Research Topics
| Direk LimmathurotsakulSummaryAffiliation: Mahidol University Country: Thailand Publications
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Detail Information
Publications
Rapid immunofluorescence microscopy for diagnosis of melioidosisVanaporn Wuthiekanun
Faculty of Tropical Medicine, Wellcome Trust Oxford University Mahidol University Tropical Medicine Research Program, Bangkok, Thailand
Clin Diagn Lab Immunol 12:555-6. 2005..The sensitivities of both IF tests were 66%, and the specificities were 99.5 and 99.4%, respectively...- Activities of daily living associated with acquisition of melioidosis in northeast Thailand: a matched case-control studyDirek Limmathurotsakul
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS Negl Trop Dis 7:e2072. 2013..The aim of this study was to provide evidence for inoculation, inhalation and ingestion as routes of infection, and develop preventive guidelines based on this evidence... - Fool's gold: Why imperfect reference tests are undermining the evaluation of novel diagnostics: a reevaluation of 5 diagnostic tests for leptospirosisDirek Limmathurotsakul
Department of Tropical Hygiene, Faculty of Tropical Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Clin Infect Dis 55:322-31. 2012..We hypothesized that our reference standard was imperfect and used statistical modeling to investigate this hypothesis... - Melioidosis in animals, Thailand, 2006-2010Direk Limmathurotsakul
Mahidol University, Bangkok, Thailand
Emerg Infect Dis 18:325-7. 2012..The highest incidence was in goats (1.63/100,000/year), followed by incidence in pigs and cattle. The estimated incidence of melioidosis in humans in a given region paralleled that of melioidosis in goats... 
Variable presentation of neurological melioidosis in Northeast ThailandDirek Limmathurotsakul
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Am J Trop Med Hyg 77:118-20. 2007..The appropriate duration and choice of parenteral and oral antimicrobial therapy for neurologic melioidosis are also discussed...- Burkholderia pseudomallei is spatially distributed in soil in northeast ThailandDirek Limmathurotsakul
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS Negl Trop Dis 4:e694. 2010..The aim of this study was to evaluate spatial distribution of B. pseudomallei in soil and consider the implications of this for soil sampling strategies... - Defining the true sensitivity of culture for the diagnosis of melioidosis using Bayesian latent class modelsDirek Limmathurotsakul
Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand
PLoS ONE 5:e12485. 2010.... - Risk factors for recurrent melioidosis in northeast ThailandDirek Limmathurotsakul
Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
Clin Infect Dis 43:979-86. 2006..A recent study revealed that 25% of patients with recurrence had reinfection rather than a relapse resulting from a failure to cure. The aim of this study was to reevaluate these 2 patient groups to define their individual risk factors... - Enzyme-linked immunosorbent assay for the diagnosis of melioidosis: better than we thoughtDirek Limmathurotsakul
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Clin Infect Dis 52:1024-8. 2011..The new cutoff was unbiased towards misclassification caused by an imperfect gold standard and resulted in an increase in both sensitivity (from 66.4% to 80.2%) and specificity (82.1% and 95.0%)... - Effectiveness of a simplified method for isolation of Burkholderia pseudomallei from soilDirek Limmathurotsakul
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Appl Environ Microbiol 78:876-7. 2012..We describe a simple method for detecting B. pseudomallei using direct culture of soil in enrichment broth. This gives a rate of positivity comparable to that obtained with a standard method but is cheaper and labor saving... - Repeat blood culture positive for B. pseudomallei indicates an increased risk of death from melioidosisDirek Limmathurotsakul
Department of Tropical Hygiene, Department of Microbiology and Immunology and Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420 6 Rajvithee Road, Bangkok, Thailand
Am J Trop Med Hyg 84:858-61. 2011..However, repeat cultures of respiratory secretions, urine, throat swabs, or pus/surface swabs provide no prognostic information. This finding highlights the need for follow-up blood cultures in patients with melioidosis... - A simple scoring system to differentiate between relapse and re-infection in patients with recurrent melioidosisDirek Limmathurotsakul
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS Negl Trop Dis 2:e327. 2008..Distinguishing between the two is important but requires bacterial genotyping. The aim of this study was to develop a simple scoring system to distinguish re-infection from relapse... - Patterns of organ involvement in recurrent melioidosisDirek Limmathurotsakul
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Am J Trop Med Hyg 81:335-7. 2009..Evaluation of 140 patients with recurrence showed that similar patterns of disease occurred during the first and second episode, independent of whether this was caused by relapse or re-infection... - Increasing incidence of human melioidosis in Northeast ThailandDirek Limmathurotsakul
