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Despite increasing antibiotic resistance, vancomycin remains the first choice to treat severe infections due to drug-resistant gram-positive bacteria. This study aimed to summarise the clinical, microbiological, and vancomycin treatment outcomes in bacteremia patients. From July to December 2019, a retrospective cohort analysis was conducted on patients with bacteremia treated with vancomycin at a tertiary hospital in Hanoi, Vietnam. Patients without vancomycin concentrations were excluded from the study. Patients had a median age of 54 years (IQR, 41.8 - 63.3), with a male/female ratio of 1.86. Renal complication was markedly different; Clcr < 60, 60 - 130, and > 130 mL/min was 29%, 60%, and 11%, respectively. The median Charlson score was 3.0 (2-4.3), the qSOFA score was 1 (1-2), and the NEWS score was 76%, with a median of 6 (5-8). Twenty-one cases had positive blood culture where85.7% were gram-positive. 93% of patients with sepsis were treated with vancomycin as the first antimicrobial, of which 72% used vancomycin in combination with other antibiotics. Renal complications occurred in 12% of all patients, with grades R, I, and F accounting for 4%, 5%, and 3%, respectively. The median duration of treatment was 12 days (IQR, 7-17), with a success rate of 82 % and a failure rate of 18%, respectively. Conclusions: In most patients with bacteremia, microbiological tests reveal no detectable bacteria. When sepsis is suspected, a vancomycin regimen should be initiated.

The coastal erosion due to storm surge and unsustainable urban development in the central region of Vietnam has become increasingly in the last decade. It requires accurate coastal vulnerability assessments (CVI). The aim of this study is to propose (1) a new approach to classify the coasts and (2) the selection of appropriate criteria to assess the CVI index at the regional scale. Accordingly, the study has calculated the CVI index for the coastal area of Son Tra - Cua Dai region based on 5 coastal characteristic variables, 3 coastal dynamics and 4 socio-economic variables. The results show that more than 15% of the coastline of the study area has very high CVI values, especially in the coastal area of Hoi An. The coastal landscape with residential and tourist sites near beaches without protection forests has been strongly affected by storm erosion.

Background Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis (PM) remains unclear. Methodology/Principal findings Adult and adolescent patients of 13 years old or above with suspected central nervous system (CNS) infections with abnormal CSF findings were prospectively enrolled at a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. Patients with EM or suspected PM (EM/PM) were defined by the presence of either ≥10% eosinophils or an absolute eosinophil cell counts of ≥10/mm3 in the CSF or blood eosinophilia (>16% of WBCs) without CSF eosinophils. In total 679 patients were enrolled: 7 (1.03%) had ≥10% CSF eosinophilia, 20 (2.95%) had ≥10/mm3 CSF eosinophilia, and 7 (1.03%) had >16% blood eosinophilia. The patients with ≥10% CSF eosinophilia were significantly younger (p = 0.017), had a lower body temperature (p = 0.036) than patients with ≥10/mm3 CSF eosinophilia among whom bacterial pathogens were detected in 72.2% (13/18) of those who were tested by culture and/or PCR. In contrast, the characteristics of the patients with >16% blood eosinophilia resembled those of patients with ≥10% CSF eosinophilia. We further conducted serological tests and real-time PCR to identify A. cantonensis. Serology or real-time PCR was positive in 3 (42.8%) patients with ≥10% CSF eosinophilia and 6 (85.7%) patients with >16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm3 CSF eosinophilia. Conclusions The etiology of PM in northern Vietnam is A. cantonensis. The eosinophil percentage is a more reliable predictor of parasitic EM than absolute eosinophil count in the CSF. Patients with PM may present with a high percentage of eosinophils in the peripheral blood but not in the CSF., Author summary Eosinophilic meningitis (EM) is a rare meningitis accompanied by eosinophils in the CSF and caused by multiple etiologies. Angiostrongylus cantonensis, which is a rat lungworm parasite, is the most common cause in tropical Asia. Previous papers have defined EM as CSF eosinophils ≥10% or CSF eosinophils ≥10/mm3. However, the relationship of EM to parasitic meningitis (PM) remains unclear. This prospective study enrolled 679 patients with suspected CNS infection who were admitted to a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. The characteristics of patients with ≥10% CSF eosinophilia resembled those of patients with >16% blood eosinophilia without CSF eosinophils, whereas those of patients with ≥10/mm3 CSF eosinophilia were comparable with those of patients with typical bacterial meningitis. Serology or real-time PCR for A. cantonensis was positive in 3 out of 7 patients with ≥10% CSF eosinophilia and 6 out of 7 patients with > 16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm3 CSF eosinophilia. The percentage, in contrast to the absolute eosinophil count in CSF, is reliable for predicting parasitic EM. Patients with PM may present with eosinophilia in the peripheral blood but not in the CSF.

