Papers by Abhinbhen Saraya
Open Forum Infectious Diseases, 2017
Background. In 2014, a global outbreak of Enterovirus D68 (EV-D68) caused severe respiratory dise... more Background. In 2014, a global outbreak of Enterovirus D68 (EV-D68) caused severe respiratory disease and was associated with an increase in acute flaccid myelitis (AFM) cases. Despite heightened surveillance, both EV-D68 detection and AFM reporting dropped in 2015. As AFM reporting increased in 2016, we sought to better understand AFM and EV-D68 epidemiology at our institution. Methods. Chart review of clinical presentation and workup was conducted on patients meeting the case definition for AFM for 2015-16. To determine EV-D68 prevalence at CHLA, samples positive for Rhinovirus/Enterovirus (RV/EV) by FilmArray ® Respiratory Panel (FA-RP) in September 2016 were screened for EV-D68 by RT-PCR. Results were compared with a research algorithm developed within the FilmArray ® Trend epidemiology software. After establishing accurate EV-D68 prediction, the algorithm was used on historic FA-RP assays to measure EV-D68 prevalence at CHLA in 2015 and 2016. Results. 7 patients with a median age of 3.3 years and no significant past medical history presented with AFM between July 15-October 15, 2016, while none were identified in 2015. All had acute onset patchy weakness involving mostly the upper limbs and grey matter involvement on MRI. 6/7 reported fever/upper respiratory infection prior to AFM onset. CSF from 7/7 was negative by FilmArray ® meningitis/encephalitis Panel and 2/7 were positive for EBV DNA. Further work up on CSF and blood were negative. 4/7 (57.1%) patients were RV/EV positive from respiratory samples and 3 were confirmed as EV-D68 by RT-PCR. IVIG was given in 7/7 cases. Patients were discharged after an average of 8.8 (4.8-13.6) days. The FilmArray Trend monitoring revealed that during the time of AFM presentation in 2016, 226/778 patients tested for respiratory viruses by the FA-RP were positive for RV/EV. Of those, 29.2% (66/226) were positive for EV-D68 compared with 0.02% (2/224) over the same period in 2015. Conclusion. As shown by CDC surveillance data, we saw a resurgence of AFM cases in 2016 compared with 2015. All 7 patients identified were previously healthy and had persistent weakness at discharge. Cases were accompanied by increases in circulating respiratory EV-D68. Further investigation of the correlation between EV-D68 resurgence and AFM is warranted.
Journal of Neurochemistry, May 17, 2023
Journal of the Neurological Sciences, Oct 1, 2017
were clearly detected in sera and CSF obtained during the acute phase, which disappeared in the r... more were clearly detected in sera and CSF obtained during the acute phase, which disappeared in the recovery phase in all cases. Conclusion: The present cases illustrated the importance of examining anti-Ngl antibodies in further subtypes of EMRN which mimicking CCPD.
Introduction: Increasing data demonstrate an association between gut microbiome in brain diseases... more Introduction: Increasing data demonstrate an association between gut microbiome in brain diseases via the gut-brain axis. However, few studies have evaluated the association between gut microbiome and large-artery atherosclerotic ischemic stroke patients.Method: A cross-sectional pilot study was conducted among 15 patients with large-artery atherosclerotic ischemic stroke and 15 asymptomatic persons. Large-artery atherosclerotic stroke were diagnosed using TOAST classification. The control group was selected based on age- and sex-match with the patient group. Participants provided a stool sample profiled by 16S- ribosomal gene-specific methods Next-generation sequencing. The Mann-Whitney U test was used to compare the differences in gut microbiota profile between stroke and control groups. Alpha (Shannon diversity index) and beta diversity (Bray-Curtis dissimilarity) were used to evaluate gut microbial diversity. Generalized linear mixed effects models were used to relate gut microb...
Supplemental material, sj-docx-1-smo-10.1177_2050312121989631 for Detection of influenza virus in... more Supplemental material, sj-docx-1-smo-10.1177_2050312121989631 for Detection of influenza virus in rectal swabs of patients admitted in hospital for febrile illnesses in Thailand by Artit Sangkakam, Pasin Hemachudha, Abhinbhen W Saraya, Benjamard Thaweethee-Sukjai, Thaniwan Cheun-Arom, Alice Latinne, Kevin J Olival and Supaporn Wacharapluesadee in SAGE Open Medicine
BMC Neurology, 2019
Background The incidence of autoimmune encephalitis has risen globally. There are two general cat... more Background The incidence of autoimmune encephalitis has risen globally. There are two general categories of disease-associated antibodies that can be tested for: neuronal surface and intracellular. However, testing both groups of autoantibodies are costly. This study aims to identify differences between groups by comparing clinical presentations, radiological findings and CSF profile of patients, and determine if any parameters are indicative of one group of autoantibodies over another. Additionally, we aim to report the local incidence of less common groups of disease-associated antibodies as well. Methods Seventy-seven records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Results Of 77 patients, 40% presented with neuronal surface antibodies and ...
