Here, we report, to our knowledge, the largest case study of human pythiosis. The disease has high rates of morbidity and mortality. Early diagnosis and effective treatment are urgently needed to improve clinical outcomes. Because P. insidiosum is distributed worldwide and can infect healthy individuals, an awareness of human pythiosis should be promoted in Thailand and in other countries.

SMTs in patients with AIDS typically arise in multiple and very unusual sites that are not often observed in SMTs among immunocompetent individuals. Our series also suggests association between EBV infection and SMTs in patients with AIDS. The exact role of EBV in smooth-muscle oncogenesis awaits further study.

Immune defects in interleukin-12-dependent interferon-gamma (IFN-γ) pathways are associated with disseminated infections caused by non-tuberculous mycobacteria (NTM) and Salmonella. Recently, there have been an increasing number of reports of acquired autoantibodies to IFN-γ in adults, especially in Asian patients. We describe here three human immunodeficiency virus-negative Thai adults who had persistent or recurrent disseminated infections caused by NTM, Salmonella, and other opportunistic pathogens, possibly due to anti-IFN-γ autoantibodies. The antibodies were shown to exhibit very high inhibitory activity to IFN-γ. Two patients also developed Sweet's syndrome during the course of infections. In addition, we also review all previous reports of patients with anti-IFN-γ antibodies who were susceptible to NTM and Salmonella infections.

The outcomes of kidney transplantation (KT) from hepatitis B surface antigen-positive [HBsAg(þ)] donors to HBsAg(À) recipients remain inconclusive, possibly due to substantial differences in methodological and statistical models, number of patients, follow-up duration, hepatitis B virus (HBV) prophylactic regimens and hepatitis B surface antibody (anti-HBs) levels. The present retrospective, longitudinal study (clinicaltrial. gov NCT02044588) using propensity score matching technique was conducted to compare outcomes of KT between HBsAg(À) recipients with anti-HBs titer above 100 mIU/mL undergoing KT from HBsAg(þ) donors (n ¼ 43) and HBsAg(À) donors (n ¼ 86). During the median follow-up duration of 58.2 months (range 16.7-158.3 months), there were no significant differences in graft and patient survivals. No HBV-infective markers, including HBsAg, hepatitis B core antibody, hepatitis B extracellular antigen and HBV DNA quantitative test were detected in HBsAg(þ) donor group. Renal pathology outcomes revealed comparable incidences of kidney allograft rejection while there were no incidences of HBV-associated glomerulonephritis and viral antigen staining. Recipients undergoing KT from HBsAg(þ) donors with no HBV prophylaxis (n ¼ 20) provided comparable outcomes with those treated with lamivudine alone (n ¼ 21) or lamivudine in combination with HBV immunoglobulin (n ¼ 2). In conclusion, KT without HBV prophylaxis from HBsAg(þ) donors without hepatitis B viremia to HBsAg(À) recipients with anti-HBs titer above 100 mIU/mL provides excellent graft and patient survivals without evidence of HBV transmission.

Abstract. We report a case of visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected 37-year-old Thai fisherman who presented with nephritonephrotic syndrome, fever, anemia, and thrombocytopenia. Bone marrow biopsy revealed many amastigotes within macrophages. Kidney biopsy showed membranoproliferative glomerulonephritis. Polymerase chain reaction (PCR) and nucleotide sequence analysis of the internal transcribed spacer 1 of the small subunit ribosomal RNA gene in blood and kidney biopsy specimens showed Leishmania species previously described in a Thai patient with visceral leishmaniasis. Only four autochthonous cases of leishmaniasis have been reported in Thailand since 1996. To the best of our knowledge, this is the first report of autochthonous visceral leishmaniasis in an HIV-infected Thai. With an increasing number of patients with autochthonous leishmaniasis in association with the presence of potential vector, it remains to be determined whether this vector-borne disease will become an emerging infectious disease in Thailand.Leishmaniasis is a vector-borne infection caused by an obligate intracellular protozoon, Leishmania sp., which is transmitted by phlebotomine sandflies.1-3 It occurs worldwide in tropical and subtropical regions including the Middle East, India, China, Africa, and southern and central America. Thailand is not a known endemic area for leishmaniasis. Most imported cases were reported between 1960 and 1986 in Thai workers returning from the Middle East. 4,5 The first reported indigenous patient with leishmaniasis was a 3-year-old girl living at Suratthani Province of southern Thailand in 1996.6 Several autochthonous cases with leishmaniasis were recently seen in northern, central, and southern Thailand.7-9 Interestingly, these patients were from provinces where a potential sandfly vector has never been reported. [10][11][12] We describe the first report of visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected patient and review all previous reports of autochthonous cases of leishmaniasis in Thailand. CASE REPORTA 37-year-old Thai fisherman with known HIV infection presented with progressive leg edema, ascites, and low-grade fever of 8 weeks duration. Seven weeks prior to admission (PTA), he was hospitalized at Chantaburi Provincial Hospital with a diagnosis of nephritonephrotic syndrome (hypertension, edema, heavy proteinuria, microscopic hematuria, azotemia, hypoalbuminemia, and hypercholesterolemia). He was treated with prednisolone 50 mg/day. Two weeks PTA, he had not improved and developed thrombocytopenia (platelet count of 85,000/µL) and anemia (hematocrit decreased from 29% to 23.4%). Bone marrow aspiration and biopsy were performed and revealed decreased cellularity and many "yeast-like" organisms 1-2 µM in size. Fungal cultures of both specimens did not grow any fungi. He was then transferred to King Chulalonkorn Memorial Hospital in Bangkok for further evaluation. The patient was born at Chantaburi, eastern Thailand. He had never been outside...