Peninnah Oberdorfer

Chiang Mai University, Amphoe Muang Chiang Mai, Chiang Mai, Thailand

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Publications (42)71.4 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The National Access to Antiretroviral Program for People Living with HIV/AIDS was launched in Thailand in 2002. HIV-infected, antiretroviral-naïve, severely-immunosuppressed children were initiated on highly active antiretroviral treatment (cART). This study aimed to determine the long-term effectiveness of cART. Data were extracted from medical records. Primary endpoints were mortality rate, proportion of children who remained on first-line cART regimen, and children with plasma HIV RNA level (pVL) <50 copies/mL at week 520. From August 2002 to July 2003, 107 children were enrolled. The baseline median age was 7.6 years (interquartile range, IQR5.7-10.0), the median CD4+ T-cell count was 60 cells/mm(3) (IQR21-272), and the median pVL was 5.37 log10 copies/mL (IQR5.01-5.76). The mortality rate during and after the first year were 3.7 and 0.006 deaths/ 100 person-years, respectively. At week 520, ninety (84%) continued to be actively followed. Their median age was 17.8 years (IQR15.8-19.8). Seventy-three (81% as-treated) remained on the first-line regimen, while 18(20%) had switched to a second-line cART regimen, at the median time of 272 weeks (IQR256-363) after the first-line cART initiation. Sixty-nine (77%) had pVL<50 copies/mL and the median CD4+ T-cell count was 636 cells/mm(3) (IQR466-804). Eighty-three (92%) and 64(71%) had CD4+ T-cell count >200, and >500 cell/mm(3), respectively. Long-term virologic control, favorable immunologic outcomes and healthy survival was achieved in severely-immunosuppressed, perinatally HIV-infected children who started first-line NNRTI-based cART. Continuing surveillance for long-term complications is warranted.
    Antiviral therapy 07/2015; DOI:10.3851/IMP2978 · 3.02 Impact Factor
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    ABSTRACT: Pseudoclavibacter has rarely been documented as an etiologic agent of infection in humans. We presented the first case report of Pseudoclavibacter otitis media in a boy with pulmonary and spinal tuberculosis.A 3-year-old boy was referred to our hospital due to prolonged fever and progressive paraplegia for 3 months. He had yellowish discharge from both ear canals. The pleural fluid culture was positive for Mycobacterium tuberculosis. The discharge from both ears culture yielded yellow colonies of gram-positive bacilli with branching. This organism was positive for modified acid-fast bacilli stain but negative for acid-fast bacilli stain. Biochemical characteristics of this isolate were positive for catalase test but negative for oxidase, nitrate, esculin, and sugar utilization tests. The organism was further subjected to be identified by 16S ribosomal deoxyribonucleic acid gene sequencing. The result yielded Pseudoclavibacter species (99.4% identical), which could be most likely a potential pathogen in immunocompromised host like this patient. He responded well with intravenous trimetroprim-sulfamethoxazole for 6 weeks.This is the first case report of Pseudoclavibacter otitis media in children, and this case could emphasize Pseudoclavibacter species as a potential pathogen in immunocompromised host.
    Medicine 05/2015; 94(17):e709. DOI:10.1097/MD.0000000000000709 · 5.72 Impact Factor
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    ABSTRACT: The incidence of diphtheria has decreased since the introduction of an effective vaccine. However, in countries with low vaccination rates it has now become a re-emerging disease. Complications from diphtheria commonly include upper airway obstruction and cardiac complications. We present a 9-year-old boy who was diagnosed with diphtheria. He presented with fever, tonsilar plaques, respiratory failure and an incomplete vaccination history. He was endotracheal intubated and received diphtheria antitoxin and penicillin on the first day of hospitalisation. He developed progressive arrhythmias and fulminant myocarditis despite early identification and treatment with equine antitoxin and antibiotics. After a temporary transvenous pacemaker insertion due to third-degree atrioventricular block and hypotension for 1 week, he developed myocardial perforation from the pacemaker tip resulting in pericardial effusion. The treatment included emergency pericardiocentesis and pacemaker removal. His electrocardiogram showed a junctional rhythm with occasional premature ventricular complexes. He then developed ventricular tachycardia and cardiac arrest and finally died. 2014 BMJ Publishing Group Ltd.
