Publication:
Agranulocytosis in Bangkok, Thailand: A predominantly drug-induced disease with an unusually low incidence

Issued Date

1999-04-01

Resource Type

Article

ISSN

00029637

Other identifier(s)

2-s2.0-0032933767

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

American Journal of Tropical Medicine and Hygiene. Vol.60, No.4 (1999), 573-577

Suggested Citation

Samuel Shapiro, Surapol Issaragrisil, David W. Kaufman, Theresa Anderson, Kanchana Chansung, Tharatorn Thamprasit, Jittima Sirijirachai, Anong Piankijagum, Yaowarat Porapakkham, Sathit Vannasaeng, Paul E. Leaverton, Neal S. Young, S. Sompradeekul, T. Vuthivatanakul, C. Sriratanasatavorn, C. Yamcharoen, P. Laewsiri, S. Kittimongcolporn, K. Tepmongcol, R. Wongkongdej, R. Vejjapinand, V. Kiatvirakul, K. Kareng, V. Suvatte, T. Intaragumthornchai, S. Chancharunee, V. Prayoonwiwat, P. Seksan, A. Chuansumrit, V. Chinarat, S. Angkuravorakul, V. Atichartkarn, S. Chutipong, S. Fucharoen, P. Hathirat, P. Isarankura, A. Jetsrisuparb, S. Jootar, N. Kiatkachorntada, S. Kitkornpan, S. Laohavinij, V. Laosombat, A. Lekhakul, C. Mahasandana, V. Makornkaewkayoon, P. Nitiyanont, P. Pootrakul, K. Singhapan, N. Siritanaratanakul, D. Sonakul, T. Srichaikul, T. Sripaisal, P. Sucharitchan, S. Sukpanichnand, S. Y. Sukpanichnand, P. Supradit, N. Suwanwela, V. S. Tanphaichitr, C. Tantechanurak, K. Tanyavudh, S. Vatanavicharn, S. Visudhiphan, W. Wanachiwanawin, P. Watananukul Agranulocytosis in Bangkok, Thailand: A predominantly drug-induced disease with an unusually low incidence. American Journal of Tropical Medicine and Hygiene. Vol.60, No.4 (1999), 573-577. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/25446

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Title

Agranulocytosis in Bangkok, Thailand: A predominantly drug-induced disease with an unusually low incidence

Author(s)

Samuel Shapiro
 Surapol Issaragrisil
 David W. Kaufman
 Theresa Anderson
 Kanchana Chansung
 Tharatorn Thamprasit
 Jittima Sirijirachai
 Anong Piankijagum
 Yaowarat Porapakkham
 Sathit Vannasaeng
 Paul E. Leaverton
 Neal S. Young
 S. Sompradeekul
 T. Vuthivatanakul
 C. Sriratanasatavorn
 C. Yamcharoen
 P. Laewsiri
 S. Kittimongcolporn
 K. Tepmongcol
 R. Wongkongdej
 R. Vejjapinand
 V. Kiatvirakul
 K. Kareng
 V. Suvatte
 T. Intaragumthornchai
 S. Chancharunee
 V. Prayoonwiwat
 P. Seksan
 A. Chuansumrit
 V. Chinarat
 S. Angkuravorakul
 V. Atichartkarn
 S. Chutipong
 S. Fucharoen
 P. Hathirat
 P. Isarankura
 A. Jetsrisuparb
 S. Jootar
 N. Kiatkachorntada
 S. Kitkornpan
 S. Laohavinij
 V. Laosombat
 A. Lekhakul
 C. Mahasandana
 V. Makornkaewkayoon
 P. Nitiyanont
 P. Pootrakul
 K. Singhapan
 N. Siritanaratanakul
 D. Sonakul
 T. Srichaikul
 T. Sripaisal
 P. Sucharitchan
 S. Sukpanichnand
 S. Y. Sukpanichnand
 P. Supradit
 N. Suwanwela
 V. S. Tanphaichitr
 C. Tantechanurak
 K. Tanyavudh
 S. Vatanavicharn
 S. Visudhiphan
 W. Wanachiwanawin
 P. Watananukul

Other Contributor(s)

Boston University - Slone Epidemiology Unit
 Mahidol University
 Khon Kaen University
 Prince of Songkla University
 University of South Florida, Tampa
 National Heart, Lung, and Blood Institute
 Faculty of Medicine, Siriraj Hospital, Mahidol University

Abstract

Agranulocytosis, a syndrome characterized by a marked reduction in circulating granulocytes, is strongly associated with medical drug use in Europe and the United States. Unregulated use of common pharmaceutical agents in developing countries has been suspected of causing large numbers of cases of agranulocytosis and deaths, especially among children. To elucidate the incidence and etiology of agranulocytosis in Thailand, a population-based case-control study of symptomatic agranulocytosis that resulted in hospital admission was conducted in Bangkok from 1990 to 1994. An attempt was also made to study the disease in Khonkaen (in northeastern Thailand) and Songkla (in southern Thailand), but there were insufficient cases in the latter regions, and the analysis was confined to subjects from Bangkok. In that region, the overall incidence of agranulocytosis was 0.8 per million per year; there were no deaths. As expected, the incidence was higher in females (0.9 per million), and it increased with age (4.3 per million beyond age 60). Among 25 cases and 529 controls the relative risk estimate for a combined category of all suspect drugs was 9.2 (95% confidence interval = 3.9-21), and the proportion of cases that could be attributed to drug use was 68%. For individual drugs and drug classes the data were sparse; within these limitations, the strongest association appeared to be with antithyroid drugs. One case and three controls were exposed to dipyrone, a drug known to cause agranulocytosis; with such scanty data the risk could not be evaluated. Exposure to pesticides or solvents was not associated with an increased risk. This is the first formal epidemiologic study of agranulocytosis in a developing country. As in the West, most cases are attributable to medical drug use. However, the incidence of agranulocytosis in Bangkok, and apparently, in Thailand as a whole, is unusually low, and the disease does not pose a public health risk.

Keyword(s)

Immunology and Microbiology
 Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/25446

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Scopus 1991-2000