Acute renal failure in Plasmodium malariae infection.

We report an unusual case of transfusion-transmitted malaria which remained undiagnosed for several months in an Italian woman splenectomised and polytransfused for thalassaemia major. The infecting species was Plasmodium malariae, and the patient developed acute renal failure, severe thrombocytopenia, and hepatic failure. Treatment with chlorochine was followed by a slow, but complete recovery of renal function.

Influence of hepatitis G virus coinfection on the clinical course of chronic hepatitis C.

Hepatitis G virus (HGV) is a parenterally transmitted virus, frequently associated with hepatitis C virus infection. Hepatitis G virus RNA was detected by reverse transcription-polymerase chain reaction in the serum of 40 patients with chronic hepatitis C. Nine (22.5%) patients had evidence of hepatitis G virus viraemia. No significant epidemiological or virological differences could be demonstrated between subjects infected with both hepatitis G virus and hepatitis C virus and subjects infected with hepatitis C virus alone. Aminotransferase values were comparable between the two groups, whereas higher levels of cholestatic enzymes (P< 0.001) were reported in the hepatitis G virus/hepatitis C virus-positive patients. A liver biopsy was performed on all 40 patients no later than 6 months before recruitment. The mean histological activity index did not differ between hepatitis G virus-positive and hepatitis G virus-negative patients, whereas specific histological features such as macrovesicular steatosis, portal granulomas, and bile duct damage were more commonly observed among the coinfected patients. The results indicate that coinfection with hepatitis G virus probably does not have a significant effect on hepatitis C virus-induced hepatic damage.

Eosinophilic ileocolitis by Enterobius vermicularis: a description of two rare cases.

BACKGROUND: Human enterobiasis is usually mild. Occasionally, however, an "ectopic" disease may occur with a more severe course. Two rare cases of eosinophilic ileocolitis due to Enterobius vermicularis infection are reported here. CASE REPORTS: Case n degree 1 was 46 years old, presenting with fever and bloody diarrhoea. Blood eosinophilia was present. Stool microscopy demonstrated red blood cells and leukocytes. A 2 mm long worm with bilateral cervical wings was found in wet-mount preparations of faecal samples. The Scotch tape test was positive for Enterobius vermicularis eggs. Colon biopsy specimens showed massive eosinophilic infiltration and a typical pinworm section overlying the infiltrated mucosa. Case n degree 2 was a 24-year-old, anti-HIV negative homosexual, presenting with watery diarrhoea. Tests for malabsorption were negative. Three mm long adult male E. vermicularis were found on stool microscopy. Biopsy specimens from the colon showed eosinophilic infiltration. In both cases a 200 mg/day course of oral mebendazole eliminated the symptoms within 3 days. CONCLUSIONS: In these two cases the clinical presentation of enterobiasis was atypical. A common finding was the eosinophilic infiltration of bowel mucosa, although it is still uncertain whether the worm per se may induce mast cell degranulation and eosinophil activation. Nevertheless, the possibility of Enterobius vermicularis infection should be considered in the presence of eosinophilic ileocolitis.

[Synergic effect of albendazole plus metronidazole association in the treatment of metronidazole-resistant giardiasis]. / Efficacia sinergica dell'associazione albendazolo-metronidazolo nella giardiasi refrattaria a monoterapia con metronidazolo.

Twenty patients with intestinal giardiasis, already resistant to 3-5 previous courses of oral metronidazole, were randomly distributed into 2 different groups: 10 subjects were given oral albendazole (440 mg/two times per day for 7 days) and 10 were submitted to the association of albendazole (400 mg/two times per day for 7 days) plus metronidazole (250 mg/three times per day for 7 days). All patients were evaluated both for clinical and parasitological status, immediately before and after therapy and, then, 4 weeks later. Only 3 patients of those treated with albendazole alone, showed a clinical and parasitological remission at the end of therapy, and one of them relapsed 4 weeks later. All patients who underwent albendazolemetronidazole association responded to the therapy and all except one were defined as "cured" 4 weeks later. Our study demonstrates that albendazole alone is not an effective therapeutic alternative for "metronidazole-resistant" giardiasis. The association of metronidazole plus albendazole seems synergic and deserves further studies.