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Infective endocarditis (IE) is a serious condition with high morbidity and mortality. This retrospective cohort study evaluated the evolution of clinical characteristics, microbiological profiles, and treatment outcomes in 435 Thai IE patients, spanning three distinct periods, at a Chiang Mai tertiary-care hospital. Patients were categorized into three timeframes: 1998–2001 ( n  = 134), 2012–2015 ( n  = 117), and 2016–2020 ( n  = 184). The median patient age significantly increased from 42 years (IQR 34–51) to 58 years (IQR 44–65) ( p  = 0.003). The study also identified an increased prevalence of co-morbidities in recent years. Notably, there was a marked decrease in the prevalence of rheumatic heart disease, from 23.1 to 10.9% ( p  = 0.009). Streptococcus suis is a unique and increasingly prevalent cause of IE in northern Thailand. Additionally, the rate of culture-negative IE declined from 38.1 to 23.9% ( p  = 0.018). Surgical interventions increased from 52.2 to 64.1% ( p  = 0.072), while the median time to surgery remained constant at 12 days. Despite advancements in diagnosis and treatment, the length of hospitalization remained stable throughout the study periods, and the in-hospital mortality rate consistently stayed at 18.6%. This study highlights significant shifts in the epidemiology and management of IE, indicating persistent challenges in reducing mortality despite improved care.

Background HIV infection and AIDS remain serious global health problems. In Thailand, previous studies have revealed that nearly half of newly diagnosed people living with HIV (PLWH) presented with AIDS-defining illnesses (ADIs). However, data regarding the burden of ADIs among PLWH in northern Thailand have been limited. Methods This retrospective cohort study analyzed 777 newly diagnosed PLWH between January 1, 2012, and December 31, 2022 at a tertiary care hospital in northern Thailand. Results The study found that 29.0% of patients presented with ADIs at diagnosis, although this prevalence showed a significant decreasing trend over time (p-value = 0.021). Among the 552 patients without ADIs, 57.2% were asymptomatic at diagnosis. The most common ADIs were pneumocystis pneumonia (42.7%), talaromycosis (27.1%), and pulmonary tuberculosis (14.2%). Median CD4 counts at diagnosis were markedly lower in patients with ADIs [34 (IQR 16–83) cells/cu.mm] compared with those without ADIs [293 (IQR 183–437) cells/cu.mm]. Overall, 25.5% of newly diagnosed PLWH required hospitalization, with rates of 72.0% in those with ADIs and 6.5% in those without. Conclusions Despite widespread availability of combination antiretroviral therapy (cART), a substantial proportion of PLWH in northern Thailand continue to be diagnosed at an advanced stage, underscoring the urgent need to strengthen HIV screening and early diagnosis strategies.

Autoantibody to interferon-gamma (IFN-γ) has been reported to be associated with adult-onset immunodeficiency in patients from Asian countries. This study aimed to determine the prevalence of autoantibody to IFN-γ among non-HIV patients in northern Thailand who were repeatedly infected with unusual intracellular pathogens. A cross-sectional, case-control study was conducted between March 2011 and March 2012 at Chiang Mai University Hospital. 20 cases, non-HIV, aged 18-60 years, presented with at least 2 episodes of culture or histopathology proven opportunistic infections were enrolled. Controls comprised 20 HIV-infected patients and 20 healthy adults who were age- and sex-matched with cases. Enzyme-linked immunosorbent assay (ELISA) was used to detect the presence of antibody to IFN-γ. 11 participants in each group were female. The mean ages were 48.1±6.4, 48.3±6.3, and 47.1±6.5 years among cases, HIV-infected, and healthy controls, respectively. The opportunistic infections among 20 cases included disseminated non-tuberculous mycobacterial (NTM) infection (19 patients/24 episodes), disseminated penicilliosis marneffei (12 patients/12 episodes), and non-typhoidal Salmonella bacteremia (7 patients/8 episodes). At the cutoff level of 99 percentile of controls, the prevalence of autoantibody to IFN-γ were 100%, 0%, and 0%, among cases, HIV-infected, and healthy controls, respectively (p-value <0.001). The mean concentrations of antibody to IFN-γ were 3.279±0.662 and 0.939±0.630 O.D. among cases with and without active opportunistic infection, respectively (p-value<0.001). In northern Thailand, autoantibody to IFN-γ was strongly associated with adult-onset immunodeficiency. The level of antibody to IFN-γ in patients who had active opportunistic infection was relatively higher than those without active infection.