Vaccine, 2010
Plasma from 10 patients who had received rabies vaccine either intradermally (ID) or intramuscula... more Plasma from 10 patients who had received rabies vaccine either intradermally (ID) or intramuscularly (IM) was examined for 20 chemo-and cytokines. Plasma samples were withdrawn on days 0, 3 and 7 after vaccination. These chemo-and cytokines and sampling days were chosen based on data collected from a protein array analysis of 122 cytokines conducted on one recipient of vaccine administered IM and one recipient of vaccine administered ID. Although eotaxin, interleukin (IL)-5 in the ID and IL-1 beta in the IM group were the only chemo-and cytokines that reached statistical significance (p < 0.05), the overall trends may suggest bias on Th1 or Th2 according to vaccination routes. IL-1 alpha,-2, and-6, hemofiltrate cysteine-cysteine chemokine (HCC-4), glucocorticoid induced tumor necrosis factor receptor (GITR), tumor necrosis factor (TNF) related apoptosis inducing ligand-receptor (TRAIL-R3) had some degree of elevation in the ID group. TNF-alpha, gamma-interferon, granulocytes/macrophages-colony stimulating factor (GM-CSF), transforming growth factor (TGF)-beta, lymphotactin and pulmonary and activation-regulated chemokine (PARC) were elevated, although not to a significant level, in the IM group. IL-12, interferon-inducible T cell alpha chemoattractrant (I-TAC) and sertoli cell factor (SCF) were not significantly elevated in both groups whereas IL-4 and-10 were unchanged. Further studies are required to determine whether the presence of specific chemokines, such as eotaxin, is responsible for the production of high levels of rabies virus neutralizing antibody after administration of the dose-sparing ID regimen.
Supplemental material, sj-png-2-smo-10.1177_2050312121989631 for Detection of influenza virus in ... more Supplemental material, sj-png-2-smo-10.1177_2050312121989631 for Detection of influenza virus in rectal swabs of patients admitted in hospital for febrile illnesses in Thailand by Artit Sangkakam, Pasin Hemachudha, Abhinbhen W Saraya, Benjamard Thaweethee-Sukjai, Thaniwan Cheun-Arom, Alice Latinne, Kevin J Olival and Supaporn Wacharapluesadee in SAGE Open Medicine
Background: Data on encephalitis in Thailand have not been completely described. Etiologies remai... more Background: Data on encephalitis in Thailand have not been completely described. Etiologies remain largely unknown. We prospectively analyzed 103 Thai patients from 27 provinces for the causes of encephalitis using clinical, microbiological and neuroimaging indices; caseswithout a diagnosis were evaluated for autoimmune causes of encephalitis. Methods: Patients with encephalitis and/or myelitis were prospectively studied between October 2010 and August 2012. Cases associated with bacterial, rickettsial and mycobacterial diseases were excluded. Herpes viruses 1-6 and enteroviruses infection was diagnosed using PCR evaluation of CSF; dengue and JE viruses infection, by serology. The serum of test-negative patients was evaluated for the presence of autoantibodies. Results: 103 patients were recruited. Fifty-three patients (52%) had no etiologies identified. Twenty-five patients (24%) were associated with infections. Immune encephalitis was found in 25 (24%); neuropsychiatric lupus eryt...
Background: Nipah virus (NiV) infection causes encephalitis and has > 75% mortality rate, maki... more Background: Nipah virus (NiV) infection causes encephalitis and has > 75% mortality rate, making it a WHO priority pathogen due to its pandemic potential. There have been NiV outbreak(s) in Malaysia, India, Bangladesh, and southern Philippines. NiV naturally circulates among fruit bats of the genus Pteropus and has been detected widely across Southeast and South Asia. Both Malaysian and Bangladeshi NiV strains have been found in fruit bats in Thailand. This study summarizes 20 years of pre-emptive One Health surveillance of NiV in Thailand, including triangulated surveillance of bats, and humans and pigs in the vicinity of roosts inhabited by NiV-infected bats. Methods: Samples were collected periodically and tested for NiV from bats, pigs and healthy human volunteers from Wat Luang village, Chonburi province, home to the biggest P. lylei roosts in Thailand, and other provinces since 2001. Archived cerebrospinal fluid specimens from encephalitis patients between 2001 and 2012 wer...