Department of Tropical Hygiene and Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Am J Trop Med Hyg 82:1113-7. 2010..63 per 100,000 people (95% CI = 7.33-10.11), the third most common cause of death from infectious diseases in northeast Thailand after human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis... - Genetic diversity and microevolution of Burkholderia pseudomallei in the environmentNarisara Chantratita
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS Negl Trop Dis 2:e182. 2008..The soil dwelling Gram-negative pathogen Burkholderia pseudomallei is the cause of melioidosis. The diversity and population structure of this organism in the environment is poorly defined... - Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosisWirongrong Chierakul
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Clin Infect Dis 41:1105-13. 2005..CONCLUSION: We conclude that the addition of TMP-SMX to ceftazidime therapy during initial treatment of severe melioidosis does not reduce the acute mortality rate... - Loop-mediated isothermal amplification method targeting the TTS1 gene cluster for detection of Burkholderia pseudomallei and diagnosis of melioidosisNarisara Chantratita
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420 6 Rajvithi Road, Bangkok 10400, Thailand
J Clin Microbiol 46:568-73. 2008..The PCR and LAMP assays evaluated here are not sufficiently sensitive to replace culture in our clinical setting... - Prospective evaluation of a rapid immunochromogenic cassette test for the diagnosis of melioidosis in northeast ThailandAllen C Cheng
Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
Trans R Soc Trop Med Hyg 100:64-7. 2006..Low sensitivity and specificity of clinical rules is consistent with the protean manifestations of melioidosis and clinical difficulty in identifying patients with melioidosis... - Molecular detection and speciation of pathogenic Leptospira spp. in blood from patients with culture-negative leptospirosisSiriphan Boonsilp
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
BMC Infect Dis 11:338. 2011..Leptospira spp. are fastidious bacteria, and we hypothesized that a false-negative culture result may represent infection with a distinct bacterial subset that fail to grow in standard culture medium... - Quantitation of B. Pseudomallei in clinical samplesVanaporn Wuthiekanun
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Am J Trop Med Hyg 77:812-3. 2007..1, 1.5 x 10(4), 1.1 x 10(5), and 1.1 x 10(7) CFU/mL in these sample types, respectively. This provides important insights into the likely feasibility of future studies such as expression microarray analysis using clinical material... - Simultaneous infection with more than one strain of Burkholderia pseudomallei is uncommon in human melioidosisDirek Limmathurotsakul
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
J Clin Microbiol 45:3830-2. 2007..Genotyping of 2,058 bacterial colonies isolated from 215 samples taken from 133 patients demonstrated that mixed infection is uncommon (2/133 cases [1.5%; 95% confidence interval, 0.2 to 5.3%])... - Accuracy of enzyme-linked immunosorbent assay using crude and purified antigens for serodiagnosis of melioidosisNarisara Chantratita
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Clin Vaccine Immunol 14:110-3. 2007..pseudomallei antigen (sensitivity, 81%; specificity, 70%), an improvement over the indirect hemagglutination assay (sensitivity, 73%; specificity, 64%)... - Trimethoprim/sulfamethoxazole resistance in clinical isolates of Burkholderia pseudomalleiVanaporn Wuthiekanun
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
J Antimicrob Chemother 55:1029-31. 2005..Isolates assigned as 'susceptible' or 'intermediate' by disc diffusion may be viewed as 'susceptible'; those assigned as 'resistant' require further evaluation by MIC methodology... - Role and significance of quantitative urine cultures in diagnosis of melioidosisDirek Limmathurotsakul
Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand
J Clin Microbiol 43:2274-6. 2005..The presence of B. pseudomallei in urine during systemic infection is associated with a poor prognosis... - Survey of antimicrobial resistance in clinical Burkholderia pseudomallei isolates over two decades in Northeast ThailandVanaporn Wuthiekanun
Mahidol Oxford Tropical Medicine Research Unit, Department of Microbiology and Immunology, Mahidol University, Bangkok, Thailand
Antimicrob Agents Chemother 55:5388-91. 2011..Resistance to carbapenem drugs was not detected. These findings support the current prescribing recommendations for melioidosis... - Proteomic analysis of colony morphology variants of Burkholderia pseudomallei defines a role for the arginine deiminase system in bacterial survivalNarisara Chantratita
Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
J Proteomics 75:1031-42. 2012..1. These data provide novel insights into proteomic alterations that occur during the complex process of morphotype switching, and lend support to the idea that this is associated with a fitness advantage in vivo... - Optimization of culture of Leptospira from humans with leptospirosisVanaporn Wuthiekanun