Background Infection caused by Streptococcus agalactiae , a Group B streptococcus, is an emerging disease in non-pregnant adults. This study describes the epidemiological, clinical, and microbiological characteristics of S. agalactiae infection in adult patients in northern Thailand. Methods A retrospective study was conducted between January 1, 2006 and December 31, 2009 at Chiang Mai University Hospital among patients aged ≥15 years, whose clinical specimens obtained from normally sterile sites grew S. agalactiae . Results One-hundred and eighty-six patients and 197 specimens were identified during the 4-year period. Among 186 patients, 82 were documented as having invasive infection; 42 patients were male (51.2%) with the mean age of 48.5 ± 19.4 years (range 17, 83). Fifty-three patients (64.6%) had underlying medical conditions; 17 patients (20.7%), 10 (12.2%), 8 (9.7%) had diabetes, chronic renal diseases, and malignancy, respectively. Among 40 patients (48.8%) with bloodstream infection, no other site of infection was determined in 29 (35.4%) patients. In the remaining 11 patients, 5 patients (6.1%), 5 (6.1%), and 1 (1.2%) had meningitis, arthritis, and meningitis with arthritis, respectively. Forty-two patients (51.2%) presented with localized infection, i.e., subcutaneous abscess (19 patients, 23.2%), chorioamnionitis (10 patients, 12.2%), urinary tract infection (5 patients, 6.1%), arthritis (3 patients, 3.7%), meningitis (2 patients, 2.4%), and spontaneous bacterial peritonitis, uveitis, and tracheobronchitis (1 patient each, 1.2%). The overall mortality was 14.6% (12 patients). Conclusions S. agalactiae infection is a growing problem in non-pregnant patients, particularly in those with underlying medical conditions. Physicians should add S. agalactiae infection in the list of differential diagnoses in patients with meningitis and/or septicemia.

Background Neurocysticercosis (NCC) is a leading cause of epilepsy and neurological morbidity in endemic regions. This study compares clinical characteristics, treatment, and outcomes between parenchymal and extraparenchymal NCC in northern Thailand. Methods A retrospective cohort of 106 adult NCC patients (2015–2024) was reviewed at Chiang Mai University. Patients were categorized based on neuroimaging. Clinical data, treatment regimens, and functional outcomes (using modified Rankin Scale) were assessed at baseline, discharge, and 3, 6, and 12 months. Results Of 106 patients, 84 (79.2%) had parenchymal and 22 (20.8%) had extraparenchymal NCC. Seizures were more common in parenchymal cases, while sensory deficits and hydrocephalus predominated in extraparenchymal cases. Surgical intervention was significantly more frequent in extraparenchymal NCC (86.4% vs. 4.8%, P  < 0.001). Despite overall improvement, extraparenchymal cases had worse outcomes at all time points. Corticosteroids did not improve long-term function and were linked to more adverse events. Conclusions Parenchymal and extraparenchymal NCC have distinct clinical patterns and outcomes. Extraparenchymal NCC is more severe, frequently requiring surgery and resulting in greater disability. Corticosteroid use showed no association with long-term outcomes, highlighting the need for early diagnosis and tailored treatment strategies. Highlights Parenchymal and extraparenchymal NCC differ in presentation and outcomes. Extraparenchymal NCC shows more severity and often requires surgery. Corticosteroids showed no clear long-term benefit in this cohort. Early diagnosis and tailored care are key in endemic, limited-resource areas.

