Evaluation of fuadin therapy in schistosomiasis japonica

Treatment with Fuadin was tried in 2,407 patients who were found positive for Schistosoma japonicum ova on stool examination. These patients represented both sexes of all ages ranging from 5 to 50 years. Only 1,135 were able to complete one course of 40 cc. given intramuscularly in nine injections. Of this number, 1,083 were followed-up during and after treatmentAt the end of one course, 847 or 78.21% ceased to pass viable ova; 236 or 21.79% were still positive on stool examination . Of these 236 patients, 62 continued to receive additional injections until all became negative. Taken together, 909 or 83.91% no longer passed ova in the stool at the end of treatmentOnly 334 out of 909 were followed-up one month after completing treatment, and 34 or 9.28% were again positive for eggs. These cases were considered relapses or treatment failures rather than re-infectionsToxic reactions appeared in 63.3% (718) of the 1,135 patients, the most common of which were nausea, vomiting, and anorexia, general body weakness, headache, joint pains, and fever. Despite these reactions, the whole course of nine injections was continued in the 1,135 patients by simply prolonging the interval of injection as long as the toxic reactions were still present. (Summary)

Serological studies in El tor cholera

Three test were utilized, namely agglutination, vibriocidal and the hemolysis-inhibition tests in determining the serological responses of 161 immunized individuals in this study. Three vaccines were given in different dosage regimen - El Tor, mixed El tor and cholera , and classical cholera vaccines. Higher agglutinative and vibriocidal antibody titers were obtained among those immunized with two or three doses of El Tor vaccine than with the other two types of vaccines. The agglutinating antibody response to classical Inaba and Ogawa challenge by those given the El tor vaccine was even higher than those that received classical cholera vaccine. Antibodies to both classical and El Tor strains of cholera vaccine but to a lesser degree than by either the pure El Tor or the mixed vaccine. These differences in percentage with rise in agglutinative titer were found significant by statistical analysisIt was further obseved that the reduction in vibriocidal antibody titer was not as marked as in the agglutinative antibody titer 6 months after primary immunization. It is of special interest and utmost importance to note that the usual single 1 cc. adult dose given as a booster 6 months after the primary immunization failed to produce sufficient agglutinative antibodies and on this basis it is felt that the double regimen should instead be preferred. (Summary)

The use of Nalidixic acid in public health

From the above study, it is quite evident that nalidixic acid has been successfully used for Salmonellosis other than S typhi, for Shigellosis and for gastroenteritis due to Edwardsiella tarda. The advantage is the shorter course of treatment which is of paramount importance in public health. While at the start of the trials we tried to follow the 2 tablets four times a day administration can be very effective and without untoward symptoms as dizziness. This was well demonstrated in the control of Shigellosis in Bataan. It has to be mentioned that the patients who complained of dizziness were all those with diarrhea. It is envisioned that in future trials, we will use the drug at 2 tablets four times a day during the first 24 hours then reduce the dose to 1 tablet four times a day for the rest of the course. This is the first time that nalidixic acid has been used in specific enteric infections in the Philippines. The practitioner has now an antimicrobial which he can use for enteric infections and effect a cure in a shorter time than other antimicrobials.(Summary)

AIDS in the Philippines: how much has it spread, what has been done, what lies ahead?

A total of 50 HIV carriers, 46 of them female prostitutes, have been detected through seroprevalence surveys of the Department of Health. Infection rate are highest in 2 cities near US military bases. Seven (7) frank AIDS cases who contracted the disease outside the country have been reported . Public information measures have heavily relied on mass media and there is anecdotal evidence that awareness of the disease among the urban population is increasing. The National AIDS Committee foresees that a large number of cases seen in the Philippines in the next few years will be in returning nationals who where infected abroad. (Auth)

The need for technical controls as an integral part in the management of medical diagnostic laboratories

For the first time a study was conducted to find out if there is actually a need to employ technical controls as an integral part in the management of diagnostic laboratories. The study involved biochemical, serological, parasitological and bacteriological units. While reproducibility was looked into in biochemical units, accuracy was studied in the other units. While it is presumed that internal controls exist in the units, the study brought out that they are not sensitive enough to detect changes which need appropriate remedial measures. It brought out variability of performance among workers and among laboratories. It showed also that an interlaboratory control can serve as an intralaboratory control. The acceptance of the need for controls will depend much on the inherent personal attitudes of the worker, the supervisor and the head of the laboratory. The proper attitude is necessary for its acceptance and implementation. Management of our diagnostic laboratories cannot be any different from management of a private firm where in the latter the manager controls the work for which he is accountable. (Summary)

Longitudinal studies of children born to HIV-1 antibody positive Filipino commercial sex workers (CSW): diagnostic dilemmas.

