Human Leptospirosis Trends: Northeast Thailand, 2001–2012

The objective of this study was to determine the changing trend of leptospirosis over time in Thailand using two prospective hospital-based studies conducted amongst adult patients with acute undifferentiated fever (AUFI) admitted to Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima Province, Thailand between July 2001 to December 2002 and between July 2011 to December 2012. During the first period, leptospirosis (98 patients, 40%) and scrub typhus (59 patients, 24.1%) were the two major causes of AUFI. In the second period, scrub typhus (137 patients, 28.3%) was found to be more common than leptospirosis (61 patients, 12.7%). Amongst patients with leptospirosis, the proportion of male patients and the median age were similar. Leptospira interrogans serogroup Autumnalis was the major infecting serogroup in both study periods. The case fatality rate of leptospirosis was significantly higher in 2011–2012 as compared with the case fatality rate in 2001–2002 (19.7% vs. 6.3%, p < 0.001). In summary, we found that number of leptospirosis cases had decreased over time. This trend is similar to reportable data for leptospirosis complied from passive surveillance by the Ministry of Public Health, Thailand. However, the case fatality rate of severe leptospirosis has increased. Severe lung hemorrhage associated with leptospirosis remained the major cause of death

Prevalence of Primary HIV Drug Resistance in Thailand Detected by Short Reverse Transcriptase Genotypic Resistance Assay.

BACKGROUND:HIV drug resistance (HIVDR) is the major cause of treatment failure after scaling up of antiretroviral therapy (ART). HIVDR testing prior to ART initiation is not routinely performed in resource-limited settings. We aimed to assess the prevalence of primary HIVDR by short reverse transcriptase (RT) genotypic resistance assay and evaluate of the impact of the mutations on the treatment outcomes. METHODS:A prospective cohort study was conducted in treatment-naïve HIV-infected patients. Fourteen major mutations of codon 99-191 on the RT gene were selected (K103N, V106A/M, V108I, Q151M, Y181C/I, M184V/I, Y188C/L/H, and G190S/A) at a cost of testing of 35 USD. The association between the presence of primary HIVDR and undetectable HIV RNA (<50 copies/mL) after 6 months of ART was determined. RESULTS:A total of 265 HIV-infected patients were included, with a median age of 35.2 (range, 16.8-75.2) years; 62.6% were males. The median (interquartile range) CD4 cell count at ART initiation was 216 (77-381) cells/mm3. The overall prevalence of primary HIVDR was 7.9%. The prevalence of each HIVDR mutation were K103N 6.0%, V106I 1.1%, V108I 0.4%, Y181C 2.3%, Y181I 0.7%, Y181V 0.4%, M184V 3.0%, M184I 1.5%, and G190A 2.3%. No associated factor of having primary HIVDR was determined. By multiple stepwise logistic regression, factors associated with undetectable HIV RNA after 6 months of ART were: having M184V/I (odds ratio [OR] 0.11; 95% confidence interval [CI] 0.02-0.62, p = 0.013), condom use (OR 2.38; 95% CI 1.12-5.06, p = 0.024), and adherence per 5% increase (OR 1.16; 95% CI 1.00-1.35, p = 0.044). CONCLUSIONS:The prevalence of primary HIVDR is approximately 8%; it is associated with detectable HIV RNA at 6 months after ART initiation. Routine "short RT" genotypic resistance assay should be considered in resource-limited settings to maximize treatment outcome

Factors Associated with Undetectable HIV RNA at 6 Months after ART Initiation, by Univariate Logistic Regression.

<p>Factors Associated with Undetectable HIV RNA at 6 Months after ART Initiation, by Univariate Logistic Regression.</p

Prevalence of primary HIV drug resistance mutations, from short reverse transcriptase genotypic resistance assay.

<p>Prevalence of primary HIV drug resistance mutations, from short reverse transcriptase genotypic resistance assay.</p

Comparison of Clinical Characteristics, Laboratory Investigations, and Clinical Outcomes between Patients with and without Primary HIV Drug Resistance.

<p>Comparison of Clinical Characteristics, Laboratory Investigations, and Clinical Outcomes between Patients with and without Primary HIV Drug Resistance.</p

Demographic and Baseline Characteristics of 265 Treatment-Naïve HIV-Infected Patients.

<p>Demographic and Baseline Characteristics of 265 Treatment-Naïve HIV-Infected Patients.</p

Additional file 1: Table S1. of An ELISA assay using a combination of recombinant proteins from multiple strains of Orientia tsutsugamushi offers an accurate diagnosis for scrub typhus

Correlation of IFA titer and ELISA in acute samples. Table S2. Distribution of IgG or IgM ELISA positive but diagnosed as scrub typhus negative. Figure S1. Correlation of IgG and IgM ELISA OD with single IFA titers at 400. One of the criteria to consider a patient as ST positive was based on IgG or IgM titer > = 400 of a single serum. The ELISA OD of patients was plotted against the IgG or IgM titer <400 (negative, open symbols) or > = 400 (positive, closed symbols). The mean OD of each group was plotted in red. The mean and standard deviation of ELISA OD of IgG (circles) or IgM (triangles). IFA positives (IFA titer > = 400) was significantly different from that of IFA negatives (t test, p < 0.0001). Figure S2. Correlation of IgG and IgM ELISA OD with ST cases. ST cases were determined by a combination of IFA and PCR results. The ELISA OD of patients who were determined as positives (closed symbols) and negatives (open symbols) were plotted. The mean and standard deviation of ELISA OD of each group was plotted in red. The mean OD of IgG (circles) or IgM (triangles) for determined positives and negatives was significantly different (t test, p < 0.0001). (DOCX 14 kb