Browsing by Author "Heiman Wertheim"

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    Acute febrile myalgia in vietnam due to trichinellosis following the consumption of raw pork
    (2009-10-01) Walter R.J. Taylor; Giang Van Tran; Thai Quoc Nguyen; Duong Van Dang; Viet Khong Nguyen; Cap Trung Nguyen; Lam Tien Nguyen; Chinh Quoc Luong; Teresa Scott; Dang Thi Cam Thach; Tran Thi Ha Ninh; Thang Danh Nguyen; Khoung Thi Pham; Annette Fox; Peter Horby; Heiman Wertheim; Doan Hanh Nhan; Hong Ha Nguyen; Lien Minh Thi Trinh; Trung Vu Nguyen; Kinh Van Nguyen; Due Hien Nguyen; University of Oxford; National Institute for Infectious and Tropical Diseases; Bach Mai Hospital; National Institute of Veterinary Research; National Institute for Malariology; Nuffield Department of Clinical Medicine; King's College London; Mahidol University
    Trichinellosis outbreaks occur occasionally in Vietnam following the consumption of undercooked pork. Diagnosing trichinella can be problematic because fever and myalgia are nonspecific, and diagnosis may be delayed. We describe 5 Vietnamese patients in whom trichinellosis was diagnosed after several weeks of illness. © 2009 by the Infectious Diseases Society of America. All rights reserved.
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    CryptoDex: A randomised, double-blind, placebo-controlled phase III trial of adjunctive dexamethasone in HIV-infected adults with cryptococcal meningitis: Study protocol for a randomised control trial
    (2014-11-12) Jeremy Day; Darma Imran; Ahmed Rizal Ganiem; Natriana Tjahjani; Retno Wahyuningsih; Robiatul Adawiyah; David Dance; Mayfong Mayxay; Paul Newton; Rattanaphone Phetsouvanh; Sayaphet Rattanavong; Adrienne K. Chan; Robert Heyderman; Joep J. van Oosterhout; Wirongrong Chierakul; Nick Day; Anatoli Kamali; Freddie Kibengo; Eugene Ruzagira; Alastair Gray; David G. Lalloo; Justin Beardsley; Tran Quang Binh; Tran Thi Hong Chau; Nguyen Van Vinh Chau; Ngo Thi Kim Cuc; Jeremy Farrar; Tran Tinh Hien; Nguyen Van Kinh; Laura Merson; Lan Phuong; Loc Truong Tho; Pham Thanh Thuy; Guy Thwaites; Heiman Wertheim; Marcel Wolbers; Oxford University Clinical Research Unit; Cipto Mangunkusum Hospital; Hasan Sadikin Hospital; RSKO Drug Dependence Hospital; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU); University of Malawi College of Medicine; Mahidol University; MRC/UVRI Uganda Research Unit on AIDS; University of Oxford; Wellcome Trust; UCL; National Hospital for Tropical Diseases; Bach Mai Hospital; Cho Ray Hospital; Oxford University Clinical Research Unit; Indonesia Christian University; Universitas Indonesia; Dignitas International
    © 2014 Day et al. Background: Cryptococcal meningitis (CM) is a severe AIDS-defining illness with 90-day case mortality as high as 70% in sub-Saharan Africa, despite treatment. It is the leading cause of death in HIV patients in Asia and Africa. Method: A double-blind placebo-controlled trial with parallel arms in which patients are randomised to receive either dexamethasone or placebo, in addition to local standard of care. The study recruits patients in both Asia and Africa to ensure the relevance of its results to the populations in which the disease burden is highest. The 10-week mortality risk in the control group is expected to be between 30% and 50%, depending on location, and the target hazard ratio of 0.7 corresponds to absolute risk reductions in mortality from 30% to 22%, or from 50% to 38%. Assuming an overall 10-week mortality of at least 30% in our study population, recruitment of 824 patients will be sufficient to observe the expected number of deaths. Allowing for some loss to follow-up, the total sample size for this study is 880 patients. To generate robust evidence across both continents, we aim to recruit roughly similar numbers of patients from each continent. The primary end point is 10-week mortality. Ethical approval has been obtained from Oxford University's Tropical Research Ethics Committee (OxTREC), and as locally mandated at each site. Trial registration: International Standard Randomised Controlled Trial Number: ISRCTN59144167 26-July-2012.