Fifteen term babies born to 12 HIV-1 antibody positive Filipino CSW have been monitored for signs and symptoms of HIV-1 infection. Eleven babies were enrolled in the study within the first 6 months after birth; 4 others were enrolled at 4, 9, 11 and 21 months of age respectively. Every 3 months after enrolment, each baby received a physical examination, serum was tested for HIV-1 antibodies and p24 antigen and peripheral blood mononuclear cells were cultured for isolation of virus. After a mean follow-up period of 39.3 months (range 7-72 months), virus isolation and serum p24 antigen assays confirmed that 2 babies have been infected with HIV-1. If the 4 babies less than 18 months of age were excluded, the vertical transmission rate was 18.2%. Seven babies who have been monitored for a minimum of 25 months (range 31-60 months) lost their maternal antibodies but 6 of them subsequently developed indeterminant Western blots (WB); reactivity to p24 and/or gp120/ 160 but no reactivity to gp41. Of the remaining 6 babies, still less than 25 months of age (range 7-24 months), 2 lost their maternal antibodies within one year. The other 4 continued to recognize either p24 or gp120/160 well after the accepted 15-month period for loss of maternal antibody. Although a diagnosis could not be established upon the basis of these laboratory findings, clinical observations (failure to thrive, anergy, persistent generalized lymphadenopathy and recurrent pneumonias) mimicked HIV-1 infection. However, because these clinical features are common among many babies in the developing world, their usefulness in supporting a diagnosis of perinatal HIV-1 infection is limited.

PIP: Clinicians monitored 15 full-term infants born to 12 HIV-1 seropositive commercial sex workers in the Philippines for signs and symptoms of HIV-1 infection. They performed a physical examination and HIV test on each infant every 3 months. The mean follow-up period was 39.3 months (range 7-72 months). Two infants tested positive for HIV-1 infection. When the researchers excluded the four infants under 18 months of age, the HIV-1 perinatal transmission rate stood at 18.2%. The maternal antibodies in seven infants who were monitored for at least 25 months disappeared; yet six subsequently developed indeterminant Western blots (i.e., reactivity to p24 and/or gp120/160, but no reactivity to gp41). The maternal antibodies in two of the six remaining infants who were under 25 months old disappeared within 1 year. The Western blots still recognized either p24 or gp120/160 in the other four infants beyond the accepted 15-month period for loss of maternal antibody. The clinicians could not establish a diagnosis based on these laboratory findings. They did diagnose signs and symptoms that may indicate HIV-1 infection (i.e., failure to thrive, anergy, persistent generalized lymphadenopathy, and recurrent pneumonias). Yet these clinical features are prevalent in many infants in developing countries, thereby making their usefulness in diagnosing perinatal HIV-1 infection limited.

Capillariasis philippinensis: a fish-borne parasitic zoonosis.

Fish from lagoons in Northern Luzon, Philippines, have been shown experimentally to be intermediate hosts of Capillaria philippinensis. Eggs ingested by the fish hatch in the intestines and the larvae double in size in 3 weeks. When fed to monkeys, Mongolian gerbils and birds, the larvae develop into adults and reproduce. Fish from the lagoons or purchased from the market were fed to gerbils and the animals developed patent infections, demonstrating natural transmission of the parasite. Philippine and Thailand populations have the habit of eating uncooked freshwater and brackish water fish and some have been experimentally infected with C. philippinensis. These countries report the largest number of cases of intestinal capillariasis. Fish-eating birds are now considered natural hosts for the parasite, fish the intermediate hosts, and humans accidentally become infected by eating infected fish.

HIV-1 seropositive women in the Philippines: pregnancy outcome and perinatal transmission of HIV-1.

