Symptoms attributable to mansonella (Dipetalonema) perstans in South Eastern Uganda and their response to levamesole and ivermectin

Among helminthic infections of medical improtance; Mansonell perstans (M.perstans) hardly features; being generally considered a non-pathogen responsible for asymptomatic eosinophilia. However; during a screening exercise for trypanosomes in various villages of South-eastern Uganda in 1996; P.falciparum accounted for 35while M.persans was identified in 26of the 105 screened cases in Kirongo village; no case of trypanosomiasis was found in this village. Methods: In the process of screening; it was observed that two of the cases with M. persans had long standing symptoms of pains in the joints; bones and muscles; body weakness anfd vague headaches; some degree of anxiety was observed. One of the cases was bedridden by these symptoms. Physical assessment was generally unrevealing. However it was noted that these two cases had the highest numbers of microfilariae load; a course of oral levamesole 120mg twice daily for three days was tried and blood from a finger prick examined daily for microfilariae. Results: It was found that the microfilariae progressively became fewer and less motile during the course of therapy. By the fourth week blood was free from microfilariae and the cases were asymptomatic. A third case from another village was identified with similar symptoms and heavy microfilariae load and responded to a single oral dose of Ivermectin; 200 micrograms. kg body weight. Conclusion: Heavy loads of microfilaria M. perstans produce severe symptoms of muscle; joint and bone pains as well as headaches and anxiety; which respond to a course of Levamesole or Ivermectin

Clinical Features of Typhoid Fever Observed in the Uganda African Patient in Mulago Hospital

Typhoid fever being a disease commonly consufed with other common febrile illnesses; especially when the diagnosis is based on clinical features alone prompted the author to look into the frequency of its presenting features. Methods: One hundred case notes confirmed by a positive blood culture for Salmonella typhi at Mulago Hospital; were retrieved and analysed for clinical features. the majority of the cases diagnosed and treated as typhoid on other evidence were excluded from the study. Results: The commonest features were fever; body weakness; headache and loss of appetite and were present in 98of the cases. The other features comprised of dizziness in 96; coated tongue in 96; dehydration in 94; abdominal pain in 92; abnormal tenderness in 86; low blood pressure on admission in 80; rise in blood pressure after admission in 76; anaemia in 68; splenomegaly in 68; backache in 66; typhoid state in 64; joint pains in 62; chills in 62; partial deafness in 52; muscular pain in 52; constipation in 40; disorientation in 36; delirium in 34; painful toes in 28; pea soup stools in 26; crepitations in lungs in 18; presence of a splenic rub in 8; jaundice in 8; death in 6; thrombo-embolism in 2and convulsions in 2. Apparently; rose spots were not observed in this series. Conclusion: the common clinical features of typhoid in 100 Ugandan confirmed cases of typhoid fever in Mulago Hospital consist of fever; body weakness; headache; loss of appetite; dizziness; features of dehydration; abdominal pain and tenderness; low blood pressure; anemia and joint pains. Pea soup stools commonly stressed by books were seen in only a quarter of the cases and the classical rose spots were not seen and accordingly desearve no emphasis in the Ugandan context