Dr Tri Wangrangsimakul MRCP FRCPath

Research Area: Microbiology

I am the clinical lead at a satellite tropical medicine research unit, affiliated to MORU, based in Chiangrai, Thailand, situated in the most northern province of the country bordering Myanmar and Laos. The region's topography is a mixture of hilly and riverine habitats. The population comprises Thais as well as groups belonging to hilltribes and migrant workers from neigbouring countries. The mainstay of the local economy is agriculture, much of it rural and small scale. 

Chiangrai is located in a region endemic for tropical rickettsioses with scrub typhus being a major cause of febrile illness. Although it remains easily treatable with available antibiotics, much of the morbidity and mortality from scrub typhus can be derived from delayed presentation, lack of recognition, and limited access to effective diagnostics. All these factors contribute to a significant health burden not only locally, but also to the wider Asia-Pacific region where it is estimated that a billion people are at risk. Furthermore, there remain uncertainties about the optimal treatment of scrub typhus in Chiangrai, an area where drug-resistant strains of Orientia tsutsugamushi, a Gram negative intracellular bacteria responsible for scrub typhus, were previously reported 20 years ago. This finding is yet to be validated and the underlying nature fully investigated.

There is currently no vaccine for scrub typhus. Immunity after an infection is short-lived and does not provide universal protection against all strains. Our understanding of the immune response to Orientia tsutsugamushi remains limited although work is underway to rectify this knowledge gap in both humans and non-human primates. In Chiangrai, we are currently studying the immune response to scrub typhus in children using novel immunoassays developed at MORU. Further work investigating the pathophysiological pathways of infection from the eschar to the bloodstream is also in progress. Important work on the optimal treatment of scrub typhus and investigating the underlying nature of reduced antimicrobial susceptibility in Orientia tsutsugamushi strains in Chiangrai are also planned.

Name Department Institution Country
Professor Daniel H Paris Tropical Medicine Oxford University, Bangkok Thailand
Professor Nicholas PJ Day FMedSci FRCP Tropical Medicine Oxford University, Bangkok Thailand
Professor Yoel Lubell Tropical Medicine Oxford University, Bangkok Thailand
Dr Jeanne Salje Tropical Medicine Oxford University, Bangkok Thailand
Matthews PC, Wangrangsimakul T, Borthwick M, Williams C, Byren I, Wilkinson D. 2014. Electronic prescribing: Reducing delay to first dose of antibiotics for patients in intensive care. BMJ Qual Improv Rep, 2 (2), pp. u202241.w1120-u202241.w1120. | Show Abstract | Read more

Delays in antibiotic therapy in the context of severe sepsis are associated with increased mortality. One way to reduce such delays may be through modifications to electronic prescribing (EP) systems. The research team evaluated the role of one such EP system in reducing delays in antibiotic administration in an Intensive Care Unit (ICU). First, the delays in antibiotic administration in adult ICU patients was quantified. The EP system was then modified to remove deafult time settings for antibiotic doses, which ensured that all antibiotic doses were scheduled for administration within an hour of the prescription being generated. Enhanced training for clinicians and nurses was also implemented, focusing on the EP system and highlighting the importance of prompt antimicrobial prescribing and delivery to the patient. The antibiotic administration was re-audited, and a significant reduction in delays (p=0.002, Mann-Whitney U test) was found. This study demonstrates how prudent use of EP systems can help to reduce delays in antibiotic administration in an ICU setting, thus potentially contributing to reducing mortality in patients with sepsis.

