Seameo Regional Tropical Medicine and Public Health Network.
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Biomedical subjects
Publications and source records attributed to C Harinasuta.
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Malaria is still a disease of public health importance in Thailand despite the encouraging downward trend in the number of malaria cases during the past ten years. In the last few years there were still nearly a quarter of million malaria cases detected and about 3,000 malaria deaths yearly reported. The social and economic factors seem to play major roles in keeping low persistent transmission of malaria in certain communities especially those residing in and near forested areas, mountains and foothills in the places not far away from Thai-Kampuchea border in East Thailand and Thai-Burmese border in West Thailand. These communities consist of migrants and local native residents living in newly opened lands for agriculture, and some are remote areas where communication and transportation are inaccessible. Preliminary results on these people revealed some interesting social and economic problems and health behaviour of the people in connection with persistent malaria transmission among them. It is suggested that further investigation should be carried out on the social and economic elements in these communities including migratory pattern, their population characteristics and life, social behaviour, health belief and practice, malaria prone behaviour, etc. in association with malaria transmission among them. The results to be obtained may lead to the effective control measures of malaria in future.
The description of the fourth stage larva of W. bancrofti provides an indication of the direction of morphological evolution in the genus showing in particular that W. kalimantani is more highly evolved than W. bancrofti and constitutes a "capture" by Presbytis of the species parasitic in man. No morphological character of adult W. bancrofti distinguishes the geographic origin of the different collections studied. By contrast, the morphological characters of the microfilariae and their biological features are significantly different, but are not inter-correlated. It therefore appears that in the genus Wuchereria, as in the other viviparous filarioids, the phenomenon of speciation is evident first of all in the morphology of the microfilaria, the stage most susceptible to selection pressures.
Two Japanese encephalitis cases with serious comatous symptoms were treated with the Human Recombinant Interferon-alpha A. The clinical responses to IFN were found to be satisfactory. The first case showed improvement on the 5th day of IFN treatment and the general condition slowly improved. The second case recovered from the comatous stage on the 6th day of IFN, followed by quick improvement of general symptoms in the 2nd week and complete recovery without any mental sequelae. Leukopenia and neutropenia occurred during the first week of administration of IFN, but were only temporary. Slight elevation of SGOT and SGPT was observed in the first case. No other side effects including general toxicity, neurotoxicity or allergy, or any abnormal hematological and blood chemistry changes were observed in these 2 cases. Two other JE cases (the 3rd and 4th consecutive JE cases) were not treated with IFN, but received the usual regimens of symptomatic and supportive drugs. Both patients died on the 7th-9th day of illness. This study suggests that the Human Recombinant Leukocyte A Interferon possibly is an effective and promising agent in the treatment of Japanese encephalitis in Thailand. More studies to treat JE cases with this IFN are being performed in order to assess the efficacy, tolerance and safety of rIFN-alpha A on Japanese encephalitis in Thailand.
The preliminary results of our study in vitro on the effect of Interferon on Flaviviruses showed that Interferon alpha and Interferon beta were more effective on JE viruses Vip local strain and JaGAr strain, but less on Dengue virus type 2 strain. However, the effect of these 2 interferons on the 2 strains of JE viruses were still variable which need further investigations. The JE virus Vip local strain seemed to be more susceptible to interferon than the Japanese prototype JaGAr strain. Thus, the in vivo trial on JE disease in Thailand is strongly recommended.
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Schistosomiasis in Southeast Asia, caused by Schistosoma japonicum, Schistosoma mekongi and Schistosoma japonicum-like, have been reported from six different countries. The S. japonicum infections are highly prevalent in the Philippines with Oncomelania hupensis quadrasi as the vector snail, and in localized areas in Indonesia with O.h. lindoensis as the snail vector. The S. mekongi infections are recent discovery in the Lower Mekong Basin in Laos and Kampuchea, with Tricula aperta as the vector snail. The S. japonicum-like infections are found as isolated cases diagnosed by the finding of S. japonicum-like eggs in the faeces, rectal biopsy, tissue biopsy or at necropsy in Thailand and Malaysia. The control measures of schistosomiasis have been implemented in the Philippines and Indonesia, while further research studies are being conducted in Thailand and Malaysia.
The studies on the effect of the Recombinant Leukocyte A Interferon (r IFN-alpha A) on 4 local strains of JE virus in Thailand were performed in vitro in our laboratories in Bangkok during August - October 1984. The procedures consisted of the plaque reduction assay and the Rhesus monkey kidney cell line, LLC-MK2 cells. These 4 strains namely Vip, KE-093, KE-094 and KE-095 were isolated from the JE patients in Thailand during 1983-1984. The results revealed that all of the JE virus strains tested were sensitive to the r IFN-alpha A with its minimal effective doses ranging from 30 I.U./ml to 1,500 I.U./ml. The studies on the effects of r IFN-alpha A on JE virus replicating in the cell culture for 0 hour, 1 hour and 6 hours indicated that if the virus had more hours to replicate in the cell culture, higher concentration of the IFN was needed in order to combat the replication of the virus in the cell culture. r IFN-alpha A at higher concentrations showed more efficacy in combating the replication of the JE virus in vitro.