    Case Reports 11/2014; 2014(nov20 1). DOI:10.1136/bcr-2014-206085
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    Ezer Kang · Darcie Ap Delzell · Manik Chhabra · Peninnah Oberdorfer ·
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    ABSTRACT: Antiretroviral medication adherence behaviour among Thai youth with perinatal HIV in Thailand has received growing attention. However, few studies have examined individual predictors of antiretroviral adherence using multiple self-reports. A convenience sample of 89 Thai youth (interquartile range 14-16 years) with perinatal HIV at three paediatric programmes in Chiang Mai completed a structured questionnaire and reported their antiretroviral adherence in the past one, seven and 30 days using count-based recall and a visual analog scale. Mean self-reported adherence rates ranged from 83.5% (past 30 days) to 99.8% (yesterday) of the time. One-inflated beta regression models were used to examine the associations between antiretroviral adherence outcomes, treatment self-efficacy, depression, anxiety, social support and beliefs/attitudes about medications. Higher percentage of medications taken in the past 30 days was independently associated with higher treatment self-efficacy and fewer symptoms of depression. Adherence monitoring would benefit from focal assessment of youth depression and perceived capacity to follow their antiretroviral regimen.
    International Journal of STD & AIDS 07/2014; 26(8). DOI:10.1177/0956462414545524 · 1.05 Impact Factor
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    ABSTRACT: Dengue is a mosquito-borne infection affecting children and adults worldwide. In newborn infants, the dengue virus can cause diseases, especially in infants born to pregnant women hospitalised with dengue or postpartum women with fever. The authors report a case of a term newborn infant who presented with haemodynamic instability and thrombocytopaenia at the age of 7 days, without a history of clinical dengue infection in the mother. The physical examination revealed an afebrile and drowsy infant with a petechial rash all over the body and ecchymosis on both palms and soles. The authors confirmed the diagnosis using the dengue NS1 antigen on the first day of admission. The treatment included fluid management and platelet transfusion. The patient recovered well and was discharged from the hospital on the 10th day of hospitalisation.
    Case Reports 07/2014; 2014. DOI:10.1136/bcr-2014-205621
  • Sakorn Pornprasert · Rotjanee Wongnoi · Peninnah Oberdorfer · Pannee Sirivatanapa ·
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    ABSTRACT: Antiretroviral (ARV) prophylaxis for prevention of mother to child transmission (MTCT) of HIV could affect hemoglobin (Hb) development of infants. A cross-sectional descriptive study was conducted in 24 HIV-infected and 21 HIV-uninfected pregnancies. ARV drugs were administered to HIV-infected pregnancies at 21 weeks of gestational age and at the labor. Their infants received zidovudine (ZDV) until 4 weeks of age. Blood sample of ARV-exposed and -unexposed infants were collected at delivery, 1, 2 and 4 months of age. Molecular analyses for α-thalassemia-1 Southeast Asian (SEA) type deletion, β-thalassemia mutations and Hb E were performed for excluding the thalassemia carrier infants. Hemoglobinopathy and Hb A, Hb F and Hb A2 were analyzed by using capillary electrophoresis (CE) while hematological parameters were measured using an automated blood counter. At delivery, 1 and 2 months of age, ARV-exposed infants had significantly lower levels of RBC counts than ARV-unexposed infants (3.56 vs 4.90, 2.66 vs 4.62 and 3.01 vs 4.05 x1012/L; P <0.001, <0.001 and 0.001, respectively). At delivery, there was a trend for low hemoglobin level in the group of ARV-exposed infants as compared to the group of ARV-unexposed infants (149 vs 154 g/L; P = 0.09) and the significantly different levels were observed among the two groups at 1 and 2 months of age (89 vs 136 and 87 vs 110 g/L; P < 0.001 and 0.001, respectively). The development of Hb A, Hb F and Hb A2 levels from delivery to 4 months of age among the two groups were not significantly different. Therefore, ARV treatments for prevention of MTCT of HIV decreased RBC counts and hemoglobin but did not alter the development of Hb A, Hb F and Hb A2 of non-thalassemia carrier infants.