Barta Z, Harrison MJ, Wangrangsimakul T, Shelmerdine J, Teh L-S, Pattrick M, Edlin H, Dale N, Ahmad Y, Bruce IN. 2010. Health-related quality of life, smoking and carotid atherosclerosis in white British women with systemic lupus erythematosus. Lupus, 19 (3), pp. 231-238. | Show Abstract | Read more

We tested the hypothesis that carotid atherosclerosis in systemic lupus erythematosus (SLE) is associated with poor health-related quality of life (HRQOL), which is independent of any association with traditional risk factors (TRFs), lifestyle and socioeconomic factors. Women with SLE completed the RAND Medical Outcome Study 36-Item Short-Form Health Survey version 1 (MOS SF-36). B-mode Doppler examination of the carotid arteries determined the presence of atherosclerotic plaque. The association between carotid plaque and HRQOL domains was analysed using logistic regression models with sequential adjustments for age, TRFs, education level and employment status. We studied 181 women, 47 (26%) of whom had carotid plaque. Carotid plaque was significantly associated with lower levels of physical functioning (p = 0.047), vitality (p = 0.04), role emotional (p = 0.04) and mental health subscales (p = 0.01) and lower mental component summary score (MCS) (p = 0.03). These associations were no longer significant after adjustment for age and TRFs, especially smoking. Smokers had lower physical functioning, vitality and mental health and more bodily pain. The association between carotid plaque and HRQOL was not independent of TRFs and smoking was a key mediator of the associations found. Poor HRQOL in smokers will need addressing as part of any smoking cessation strategies in SLE patients.

Matthews PC, Wangrangsimakul T, Borthwick M, Williams C, Byren I, Wilkinson D. 2014. Electronic prescribing: Reducing delay to first dose of antibiotics for patients in intensive care. BMJ Qual Improv Rep, 2 (2), pp. u202241.w1120-u202241.w1120. | Show Abstract | Read more

Delays in antibiotic therapy in the context of severe sepsis are associated with increased mortality. One way to reduce such delays may be through modifications to electronic prescribing (EP) systems. The research team evaluated the role of one such EP system in reducing delays in antibiotic administration in an Intensive Care Unit (ICU). First, the delays in antibiotic administration in adult ICU patients was quantified. The EP system was then modified to remove deafult time settings for antibiotic doses, which ensured that all antibiotic doses were scheduled for administration within an hour of the prescription being generated. Enhanced training for clinicians and nurses was also implemented, focusing on the EP system and highlighting the importance of prompt antimicrobial prescribing and delivery to the patient. The antibiotic administration was re-audited, and a significant reduction in delays (p=0.002, Mann-Whitney U test) was found. This study demonstrates how prudent use of EP systems can help to reduce delays in antibiotic administration in an ICU setting, thus potentially contributing to reducing mortality in patients with sepsis.

Barta Z, Harrison MJ, Wangrangsimakul T, Shelmerdine J, Teh L-S, Pattrick M, Edlin H, Dale N, Ahmad Y, Bruce IN. 2010. Health-related quality of life, smoking and carotid atherosclerosis in white British women with systemic lupus erythematosus. Lupus, 19 (3), pp. 231-238. | Show Abstract | Read more

We tested the hypothesis that carotid atherosclerosis in systemic lupus erythematosus (SLE) is associated with poor health-related quality of life (HRQOL), which is independent of any association with traditional risk factors (TRFs), lifestyle and socioeconomic factors. Women with SLE completed the RAND Medical Outcome Study 36-Item Short-Form Health Survey version 1 (MOS SF-36). B-mode Doppler examination of the carotid arteries determined the presence of atherosclerotic plaque. The association between carotid plaque and HRQOL domains was analysed using logistic regression models with sequential adjustments for age, TRFs, education level and employment status. We studied 181 women, 47 (26%) of whom had carotid plaque. Carotid plaque was significantly associated with lower levels of physical functioning (p = 0.047), vitality (p = 0.04), role emotional (p = 0.04) and mental health subscales (p = 0.01) and lower mental component summary score (MCS) (p = 0.03). These associations were no longer significant after adjustment for age and TRFs, especially smoking. Smokers had lower physical functioning, vitality and mental health and more bodily pain. The association between carotid plaque and HRQOL was not independent of TRFs and smoking was a key mediator of the associations found. Poor HRQOL in smokers will need addressing as part of any smoking cessation strategies in SLE patients.

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