Tropical Medicine and Infectious Disease, 2021
From 2013 to 2018, the Thai Red Cross Emerging Infectious Disease–Health Science Center (TRC-EID-... more From 2013 to 2018, the Thai Red Cross Emerging Infectious Disease–Health Science Center (TRC-EID-HS), in collaboration with the Department of Disease Control (DDC) and the Ministry of Public Health (MOPH) Thailand, conducted encephalitis surveillance. A total of 1700 cerebrospinal fluid (CSF) samples from patients with encephalitis were tested by a predesigned multiplex PCR. Diagnosis was made in 318 cases (18.7%), 86 (27%) of which were caused by Epstein–Barr virus (EBV), 55 (17.3%) by enteroviruses (EV), 36 (11.3%) by varicella–zoster virus (VZV), 31 (9.7%) by cytomegalovirus (CMV), 25 (7.8%) by herpes simplex virus type 1 (HSV-1), and 20 (6.3%) by human herpesvirus 6 (HHV-6). Results were compared with 3099 CSF samples from patients with encephalitis collected between 2002 to 2012, which were tested by specific PCR assays. Diagnosis was made in 337 (10.9%) of these cases, and 91 (27%) were CMV, 79 (23.4%) were VZV, 72 (21.4%) were EBV, 39 (11.6%) were EVs, 39 (11.6%) were HSV-1, ...
Author’s response to reviews: Dear BMC Neurology Editors, Please consider our second-revised manu... more Author’s response to reviews: Dear BMC Neurology Editors, Please consider our second-revised manuscript, “Differences and diversity of autoimmunemediated encephalitis in 77 cases from a single tertiary care center” for publication in BMC Neurology. We appreciate the interest that the editors and reviewers have shown in our manuscript and the constructive criticism they have given. We have addressed the concerns of the reviewers. More specifically, we have rewritten some section and included a point-by-point response to the reviewers. Changes to the text and footnotes of the tables in the manuscript are marked in red. We are grateful for the valuable comments and hope that this revised version will be suitable for publication at BMC Neurology. Thank you again for your kind consideration.
Background: Nipah virus (NiV) infection causes encephalitis and has > 75% mortality rate, maki... more Background: Nipah virus (NiV) infection causes encephalitis and has > 75% mortality rate, making it a WHO priority pathogen due to its pandemic potential. There have been NiV outbreak(s) in Malaysia, India, Bangladesh, and southern Philippines. NiV naturally circulates among fruit bats of the genus Pteropus and has been detected widely across Southeast and South Asia. Both Malaysian and Bangladeshi NiV strains have been found in fruit bats in Thailand. This study summarizes 20 years of pre-emptive One Health surveillance of NiV in Thailand, including triangulated surveillance of bats, and humans and pigs in the vicinity of roosts inhabited by NiV-infected bats. Methods: Samples were collected periodically and tested for NiV from bats, pigs and healthy human volunteers from Wat Luang village, Chonburi province, home to the biggest P. lylei roosts in Thailand, and other provinces since 2001. Archived cerebrospinal fluid specimens from encephalitis patients between 2001 and 2012 wer...
SAGE Open Medicine, 2021
Introduction: Influenza virus favours the respiratory tract as its primary site of host entry and... more Introduction: Influenza virus favours the respiratory tract as its primary site of host entry and replication, and it is transmitted mainly via respiratory secretions. Nasopharyngeal swab is the gold standard specimen type for influenza detection, but several studies have also suggested that the virus replicates in the human gastrointestinal tract. Methods: A retrospective study was conducted on all patients positive for influenza virus and initially recruited as part of the PREDICT project from 2017 to 2018. The objectives of the study were to investigate whether rectal swab could aid in improving influenza detection, and if there was any correlation between gastrointestinal disturbances and severity of infection, using length of hospital stay as an indicator of severity. Results: Of the 51 influenza-positive patients, 12 had detectable influenza virus in their rectal swab. Among these 12 rectal swab positive patients, influenza virus was not detected in the nasopharyngeal swab of ...