    Current HIV Research 07/2014; 12(3). DOI:10.2174/1570162X12666140713170800 · 1.76 Impact Factor
  • Charles Henry Washington · Peninnah Oberdorfer ·
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    ABSTRACT: Summary Osteoarticular involvement is one manifestation of extrapulmonary tuberculosis (TB). We present a 5-year-old Burmese boy with 10 months of right hip pain and decreased range of motion. The patient also had low-grade fever, cough and decreased appetite. The patient was undocumented and had recently moved from Myanmar. He was thin, in moderate distress with bilateral lung rhonchi, mild subcostal retractions, low back pain, right hip tenderness and painful and limited right range of motion. The patient's chest and pelvis radiographs showed a miliary pattern and right acetabulum osteolytic lesions, respectively. He was started on anti-TB medication and cefotaxime. Ofloxacin was added because of the concern of drug-resistant TB. The patient underwent a right hip debridement. His symptoms improved markedly, with improved mobility. TB is a challenging infection to diagnose, which can cause significant delays in management.
    Case Reports 05/2014; 2014. DOI:10.1136/bcr-2014-204217
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    ABSTRACT: Malaria and dengue fever are major mosquito-borne public health problems in tropical countries. The authors report a malaria and dengue co-infection in an 11-year-old boy who presented with sustained fever for 10 days. The physical examination revealed a flushed face, injected conjunctivae and left submandibular lymphadenopathy. His peripheral blood smear showed few ring-form trophozoites of Plasmodium falciparum. His blood tests were positive for dengue NS-1 antigen and IgM antibody, and negative for IgG antibody. After the initiation of antimalarial treatment with artesunate and mefloquine, his clinical condition gradually improved. However, he still had low-grade fever that persisted for 6 days. Finally, he recovered well without fluid leakage, shock or severe bleeding. This case report emphasises that early recognition and concomitant treatment of malaria and dengue co-infection in endemic areas can improve clinical outcome and prevent serious complications.
    Case Reports 04/2014; 2014(apr01 1). DOI:10.1136/bcr-2013-202998
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    ABSTRACT: More perinatally HIV-infected children in Asia are reaching adolescence. We analyzed data from July 1991 to March 2011 reported by 18 clinics in six countries of children age >12 years. Of 1,254 adolescents, 33 (2.6%) died, and 52 (4.2%) were lost to follow-up within 2.4-year (3566 person-years) median follow-up period. Of 1,061 adolescents under active follow-up, 485 (46%) were male, median (IQR) age was 14.7 (13.3-16.4) years, 73% had lost a parent(s), 93% attended school, and 62% were aware of their HIV status. At the most recent evaluation, 93% were receiving highly active antiretroviral therapy (ART), 71% (N=737/1035) had CD4 ≥500 cells/mm3 and 86% (N=718/830) had viral load (VL) <400 copies/mL. Current CD4 >200 cells/mm, no previous WHO stage 3 or 4, and being on a first-line regimen were independently associated with recent VL <400 copies/mL. Current age <15 years, VL <400 copies/ml, CD4 15-24% (vs. <10%) at ART initiation, no previous WHO stage 3 or 4, and ART duration of >1 year were associated with recent CD4 ≥500 cells/mm.Primary causes of death after age 12 were opportunistic infections (N=15/33) and other AIDS- or treatment-related conditions (N=9/33). Those at age 12 with CD4 <200 vs. ≥500 cells/mm3 and those with VL ≥10,000 vs. <10,000 copies/mL were 17.4 and 4.76 times more likely to die in adolescence, respectively. Adolescents in this cohort have been successfully maintained in HIV care. Initiating treatment at earlier stages of disease was associated with immune recovery and virologic suppression during adolescence.
