[Protection against biting mosquitoes]. / Schutz gegen stechmücken.

The protection against arthropods especially disease transmitting mosquitoes is becoming more and more important. The problems with drugs used for treatment and prophylactic of malaria are rapidly growing due to emergence of resistant parasites and unwanted side effects. Furthermore the population living in endemic area often can't afford the new expensive drugs. A safe and effective way of preventing insect bites is needed. One can prevent arthropod born diseases by avoiding insect bites through physical and chemical means or a combination of both. Repellents are substances applied to the skin, which effectively prevent insects from biting. The gold standard is still Diethylbenzamine (DEET), which is highly effective, well documented and in use for more than 50 years. The new repellent Bayrepel (hydroxyethyl isobutyl piperidin carboxylate) available to the consumer since 1998, seems to have an efficacy comparable with DEET. Insecticides have a direct toxic effect on the nervous system of arthropods. Mainly synthetic pyrethroids, which produce less ecological problems than the older products, are used. They are supplied in form of sprays, vaporising mats or coils. An important progress is the combination of insecticides with physical means. Insecticide treated bed nets or clothes give an excellent protection. Topical or systemic Vitamin B1, acoustic devices and electrocuters are still sold and widely used although their complete ineffectivity is documented in many studies.

[Chronic abdominal pain and eosinophilia in a patient from Southern Italy]. / Chronische Abdominalschmerzen und Eosinophilie bei einem Süditaliener.

Strongyloidiasis is a parasitic disease which occurs not only in tropical regions, but to some extent in the South of Europe. Diagnosis is often difficult because of a polymorphic clinical picture and low larvae excretion in the stool. A case of an Italian patient suffering from a long-standing intestinal strongyloidiasis is reported. Diagnosis was made only after a long time and after a couple of superfluous examinations. Several treatment attempts were necessary to eradicate the infection.

[Malaria prevention without drugs]. / Malariaprophylaxe ohne Medikamente.

One can prevent malaria without antimalaria drug by avoiding insect bites through physical and chemical means. Because of the growing problems with the drugs used for malaria prophylaxis such as resistance and side effects, prevention without drugs is becoming increasingly important again. Repellents are substances applied to the skin which effectively prevent mosquitoes from biting. The most efficient and best documented repellents are diethyl-m-toluamide (DEET) and dimethylphthalate (DMP). Insecticides have a direct toxic effect on the nervous system of the arthropods. Nowadays, mainly synthetic pyrethroids are used because they produce less ecological problems. Such pyrethroids are supplied in form of sprays, vaporizing mats, mosquito coils or in combination with physical means such as bed nets. Although completely ineffective against mosquitoes, systemic vitamin B1, acoustic devices and so-called electrocuting light traps are still sold and used. Travellers must be made aware that they will not get malaria if they can avoid being bitten by mosquitoes.

[Hepatitis A vaccination: a sensible luxury?]. / Hepatitis-A-Impfung: sinnvoller Luxus?

Up to now travellers to the tropics could be protected against hepatitis A passively by administration of immunoglobulins prior to departure. Since February 1992 an effective active killed vaccine is available. The vaccination is indicated for the same group of people to whom protection with immunoglobulins was previously given, namely long-term residents and back-packers. Because it is effective and well tolerated, more liberal indications for the vaccine can be recommended. As hepatitis A is a self-limiting and mainly benign disease, passive and active vaccination is not essential and is somewhat of a luxury. Although the vaccine is effective and safe, general hygienic advice to travellers should still be the first priority.

[Malaria prophylaxis: what is safe?]. / Malariaprophylaxe: Was ist gesichert?

Plasmodium falciparum is resistant to proguanil, chloroquine and pyrimethamine/sulfadoxine (Fansidar) in many parts of the world. It can be assumed that in the future resistance to mefloquine and quinine will also increase. This will have important consequences for the recommended schemes for drug prophylaxis. No new drugs suitable for prophylaxis will be on the market in the near future. Neither the combination of mefloquine with pyrimethamine/sulfadoxine (Fansimef) nor the new drug halofantrine will solve the impending problems. It has to be accepted that no absolute protection against malaria infection can be guaranteed by the presently available drugs. In regions with low transmission no permanent prophylaxis but only a standby therapy is recommended. Moreover, personal protection against mosquitoes with pyrethrum-impregnated bed-nets and repellents will gain importance.