Autochthonous cutaneous larva migrans in Germany.

Cutaneous larva migrans syndrome is extremely rare in Germany. However, three cases of this syndrome were diagnosed in patients from Berlin, Germany, in the summer of 1994. Exposure to the infective agent in endemic areas and close contact with animals were excluded. It is assumed that the extreme temperatures in summer 1994 favoured the conditions of infection.

Malaria therapy in 452 patients, with special reference to the use of quinine.

We investigated the efficacy and toxic potential of antimalarial therapy regimens in 452 malaria patients treated between 1980 and 1990. Drug regimens in 330 non-immune travellers were compared with those of 122 semi-immunes with acute malaria; 71% patients acquired their infection in tropical Africa, and the 288 Plasmodium falciparum infections were the most prevalent species. Because of increasing drug resistance or toxicity of chloroquine, pyrimethamine-sulfadoxine and even mefloquine, quinine proved to be the most effective antimalarial against P. falciparum and the only one which did not lead to recrudescences. These occurred in 10% patients after chloroquine and 6% after mefloquine. Cinchonism occurred in 25% of those treated with quinine, but it was fully reversible and never necessitated withdrawal of the drug. We conclude that quinine is highly effective in the treatment of P. falciparum infection and is mandatory if the clinical condition requires a fast-acting blood schizonticide, in cases of hyper-parasitaemia and if multi-drug resistance occurs; its use should not be restricted by reversible side-effects such as cinchonism.

[Clinical experiences with mefloquine in tropical malaria--a prospective study]. / Klinische Erfahrungen mit Mefloquin bei Malaria tropica--eine prospektive Studie.

The therapeutic effects and side effects of mefloquine in falciparum malaria were investigated in an open prospective trial involving 20 patients. None of them had a history of neurologic or psychiatric disorders. Mefloquine was given in a total dose of 1500 mg base. The cure rate was 100%, fever and parasitemia subsided within 3 days. Side effects were vomitus and nausea in 25% of the patients. No neurological or psychiatric disorders were observed. Mefloquine was shown to be a safe therapeutic agent in the dosage used. However, regular follow-up examinations should be done in short intervals because of the possibility of late neuropsychiatric side effects; the patients and their relatives should be informed about this fact.

[Chronic recurrent fever as the sole symptom of Yersinia enterocolitica infection]. / Chronisch rezidivierendes Fieber als Monosymptom bei Yersinia-enterocolitica-Infektion.

Recurrent fever lasting for nine months up to ten years occurred in seven women and three men, with fever of up to 39 degrees C lasting from two to seven days. All patients had travelled outside of Germany at least one year previously. Micro-Widal reaction revealed antibodies against Yersinia enterocolitica (serotype 0:3 or 0:9), with a titre of between 1:80 and 1:1280. Antibiotic treatment (doxycycline or cotrimoxazole) brought cure in all ten. The antibody titres fell in seven of nine patients; titres could not be followed in one.

[Kala-azar with marked ferritinemia in a German school child]. / Kala-Azar mit ausgeprägter Ferritinämie bei einem deutschen Schulkind.

We report on a case of visceral leishmaniasis acquired during a summer holiday in Spain. Apart from therapeutic aspects some mechanisms for the development of anaemia are discussed with regard to changes of the red blood cell counts, serum iron and ferritin concentrations measured before, during and after therapy.

[Malaria prevention. Risk of infection in relation to preventive measures]. / Malaria-Prophylaxe. Erkrankungsrisiko in Beziehung zum Prophylaxeverhalten.

Between 1980 and 1985 falciparum malaria was diagnosed in 28 and tertian malaria in 17 patients. Only three of the 35 non-immune patients complied with the appropriate chemoprophylaxis; these three patients nevertheless developed tertian malaria (recurrences caused by "dormant" merozoites). The main drawbacks of chemoprophylaxis were lack of patient compliance (26 out of 35 patients) and inappropriate medical advice (14 out of 35 patients). Initial symptoms developed within one month after the end of exposition in 21 out of 23 patients infected by Plasmodium falciparum, but only in three out of twelve cases of tertian malaria. Risk of infection by Plasmodium falciparum is highest in Africa, while most of the malaria cases in India are caused by Plasmodium vivax. Long-term prophylaxis using pyrimethamine-sulfadoxine (Fansidar) is not advisable as there is a risk of life-threatening side effects.

[Mature avian eye fluke (Philophthalmus sp.) under the human conjunctiva (author's transl)]. / Ein ausgereifter Saugwurm der Gattung Philophthalmus unter der Bindehaut des Menschen.

A living mature eye fluke of the genus Philophthalmus was removed from under the conjunctiva of a man from the north of Sri Lanka. This is the third report on infection of a human by Philophthalmus sp., the second with subconjunctival infection by cercaria is discussed.

[Diagnostic significance of identification of anti-entamoeba histolytica antibodies (author's transl)]. / Diagnostische Bedeutung des Anti-körpernachweises gegen Entamoeba histolytica

Examinations were performed with the indirect immunofluorescence test (IFAT) and the indirect haemagglutination test (IHAT). Negative titers (less than 1:5) do not exclude an infection with E. histolytica. Titers up to 1:80 in both reactions are found in patients with negative stool specimens or indicate an asymptomatic infection of the intestinal lumen, an incipient or past symptomatic amoebiasis. IFAT values of 1:160 together with a negative or positive IHAT are also suggestive of the two last-mentioned types of infection. These titers are also found in patients with gastrointestinal disorders of other orgin. IFAT values higher than 1:60 with a positive IHAT are probably due to an invasive amoebiasis. Titres are, however, only diagnostic pointers.