The Rhesus (Rh) blood group is the most polymorphic human blood group and it is clinically significant in transfusion medicine. Especially, D antigen is the most important and highly immunogenic antigen. Due to anti-D, it is the cause of the hemolytic disease of the newborn and transfusion reaction. About 0.1%–0.5% of Asian people are RhD-negative, whereas in the Thai population, the RhD-negative blood type only occurs in 0.3%. Approximately 10%–30% of RhD-negative in Eastern Asian people actually were D-elute (DEL) phenotype, the very weak D antigen that cannot be detected by indirect antiglobulin test (IAT). There are many reports about anti-D immunization in RhD-negative recipients through the transfusion of red blood cells from individuals with DEL phenotype. D-elute phenotype screening in Thai RhD-negative blood donors was studied to distinguish true RhD-negative from DEL phenotype. A total of 254 Thai serologically RhD-negative blood donors were tested for RhCE phenotypes and anti-D adsorption/elution test. In addition, RhC(+) samples were tested for RHD 1227A allele by SSP-PCR technique. The RhD-negative phenotype samples consisted of 131 ccee, 4 ccEe, 1 ccEE, 101 Ccee, 16 CCee, and 1 CcEe. The 42 Ccee and 8 CCee phenotype samples were typed as DEL phenotype and 96% of DEL samples were positive for RHD 1227A allele. The incidence of RhC(+) was 46.4%, and 48 of the 118 RhC(+) samples were positive for both anti-D adsorption/elution test and SSP-PCR technique for RHD 1227A allele. The sensitivity and specificity were 96% and 100%, respectively, for RHD 1227A detection as compared with the adsorption/elution test. In conclusion, RhC(+) phenotype can combine with anti-D adsorption/elution test and RHD 1227A allele SSP-PCR technique for distinguishing true RhD-negative from DEL phenotype.

Background: Subtype A is a major strain in the HIV-1 pandemic in eastern Europe, central Asia and in certain regions of east Africa, notably in rural Kenya. While considerable effort has been focused upon mapping and defining immunodominant CTL epitopes in HIV-1 subtype B and subtype C infections, few epitope mapping studies have focused upon subtype A.

HIV-1 strains containing subsubtype A2 are relatively rare in the pandemic but have been repeatedly identified in Kenya, where candidate vaccines based in part on subtype A, but not A2 strains, may be evaluated. Among the most recent is CRF16_A2D, a circulating recombinant form (CRF) whose prototypes are complete or partial HIV-1 sequences from Kenya, Korea, and Argentina. Using samples from blood bank discards in Kenya and complete genome sequencing, this report further documents CRF16_A2D and related recombinants and identifies a second CRF, CRF21_A2D. The two A2-containing CRFs, and two recombinants related to CRF16_A2D, share common structural elements but appear to have been independently derived. Concerted selection may have influenced the emergence and spread of certain A2-containing strains in Kenya. The second complete subtype C sequence from Kenya is also reported here. Monitoring of A2-containing recombinants and subtype C strains, both relatively rare in Kenya, may be informative in the course of cohort development and evaluation of candidate vaccines.

Background: Candidemia is a major cause of morbidity and mortality which can be treated using antifungal agents, triazoles and echinocandins. Objectives: We aimed to determine Candida species and their sensitivities to triazoles (fluconazole, itraconazole, voriconazole, and posaconazole) and echinocandins (caspofungin, micafungin, and anidulafungin) among patients with candidiasis to guide future treatment of patients with candidemia or invasive candidiasis. Methods: All firstly isolated Candida spp. from patients admitted at Phramongkutklao Hospital, Bangkok, Thailand from January 2012 to December 2013 were included in this study. The antifungal susceptibility testing of Candida spp. isolates was assessed based on micro-dilution method. Results: During the 24-month study period, a total of 66 Candida isolates from 66 patients were identified. Of the 66 isolates, 35 (53%) were C. albicans, 18 (27.3%) were C. tropicalis, 10 (15.2%) were C. glabrata and 3 (4.5%) were C. parapsilosis. Fluconazole resistant Candida isolates were found in C. glabrata (100%), C. albicans (14.3%), C. tropicalis (22.2%) and C. parapsilosis (66.7%). Most Candida spp. isolates were mainly susceptible to echinocandins (>90%). Notably, 10%-20% of C. glabrata isolates showed resistance to echinocandins. Conclusion: Fluconazole, an empirical therapy, has been cautiously used due to resistant non-albicans Candida species especially, C. glabrata, C. tropicalis and C. parapsilosis. However, the emerging echinocandins resistant C. glabrata isolates need to be closely monitored.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a group of S. aureus strains containing the SCCmec gene causing beta-lactam antibiotic resistance. MRSA is common in healthcare settings and can cause serious problems. Objective: The study aimed to investigate the prevalence of MRSA nasal colonization among privates of the Medical Private Company, Phramongkutklao Hospital, including antibiotic susceptibility pattern of S. aureus isolates and risk factors of S. aureus nasal carriage. Methods: Nasal swabs were obtained from the anterior nares of 170 privates. Staphylococcal isolates were identified using a catalase test, tube coagulase test and matrix-assisted laser desorption/ ionization time of flight mass spectrometry (MALDI-TOF MS). MRSA detection was screened using cefoxitin disk diffusion and confirmed using the mecA gene detection and SCCmec typing. Antibiotic susceptibility patterns of S. aureus were examined using the disk diffusion method. A questionnaire was collected from the subjects to determine risk factors for S. aureus nasal carriage. Results: Of 170 subjects, 157 (92.35%) revealed staphylococcal positive, yielding 161 staphylococcal isolates. The prevalence of MRSA, methicillin-resistant Staphylococcus epidermidis (MRSE), and methicillin-susceptible Staphylococcus aureus (MSSA) nasal carriage was 0.59, 1.18 and 8.82%, respectively. The MRSA isolate carried mecA revealing SCCmec type II. The MSSA isolates indicated low resistance to tetracycline (13.3%), whereas the MRSA isolate resisted ciprofloxacin, clindamycin, erythromycin, gentamicin, oxacillin and tetracycline. Using multiple logistic regression analysis, a significant risk factor for S. aureus nasal carriage was utensil sharing (adjusted odds ratio=4.41; 95% CI=1.33-14.61). Conclusion: Healthcare-associated MRSA existed among privates of the Medical Private Company. An associated risk factor for acquiring S. aureus was utensil sharing which could be used to help improve prevention and control management among privates.