Late onset of Strongyloides stercoralis meningitis in a retired Belgian miner.

We report a rare case of Strongyloides stercoralis meningitis in an immunocompromised patient treated for a lung carcinoma. Despite his Belgian origin, he was infected with S. stercoralis due to his former work as a miner. Although mostly prevalent in (sub)tropical areas, there are temperate regions where this nematode can occur.

Imported malaria in a tertiary hospital in Belgium: epidemiological and clinical analysis.

BACKGROUND AND OBJECTIVE: There has been a marked increase in tourism, immigration, and business travel to malaria-endemic areas. Non-immune individuals (western travellers) or immigrants living for more than one year in non-endemic areas who visit friends and relatives (VFR) are particularly susceptible to developing severe malaria when travelling to areas with high levels of transmission. In this study, epidemiological, clinical and biological features of malaria in travellers returning from endemic areas were analysed. This may help clinicians unfamiliar with malaria not to overlook this disease in its early stage, and to initiate prompt treatment. PATIENTS AND METHODS: We retrospectively analysed all cases of patients who presented with malaria in our institution between 2003 and 2008. RESULTS: Eighty patients were included. Most patients visited Africa (93.6%). Accordingly, P. falciparum was the main species identified (67/77 patients i.e. 87%). Sixty-five patients (65/78 i.e. 83.3%) had not taken any prophylaxis and 13 (16.7%) had taken it inadequately. Common clinical features were fever (80/80, 100%), influenza-like symptoms (16/80, 20.1%), respiratory symptoms (5/80, 6.3%), neurological symptoms (2/80, 2.5%) or digestive symptoms (15/80, 18.8%). Digestive symptoms were predominant in children < 16 y.o. (60% of these patients). CONCLUSION: Imported malaria cases are mostly related to the lack of adequate use of chemoprophylaxis. Plasmodium falciparum is the main species responsible for imported cases of malaria in our institution. Clinical features vary, but fever is universally present at presentation. As such, all cases of fever upon return from a malaria-endemic area must be considered as malaria until proven otherwise, at least during the first three months after the return.

An itchy holiday.

A 33-year-old Dutch woman developed itchy skin lesions during a beach holiday in Thailand. She was treated for various diagnoses, without success. Finally she was successfully treated for a clinically suspected hookwormrelated folliculitis. A brief overview of hookworm-related folliculitis is given.

Anti-DNA antibodies can bind to the glomerulus via two distinct mechanisms.

It is generally assumed that antibodies to double stranded DNA (anti-DNA) play a pivotal role in the pathogenesis of SLE nephritis. Recently, we reported that anti-DNA antibodies can bind to heparan sulphate proteoglycan (HSPG), a constituent of the glomerular basement membrane (GBM), via histones and DNA. We postulated that these histone/DNA/anti-DNA complexes can bind via their histone part to the glomerulus in vivo. To test this hypothesis we performed in vitro binding studies with isolated GBM loops and renal perfusion studies in the rat using histones, DNA and an anti-DNA monoclonal antibody (mAb) with high avidity for dsDNA. A strong granular binding of anti-DNA mAb to isolated GBM loops occurred via histones and DNA and a moderate granular binding was found via DNA alone. Anti-DNA mAb alone did not bind to the GBM loops. After perfusion of histones, DNA and immediately thereafter anti-DNA, we found with immunoelectron microscopy (IEM) a strong binding to endothelial cells in the glomerulus and to a lesser extent in the GBM. When the anti-DNA mAb was injected i.v. one hour after perfusion of histones and DNA, we observed a strong fine granular binding to the capillary wall by immunofluorescence (IF) in a membranous pattern along with some minor mesangial deposits. After perfusion of DNA alone followed by anti-DNA mAb, binding in the glomerulus was less than with histones and DNA, and was more restricted to the mesangium. No direct binding to the glomerulus was observed after perfusion with anti-DNA mAb alone, histones and anti-DNA mAb, or histones, DNA and a control mAb.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-reactivity of monoclonal anti-DNA antibodies with heparan sulfate is mediated via bound DNA/histone complexes.

