2006 ที่น้องแอนทำ.pmd - Mahidol University

Mahidol University Abstract of International Publications 2006
No.125
Author(s) : Carrara VI, Sirilak S, Thonglairuam J, Rojanawatsirivet C, Proux S, Gilbos V,
Brockman A, Ashley EA, McGready R, Krudsood S, Leemingsawat S,
Looareesuwan S, Singhasivanon P, White N, Nosten F.
Title : Deployment of early diagnosis and mefloquine – artesunate treatment of falciparum
malaria in Thailand: The Tak malaria initiative.
Source : PLoS Medicine. 3 (6): 856 – 864, 2006 (Jun).
Document Type : Article.
Keywords : Monoclonal – antibodies, ELISA development, Western border, Combination,
Sporozoites, Trial.
Abstract : Background: Early diagnosis and treatment with artesunate – mefloquine combination
therapy (MAS) have reduced the transmission of falciparum malaria dramatically
and halted the progression of mefloquine resistance in camps for displaced persons
along the Thai – Burmese border, an area of low and seasonal transmission of
multidrug – resistant Plasmodium falciparum. We extended the same combination
drug strategy to all other communities (estimated population 450,000) living in five
border districts of Tak province in northwestern Thailand. Methods and Findings:
Existing health structures were reinforced. Village volunteers were trained to use
rapid diagnostic tests and to treat positive cases with MAS. Cases of malaria,
hospitalizations, and malaria – related deaths were recorded in the 6 y before, during,
and after the Tak Malaria Initiative (TMI) intervention. Cross – sectional surveys
were conducted before and during the TMI period. P. falciparum malaria cases fell by
34% (95% confidence interval [CI], 33.5 – 4.4) and hospitalisations for falciparum
malaria fell by 39% (95%CI, 37.0 – 39.9) during the TMI period, while hospitalisations
for P. vivax malaria remained constant. There were 32 deaths attributed to malaria
during, and 22 after the TMI, a 51.5% (95%CI, 39.0 – 63.9) reduction compared to the
average of the previous 3 y. Cross – sectional surveys indicated that P. vivax had
become the predominant species in Thai villages, but not in populations living on the
Myanmar side of the border. In the displaced persons population, where the original
deployment took place 7 y before the TMI, the transmission of P. falciparum continued
to be suppressed, the incidence of falciparum malaria remained low, and the in vivo
efficacy of the 3 – d MAS remained high. Conclusions: In the remote malarious north
western border area of Thailand, the early detection of malaria by trained village
volunteers, using rapid diagnostic tests and treatment with mefloquine – artesunate
was feasible and reduced the morbidity and mortality of multidrug – resistant P.
falciparum.
No.126
Author(s) : Caws M, Thwaites G, Stepniewska K, Lan NTN, Duyen NTH, Phuong NT,
Huyen MNT, Duy PM, Loc TH, Chau TTH, van Soolingen D, Kremer K, Chau NVV,
Chinh NT, Farrar J.
Title : Beijing genotype of Mycobacterium tuberculosis is significantly associated with human
immunodeficiency virus infection and multidrug resistance in cases of tuberculous
meningitis.
Source : Journal of Clinical Microbiology. 44 (11): 3934 – 3939, 2006 (Nov).
Document Type : Article.
Keywords : Chi – Minh city, Drug – resistance, HIV – infection, Gran – canaria, Strain, Adults,
Epidemiology, Vietnam, Pathogenesis, Prevalence.
Abstract : Multidrug – resistant tuberculous meningitis is fatal without rapid diagnosis and use
of second – line therapy. It is more common in human immunodeficiency virus (HIV)
– positive patients. Beijing genotype strains of Mycobacterium tuberculosis are
associated with drug resistance, particularly multidrug resistance, and their prevalence
is increasing worldwide. The prevalence of Beijing genotype strains among
Mycobacterium tuberculosis isolates from the cerebrospinal fluid of HIV – positive (n
= 35) and HIV – negative (n = 187) patients in Ho Chi Minh City was determined. The
Beijing genotype was significantly associated with HIV status (odds ratio [OR] = 2.95
[95% confidence interval {CI}, 1.38 to 6.44]; P = 0.016), resistance to any drug (OR =
3.34 [95%C1, 1.87 to 5.95]; P < 0.001) and multidrug resistance (Fisher’s exact test; P
= 0.001). The association of the Beijing genotype with drug resistance was independent
of HIV status. This is the first report of Beijing genotype association with HIV status,
which may be an association unique to tuberculous meningitis.
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