Opisthorchis viverrini has been found to be the only species of liver fluke in Thailand. The morphology is similar to that of O. felineus, but it has more deeply lobated testes, situated near the ovary. The appearance and distribution of the vitellaria with few granular clumps and the shorter and wider egg closely resemble that of C. sinensis. The adult worms live in the biliary system. Eggs pass out in faeces. On reaching water the eggs are eaten by snails, the first intermediate host. In the snail the miracidia hatch and develop further through the stages of sporocysts, rediae and cercariae in six to eight weeks. The cercariae then leave the snail, penetrate into susceptible fresh water fish, encyst in the muscle and develop into metacercariae, and infective stage, in six weeks. When ingested by man or animal the metacercariae excyst in the duodenum or jejunum and then migrate to the bile duct. They become mature within four weeks and begin to produce eggs. The life span of the fluke is over 10 years. The snail intermediate hosts are Bithynia goniomphalus, B. funiculata and B. siamensis. Many species of cyprinoid fish serve as second intermediate host; Cyclocheilichthys siaja is the most important. Cats, dogs and many fish eating mammals are definitive hosts. Man and animals acquire infection by eating raw fish containing metacercariae cysts. In Northeast Thailand "Koi-Pla" is the most popular raw fish dish. In 1980-1981 the prevalence in the north, northeast, centre and south of Thailand was 5.59, 34.60, 6.34, and 0.01%, respectively, with an overall prevalence of 14% or 7 million people.
Oviposition characteristics of Mansonia (Mansonioides) mosquitoes were studied to assess future possibilities for their control. Special emphasis was given to the study of the factors, especially the host plant species, which guide the gravid females towards the oviposition site. Initially, egg dispersal throughout the breeding place was assessed by comparing egg densities between so-called areas of 100-200 m2, each characterized by reasonable homogeneity in its flora. Some of these areas were preferred by gravid females, indicating an aggregative type of distribution. There was no evidence that the attractiveness of areas was correlated with the availability of preferred host plants. Egg dispersal within areas was then studied using randomly chosen plots of 1 X 1 m or 15 X 15 cm as sampling units. This again revealed aggregative egg distributions which could be fitted to a negative binomial expectation. The amount of visible water surface, rather than the availability of host plants, appeared to determine the attractiveness of the plots. The dispersal within 1 m2 experimental plots containing the host plants Pistia, Eichhornia and Salvinia was then investigated and this showed clearly that specific levels of attractiveness of plant species influenced egg dispersal. These levels were modified by (i) the presence of grasses in the immediate surroundings, (ii) features of grass growth and (iii) the type of host plant arrangement. It was concluded that the factors responsible for egg aggregations vary with the size of the samples compared, and that the host plant species plays a significant role only for the distribution within quite small units of the breeding place.
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Infective larvae of nocturnally subperiodic Wuchereria bancrofti were obtained from laboratory-raised Aedes togoi mosquitoes which had fed on an infected human volunteer from Kanchanaburi, Thailand, and 471 of them were inoculated subcutaneously into the inguinal regions of an immunosuppressed Presbytis melalophos. Microfilaremia was first detected 287 days after inoculation, and 77 days later, at 364 days of infection, the number of microfilariae determined at 2-hour intervals reached a maximum of 619/20 mm3 at 4 hours past midnight, and the daytime levels were 11-35/20 mm3; the corresponding levels in the human volunteer were 121 and 13-32/20 mm3. Thus the nocturnal periodicity was relatively greater in the monkey than it was in the human host. Eight days after the periodicity study the monkey died and 77 adult worms were recovered from the popliteal (4), inguinal (58), iliac (6) and para-aortic (9) lymph nodes and 1 each from the ovary and liver. Of 56 females, only half were gravid.
In an attempt to control opisthorchiasis, a single dose of 40 mg/kg of Praziquantel was given to 666 people in the three villages of Nam Pong Water Resource Development Project, Khon Kaen, Northeast Thailand. The results showed a cure rate after 1 month was 95.9%. The side effect was minimized by alternation of the time of treatment from after breakfast to after dinner. The use of Praziquantel for the mass treatment in control of opisthorchiasis is possible. However, to achieve the objective of control programme other measures such as environmental sanitation improvement, health education and change in eating habits must be integrated into the programme.
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