To study in more detail the cross-reactive binding of anti-DNA antibodies to heparan sulfate (HS) and heparan sulfate proteoglycan (HSPG) purified from glomerular basement membranes (GBM), the binding pattern of 31 murine IgG anti-DNA MoAbs, derived from MRL/lpr, NZB/W and graft-versus-host diseased mice, was analysed. In ELISA we found binding of 10 anti-DNA MoAbs to HS. Seven of the 10 anti-HS positive clones bound to HSPG but not to the HSPG core protein in ELISA and/or on Western blots. However, DNase-I treatment partly reduced this binding, whereas after purification of MoAb by protein-A sepharose chromatography under dissociative conditions, all clones completely lost their binding capacity to HS and HSPG. Culturing of hybridoma cells in the presence of 3H-thymidine revealed DNA bound to the MoAb. Although the binding to HS and HSPG could be reconstituted by the addition of the protein-A column effluent, this was not possible by the addition of DNA alone. Therefore, we performed immunoprecipitation of the effluent with purified MoAb and subsequent SDS-PAGE which showed that the complex also contained histones. However, histones alone were also not able to reconstitute the binding to HS and HSPG. It is concluded that binding of anti-DNA MoAb to HS and GMB-HSPG is mediated via bound complexes containing both DNA and histones. A comparable reaction with polyclonal anti-DNA Ab might play a role in the pathogenesis of SLE nephritis, since histones have a very high affinity for HS, the major glycosaminoglycan of the GBM.

Estrogen-progesterone treatment of Osler-Weber-Rendu disease.

A 56-year-old woman with Osler-Weber-Rendu disease had longstanding iron deficiency anemia from recurrent melena. Since neither laser photocoagulation nor surgery were successful in stopping the increasing transfusion need, combined estrogen-progesterone therapy was started. Except for slight bleeding from a temporary ileostomy, the bleeding and need for transfusion terminated promptly. This experience confirms that estrogen-progesterone therapy may promote cessation of bleeding gastrointestinal telangiectasias and indicates the need for controlled investigations.

Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium Yag laser photocoagulation.

The effect of Yag laser photocoagulation on the course of bleeding of gastrointestinal vascular malformations was studied in 59 patients, with a total of 482 lesions. The lesions were located in the upper gastrointestinal tract alone in 25 patients, in the lower tract alone in 31 patients and in both the lower and the upper gastrointestinal tract in three patients. In the month before laser therapy the number of bleeding episodes averaged 1.09 +/- 0.6 (SD) per patient (n = 57) and the transfusion requirements 2.4 +/- 2.6 red blood cells units per patient, while in the month after treatment the bleeding incidence averaged 0.16 +/- 0.5 and the transfusion requirements 0.21 +/- 0.8 (both p less than 0.001). Long term results were analysed considering for each patient an equally long pretreatment and follow up period. After a mean follow up period of 11.5 months (1-48 months), 17 of the 57 patients available for follow up rebled. The reduction of the bleeding rate was statistically significant at one, six, 12, and 18 months of follow up, while transfusion rate was significantly decreased at one, six, and 12 months. The results were disappointing in patients with Osler-Weber-Rendu (n = 4) and in patients with angiomas associated with Von Willebrand's disease (n = 3), who all rebled. In angiodysplasia the treatment was successful in 82% of the 49 patients. The more numerous the lesions, the less effective the reduction in bleeding rate by laser treatment was. Histological studies showed that the haemostatic effect of Yag laser photocoagulation was obtained by destruction of the lesion. Rebleeding was due to lesions missed at the first treatment, incompletely treated lesions and recurrence of new lesions. In two patients a free caecal perforation necessitated a right hemicolectomy. In both patients numerous or very large lesions had been treated in the caecum.