The coastal area in the Son Tra – Tam Ky region have various kinds of sand dunes: (1) embryo dunes; (2) foredunes; (3) yellow dunes; (4) gray dunes; (5) white dunes; (6) brown dunes. These sand dunes play an important role in maintaining biodiversity, minimizing the damage of natural hazards and tourism development. In last decade, the sand dunes in Son Tra (Da Nang) - Tam Ky (Quang Nam) is strongly influenced by urbanization and tourism development. Different resorts have been built along the beaches, narrowing protective forests on the sand dunes. It does not only reduce the value of cultural ecosystem services; but also, the ability to regulate natural disasters and air pollution. Therefore, the study aims to assess the unbalance in sand dune ecosystems service supply in Son Tra - Tam Ky area. Methods used in the study include: remote sensing and GIS, collecting statistics and specialist interviews. The results showed a clear differentiation in the potential of the ecosystem services in different sand dune types. Lastly, the study analyzed the values of sand dune ecosystem services in Son Tra - Cua Dai part; to assess differences in planning and development policies between the coastal zones of Quang Nam and Da Nang.

The most important function of the coastal setback is to minimize damage due to coastal erosion, climate change response, and sea-level rise. There are many directions and methods of researching and assessing coastal changes and coastal erosion. This study presents the results of the shoreline changes in the area from Son Tra (Da Nang City) to Cua Dai (Hoi An City), Central Vietnam based on remote sensing data from 1965 to 2019. Three methods are used to include End Point Ratio (EPR), Linear Regression Rate (LRR), and Weighted Linear Regression (WLR). The results show that the EPR method is effective when calculating the rate of shoreline changes only at two different times. For more objective and reliable calculation, it is necessary to assess the shoreline changes over time. Meanwhile, the LRR method was shown to be superior because all shoreline data were taken into account during the construction of the regression line. However, when there is much shoreline data with different reliability, the WLR method proved more superior because of limited objective errors. The results show that from 1965 to 2019, the coast of the Son Tra - Cua Dai area had quite complicated fluctuations, of which the northern area (Son Tra) tended to accretion, the central area tends to be alternate between accretion and erosion, while the south area (Cua Dai) is strong to very strong erosion. The coast with sudden changes is the Cua Dai area with the shoreline change envelope (SCE) reaching 512m. The results also allow us to divide the coast of the Son Tra - Cua Dai area into 30 segments. They are clustered into 8 groups with different levels of erosion and accretion. This is an important basis for the setback zone establishment in the study area.