Faculty of Tropical Medicine, Mahidol University, 420 6 Rajvithi Road, Bangkok 10400, Thailand
J Clin Microbiol 45:1363-5. 2007.... - Burkholderia pseudomallei genome plasticity associated with genomic island variationSarinna Tumapa
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
BMC Genomics 9:190. 2008..pseudomallei isolates, little is known about the extent of variation between related strains or their association with disease or environmental survival... - Lack of correlation of Burkholderia pseudomallei quantities in blood, urine, sputum and pusGumphol Wongsuvan
Faculty of Tropical Medicine, Mahidol University, Bangkok Thailand
Southeast Asian J Trop Med Public Health 40:781-4. 2009..It is likely that an initial seeding event to extracellular organs is followed by independent growth of B. pseudomallei, and that bacteria in the urine were not passively filtered from the bloodstream... - Antibodies from patients with melioidosis recognize Burkholderia mallei but not Burkholderia thailandensis antigens in the indirect hemagglutination assayRachaneeporn Tiyawisutsri
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
J Clin Microbiol 43:4872-4. 2005..pseudomallei, B. mallei, and B. thailandensis antigens. We demonstrate a lack of cross-reactivity between B. pseudomallei and B. thailandensis but marked cross-reactivity between B. pseudomallei and B. mallei... - Accuracy of loop-mediated isothermal amplification for diagnosis of human leptospirosis in ThailandPiengchan Sonthayanon
Department of Clinical Tropical Medicine, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 420 6 Rajvithi Road, Mahidol University, Bangkok, Thailand
Am J Trop Med Hyg 84:614-20. 2011..84.6, 95% CI = 69.5-94.1). The rrs LAMP can provide an admission diagnosis in approximately half of patients with leptospirosis, but its clinical utility is reduced by a lower specificity... - Prospective observational study of the frequency and features of intra-abdominal abscesses in patients with melioidosis in northeast ThailandRapeephan R Maude
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Rajthevi, Bangkok, Thailand
Trans R Soc Trop Med Hyg 106:629-31. 2012..The mortality rate at 4 weeks post-discharge was lower in patients who were abscess-positive vs abscess-negative (10%, 8/77 vs 20%, 31/153)... - Diagnostic accuracy of real-time PCR assays targeting 16S rRNA and lipL32 genes for human leptospirosis in Thailand: a case-control studyJanjira Thaipadungpanit
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS ONE 6:e16236. 2011..Here, we compare the diagnostic sensitivity and specificity of two real-time PCR assays targeting rrs or lipL32 for the diagnosis of leptospirosis in northeast Thailand... - Accuracy of a commercial IgM ELISA for the diagnosis of human leptospirosis in ThailandVarunee Desakorn
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Am J Trop Med Hyg 86:524-7. 2012..This was 20 Panbio units, which gave a sensitivity and specificity of 76.1% and 82.6%, respectively, on paired sera. We conclude that using either cutoff value, the accuracy of IgM ELISA is limited in our setting... - Biological relevance of colony morphology and phenotypic switching by Burkholderia pseudomalleiNarisara Chantratita
Faculty of Tropical Medicine, Mahidol University, 420 6 Rajvithi Road, Bangkok 10400, Thailand
J Bacteriol 189:807-17. 2007..These findings have major implications for therapeutics and vaccine development... - Antimicrobial resistance to ceftazidime involving loss of penicillin-binding protein 3 in Burkholderia pseudomalleiNarisara Chantratita
Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Proc Natl Acad Sci U S A 108:17165-70. 2011..The mechanism described here represents an explanation for ceftazidime treatment failure, and may be a frequent but undetected resistance event... - Rapid isolation and susceptibility testing of Leptospira spp. using a new solid medium, LVW agarVanaporn Wuthiekanun
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
Antimicrob Agents Chemother 57:297-302. 2013..The use of LVW agar, which enables rapid growth, isolation of single colonies, and simple antimicrobial susceptibility testing for Leptospira spp., provides an opportunity for new areas of fundamental and applied research... - Prospective clinical evaluation of the accuracy of 16S rRNA real-time PCR assay for the diagnosis of melioidosisNarisara Chantratita
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Am J Trop Med Hyg 77:814-7. 2007..4 CFU/ml (0.2-13.5 CFU/ml); this may explain the low sensitivity of PCR for this specimen. The PCR assay described here is not sufficiently sensitive to replace culture in our clinical setting... - Melioidosis vaccines: a systematic review and appraisal of the potential to exploit biodefense vaccines for public health purposesSharon J Peacock
Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS Negl Trop Dis 6:e1488. 2012..Here, we discuss target populations for vaccination, consider the cost-benefit of different vaccination strategies and review potential vaccine candidates... 
