evaluation of the susceptibility to antifu... more Candiduria is a common infection of the urinary tract. Evaluation of the susceptibility to antifungal drugs could be used for treatment and control of infection. Background: Candiduria is one of the most common symptoms of urinary tract infections caused by several species of Candida spp.. Several antifungals are available to treat such candidal infections. During the last decades, resistance to antifungal especially to non-albicans species has increased. Objectives: The present study aimed to evaluate the susceptibility to antifungal drugs of Candida species isolated from candiduria in Ahvaz. Materials and Methods: Ninety three species of yeasts and yeast like organisms isolated from urine samples [Candida albicans (58), C. glabrata (25), C. tropicalis (4), C. krusei (1), unknown Candida species (4) and Geotrichum species (1)] were used for susceptibility tests. All species were re-identified based on standard mycological methods. Then a suspension of each isolate of overnight cultures was prepared in 1ml of sterile PBS and adjusted to 0.5 McFarland turbidity standards. In the present study several antifungal drugs (fluconazole, amphotericine B, ketoconazole, econazole, itraconazole) were used for susceptibility test using disk diffusion method. Results: In the present study all tested isolates were sensitive/dose dependent to amphotericine B and nystatin, whereas only one isolate of C. glabrata was resistant to both antifungals. Resistance against fluconazole (48.4%) and ketoconazole (26.9%) were observed among tested isolates. Resistance against fluconazole was detected among all tested organisms, 34.4% of C. albicans, and 7.5% of C. glabrata. On the other hand, all isolates were sensitive to econazole (93.5% sensitive, 6.5% dose dependent). Conclusions: It was concluded that Candida species isolated from candiduria in hospitalized patients had excellent in vitro sensitivity against econazole. Other suitable antifungal drugs were amphotericine B and nystatin, itraconazole. Whereas, resistance against ketoconazole (26.9%) and especially fluconazole (48.4%) was significant.
Scandinavian Journal of Infectious Diseases, 2003
Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococ... more Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococci. Both tuberculous and cryptococcal thyroid abscess are even rarer. The incidence of extrapulmonary forms of tuberculosis and cryptococcosis has increased in areas with a high prevalence of human immunodeficiency virus (HIV) infection. A case is reported of dual infection by M. tuberculosis and Cryptococcus neoformans presenting as a thyroid abscess in a 32-y-old woman with symptomatic HIV infection. Atypical presentations of both tuberculosis and cryptococcosis should be considered in areas with a high incidence of these diseases.
Japanese journal of infectious diseases, 2004
Fungal infection of the genitourinary system is a relatively uncommon presentation. Cryptococcuri... more Fungal infection of the genitourinary system is a relatively uncommon presentation. Cryptococcuria has rarely been recognized in clinical practice. Patients with positive urine culture for Cryptococcus neoformans from 1992 to 2003 were retrospectively reviewed. Sixteen patients were identified. Nine (56%) patients were male, with a mean age of 44 +/- 21 (range, 16-88) years. Fifteen (94%) patients had underlying conditions such as HIV infection, diabetes mellitus, hypertension, and/or systemic lupus erythematosus. Thirteen (81%) patients had cryptococcuria as a manifestation of disseminated cryptococcosis, and the rest had only isolated cryptococcuria. Urinary analysis revealed proteinuria (75%), pyuria (31%), and budding yeast (13%). Nine (56%) patients received antifungal therapy. Other patients were misdiagnosed or died before treatment. The mortality rate was 64%. In conclusion, cryptococcuria is not extremely rare and can present as a manifestation of disseminated cryptococcosi...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003
A series of cases infected with rapidly growing mycobacteria were studied to reveal the spectrum ... more A series of cases infected with rapidly growing mycobacteria were studied to reveal the spectrum of disease, antimicrobial susceptibility, pathology, and treatment outcomes. The cases identified as rapidly growing mycobacterial infections in Ramathibodi Hospital from January 1993 to June 1999 were retrospectively studied. There were 20 patients and most of the cases had no underlying disease. Only two cases were HIV-infected patients. The presenting clinical features were lymphadenitis (7), skin and subcutaneous abscess (7), eye infection (4), pulmonary infection (1), and chronic otitis media (1). Four of the seven cases with lymphadenitis had Sweet's syndrome. The organisms were Mycobacterium chelonae/abscessus group (17 cases) and Mycobacteriumfortuitum group (3 cases). The organisms were susceptible to amikacin, netilmicin and imipenem. The M. fortuitum group was susceptible to more antibiotics than the M. chelonaelabscessus group. Pathology of the infected tissue varied from...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2002
A rapid, inexpensive, and reliable antimycobacterial susceptibility assay is needed to effectivel... more A rapid, inexpensive, and reliable antimycobacterial susceptibility assay is needed to effectively deal with the increasing prevalence of resistant strains of M. tuberculosis in Thailand. The microtiter plate Alamar blue assay (MABA) appears to be promising but requires additional data regarding correlation with clinical outcome. The correlation between the susceptibility by MABA and clinical outcomes was studied. There were 123 specimens obtained from extra-pulmonary sites of 108 patients at Ramathibodi Hospital in 1999. The authors found that susceptibility of M. tuberculosis isolates by the MABA correlated with the clinical outcome; patients with isolates sensitive to isoniazid, rifampicin, and ethambutol had a better clinical outcome than patients with isolates resistant to at least one of these drugs (p=0.004). Studies to determine this correlation in pulmonary tuberculosis are still needed.