BACKGROUND: Scrub typhus (ST) is a leading cause of non-malarial febrile illness in Southeast Asia, but evidence of its true disease burden is limited because of difficulties of making the clinical diagnosis and lack of adequate diagnostic tests. To describe the epidemiology and clinical characteristics of ST, we conducted an observational study using multiple diagnostic assays at a national tertiary hospital in Hanoi, Vietnam. METHODOLOGY/PRINCIPAL FINDINGS: We enrolled 1,127 patients hospitalized with documented fever between June 2012 and May 2013. Overall, 33 (2.9%) patients were diagnosed with ST by PCR and/or screening of ELISA for immunoglobulin M (IgM) with confirmatory tests: 14 (42.4%) were confirmed by indirect immunoperoxidase assay (IIP), and 19 (57.6%) were by IIP and PCR. Living by farming, conjunctival injection, eschar, aspartate aminotransferase elevation, and alanine aminotransferase elevation were significantly associated with ST cases (adjusted odds ratios (aORs): 2.8, 3.07, 48.8, 3.51, and 4.13, respectively), and having a comorbidity and neutrophilia were significantly less common in ST cases (aORs: 0.29 and 0.27, respectively). The majority of the ST cases were not clinically diagnosed with rickettsiosis (72.7%). Dominant IIP reactions against a single antigen were identified in 15 ST cases, whereas indistinguishably high reactions against multiple antigens were seen in 11 ST cases. The most frequently observed dominant IIP reaction was against Karp antigen (eight cases) followed by Gilliam (four cases). The highest diagnostic accuracy of IgM ELISA in acute samples was 78%. In a phylogenetic analysis of the 56-kDa type-specific antigen gene, the majority (14 cases) were located in the Karp-related branch followed by the Gilliam-related (two cases), Kato-related (two cases), and TA763-related clades (one case). CONCLUSIONS/SIGNIFICANCE: Both the clinical and laboratory diagnoses of ST remain challenging at a tertiary hospital. Implementation of both serological and nucleic acid amplification assays covering endemic O. tsutsugamushi strains is essential., PLoS neglected tropical diseases, 13(12), e0007928; 2019

A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non-scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting.

Background: Laboratory facilities for etiological diagnosis of central nervous system (CNS) infection are limited in developing countries; therefore, patients are treated empirically, and the epidemiology of the pathogens is not well-known. Tubercular meningitis is one of the common causes of meningitis, which has high morbidity and mortality, but lacks sensitive diagnostic assays. The objectives of this study were to determine the causes of meningitis in adult patients by using molecular assays, to assess the risk factors associated with them, and to explore whether biomarkers can differentiate tubercular meningitis from bacterial meningitis.Methods: We conducted a cross-sectional study in the Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam, from June 2012 to May 2014. All patients who were ≥ 16 years old and who had meningoencephalitis suggested by abnormal cerebrospinal fluid (CSF) findings (CSF total cell >5/mm3 or CSF protein ≥40 mg/dL) were included in the study. In addition to culture, CSF samples were tested for common bacterial and viral pathogens by polymerase chain reaction (PCR) and for biomarkers: C-reactive protein and adenosine deaminase (ADA).Results: Total number of patients admitted to the department was 7506; among them, 679 were suspected to have CNS infection, and they underwent lumbar puncture. Five hundred eighty-three patients had abnormal CSF findings (meningoencephalitis); median age was 45 (IQR 31–58), 62.6% were male, and 60.9% were tested for HIV infection. Among 408 CSF samples tested by PCR, out of them, 358 were also tested by culture; an etiology was identified in 27.5% (n=112). S. suis (8.8%), N. meningitis (3.2%), and S. pneumoniae (2.7%) were common bacterial and HSV (2.2%), Echovirus 6 (0.7%), and Echovirus 30 (0.7%) were common viral pathogens detected. M. tuberculosis was found in 3.2%. Mixed pathogens were detected in 1.8% of the CSF samples. Rural residence (aOR 4.1, 95% CI 1.2–14.4) and raised CSF ADA (≥10 IU/L) (aOR 25.5, 95% CI 3.1–212) were associated with bacterial meningitis when compared with viral meningitis; similarly, raised CSF ADA (≥10 IU/L) (aOR 42.2, 95% CI 2.0–882) was associated with tubercular meningitis.Conclusions: Addition of molecular method to the conventional culture had enhanced the identification of etiologies of CNS infection. Raised CSF ADA (≥10 IU/L) was strongly associated with bacterial and tubercular meningitis. This biomarker might be helpful to diagnose tubercular meningitis once bacterial meningitis is ruled out by other methods., 長崎大学学位論文 学位記番号:博(医歯薬)甲第1357号 学位授与年月日:令和3年6月2日, Author: Cuong Chi Ngo, Shungo Katoh, Futoshi Hasebe, Bhim Gopal Dhoubhadel, Tomoko Hiraoka, Sugihiro Hamaguchi, Anh Thi Kim Le, Anh Thi Hien Nguyen, Anh Duc Dang, Chris Smith, Lay-Myint Yoshida, Cuong Duy Do, Thuy Thi Thanh Pham and Koya Ariyoshi, Citation: Tropical Medicine and Health, 49, art. no. 42; 2021