[Histoplasmosis: not only a tropical disease]. / Istoplasmosi: una malattia non solo tropicale.

Histoplasmosis is a fungal infection resulting from inhalation of spores from the fungus Histoplasma capsulatum; it is known to be endemic in various parts of the world, especially in North and Latin America, and can produce a spectrum of illness, from subclinical infection to progressive disseminated disease. The majority of infected persons have an asymptomatic, self-limiting illness. Clinical pneumonia occurs in those with exposure to a large number of infecting spores. Disseminated histoplasmosis usually occurs in immunosuppressed patients or in patients with chronic illness. Diagnosis is best made by visualization of yeast in tissue or by culture. In most cases, amphotericin B is the initial drug of choice, followed by one of the azoles for lifelong maintenance therapy. Itraconazole is the drug of choice for treatment of disseminated histoplasmosis in less severe cases, while fluconazole therapy for histoplasmosis is only moderately effective.

Azithromycin in the treatment of Plasmodium falciparum gametocytes. Preliminary observation.

BACKGROUND: Treatment of malaria represents a problem as antimalarial drugs are relatively few, and because of the increasing widespread resistance of Plasmodium falciparum to most of these drugs. A partial efficacy of azithromycin against Pl. falciparum hepatic stage and against trophozoytes in the erythrocytic stages of the disease has been demonstrated. No data concerning the activity against gametocytes are available, and primaquine stands as the only therapy against Pl. falciparum gametocytes. Primaquine causes haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, so primaquine therapy is usually avoided. A better tolerated therapy against gametocytes would be useful to reduce malaria transmission. We present the results of a study concerning the efficacy of azithromycin in the treatment of P. falciparum gametocytes. METHODS: A prospective study was performed: 4 patients with Pl. falciparum gametocytes (3 children, 1 adult) were treated with azithromycin for concomitant bacterial infections; in the meantime two children with gametocytes were taken as control. Azithromycin was administered as recommended. RESULTS: Gametocytes were detectable in children thick blood smears after 8, 5 and 6 days respectively after the beginning of azithromycin therapy, while they were undetectable in the adult thick blood smear 5 days after the beginning of the therapy. The gametocytes spontaneously disappeared in the two controls 4 to 6 days after the beginning of observation. CONCLUSIONS: These data suggest that azithromycin seems ineffective against Pl. falciparum gametocytes. Further studies are needed in order to determine whether azithromycin treated gametocytes are infective to mosquitoes or not, and to confirm this first observation.

Mefloquine-induced grand mal seizure in tubercular meningitis.

Mefloquine represents a promising antimalarial drug against Plasmodium falciparum. It has been related to an increase in seizure frequency in epileptic patients and should not be administered to patients with a history of convulsions, epilepsy in first degree relatives, or serious psychiatric disorders. We report a case of a man from the Ivory Coast complaining of fever, headache and anemia treated with chloroquine and subsequently with mefloquine in the suspicion of malaria, even in the absence of laboratory confirmation. When the patient came to our division, malaria was excluded, but the patient developed two convulsive episodes, respectively 4 and 7 days after the ingestion of the second therapeutic dose of mefloquine. Further investigation was performed; particularly an EEG showed abnormalities compatible with tendency for seizures, diffuse waves and spikes. CSF culture was positive for M. tuberculosis as well as urine, sputum and blood cultures. Anti-HIV antibodies were positive, so the final diagnosis was tuberculosis in HIV infection. As seizures are common signs of cerebral tuberculomas, but not of meningitis it is possible that tubercular meningitis might have enhanced severe neuropsychiatric side effects of mefloquine. Physicians should be aware that treatment with mefloquine with concomitant meningitis could have a risk of development of grand mal seizure.

[A case of arterial hypertension after use of oral contraceptives]. / Un caso di ipertensione arteriosa dopo uso di contraccettivo orale.

It is known that oral contraceptives may induce high blood pressure that usually returns to normal values a few weeks after interruption of the drugs, and without any specific treatment. The precise mechanism by which oral contraceptives cause hypertension is not clear. A severe hypertension and mild heart failure in a young woman using oral contraceptives has been observed in the case described. The patient needed a careful and prolonged therapy to maintain a normal blood pressure.

Determination by coupled high-performance liquid chromatography-gas chromatography of the beta-blocker levomoprolol in plasma following ophthalmic administration.

Levomoprolol is a beta-blocking agent used in the topical treatment of glaucoma. The necessity for comparing the plasma levels of a drug administered by the ophthalmic route with those obtained following systemic treatment requires increasingly sensitive methods in order to determine the low plasma concentrations produced by the administration of eye drops. On-line high-performance liquid chromatography-gas chromatography and concurrent solvent evaporation proved to be advantageous in the determination of levomoprolol in human plasma. Levomoprolol was determined by capillary gas chromatography (GC) with electron-capture detection (ECD) after solid-phase extraction from plasma and derivatization. Quantitation was based on the internal standard method. The detection limit of 0.2 ng/ml is 50 times lower than that obtained with previous GC methods involving on-column injection and ECD.