    The Pediatric Infectious Disease Journal 08/2013; 33(3). DOI:10.1097/INF.0b013e3182a18223 · 2.72 Impact Factor
  • Orawan Louthrenoo · Peninnah Oberdorfer · Virat Sirisanthana ·
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    ABSTRACT: Background: With effective highly active antiretroviral therapy (HAART), perinatally HIV-infected children are living longer through adolescence. Methods: We conducted a cross-sectional study of perinatally HIV-infected adolescents, aged 11 to 18 years. Demographically matched controls were also enrolled. The adolescents completed the Youth Self-Report (YSR), while the caregivers filled out the Child Behavior Checklist (CBCL), to determine emotional and behavioral problems. Results: The sample included 50 HIV-infected adolescents and 56 controls. The internalizing problem scores from the YSR were significantly higher in the HIV-infected group than those in the control group (13.76 versus 9.95, P = .02). The total competence scores, from both the self-report and the caregiver report in the HIV-infected group, were significantly lower than those of the control group (P = .005 and .001). Conclusion: Although HAART has prolonged the survival of HIV-infected children, they remain at increased risk of psychosocial problems as well as impaired social functioning.
    Journal of the International Association of Providers of AIDS Care 05/2013; 13(2). DOI:10.1177/2325957413488171
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    ABSTRACT: The effects of antiretroviral (ARV) drugs administered to HIV-infected pregnancy on hematological parameters and hemoglobin (Hb) synthesis in ARV-exposed newborns with and without thalassemia carrier and of ARV drugs in worsening anemia in thalassemia carrier newborns are not well understood. Cord blood samples were collected from newborns of HIV-infected and -uninfected pregnancies. Hematological parameters and hemoglobin typing were analyzed by automated blood counter and capillary electrophoresis (CE), respectively. In the group of thalassemia carrier, the ARV-exposed newborns had significantly lower mean levels of red blood cell counts and hematocrit and had significantly higher mean levels of MCH than the ARV-unexposed newborns. Similar results were found in the group of newborns without thalassemia carrier. There were no statistically differences in mean levels of Hb-A2, Hb-A, Hb-F and Hb-E (when applicable) in ARV-exposed and -unexposed newborns either with or without thalassemia carrier. However, ARV-exposed newborns who were thalassemia carrier had the lowest levels of hemoglobin and hematocrit when compared to the other groups. Therefore, ARV drugs used for prevention of HIV-mother-to-child transmission (HIV-MTCT) alter hematological parameters but did not affect hemoglobin synthesis in newborns with and without thalassemia carrier. However, thalassemia and ARV drugs might have synergetic effect in inducing severe anemia.
    Current HIV research 04/2013; 11(3). DOI:10.2174/1570162X11311030002 · 1.76 Impact Factor

  • JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2013; 62(1):e27-e29. DOI:10.1097/QAI.0b013e3182769cd5 · 4.56 Impact Factor
  • Anchalee Wangjirapan · Kritsana Kongthavonsakul · Peninnah Oberdorfer ·
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    ABSTRACT: We report an 8-year-old boy who developed high fever and low-back pain. He was diagnosed as having a paravertebral abscess with severe disseminated Staphylococcus aureus infection. He received intravenous antibiotics and drainage of the abscess. Afterwards, he developed thrombosis, endocarditis and empyema thoracis. He received further intravenous antibiotics and proper drainages for his conditions. He eventually recovered well. This case highlights the need for rapid diagnosis and appropriate treatment of severe S aureus infection to prevent serious complications.