Scandinavian Journal of Infectious Diseases, 2003
A 43-y-old woman with underlying cervix carcinoma stage IIIB, status postirradiation, and diabete... more A 43-y-old woman with underlying cervix carcinoma stage IIIB, status postirradiation, and diabetes mellitus with tripathy suffered from chronic diarrhoea for more than 6 months. Stool examination showed few white blood cells and red blood cells. Rectal swab cultures disclosed Cryptococcus neoformans in 2 samples obtained 2 weeks apart. The diarrhoea responded to treatment with oral fluconazole for 4 weeks. Repeated rectal swabs revealed no yeast growth. During follow-up for 4 y, she had no problems with diarrhoea. Chronic diarrhoea caused by C. neoformans is rare and clinical suspicion is needed.
Scandinavian Journal of Infectious Diseases, 2003
Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococ... more Suppurative thyroiditis is a rare condition caused mostly by Staphylococcus aureus and streptococci. Both tuberculous and cryptococcal thyroid abscess are even rarer. The incidence of extrapulmonary forms of tuberculosis and cryptococcosis has increased in areas with a high prevalence of human immunodeficiency virus (HIV) infection. A case is reported of dual infection by M. tuberculosis and Cryptococcus neoformans presenting as a thyroid abscess in a 32-y-old woman with symptomatic HIV infection. Atypical presentations of both tuberculosis and cryptococcosis should be considered in areas with a high incidence of these diseases.
International Journal of Infectious Diseases, 2003
International Journal of Infectious Diseases, 2006
To describe the clinical characteristics, treatment, and outcomes of cryptococcosis in HIV-negati... more To describe the clinical characteristics, treatment, and outcomes of cryptococcosis in HIV-negative patients. HIV-negative adult patients with positive culture for Cryptococcus neoformans who attended Ramathibodi Hospital between 1987 and 2003 were retrospectively reviewed. During the 17 year review period, 40 HIV-negative patients with cryptococcosis were identified. Of these, 37 patients had medical records available for study. The mean age was 49+/-18 (range 16-83) years and 73% were female. Twenty-four patients (65%) had associated underlying conditions. The most common associated conditions included immunosuppressive drug treatment (41%), presence of systemic lupus erythematosus (16%), malignancies (16%), and diabetes mellitus (14%). C. neoformans was mainly recovered from cerebrospinal fluid (32%), blood (28%), and sputum/bronchoalveolar lavage/lung tissue (28%). Twenty-three patients (62%) had disseminated cryptococcosis. Six of 14 patients with cryptococcal meningitis were asymptomatic. About half of the patients were treated with amphotericin B and subsequent fluconazole. Five patients (14%) were initially misdiagnosed and treated for tuberculosis or bacterial infection. The overall mortality rate was 27%. Cryptococcosis is not rare in HIV-negative patients. The mortality rate is high. Early recognition of cryptococcosis and use of appropriate antifungal therapy in these patients may improve clinical outcomes.
Clinical Infectious Diseases, 1998
A 14-year-old Thai boy presented because of a history of headache, mandibular swelling, and facia... more A 14-year-old Thai boy presented because of a history of headache, mandibular swelling, and facial nerve palsy. A microorganism identified as Pythium insidiosum was cultured from the mandibular abscesses. Despite treatment with amphotericin B, iodides, ketoconazole, and surgery, the infection progressed. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the neck revealed an aneurysm in the external carotid artery. The aneurysm was removed. MRA performed later showed stenosis of the internal carotid artery. Immunotherapy was recommended as a last resort. One hundred microliters of the P. insidiosum vaccine was subcutaneously injected into the patient's left shoulder, and 14 days later a similar dose was administered. Four weeks following the first vaccination, the patient's headache had disappeared, the facial swellings had dramatically diminished, the cervical lymph node had shrunk, and the proximal left internal carotid artery stenosis had significantly improved. One year after the vaccinations, the boy was considered clinically cured.
