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Opened in 1986, the Microbiology Department’s first focus of research, melioidosis in Ubon Ratchathani, northeast Thailand, led to a landmark randomized controlled trial on the treatment of melioidosis published in 1989, that reduced the mortality of the disease in Thailand by half.

B41pi3_d.jpeg © 2016 Nature
Priority countries where microbiological diagnosis facilities and disease reporting systems for melioidosi should be strengthened. Countries where melioidosis is predicted to be endemic but is underreported or never reported are shown in red and pink, respectively.

Microbiology’s significant achievements reflect our continued research focus on:

Melioidosis | Sepsis | Antimicrobial resistance / drug resistant infections (AMR/DRI) | Acute febrile illness | Rickettsial infections | Clinical studies | Ongoing work

Melioidosis

  • Estimated that the global burden of melioisosis is 4.6 million disability-adjusted life-years (DALYs) pear year (Lancet Infect Dis. 2019 Aug;19(8):892-902)
  • Estimated that there are 165,000 human melioidosis cases per year worldwide, of which 89,000 die. (Nat Microbiol. 2016 Jan 1;1(1))
  • Led and supported a large series of publications describing current burden and challenges of melioidosis from melioidosis network in each country (21 publications; Trop Med Infect Dis. 2018;3(2):38)
  • Showed feasibility and initial outcomes of a multifaceted prevention programme of melioidosis in pilot groups of diabetic patients (PLoS Negl Trop Dis. 2018;12(9):e0006765)
  • Developed a rapid immunochromatography test (ICT) for POC detection of IgG antibodies to Hcp1 (J Clin Microbiol. 2018;56(8)).
  • Demonstrated that Burkholderia pseudomallei undergo phenotypic adaptation at the proteomic and transcriptomic levels in response to an increase in growth temperature (Paksanont S et al, Sci Rep. 2018;8(1):9167).
  • Reported that B. pseudomallei is commonly misidentified as Acinetobacter spp. and other bacteria even in the laboratory of a provincial hospital in northern Thailand ( Trans R Soc Trop Med Hyg. 2019 Jan 1;113(1):48-51).

Sepsis

  • Showed that mortality of community-acquired sepsis in Northeast Thailand is considerable and transferred patients with infection are at increased risk of death, using a large Ubon-sepsis cohort (NCT02217592) (PLoS One. 2018:e0204509)
  • Contributed to the Sepsis Assessment and Identification in Low Resource Settings Collaboration, and showed that the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score score can identify infected patients at risk of death beyond that explained by baseline factors (JAMA. 2018:319(21):2202-2211)
  • Showed that sepsis in Southeast Asia is caused by a wide range of known and emerging pathogens, and is associated with substantial mortality, using a large multi-national sepsis cohort (NCT02157259) (Lancet Glob Health. 2017 Feb; 5(2): e157–e167)
  • Showed that a number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock, and recommened that rapid diagnostic tests for dengue should be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. (PLoS One. 2017 Apr 24;12(4):e0176233.)

Antimicrobial resistance / drug resistant infections (AMR/DRI)

  • Reviewed and proposed how to improve the methodology to estimate the global burden of AMR (Lancet Infect Dis. 2019 Aug; 19(8): 892-902)
  • Developed Microbiology Investigation Criteria for Reporting Objectively (MICRO): a framework for the reporting and interpretation of clinical microbiology data (BMC Med. 2019 Mar 29;17(1):70.)
  • Introduced the concept of ‘Antibiotic footprint’ as a communication tool to aid reduction of antibiotic consumption (J Antimicrobial Chemotherapy. 2019 Aug 1;74(8):2122-2127)
  • Estimated and reported burden of AMR in Thailand countrywide (Elife. 2016 Sep 6;5. pii: e18082).
  • Reported antibiotic use in poultry farm in Thailand (Bull World Health Organ. 2018;96(2):94-100).

Acute febrile illness

  • Reported the causes of fever in Chiangrai, northern Thailand. Scrub typhus and dengue were the major aetiologies seen with biomarkers (particularly CRP) found to have a role in differentiating viral from bacterial infections (PLoS Negl Trop Dis. 2018;12(5): e0006477).
  • Conducted a retrospective review of antibiotic prescribing in acute illness (BMJ open. 2018;8(7):e022250. doi: 10.1136/bmjopen-2018-022250).
  • Completed social science studies on local conceptions of illness, medicine, and the role of point of care CRP testing (Am J Trop Med Hyg. 2018;98(6):1661-70 and Soc Sci Med. 2018;202:1-12).
  • Demonstrated a modest reduction in antibiotic prescribing with use of standalone CRP testing in the community in acutely febrile patients in Southeast Asia – results of the CRP RCT (Lancet Global Health. 2019; 7(1):e119-e131).

Rickettsial infections

  • Produced six new complete genomes of Orientia tsutsugamushi using long-read sequencing and characterised genomic variation in this species. (PLoS Negl Trop Dis. 2018;12(6): e0006566)
  • Expanded the rickettsial cell biology group to include a second research site at Rutgers University, USA.
  • Championed a risk-based approach to lab safety when working with rickettsial pathogens (Clin Infect Dis. 2018. doi: 10.1093/cid/ciy675).
  • Clinically characterised paediatric scrub typhus in Chiangrai, northern Thailand, and explored the factors contributing to high complication and treatment failure rates (J Ped Inf Dis Soc. 2019).

Clinical studies

Completed in the last two years:

  • Paediatric scrub typhus immunology study (CCRU, Chiangrai)
  • Acute fever and the utility of CRP testing in the community study (CCRU, Chiangrai)
  • Scrub typhus ecology and epidemiology study (CCRU, Chiangrai)
  • Sociological factors influencing antibiotic prescriptions and antibiotic seeking behaviour (CCRU  and LOMWRU)

Ongoing Work

  • Eschar investigations in scrub typhus study (CCRU, Chiangrai)
  • Scrub typhus antibiotic resistance trial (CCRU, Chiangrai)
  • Sepsis-3 study (Ubon Ratchathani Unit)
  • Hospital-acquired antibiotic-resistant infection (Ubon Ratchathani Unit)
  • Co-trimoxazole as maintenance therapy for melioidosis (Udon Thani and Ubon Ratchathani Unit)
  • Cluster randomised behaviour change trial to determine effectiveness of prevention programme on melioidosis in diabetics (the PREMEL study, Ubon Ratchathani Unit)
  • Multicentre trial on the antibiotic treatment of scrub typhus (INTREST study) in India.