    Case Reports 12/2012; 2012. DOI:10.1136/bcr-2012-007398
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    ABSTRACT: OBJECTIVES: To investigate the effects of antiretroviral (ARV) drugs on hematological parameters and thymic function in HIV-uninfected newborns of HIV-infected mothers. STUDY DESIGN: Cross sectional study. SETTING: Chiang-Mai University Hospital, Chiang-Mai, Thailand. PARTICIPANTS/PATIENTS: 49 HIV-uninfected and 26 HIV-infected pregnancies. METHODS: Cord blood samples of newborns from HIV-uninfected and HIV-infected mothers were collected. Hematological parameters were measured using automatic blood cell count. T-cell receptor excision circles (TRECs) levels in cord blood mononuclear cells (CBMCs), CD4+ and CD8+ T-cells were quantified using real-time PCR. MAIN OUTCOME MEASURES: Effect of ARV drugs used for prevention of HIV-mother-to-child transmission (MTCT) on hemotological parameters and thymic function. RESULTS: Newborn of HIV-infected mother tended to have lower mean levels of hemoglobin than those of HIV-uninfected mother (137 ±22 vs 146 ±17 g/L, P = 0.05). Furthermore, mean of red blood cell (RBC) counts and hematocrit and median of TRECs in CD4+ T-cells in the newborns of the former were significantly lower than those of the latter [3.6 ±0.7 vs 4.8 ±0.6 x 1012 cells/L, P <0.001; 0.40 ±0.07 vs 0.46 ±0.05 L/L, P <0.001 and 0.53 (IQR: 0.03-5.76) vs 13.20 (IQR: 2.77-27.51) x 10-3pg/?L, P = 0.02, respectively]. CONCLUSION: The finding suggested that the ARV drugs altered hematological parameters and impaired thymic function (TRECs CD4+ T-cells) in HIV-uninfected newborns of HIV-infected mothers.
    Indian pediatrics 12/2012; 50(6). DOI:10.1007/s13312-013-0169-y · 1.04 Impact Factor
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    ABSTRACT: Severe acute hepatitis is a rare complication of Epstein-Barr virus (EBV) infection. The authors report a case of an 8-month-old male infant who presented with subacute fever and jaundice. The physical examination showed hepatosplenomegaly and ecchymoses on his abdomen, chest wall and extremities. He received vitamin K therapy and prednisolone, and he recovered well without further complications or sequelae. Although severe acute hepatitis is a rare complication of EBV infection, clinicians should recognise this condition in order to provide a prompt treatment.
    Case Reports 11/2012; 2012. DOI:10.1136/bcr-2012-007410
  • Deanna Friedman · Kritsana Kongthavonsakul · Peninnah Oberdorfer ·
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    ABSTRACT: Cryptococcosis is rare among children, only occurring in about 1% of children with HIV. We report the case of a 12-year-old boy with disseminated cryptococcosis. He had a history of recurrent pneumonia. He then developed meningeal symptoms and was found to have disseminated Cryptococcus neoformans by cerebrospinal fluid and bone marrow aspirate culture. He was treated with amphotericin B for 2&emsp14;weeks (1&emsp14;mg/kg/day), and then with fluconazole orally for 8&emsp14;weeks (12&emsp14;mg/kg/day). He also received a new diagnosis of HIV and was started on antiretroviral therapy 2&emsp14;weeks after starting antifungal treatment. At follow-up 8&emsp14;weeks later, he was doing well.
