The current status of neurocysticercosis in Eastern and Southern Africa.

Some information has been documented on the epidemiology of neurocysticercosis in Eastern and Southern Africa through the monitoring of hospital-based patients with neurocysticercosis, community-based serological surveys of particular socio-economic groups of people and surveys of porcine cysticercosis. Studies have revealed that non-pork eaters have as great a chance of infection as a pork eater, the Xhosa-speaking people of the Eastern Cape Province have the highest prevalence of cysticercosis/taeniosis in South Africa probably due to the common practice of free-range pig farming and the lack of sanitation in these areas. Several studies have revealed high prevalence rates in children and interestingly, patients with active cysts suffering from epilepsy. A startling mode of transmission is where self-trained healers use Taenia segments either for benevolent (e.g. in the treatment of severe intestinal tapeworm infections) or malevolent (evil) purposes (e.g. women "poisoning" an unfaithful husband or lover by adding the contents of Taenia solium segments to beer).

Problems in the optimal management of myasthenia gravis patients--a prospective clinical survey at Kalafong Hospital.

OBJECTIVES: This study forms part of a clinical survey of problems in the optimal management of patients with inherited neuromuscular diseases seen at Kalafong Hospital in Pretoria. Our objectives were to determine the problems associated with providing patients with optimal management until true remission (cure), and to apply the findings to ongoing improvement of optimal management. This is the first report of the series. METHODS: Twenty-six patients were studied prospectively from 1986 to 1998. Early sternal-splitting thymectomy on class II-V patients as well as anticholinesterases, corticosteroids, azathioprine, plasma exchange, intensive care and various combinations of these constituted part of the optimal management. An assessment of the total monthly income and distance from hospital was done for each patient. RESULTS: Five of the 15 thymectomised patients (33.3%) were lost to follow-up after reaching remission. Of the remaining 10 patients, 6 (40%) are in true remission and the remaining 4 (26.7%) are in pharmacological remission. Four of the 11 patients (36%) treated non-surgically were lost to follow-up. Of the remaining patients, 1 (9.1%) is in true remission and the remaining 6 (54.5%) are in pharmacological remission. The average monthly income of patients lost to follow-up in the thymectomised group was lower than that of patients who continued follow-up, and their homes were further away from hospital. In the non-surgical group the average monthly income of patients lost to follow-up was higher than that of patients who continued follow-up and their homes were nearer to the hospital. CONCLUSION: Early thymectomy (the aggressive approach) resulted in 40% cures, 26.7% pharmacological remissions, no mortality, minimal morbidity, and early discharge. Loss to follow-up was one of the biggest problems in providing optimal management for these patients. We modified optimal management in response to our patients' concerns without sacrificing excellence, and found that poverty and poor access to tertiary hospitals were possible contributory factors to loss to follow-up. Suggestions are made with regard to tackling the problems. Myasthenia gravis (MG) is a disorder of neuromuscular function resulting from an immunologically based premature destruction of acetylcholine receptors.

The neurocysticercosis project in Atteridgeville-Mamelodi townships.

The incidence and prevalence of neurocysticercosis in South Africa are unknown. A hospital-based prospective study to determine the incidence of neurocysticercosis was therefore undertaken. A research questionnaire and strict inclusion and exclusion criteria were used. Apart from determining the incidence, our other aims were to determine the sources of infection and routes of transmission, evaluate therapeutic programmes and, on the basis of our findings, develop prevention programmes. We found that it was impossible to determine the sources of infection and routes of transmission. When strict selection criteria were applied the number of patients (13) was significantly smaller than the 58 patients in an earlier pilot project. The implications of the findings for incidence surveys are discussed. The implications of the enzyme-linked immunosorbent assay (ELISA) of serum and cerebrospinal fluid for diagnosis are discussed. The effectiveness of praziquantel was confirmed, and therapeutic approaches and preventive measures based on our findings are suggested.