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    Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use
    (2018-08-09) Poojan Shrestha; Ben S. Cooper; Joanna Coast; Raymond Oppong; Nga Do Thi Thuy; Tuangrat Phodha; Olivier Celhay; Philippe J. Guerin; Heiman Wertheim; Yoel Lubell; University of Oxford; University of Bristol; University of Birmingham; Mahidol University; Nuffield Department of Clinical Medicine; Radboudumc; National Hospital for Tropical Diseases; Oxford University Clinical Research Unit
    © 2018 The Author(s). Background: Antimicrobial resistance (AMR) poses a colossal threat to global health and incurs high economic costs to society. Economic evaluations of antimicrobials and interventions such as diagnostics and vaccines that affect their consumption rarely include the costs of AMR, resulting in sub-optimal policy recommendations. We estimate the economic cost of AMR per antibiotic consumed, stratified by drug class and national income level. Methods: The model is comprised of three components: correlation coefficients between human antibiotic consumption and subsequent resistance; the economic costs of AMR for five key pathogens; and consumption data for antibiotic classes driving resistance in these organisms. These were used to calculate the economic cost of AMR per antibiotic consumed for different drug classes, using data from Thailand and the United States (US) to represent low/middle and high-income countries. Results: The correlation coefficients between consumption of antibiotics that drive resistance in S. aureus, E. coli, K. pneumoniae, A. baumanii, and P. aeruginosa and resistance rates were 0.37, 0.27, 0.35, 0.45, and 0.52, respectively. The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins. Conclusion: The economic costs of AMR per antibiotic consumed were considerable, often exceeding their purchase cost. Differences between Thailand and the US were apparent, corresponding with variation in the overall burden of AMR and relative prevalence of different pathogens. Notwithstanding their limitations, use of these estimates in economic evaluations can make better-informed policy recommendations regarding interventions that affect antimicrobial consumption and those aimed specifically at reducing the burden of AMR.
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    Systematic Review and Consensus Guidelines for Environmental Sampling of Burkholderia pseudomallei
    (2013-01-01) Direk Limmathurotsakul; David A.B. Dance; Vanaporn Wuthiekanun; Mirjam Kaestli; Mark Mayo; Jeffrey Warner; David M. Wagner; Apichai Tuanyok; Heiman Wertheim; Tan Yoke Cheng; Chiranjay Mukhopadhyay; Savithiri Puthucheary; Nicholas P.J. Day; Ivo Steinmetz; Bart J. Currie; Sharon J. Peacock; Mahidol University; Mahosot Hospital; Nuffield Department of Clinical Medicine; Royal Darwin Hospital; James Cook University, Australia; Northern Arizona University; Oxford University Clinical Research Unit; DSO National Laboratories; Kasturba Medical College, Manipal; Duke-NUS Graduate Medical School Singapore; Ernst-Moritz-Arndt-Universitat Greifswald; University of Cambridge
    Background: Burkholderia pseudomallei, a Tier 1 Select Agent and the cause of melioidosis, is a Gram-negative bacillus present in the environment in many tropical countries. Defining the global pattern of B. pseudomallei distribution underpins efforts to prevent infection, and is dependent upon robust environmental sampling methodology. Our objective was to review the literature on the detection of environmental B. pseudomallei, update the risk map for melioidosis, and propose international consensus guidelines for soil sampling. Methods/Principal Findings: An international working party (Detection of Environmental Burkholderia pseudomallei Working Party (DEBWorP)) was formed during the VIth World Melioidosis Congress in 2010. PubMed (January 1912 to December 2011) was searched using the following MeSH terms: pseudomallei or melioidosis. Bibliographies were hand-searched for secondary references. The reported geographical distribution of B. pseudomallei in the environment was mapped and categorized as definite, probable, or possible. The methodology used for detecting environmental B. pseudomallei was extracted and collated. We found that global coverage was patchy, with a lack of studies in many areas where melioidosis is suspected to occur. The sampling strategies and bacterial identification methods used were highly variable, and not all were robust. We developed consensus guidelines with the goals of reducing the probability of false-negative results, and the provision of affordable and 'low-tech' methodology that is applicable in both developed and developing countries. Conclusions/Significance: The proposed consensus guidelines provide the basis for the development of an accurate and comprehensive global map of environmental B. pseudomallei. © 2013 Limmathurotsakul et al.