Background The use of combination antiretroviral therapy (cART) has become a standard of care for the treatment of HIV infection. However, cost and resistance to cART are major obstacles for access to treatment especially in resource-limited settings. In this study, we aimed to determine the incidence and risk factors of treatment failure in a cohort of treatment-naïve Thai HIV-infected patients. Methods A retrospective cohort study was conducted among HIV-infected patients initiating their first cART at Chiang Mai University Hospital, Thailand. Results From January 2002 to December 2008, 788 patients were enrolled; 365 were male (46.3%), and the mean age was 37.9 ± 8.6 years. The median baseline CD4 count was 57.7 cells/mm 3 (IQR 22, 127). GPO-VIR ® (a fixed-dose combination of lamivudine, stavudine, and nevirapine) was the most common prescribed cART (657 patients, 83.4%). Seventy-six patients developed virological failure given the cumulative incidence of 9.6%. The incidence of virological failure was 2.79 (95% CI 2.47, 3.14) cases per 100 person years. Poor adherence was the strongest predictor for virological failure. Of 535 immunologically evaluable patients, 179 (33.5%) patients developed immunological failure. A low CD4 cell count at baseline (< 100 cells/mm 3 ) and the increment of CD4 cell count of < 50 cell/mm 3 after 6 months of cART were the predictors for immunological failure (p < 0.001). Conclusions This study demonstrated that even in resource-limited settings, the high rate of success could be expected in the cohort with good and sustainable drug adherence. Poor adherence, older age, and low baseline CD4 cell count are the predictors for unfavorable outcome of cART.

This study aimed to evaluate the correlation between in-house and commercial binding-specific IgG antibodies and between in-house and commercial SARS-CoV-2 surrogate virus neutralization tests (sVNT). Samples from healthcare workers who received vaccines against SARS-CoV-2 were tested for RBD-specific antibody, S-specific antibody, and in-house ELISA, commercial sVNT, and in-house sVNT, against wild-type SARS-CoV-2. Three hundred and five samples were included in the analysis. The correlation between S-specific binding antibodies and in-house ELISA was 0.96 (95% CI 0.96–0.97) and between RBD-specific antibodies and in-house ELISA was 0.96 (95% CI 0.95–0.97). The Cohen’s kappa between in-house sVNT and the commercial test was 0.90 (95% CI 0.80, 1.00). If using 90% inhibition of sVNT as the reference standard, the optimal cut-off value of RBD-specific antibodies was 442.7 BAU/mL, the kappa, sensitivity, and specificity being 0.99, 99%, and 100%, respectively. The optimal cut-off value of S-specific antibodies was 1155.9 BAU/mL, the kappa, sensitivity, and specificity being 0.99, 100%, and 99%, respectively. This study demonstrated a very strong correlation between in-house ELISA and 2 commercial assays. There was also a very strong correlation between in-house and commercial SARS-CoV-2 sVNT, a finding of particular interest which will inform future research.

Background: Cryptococcal meningitis is one of the most devastating infections, particularly in HIV-infected individuals. The increased use of immunosuppressants led to an increase in the incidence of cryptococcosis in HIV-uninfected individuals. This study aimed to compare the characteristics between groups. Methods: This retrospective cohort study was conducted from 2011 to 2021 in northern Thailand. Individuals diagnosed with cryptococcal meningitis aged ≥15 years were enrolled onto the study. Results: Out of 147 patients, 101 were individuals infected with HIV and 46 were non-infected. Factors associated with being infected with HIV included age < 45 years (OR 8.70, 95% CI 1.78–42.62), white blood cells < 5000 cells/cu.mm. (OR 7.18, 95% CI 1.45–35.61), and presence of fungemia (OR 5.86, 95% CI 1.17–42.62). Overall, the mortality rate was 24% (18% in HIV-infected vs. 37% in HIV-uninfected individuals, p-value = 0.020). Factors associated with mortality included concurrent pneumocystis pneumonia (HR 5.44, 95% CI 1.55–19.15), presence of alteration of consciousness (HR 2.94, 95% CI 1.42–6.10), infection caused by members of C. gattii species complex (HR 4.19, 95% CI 1.39–12.62), and anemia (HR 3.17, 95% CI 1.17–8.59). Conclusions: Clinical manifestations of cryptococcal meningitis differed between patients with and without HIV-infection in some aspects. Increasing awareness in physicians of this disease in HIV-uninfected individuals may prompt earlier diagnosis and timely treatment.