Clinical Infectious Diseases, 2006
Pythiosis is an emerging and life-threatening infectious disease in humans and animals that is ca... more Pythiosis is an emerging and life-threatening infectious disease in humans and animals that is caused by the pathogenic oomycete Pythium insidiosum. Human pythiosis is found mostly in Thailand, although disease in animals has been increasingly reported worldwide. Clinical information on human pythiosis is limited, and health care professionals are unfamiliar with the disease, leading to underdiagnosis, delayed treatment, and poor prognosis. To retrospectively study the clinical and epidemiological features of human pythiosis, we analyzed clinical data from patients with pythiosis diagnosed during the period of January 1985 through June 2003 at 9 tertiary care hospitals throughout Thailand. A total of 102 cases of human pythiosis were documented nationwide. A substantial proportion (40%) of cases occurred in the last 4 years of the 18-year study interval. Clinical presentations fell into 4 groups: cutaneous/subcutaneous cases (5% of cases), vascular cases (59%), ocular cases (33%), and disseminated cases (3%). Almost all patients with cutaneous/subcutaneous, vascular, and disseminated pythiosis (85%) had underlying thalassemia-hemoglobinopathy syndrome. Most ocular cases (84%) were associated with no underlying disease. A majority of the patients were male (71%), were aged 20-60 years (86%), and reported an agricultural occupation (75%). Regarding treatment outcomes, all patients with disseminated infection died; 78% of patients with vascular disease required limb amputation, and 40% of these patients died; and 79% of patients with ocular pythiosis required enucleation/evisceration. Here, we report, to our knowledge, the largest case study of human pythiosis. The disease has high rates of morbidity and mortality. Early diagnosis and effective treatment are urgently needed to improve clinical outcomes. Because P. insidiosum is distributed worldwide and can infect healthy individuals, an awareness of human pythiosis should be promoted in Thailand and in other countries.
Clinical and Vaccine Immunology, 2002
Human pythiosis is an emerging, fatal, infectious disease caused by Pythium insidiosum and occurs... more Human pythiosis is an emerging, fatal, infectious disease caused by Pythium insidiosum and occurs in both tropical and subtropical countries. Thalassemic patients, farmers, and aquatic-habitat residents are predisposed to this disease. Delayed treatment due to the long time required for isolation and identification of the causative organism, as well as the difficulty in obtaining internal organ specimens, results in high morbidity and mortality. To facilitate rapid diagnosis, an in-house enzyme-linked immunosorbent assay (ELISA) for the detection of immunoglobulin G antibodies against P. insidiosum was developed and evaluated for the diagnosis and monitoring of human pythiosis. Sixteen sera were collected from seven culture-proven human pythiosis cases. A total of 142 sera from thalassemic patients, from patients with other infectious diseases, and from healthy blood donors served as controls. All sera were tested in duplicate. By choosing a suitable cutoff point to maximize sensitivity and specificity, sera from pythiosis cases were all determined to be positive, whereas sera from control groups were all determined to be negative. ELISA signals from serial samples of sera taken from treated patients showed gradually declining levels of antibodies to P. insidiosum. The ELISA test was highly sensitive (100%) and specific (100%) and was useful for early diagnosis and for monitoring the treatment for pythiosis.
Journal of Clinical Microbiology, 2006
The oomycetous, fungus-like, aquatic organism Pythium insidiosum is the etiologic agent of pythio... more The oomycetous, fungus-like, aquatic organism Pythium insidiosum is the etiologic agent of pythiosis, a life-threatening infectious disease of humans and animals that has been increasingly reported from tropical, subtropical, and temperate countries. Human pythiosis is endemic in Thailand, and most patients present with arteritis, leading to limb amputation and/or death, or cornea ulcer, leading to enucleation. Diagnosis of pythiosis is time-consuming and difficult. Radical surgery is the main treatment for pythiosis because conventional antifungal drugs are ineffective. The aims of this study were to evaluate the use of Western blotting for diagnosis of human pythiosis, to identify specific immunodominant antigens of P. insidiosum, and to increase understanding of humoral immune responses against the pathogen. We performed Western blot analysis on 16 P. insidiosum isolates using 12 pythiosis serum samples. These specimens were derived from human patients with pythiosis who had different forms of infection and lived in different geographic areas throughout Thailand. We have identified a 74-kDa immunodominant antigen in all P. insidiosum isolates tested. The 74-kDa antigen was also recognized by sera from all patients with pythiosis but not by control sera from healthy individuals, patients with thalassemia, and patients with various infectious diseases, indicating that Western blot analysis could facilitate diagnosis of pythiosis. Therefore, the 74-kDa antigen is a potential target for developing rapid serodiagnostic tests as well as a therapeutic vaccine for pythiosis. These advances could lead to early diagnosis and effective treatment, crucial factors for better prognosis for patients with pythiosis.