A unique case of phaeohyphomycosis subretinal abscess in a patient with arthropathy and lung pathology.

A 67‑year‑old former gold miner with rheumatoid arthritis, treated with steroids and methotrexate, presented to eye casualty with a painful right eye. Examination revealed an anterior uveitis and despite an initial response to topical steroids, the intraocular inflammation worsened with anterior and posterior uveitis development. Re‑examination showed a white mass in the peripheral nasal retina initially suspected of being active Toxoplasmosis infection and anti‑toxoplasmosis treatment commenced. After improvement and tapering of this treatment, the intraocular inflammation reoccurred. Cytopathological examination of a pars plana vitrectomy obtained vitreous sample that showed a non‑diagnostic non‑infectious chronic vitritis. The vitreoretinal surgeons elected to do a direct biopsy of the white subretinal mass in the peripheral nasal area. This revealed, quite unexpectedly, an abscess containing pigmented phaeohyphomycosis fungi. This case report documents the multidisciplinary approach that assisted in clinching a final diagnosis and the role of sub‑retinal biopsy in this unprecedented scenario.

Life history and larval morphology of Eurhinus magnificus Gyllenhal (Coleoptera: Curculionidae), a new weevil to the United States

Eurhinus magnificus Gyllenhal has been collected in south Florida, presumably introduced through trade with countries in its native range. Very little information has been published on the biology or taxonomy of this insect. We conducted studies to investigate various aspects of its life history and host plant associations. The pre-imaginal life stages of E. magnificus are described for the first time. Dimensions of the adult, egg, larval, and pupal stages are also provided; head capsule measurement revealed five larval instars. All life stages of E. magnificus were collected at several sites in Broward and Miami-Dade counties from the host plant Cissus verticillata (L.) Nicolson & Jarvis (Vitaceae). Eggs were laid singly within the succulent, young subterminal portion of the host plant stem, one or two occurring between two nodes. Gall formation was apparent by the first to third instar and continued to increase in size until pupation which occurred within the gall. Predators and pathogens appeared to be responsible for considerable mortality in the field; there was no evidence of parasitism of any of the life stages. Greenhouse studies were undertaken to determine E. magnificus development time and host specificity. Adult weevils attacked grape cultivars (Vitis spp.) and feeding opened the stems to fungal agents but no physical evidence of larval development was apparent on grapes.

Se ha recolectado, en el sur de Florida, a Eurhinus magnificus Gyllenhal. Se efectuaron estudios de investigación sobre varios aspectos del ciclo biológico, y asociaciones entre el picudo y plantas hospederas. Se describen aquí por primera vez los estados inmaduros de E. magnificus. Se dan a conocer las dimensiones de los estados de adulto, huevo, larva y pupa. Las medidas de la cápsula cefálica revelaron que hay cinco estadios en esta especie. Todos los estados de E. magnificus fueron colectados en la planta hospedera Cissus verticillata (L.) Nicholson y C.E. Jarvis (Vitaceae) en varios lugares localizados en los condados de Broward y Miami-Dade. Los picudos depositan un o dos huevos dentro de la parte más tierna del tallo que se encuentra entre dos yemas laterales localizadas en la región subterminal de la planta hospedera. En esta región, aparece una agalla, la cual es más visible cuando la larva esta entre el primer y tercer estadios. La agalla crece en tamaño hasta empupamiento, el cual ocurre dentro de esta. Los depredadores y patógenos parecen ser responsables por una gran mortalidad de estados inmaduros en el campo; En el campo, no se observó ningun indice de parasitismo en esta especie. Se llevaron a cabo estudios en casa de malla con el fin de determinar el tiempo de desarrollo y especificidad de hospederos de E. magnificus. Los picudos atacaron cultivares de uva (Vitis spp. - Vitaceae). No se observó el desarrollo larvario de E. magnificus en Vitis L.

Unequal treatment access and malaria risk in a community-based intervention program in the Philippines.