Melioidosis: a clinical overviewDirek Limmathurotsakul
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Br Med Bull 99:125-39. 2011..Melioidosis, an infection caused by the environmental Gram-negative bacillus Burkholderia pseudomallei, has emerged as an important cause of morbidity and mortality in Southeast Asia and northern Australia...- Effect of colony morphology variation of Burkholderia pseudomallei on intracellular survival and resistance to antimicrobial environments in human macrophages in vitroSarunporn Tandhavanant
Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
BMC Microbiol 10:303. 2010..Isogenic colony morphology types II and III were generated from 5 parental type I B. pseudomallei isolates using nutritional limitation. Survival of types II and III were compared with type I for all assays... - Burkholderia pseudomallei Is Genetically Diverse in Agricultural Land in Northeast ThailandVanaporn Wuthiekanun
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS Negl Trop Dis 3:e496. 2009..pseudomallei exists despite the effects of flooding and the physical and chemical processes associated with farming. These findings form an important baseline for future studies of environmental B. pseudomallei... - Host responses to melioidosis and tuberculosis are both dominated by interferon-mediated signalingGavin C K W Koh
Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
PLoS ONE 8:e54961. 2013.... - Estimating the true accuracy of diagnostic tests for dengue infection using bayesian latent class modelsWirichada Pan-Ngum
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS ONE 8:e50765. 2013..We hypothesized that those estimates might be inaccurate if the accuracy of the reference assays is not perfect. Here, we investigated this using statistical modeling... - Staphylococcus aureus bacteraemia in a tropical setting: patient outcome and impact of antibiotic resistanceEmma K Nickerson
Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
PLoS ONE 4:e4308. 2009..Most information on invasive Staphylococcus aureus infections comes from temperate countries. There are considerable knowledge gaps in epidemiology, treatment, drug resistance and outcome of invasive S. aureus infection in the tropics... - Systematic Review and Consensus Guidelines for Environmental Sampling of Burkholderia pseudomalleiDirek Limmathurotsakul
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
PLoS Negl Trop Dis 7:e2105. 2013..CONCLUSIONSSIGNIFICANCE: The proposed consensus guidelines provide the basis for the development of an accurate and comprehensive global map of environmental B. pseudomallei... - Toll-like receptor 2 impairs host defense in gram-negative sepsis caused by Burkholderia pseudomallei (Melioidosis)W Joost Wiersinga
Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
PLoS Med 4:e248. 2007..Melioidosis is a severe infection caused by the gram-negative bacterium, Burkholderia pseudomallei, that is endemic in Southeast Asia. We aimed to characterize the expression and function of TLRs in septic melioidosis... - Open-label randomized trial of oral trimethoprim-sulfamethoxazole, doxycycline, and chloramphenicol compared with trimethoprim-sulfamethoxazole and doxycycline for maintenance therapy of melioidosisWipada Chaowagul
Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand
Antimicrob Agents Chemother 49:4020-5. 2005..7-fold increase of relapse or death. A combination of TMP-SMX and doxycycline is as effective as and better tolerated than the conventional four-drug regimen for the oral treatment phase of melioidosis... - Evaluating Burkholderia pseudomallei Bip proteins as vaccines and Bip antibodies as detection agentsChris Druar
Cangene Corporation, Mississauga, ON, Canada
FEMS Immunol Med Microbiol 52:78-87. 2008..However, these ELISAs had low diagnostic accuracy in endemic regions, possibly due to previous patient exposure to B. pseudomallei... - Consensus guidelines for dosing of amoxicillin-clavulanate in melioidosisAllen C Cheng
Department of Medicine, University of Melbourne, Melbourne, Australia
Am J Trop Med Hyg 78:208-9. 2008..For eradication therapy for melioidosis, we recommend 20/5 mg/kg orally, three times daily... - Invasive Erysipelothrix rhusiopathiae infection in northeast ThailandWeera Mahavanakul
Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand
Southeast Asian J Trop Med Public Health 38:478-81. 2007..Patients presented with variable clinical manifestations including diffused cutaneous lesions, bacteremia and endocarditis. Erysipelothrix infection may be an emerging infection in immunocompromized individuals in Thailand... - A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in ThailandAllen C Cheng
Menzies School of Health Research, Charles Darwin University, Darwin, Australia
Clin Infect Dis 45:308-14. 2007..Melioidosis is a tropical infectious disease associated with significant mortality. Most deaths occur early and are caused by fulminant sepsis... - Strategies to reduce mortality from bacterial sepsis in adults in developing countriesAllen C Cheng
Department of Medicine, University of Melbourne, and the Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
PLoS Med 5:e175. 2008 - High-throughput mRNA profiling characterizes the expression of inflammatory molecules in sepsis caused by Burkholderia pseudomalleiW Joost Wiersinga
Academic Medical Center, Meibergdreef 9, Room G2 132, 1105 AZ Amsterdam, The Netherlands
Infect Immun 75:3074-9. 2007..Gene profiling such as was done here provides an excellent tool to obtain insight into the extent of inflammation activation in patients with severe infection...