Acute hepatitis non-A non-B in Cairo residents (a preliminary report).

Of 110 patients admitted with jaundice to the Abbassia Fever Hospital (AFH) in Cairo, 49 had acute hepatitis A infection (positive for anti-hepatitis A specific IgM), 28 had hepatitis B infection (positive for HBsAg) and seven had both markers. Of great interest, however, was the finding that 26 patients had no markers for either A or B virus infection. Clinically and biochemically, the non-A non-B hepatitis group resembled the other two infections. None of the 26 patients lacking both markers gave a history of previous blood transfusion or parenteral injections. Thus, the possibility of a faecal-oral or water-borne infection must be considered in these cases.

The use of dexamethasone in preventing ocular complications in tuberculous meningitis.

Twenty-seven patients with tuberculous meningitis (TBM) were treated with ethambutol, isonicotinic acid hydrazide, streptomycin and dexamethasone and 28 were treated with triple anti-tuberculous drugs only. Only two of the patients to whom steroids were given developed ocular complications as compared to seven of those not receiving dexamethasone. High dose dexamethasone apparently prevents optic atrophy in TBM. Controlled double-blind studies with and without dexamethasone are needed to confirm this postulation.

Activation of protein mediators of inflammation and evidence for endotoxemia in Borrelia recurrentis infection.

Fifteen patients with Borrelia recurrentis infection were studied to evaluate the role of certain plasma proteins and endotoxin in the pathophysiology of both the acute illness and the Jarisch-Herxheimer-like reaction. The causative spirochetes disappeared from the blood during the Jarisch-Herxheimer-like reaction, which occurred about 2 hours after antibiotic therapy. The mean titers of Hageman factor, plasma prekallikrein and serum hemolytic complement activity were decreased at the time of admission and 2 hours after treatment, and rose to normal values during convalescence. Serum properdin titers were decreased in 14 patients at the time of admission, in 12 patients 2 hours after treatment, and in none during convalescence. The frequency of elevated levels of fibrinogen-related antigens increased from three patients at the time of admission to 12 patients 2 hours after treatment. Results of plasma limulus tests for endotoxin-like material were positive in 11 patients at the time of admission and in 13 patients 2 hours after treatment. These findings demonstrated that Hageman factor, prekallikrein and proteins of the complement system are activated in B. recurrentis infection and that endotoxin may play a role in both the acute illness and in the development of the Jarisch-Herxheimer-like reaction after treatment.

Microfilaruria in onchocerciasis. A clinical and epidemiological follow-up study in the Republic of Chad.

Microfilariae of O. volvulus were recovered from the urine of 11% of the residents of a village in the Republic of Chad where onchocerciasis was holoendemic. A follow-up study of the same population 3 years after the original investigation revealed that microfilaruria was still present and that living microfilariae of O. volvulus could be recovered from small urine samples obtained by high catherization of the ureters. Radiological changes consistent with chronic pyelitis were found in 4 out of 14 persons with microfilaruria who were examined by retrograde pyelography. The recovery of microfilariae in the urine was associated with the intensity of the infection, as determined by counts of microfilariae in skin snips and the number of onchocercomata. A systematic comparison for differences between onchocerciasis patients with and without microfilaruria revealed that the microfilaruria patients had a low weight: height ratio, deficient antibody responses in indirect haemagglutination tests with O. volvulus antigen, elevated serum aminotransferase levels, and reduced systolic blood pressure.