This study assesses the influence of several malaria risk factors and volunteer health worker (VHW) accessibility on parasite prevalence and treatment-seeking in a remote area of Mindanao, the Philippines. An anti-malaria program in the area seeks to devolve malaria diagnosis and treatment to the VHWs. Firstly, the relationship between malaria and demographic factors, bednet use, and access to treatment was investigated. Secondly, adults from villages with and without resident VHWs were questioned on historical and proposed treatment-seeking for fever and the capacity of the communities to support more health workers was assessed. Parasite prevalence was significantly higher among patients living in villages lacking a resident VHW (adjusted OR=3.88, p=0.02), where proposed delays in consulting VHWs and the official health service, and the use of alternative medicine, were also significantly higher. Kinship or social closeness to VHWs appears to play a role in accessibility. The educational and economic requirements demanded of VHWs impede potential expansion of the program to non-serviced villages. If the effectiveness and equity of community-based treatment strategies is to be increased, increased flexibility allowing use of local, less-educated, drug dispensers needs to be considered.

Gender, mosquitos and malaria: implications for community development programs in Laputta, Myanmar.

This paper examines the gender roles linked to division of labor and potential exposure to mosquitos and malaria prevention activities. A "Human Development Initiative" (HDI) Project has been launched in Laputta, a mangrove delta region of Myanmar assisted by United Nations Development Program since 1994. The project aims to improve rural community access to primary health care and provide micro-credit programs, income generation schemes, and educational opportunities as a basis for community empowerment. Women and children of low-income households are the target beneficiaries. Prior to self-care training program and distribution of self-care manuals, altogether 20 focus group discussions (separately assigned to men and women) were conducted in eight study villages between January to February 2000. The primary vector for malaria in study area is Anopheles sundaicus. Rural women were prone to malaria due to exposure to mosquitos within the peak biting period at night because of their gender assigned roles. Both men and women perceived that mosquitos commonly bite before midnight, more at dusk. Lack of awareness of correlation between mosquitos and malaria together with lack of affordability enhance either non-use or shared use of bed-nets at home. Rural women did not consider destruction of breeding places of mosquitos as their major concern. Thus, it is essential for program planners to motivate local women for more active participation in vector control measures within and beyond their households in the context of community development programs.

Malaria in Honiara, Solomon Islands: reasons for presentation and human and environmental factors influencing prevalence.

During February and March 1995, out-patients attending health clinics and the Central Hospital in East Honiara, Guadalcanal, Solomon Islands, were surveyed with the aim of determining factors influencing the differing rates of malaria, the proportion of transmission occurring within the town, and the reasons for presentation. Three hundred and nine adult patients, who were sick and had blood smears taken, were asked about their general knowledge of malaria transmission. Of those interviewed, 120 were visited at their home in East Honiara, to determine variables. EpiInfo 5.1 was used in analysis. A history of fever alone was not a good indicator of parasitemia. Most precautions, including bed nets, window screens and personal precautions were of little benefit. Significant protection was afforded individuals and families with indoor kitchens. Patients not completing their antimalarial treatment fared worse in terms of parasitemia and malaria history. Most malaria/parasitemia was indigenous to Honiara. Many patients had a good knowledge of malaria transmission and mosquitos, but this did not translate into a lower rate of parasitemia or malaria.

Malaria in Honiara, Solomon Islands: vector studies.

Adult and larval specimens of anopheline mosquitos were collected throughout eastern Honiara during a study into risk factors for malaria illness in adults. Species identification was by morphology, DNA probes and by PCR. Only Anopheles farauti s.s. were identified from part-night landing catches carried out from 1900 to 2200 hours. Most mosquitos attracted to humans were culicines. The majority of anophelines (85%) were captured between 1900 and 2000 hours. An. farauti s.s. larvae were most common but one An. farauti No. 7, and ten An. punctulatus larvae were also collected.

Primary nasopharyngeal tuberculosis presenting as bilateral conductive deafness

A case is reported of primary nasopharyngeal tuberculosis presenting as bilateral conductive deafness without any other symptoms. After antituberculous therapy repeat biopsies of the nasopharynx were normal and the conductive deafness resolved