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    Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: A multinational multicenter prospective observational study
    (2018-02-14) Khie Chen Lie; Chuen Yen Lau; Nguyen Van Vinh Chau; T. Eoin West; Direk Limmathurotsakul; Pratiwi Sudarmono; Abu Tholib Aman; Mansyur Arif; Armaji Kamaludi Syarif; Herman Kosasih; Muhammad Karyana; Tawee Chotpitayasunondh; Warunee Punpanich Vandepitte; Adiratha Boonyasiri; Keswadee Lapphra; Kulkanya Chokephaibulkit; Pinyo Rattanaumpawan; Visanu Thamlikitkul; Achara Laongnualpanich; Prapit Teparrakkul; Pramot Srisamang; Phan Huu Phuc; Le Thanh Hai; Nguyen Van Kinh; Bui Duc Phu; Nguyen Thanh Hung; Tang Chi Thuong; Ha Manh Tuan; Lam Minh Yen; Nguyen Van Vinh Chau; Janjira Thaipadungpanit; Stuart Blacksell; Nicholas Day; Claire Ling; Guy Thwaites; Heiman Wertheim; Le Van Tan; Motiur Rahman; H. Rogier van Doorn; Sappasitthiprasong Hospital; Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia; University of Indonesia, RSUPN Dr. Cipto Mangunkusumo; UCL; National Institute of Allergy and Infectious Diseases; University of Washington, Seattle; Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University; Queen Sirikit National Institute of Child Health; Nuffield Department of Clinical Medicine; Oxford University Clinical Research Unit; Hue Central Hospital; National Hospital of Peadiatrics; Wahidin Soedirohusodo Hospital; Shoklo Malaria Research Unit; Children's Hospital 2; Children's Hospital 1; Sardjito Hospital; National Hospital of Tropical Diseases; Chiangrai Prachanukroh Hospital; Oxford University Clinical Research Unit
    © 2018 The Author(s). Background: Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia. Methods: We prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia (n=3), Thailand (n=3), and Vietnam (n=3). In patients with organ dysfunction (total SOFA score ≥2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ≥3 for an individual organ system. Results: From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ≥1500 mL fluid in 50% of patients with hypotension or lactate ≥4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p<0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs (p<0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62-0.74). Conclusions: Community-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality.
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    What is in the drug packet?: Access and use of non-prescribed poly-pharmaceutical packs (Yaa Chud) in the community in Thailand
    (2019-07-22) Malee Sunpuwan; Sureeporn Punpuing; Wipaporn Jaruruengpaisan; John Kinsman; Heiman Wertheim; Umeå Universitet; Mahidol University; Karolinska Institutet; Nuffield Department of Clinical Medicine; Radboud Center for Infectious Diseases; Oxford University Clinical Research Unit
    © 2019 The Author(s). Background: 'Yaa Chud' is a non-prescribed poly-pharmaceutical pack containing several types of drugs, including antibiotics and steroids, which can be purchased over the counter in Thailand for self-medication. Although it is illegal, it is still available at some community outlets. This study aimed to understand access to and use of Yaa Chud at the community level in order to raise awareness on its usage and to provide policy recommendations to address the problem. Methods: This study employed qualitative methods, including in-depth interviews with 18 drug suppliers and 16 community members, and six focus group discussions. It included inventories from 17 drug suppliers. Data were collected in selected communities of the Kanchanaburi Demographic Surveillance System, located in the western region of Thailand.Thematic analysis was based upon the Health Services Utilization Model and conducted using the Open Code qualitative software program. Results: Overcrowding, long waiting times, and a perceived unwelcoming environment at public health-care service outlets were identified as factors that drive people into the private sector, where loose regulation of drug laws facilitates access and use of Yaa Chud. Migrants and older people were most likely to seek and use Yaa Chud, especially for mild illness. Availability, easy access through a user's network, low cost, and perceived effectiveness were identified as factors that enable access and use of Yaa Chud. Conclusions: Though illegal in Thailand, Yaa Chud is likely to remain available for self-medication by community members, due to the persisting demand by the elderly and migrant workers. There is an urgent need to replace these mixed medications with better choices. Safer Yaa Chud may be a preferred, first-line health-care option, which could help reduce congestion in the formal health-care setting. At the same time, enforcement of regulatory compliance needs to be continued in order to stop the supply of unsafe Yaa Chud.