Annual surveillance studies were initiated in 1985 to determine the incidence and prevalence of HIV-1 infection in female prostitutes registered through the Social Hygiene Clinic System of the Philippine Department of Health. All of the confirmed HIV-1 seropositive women detected in the above surveys who could be contacted were followed up about every three months to monitor their clinical and immunological status. Since we regularly interviewed and examined these HIV-1 seropositive women, we were able to note the occurrence of pregnancies following HIV diagnosis. By September 1990, 54 HIV-1 seropositive women (aged 18-35) detected from the above surveys had been interviewed and examined. Twenty-six of these HIV-1 positive women had a total of 37 pregnancies. Eight were pregnant at the time of HIV diagnosis: three term deliveries, one premature delivery (PD) at eight months, three abortions, and one lost to follow-up while still pregnant. Five of these eight had repeat pregnancies: two term deliveries, two abortions, and one lost to follow-up while pregnant. Eighteen other women became pregnant one or more times after HIV diagnosis: seven term deliveries, 13 abortions, two PDs, one ectopic pregnancy terminated, one currently pregnant, and one lost to follow-up during pregnancy. There was no clear indication from clinical examinations and CD4+ cell counts that pregnancy exacerbated the course of HIV-1 related disease in these women. One of the 12 term infants has died and eight have developed non-specific findings that are suggestive but not diagnostic of HIV infection.2+ strongly seropositive by both ELISA and Western blot assay at 16 months.

Sexual behavior of Filipino female prostitutes after diagnosis of HIV infection.

A study of female prostitutes in Manila who tested positive for human immunodeficiency virus (HIV) antibody ascertained demographic and sexual behavior information following diagnosis. Counselling alone did not appear to have a major impact on the sexual behavior of the HIV positive women since most continued to work as prostitutes. Switching from high risk to low risk jobs in bars is not effective in preventing HIV positive women from engaging in prostitution. Revoking work permits is only effective if enforced with adequate follow up. Alternative job training programs may offer a viable approach.

Epidemiology of HIV infection among prostitutes in the Philippines.

Between 1985 and 1987, examinations for human immune deficiency virus (HIV) antibody were done on 25,392 prostitutes working in 64 cities throughout the Philippines. The country-wide seropositivity rate among prostitutes based on this sample was 0.8/1,000. Of the HIV cases, 85% were working in just two cities whose prostitute populations comprised 50% of the total sample. The average incidence rate for the same two cities after 1 year was 2.3/1,000. HIV antibody-positive women were enrolled in a case-control study to determine demographic and epidemiologic risk factors. This study involving 34 HIV-positive prostitutes and 61 randomly selected negative control prostitutes did not reveal any risk factors related to sexual or other types of behavior. A history of genital warts, a history of abnormal vaginal discharge, and cytomegalovirus antibody were significantly more frequent in the HIV-positive cases than in the controls; however, by logistic regression analysis, only an abnormal vaginal discharge was independently associated with HIV infection. Absence of any evidence of transmission by blood transfusion or i.v. drug abuse suggests that HIV was introduced by the heterosexual route.

Albendazole in the treatment of intestinal capillariasis.

Albendazole or Zentel a benzimidazole derivative, was used to treat intestinal capillariasis in hospitalized patients seen in Northern Luzon in the Philippines. In initial studies, four patients responded satisfactorily to the drug in dosages of 400 mg/day in divided doses for 20 days. This is the same dosage used for mebendazole, which has been the drug of choice in treating the parasitosis. In further studies, 16 patients with Capillaria philippinensis, were treated with 400 mg/day of the drug for 10 days, and 15 were completely cured. The one treatment failure was found to be passing eggs of the parasite three months later, and was retreated with the standard mebendazole regimen of 400 mg/day for 20 days. Side effects attributed to albendazole were not reported in any of the patients. Albendazole, 400 mg/day in two divided doses, is now the recommended drug of choice in Northern Luzon in the Philippines.

Emerging patterns of HIV infection and control in the Philippines.

PIP: In the Philippines, a total of 46 female prostitutes were found seropositive for the antibodies of HIV as of July 31, 1987. A total of 53,376 tests were performed among these women, and repeated positive tests by enzyme-linked immunosorbent assay (ELISA) were confirmed by the Western blot test. 40 of the cases were found in the Angeles City and Olongapo areas adjacent to military bases, and they were detected from among 34,998 blood examinations, for an overall HIV antibody positivity rate of 1.1/1000. In the MetroManila area, 4 prostitutes were found positive from among 10,549 tested, yielding an antibody positivity rate of 0.4/1000. The Department of Health tested 867 male homosexuals, and found only 1 individual seropositive. 3 other infections were reported by private sources, 2 of them in male homosexuals. No infection was detected in 3200 blood donors or in 12,000 overseas workers. A total of 9 cases of AIDS were reported, and all contracted the disease abroad. 7 were Filipinos: 4 homosexual/bisexual men, 1 elderly woman got it via blood transfusion, and 2 other undisclosed persons. The Philippines AIDS control plan for the period from July 1987 to December 1990 estimated about 500 cases of HIV infection in 1987 which could progress to 150 cases of AIDS by 1992. A total of 4000 cases of HIV infection by 1990 could result in approximately 1000 cases of AIDS by 1995. The AIDS Committee projected 300 cases by 1990. The strategy of AIDS control is to block the 3 main routes of transmission: sexual activity, contaminated blood supply, and infected mother to child. Control activities concern surveillance (high-risk behavior groups during the next 3 years) and laboratory testing, education, personnel development (counseling, clinical management, research), and organization of local AIDS committees in Angeles City, Olongapo, and Manila.^ieng

Prevalence of Trichomonas vaginalis in some Filipino women.

