Microbiology - Achievements
Bacterial & viral diseases
Our achievements include:
Melioidosis remains a major cause of severe illness in Northeast Thailand; most worryingly patient numbers are increasing each year and it is now being increasingly recognised elsewhere in SE Asia, India, China, and Brazil.
Current treatment recommendations are based on MORU’s work. We study over 400 patients each year, and since 1986 over 4,000 patients with melioidosis have been studied. Recent achievements include:
- Completion of an acute melioidosis antibiotic treatment study in Thailand comparing the two most widely used treatments
- Metabolic studies found no metabolic aetiology for the wasting seen in severe melioidosis patients, leading to the conclusion that low energy intake is the cause
- Diabetes is a major risk factor for melioidosis. However a retrospective study showed that very few diabetic patients with melioidosis are insulin-dependent, suggesting that insulin deficiency is not the cause of the increased susceptibility
- Improvements in melioidosis diagnosis include development of a very rapid DIF test (30 minutes)
- Melioidosis was described for the first time in Laos, and the bacterium that causes it (Burkholderia pseudomallei) identified and quantified in the soil
Causes of febrile illness in rural Thailand and Laos
- MORU has identified scrub typhus and leptospirosis as major causes of febrile illness (fever) leading to hospital admission in rural areas of Thailand and Laos
- A two year study of unexplained fever in 1,263 patients from Udon Thani has been undertaken. Extensive microbiological and serological testing was carried out. Early indications are that approximately 25% of cases were due to scrub typhus, and a further 25% were caused by leptospirosis
- In Vientiane, Laos, an unexplained fever study has finished recruitment, and serological testing is almost complete. Scrub typhus and, unlike in Thailand, murine typhus are major causes of febrile illness
Because scrub and murine typhus have been found to be so important in rural areas in SE Asia we have greatly increased our research in this field. Large-scale comparisons of diagnostic tests for scrub typhus have been conducted, and the results are currently being analysed.
- A randomised trial conducted in Udon Thani in collaboration with Siriraj Hospital compared three antibiotics in the treatment of suspected severe leptospirosis
- Working in collaboration with Thailand Centre for Disease Control, a rapid antigen detection test has been developed
Identification of Staphylococcus aureus disease (caused by both MRSA and MSSA) as a major cause of morbidity and mortality in Thai and Cambodian rural hospital settings. This is not unexpected, as the same is true in Western countries, but in resource-limited settings the ability to diagnose and treat is much more restricted than in the developed world. Our findings also highlight the fact that staphylococcal infection is as much a tropical disease as a temperate one.
We have been involved in researching the diagnosis, mechanisms and treatment of a number of fungal infections. These represent a major disease burden in the populations with which we work, particularly in northeast Thailand. These include:
- Cryptococcal meningitis