Since 1996, there have been several case reports of autochthonous visceral leishmaniasis in Thailand. Here we report a case in a 52-year-old Thai male from northern Thailand, who presented with subacute fever, huge splenomegaly and pancytopenia. Bone marrow aspiration revealed numerous amastigotes within macrophages. Isolation of Leishmania LSCM1 into culture and DNA sequence analysis (ribosomal RNA ITS-1 and large subunit of RNA polymerase II) revealed the parasites to be members of the Leishmania enriettii complex, and apparently identical to L. martiniquensis previously reported from the Caribbean island of Martinique. This is the first report of visceral leishmaniasis caused by L. martiniquensis from the region. Moreover, the majority of parasites previously identified as \"L. siamensis\" also appear to be L. martiniquensis.

Cutaneous manifestations in adult-onset immunodeficiency (AOID) resulting from anti-interferon-gamma autoantibody (AIGA) are prevalent and can be classified into infective and reactive disorders. To date, no clinical studies have specifically examined pustular reaction in patients with AOID. This study aimed to provide an original characterization of the clinical manifestations associated with pustular reaction in AOID and to compare these features with those observed in a clinically similar entity, generalized pustular psoriasis (GPP). A retrospective study was conducted between January 2014 and June 2023 at the dermatology clinics of Maharaj Nakorn Chiang Mai Hospital, Chiang Mai and Srinagarind Hospital, Khon Kaen, Thailand. The study included adult patients diagnosed with AOID presenting with pustular reaction, defined as pinhead-sized pustules on an erythematous base occurring any area of skin, as well as those diagnosed with GPP. Cases with pustular drug eruption and with non-sterile pustules were excluded. Data analysis was performed using both univariable and multivariable statistical methods. Total of 64 patients diagnosed with AOID who subsequently developed a pustular reaction were included in the study. Clinically, the cutaneous manifestations were characterized by discrete, pinhead-sized pustules distributed on erythematous bases, predominantly affecting the trunk and extremities. A concomitant infection was identified in 54 patients (84.4%). Rapid-growing mycobacteria represented the most frequently identified pathogens, with lymph nodes being the most commonly involved anatomical site. Comparative analysis with a cohort of 77 patients diagnosed with GPP elucidated distinct clinical hallmarks differentiating the two entities. Lymphadenopathy, hepatomegaly, and splenomegaly emerged as distinguishing features more frequently associated with AOID-related pustular reaction. In contrast, the presence of geographic tongue and nail involvement was more characteristic of GPP. In instances where these pathognomonic features were absent, a multivariable predictive model was developed to aid in diagnostic differentiation. This model incorporated the presence of concomitant infections, elevated serum globulin levels, and increased alkaline phosphatase levels. Among patients presenting with sterile pustular eruptions, the presence of lymphadenopathy, hepatomegaly, and splenomegaly served as perfect clinical predictors of an underlying pustular reaction associated with AOID. In cases where these hallmark features were absent, a predictive algorithm incorporating the presence of a concomitant infections, serum globulin concentration, and alkaline phosphatase level demonstrated robust utility in estimating the likelihood of AOID-associated pustular reaction.