    Case Reports 10/2012; 2012(oct24_2). DOI:10.1136/bcr-2012-007036
  • N Wattanutchariya · V Sirisanthana · P Oberdorfer ·
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    ABSTRACT: Objectives: Virological failure on first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based treatment regimens has become a problem in HIV-infected children on long-term antiretroviral therapy (ART). Protease inhibitor (PI)-based regimens are therefore often given to children failing NNRTI-based regimens. The aim of the study was to assess the 48-week effectiveness, safety and predictive factors for viral suppression of PI-based regimens in HIV-infected Thai children who had failed NNRTI-based regimens. Methods: This study assessed 41 HIV-infected children who had failed first-line NNRTI-based regimens and were switched to PI-based regimens for at least 48 weeks. We assessed their CD4 cell counts, plasma HIV RNA levels, weight-for-age and height-for-age z-scores, and adverse events. Results: The children's median age was 9.5 years (range 1.5-15.8 years). At baseline, their median CD4 cell count was 276 cells/μL [interquartile range (IQR) 160-749 cells/μL], and their median plasma HIV RNA level was 4.5 log10 HIV-1 RNA copies/mL (IQR 3.9-4.8 log10 copies/mL). After 48 weeks of PI-based therapy, their CD4 cell counts increased to a median of 572 cells/μL (IQR 343-845 cells/μL) and in 73.2% plasma HIV RNA levels decreased to < 50 copies/mL. Their median weight-for-age and height-for-age z-scores were stable over the period of the study. Diarrhoea occurred in 29.3% of patients. Triglyceride levels were significantly higher at weeks 24 and 48 in comparison to baseline measurements. Conclusions: PI-based regimens are safe and effective for HIV-infected Thai children who have failed first-line NNRTI-based regimens. However, long-term follow-up is warranted in order to ascertain the feasibility and sustainability of these new regimens.
    HIV Medicine 10/2012; 14(4). DOI:10.1111/j.1468-1293.2012.01061.x · 3.99 Impact Factor
  • Peninnah Oberdorfer · Kritsana Kongthavonsakul · Jintana Intachumpoo · Shaun Odell ·
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    ABSTRACT: Tuberculosis is a rare cause of chronic suppurative otitis media and mastoiditis. Intracranial complications are rare. The authors report a case of a 14-year-old girl with chronic otitis media of her right ear for 2&emsp14;years. Her presentation was as follows: 10&emsp14;days before admission she had a high fever, headache, alteration of consciousness and a generalised seizure. CT scanning of her brain showed right otomastoiditis with early brain abscess of the right cerebellum. She underwent right radical mastoidectomy and aspiration of the cerebellar abscess. The pus from the mastoid and cerebellar abscess was stained positive for acid-fast bacilli (AFB). The pus culture grew Mycobacterium tuberculosis (MTB). Her discharge diagnosis was tuberculous mastoiditis (TM) with cerebellar abscess. Long-term treatment plans included antituberculous drugs for 1&emsp14;year.
    Case Reports 07/2012; 2012. DOI:10.1136/bcr-2012-006618
  • Peninnah Oberdorfer · Kritsana Kongthavonsakul · H Patricia Lochungvu ·
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    ABSTRACT: Spinal tuberculosis (TB) in children is uncommon. The authors report a case of a 3-year-old boy who was diagnosed with TB spondylitis. He presented to the hospital with a back mass, back pain and inability to walk. He failed to receive TB prophylaxis after having been in close contact to his mother who had pulmonary TB. He received incision and drainage and continued on anti-TB regimens without complications. At 4-month follow-up, he was able to stand and walk without assistance. It is important to carry out contact investigations and provide TB prophylaxis to children who have had a history of contacting TB index cases to prevent TB disease and serious complications of TB infection.
    Case Reports 06/2012; 2012(jun11 1). DOI:10.1136/bcr.02.2012.5918
  • Kritsana Kongthavonsakul · Charles Henry Washington · Peninnah Oberdorfer ·
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    ABSTRACT: The authors report a 6-year-old boy with fever, rash and cough. He was diagnosed with severe measles pneumonia and admitted to the paediatric intensive care unit with severe dyspnoea 8 days after symptom onset. He received intravenous antibiotics and high dose vitamin A. Three days later, he had recovered and was discharged home. He had not been vaccinated for measles, mumps and rubella according to the schedule. This case highlights the need for rapid diagnosis, appropriate treatment and determination of vaccination status of children with measles in order to prevent complications.
    Case Reports 05/2012; 2012. DOI:10.1136/bcr.12.2011.5411