Background Since the discovery of N-methyl-D-aspartate receptor (NMDAr) antibody in 2007, the inc... more Background Since the discovery of N-methyl-D-aspartate receptor (NMDAr) antibody in 2007, the incidence of autoantibody-mediated encephalitis has risen globally. Here we analyzed and compared groups of autoantibody-associated encephalitis patients based on clinical findings and laboratory results in order to find differences between two major groups of autoantibody-mediated encephalitis: intracellular and neuronal surface antibodies. Methods 77 records of autoimmune encephalitis/encephalomyelitis patients admitted to King Chulalongkorn Memorial Hospital (KCMH) between October 2010 and February 2017 were reviewed. Patients with infections or those with classic central nervous system demyelinating features were excluded. Categorical data was analyzed using chi-square and Fisher’s exact test. Unpaired, two-tailed t-test was performed to analyze numerical data. Results Of 77 patients, 40% presented with neuronal surface antibodies and 33% had intracellular antibodies. The most common au...
International Journal of Infectious Diseases, 2012
International Journal of Infectious Diseases, 2012
Background: Herpes simplex virus (HSV) infection can involve central and peripheral nervous syste... more Background: Herpes simplex virus (HSV) infection can involve central and peripheral nervous system. Absence of CSF pleocytosis has been described which can lure physicians to look for noninfectious causes. The objective was to determine the extent to which normal CSF cells could be found in neurological infection associated with HSV. Methods: We studied patients with HSV associated neurological infections whose diagnosis was confirmed by PCR, admitted to King Chulalongkorn Memorial Hospital between January 2002 and October 2010. Results: Among 109 patients with neurological infections, HSV was found in 34 (31%). Among 29, where we had complete records, 16 had encephalitis, 8 had meningitis, 2 myelitis, 2 myeloradiculitis and 1 presented with radiculitis. Twenty-eight patients had CSF collected at initial and subsequent visits. Four patients with encephalitis, 2 myeloradiculitis, 1 myelitis and 1 radiculitis had no elevated CSF cells. Four had normal CSF protein levels. Seven among 8 had CSF examinations within 10 days after onset of illness (average of 3 days). Three of 4 patients with HIV infection had low CD4 counts (<200cells). One of these had WBC of 3,150cells. CSF white cell counts remained normal in 5 of 6 who had repeated lumbar punctures. Among the CSF pleocytosis group of 20 and a cell range of 6-730 CSF cells (mean 105), none had HIV infection. This group was composed of 11 encephalitis, 8 meningitis, 1 myelitis cases. Three in the normo-cellular CSF group had unremarkable CT brains (2 with HIV) and 3 had abnormal MRIs (1 brain and 2 spinal cords) (1 with HIV). One CT brain and 2 MRI brains in the pleocytosis group were normal (MRI brains were abnormal in 10 and CT brains in 2). Six of 8 in the normo-cellular and 9 of 20 in the pleocytosis groups could resume daily life activities after recovery. Two in the pleocytosis group completely recovered and 2 died. Conclusion: Normal CSF cell counts in HSV infection of the nervous system is not uncommon and can be seen in normal as well as HIV infected patients. Clinicians should not exclude infection especially with HSV based on absence of CSF pleocytosis.
Asian Biomedicine
Background: Ciguatera intoxication is a form of food poisoning. It is caused by the consumption o... more Background: Ciguatera intoxication is a form of food poisoning. It is caused by the consumption of certain warm-water fish that have accumulated ciguatera toxin (CTX) through the marine food chain. Ciguatera fish poisoning (CFP) is a global disease, which although common, has been largely ignored in Thailand. This may be attributed to lack of confirmatory tests and seemingly nonspecific clinical presentations.Objective: We studied CTX contamination in marine fish sold at Bangkok markets.Methods: A surveillance of CTX in fish using the Cigua-Check assay has been conducted in Bangkok, the center of seafood marketing in Thailand. Here, there are several types of fish. Some come from domestic fishing and others are imported from Indonesia, Myanmar, or India.Results: A random survey at three fish markets in Bangkok revealed two samples possibly contaminated with ciguatera toxin from a total 227 fish samples (of 21 fish species). This is the first report of finding CTX contamination in fi...
Clinical Medicine Insights: Case Reports, 2016
In 2014, two unusual peaks of H1N1 influenza outbreak occurred in Nakhon Ratchasima Province, in ... more In 2014, two unusual peaks of H1N1 influenza outbreak occurred in Nakhon Ratchasima Province, in Thailand. Among 2,406 cases, one of the 22 deaths in the province included a 6-year-old boy, who initially presented with acute necrotizing encephalopathy. On the other hand, his sibling was mildly affected by the same influenza virus strain, confirmed by whole-genome sequencing, with one silent mutation. Absence of acute necrotizing encephalopathy and other neurological illnesses in the family and the whole province, with near identical whole viral genomic sequences from the two siblings, and an absence of concomitant severe lung infection (cytokine storm) at onset suggest nonpermissive infection as an alternative pathogenetic mechanism of influenza virus.
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Papers by Abhinbhen Saraya