Vaginal specimens obtained from 1,284 hospitality girls and 87 expectant mothers were examined for Trichomonas vaginalis by first examining material collected from vaginal swabs and after incubation in Feinberg and Whittington culture medium. Twenty-four percent of the specimens examined, shortly after the cotton-tip swab was placed into 1 ml culture medium, were positive by direct microscopic examination and 37% positive following 3 to 5 days incubation at 37 degrees C. Only 3 of the specimens from mothers were positive after the first examination and 4 positive after culture. These high prevalence rates are expected among hospitality girls and are the highest rates thus far reported from the Philippines. These results provide convincing evidence of the value of using cultural methods in determining prevalence rates for Trichomonas vaginalis infections in females.

Leptospirosis in the Philippines.

Leptospirosis was first isolated in the Philippines from one of the human cases of Weil's Disease in 1932 and from then up to 1970 a total of 65 cases were studied sporadically. From 1971 up to 1973 a total of 390 cases were studied out of which 82 (21.02%) were found positive by isolation and serological examination. An outbreak of leptospirosis was followed up from 1976 to 1983 in a penal farm in Sablayan, Mindoro. At the time of the outbreak, 31% of the sera from patients and those with complaints reacted to one or more antigen pools with 40% of these reactors reacting to only one antigen pool. Only one percent of prisoners and residents without complaints reacted to one or more antigen pools, with 80% of these reactors reacting to pool 3 alone. Three and half years later, a first follow-up was done in which 9.07% reacted to one or more pools. Of these, 42% reacted to pool 2 and 82% to pool 3 alone or in combination with other pool. Ninety five percent of those reacting to Pool 2 reacted to L. pyrogenes and 88% of those that reacted to Pool 3 reacted to L. autumnalis. More than three years later after the first follow-up, a second follow up was done. This time 2.29% reacted to one or more pools. Most reacted specifically to L. autumnalis. The residents outside the penal farm were all non-reactive. Sampling from another penal colony and in four agricultural areas revealed no significant reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Studies on Echinostoma ilocanum in the Philippines.

Echinostoma ilocanum is widespread among the Philippine Islands but only 3% of over 30,000 stools were found to be positive for eggs. The prevalence rates were highest in Ilocana populations of northern Luzon; 11% of over 7,000 stools examined, however, rates as high as 44% were found. Pila luzonica is eaten uncooked by some people and metacercariae from these snails developed into adults in a number of laboratory animals. Rats, mice and hamsters were the most susceptible with patent infections developing as early as 7 days and lasting for 328 days. There seems to be little disease in humans and animals infected with this parasite.

HBsAG and HBeAG markers among pregnant women in Manila, Philippines.

The sera of 5,684 pregnant women were tested for HBsAG and 432 (7.6%) were found positive. Positive HBsAG sera were then tested for the e antigen and of 413 tested, 115 or 27.8% were positive. The over-all prevalence rate of e antigen was 2.03%. All women were asymptomatic. Six of 13 HBsAG-HBeAg-positive mothers delivered infants who became HBsAg-positive within two years of age for a rate of 46%. The findings support earlier studies on the importance of the e antigen as an index of perinatal transmission. Also, they support evidence of unusually high rates of transmission among Asian ethnic groups.

Attempts to modify treatment of intestinal capillariasis.

Attempts to reduce the standard treatment of intestinal capillariasis of 200 mg mebendazole twice daily for 20 days were not successful. Two of 13 patients given mebendazole at single daily dosages of 500 mg per day for 16 days relapsed 3 to 6 months after treatment. Attempts to reduce the treatment to 14 days were even less satisfactory in that 4 of 8 patients treated experienced relapses 2 to 9 months later. Since intestinal capillariasis can be fatal it is recommended to continue the use of the standard schedule of 400 mg mebendazole daily for 20 days for new cases and 30 days for relapsed cases until a more effective drug is available.