To investigate whether there are methicillin-resistant Staphylococcus aureus (MRSA) strains with reduced susceptibility to vancomycin in Thailand, a total of 155 MRSA strains isolated from patients hospitalized between 1988 and 1999 in university hospitals in Thailand were tested for glycopeptide susceptibility. All the strains were classified as susceptible to vancomycin and teicoplanin when judged by NCCLS criteria for glycopeptide susceptibility using the agar dilution MIC determination. Vancomycin MICs at which 50 and 90% of the isolates tested were inhibited (MIC 50 and MIC 90 , respectively) were 0.5 and 1 g/ml, respectively, with a range of 0.25 to 2 g/ml. For teicoplanin, MIC 50 and MIC 90 were 2 g/ml, with a range of 0.5 to 4 g/ml. However, one-point population analysis identified three MRSA strains, MR135, MR187, and MR209, which contained subpopulations of cells that could grow in 4 g of vancomycin per ml. The proportions of the subpopulations were 2 ؋ 10 ؊4 , 1.5 ؋ 10 ؊6, and 4 ؋ 10 ؊7 , respectively. The subsequent performance of a complete population analysis and testing for the emergence of mutants with reduced susceptibility to vancomycin (MIC > 8 g/ml) confirmed that these strains were heterogeneously resistant to vancomycin. Two of these strains caused infection that was refractory to vancomycin therapy. Pulsed-field gel electrophoresis showed that the two strains had identical SmaI macrorestriction patterns and that they were one of the common types of MRSA isolated in the hospital. This is the first report of heterogeneous resistance to vancomycin in Thailand and an early warning for the possible emergence of vancomycin resistance in S. aureus in Southeast Asia.

Background The epidemiology and outcomes of COVID-19 patients in Thailand are scarce. Methods This retrospective cohort study included adult hospitalized patients who were diagnosed with COVID-19 at Siriraj Hospital during February 2020 to April 2020. Results The prevalence of COVID-19 was 7.5% (107 COVID-19 patients) among 1409 patients who underwent RT-PCR for SARS-CoV-2 detection at our hospital during the outbreak period. Patients with COVID-19 presented with symptoms in 94.4%. Among the 104 patients who were treated with antiviral medications, 78 (75%) received 2-drug regimen (lopinavir/ritonavir or darunavir/ritonavir plus chloroquine or hydroxychloroquine), and 26 (25%) received a 3-drug regimen with favipiravir added to the 2-drug regimen. Disease progression was observed in 18 patients (16.8%). All patients with COVID-19 were discharged alive. Conclusions The prevalence of COVID-19 was 7.5% among patients who underwent RT-PCR testing, and 10% among those having risk factors for COVID-19 acquisition. Combination antiviral therapies for COVID-19 patients were well-tolerated and produced a favorable outcome.

Penicillium marneffei, a dimorphic fungus endemic in parts of Asia, causes disease in those with impaired cell-mediated immunity, especially persons with AIDS. The histopathology of penicilliosis marneffei features the intracellular infection of macrophages. We studied the interactions between human leukocytes and heat-killed yeast-phase P. marneffei. Monocyte-derived macrophages bound and internalized P. marneffei in the presence of complement-sufficient pooled human serum (PHS). Binding and phagocytosis were still seen if PHS was heat inactivated or omitted altogether. The binding of unopsonized P. marneffei to monocyte-derived macrophages occurred in the absence of divalent cations and was not affected by inhibitors of mannose and β-glucan receptors or monoclonal antibodies directed against CD14 and CD11/CD18. Binding was profoundly inhibited by wheat germ agglutinin. A vigorous respiratory burst was seen in peripheral blood mononuclear cells (PBMC) stimulated with P. marneffei, regardless of whether the fungi were opsonized. However, tumor necrosis factor alpha (TNF-α) release from PBMC stimulated with P. marneffei occurred only if serum was present. These data demonstrate that (i) monocyte-derived macrophages bind and phagocytose P. marneffei even in the absence of opsonization, (ii) binding is divalent cation independent but is inhibited by wheat germ agglutinin, suggesting that the major receptor(s) recognizing P. marneffei is a glycoprotein with exposedN-acetyl-β-d-glucosaminyl groups, (iii)P. marneffei stimulates the respiratory burst regardless of whether opsonins are present, and (iv) serum factors are required forP. marneffei to stimulate TNF-α release. The ability of unopsonized P. marneffei to parasitize mononuclear phagocytes without stimulating the production of TNF-α may be critical for the virulence of this intracellular parasite.

A serologic study with simultaneous self‐administered questionnaire regarding infection control (IC) practices and other risks of influenza A (H1N1) pdm09 (2009 H1N1) infection was performed approximately 1 month after the first outbreak among frontline healthcare professionals (HCPs). Of 256 HCPs, 33 (13%) were infected. Self‐reported adherence to IC practices in >90% of exposure events was 82·1%, 73·8%, and 53·5% for use of hand hygiene, masks, and gloves, respectively. Visiting crowded public places during the outbreak was associated with acquiring infection (OR 3·1, P = 0·019). Amongst nurses, exposure to HCPs with influenza‐like illness during the outbreak without wearing a mask was the only identified risk factor for infection (OR = 2·3, P = 0·039).

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