An open, randomized, phase III clinical trial of mefloquine and of quinine plus sulfadoxine-pyrimethamine in the treatment of symptomatic falciparum malaria in Brazil.

The clinical and parasitological response of adult male patients to mefloquine and to a combination of quinine and sulfadoxine-pyrimethamine during the treatment of falciparum malaria was compared. These patients were from an area in Brazil where Plasmodium falciparum is showing increasing resistance to quinine and to sulfadoxine-pyrimethamine. The drugs were administered to 100 patients (50 in each group), based on a randomized study design.The rates of clearance of parasitaemia and fever were similar in both groups. However, the parasitological cure rate ("S" response) was 100% for mefloquine but only 92% for quinine plus sulfadoxine-pyrimethamine. Tolerance was good in both groups. The main side-effects (nausea, vomiting, abdominal pain, and dizziness) were mild, transient and required no specific treatment. Nausea and vomiting were more frequent in patients who received quinine plus sulfadoxine-pyrimethamine, while abdominal pain and loose stools or mild diarrhoea were more frequent in the mefloquine group. Tinnitus and hearing difficulty were observed following the administration of quinine plus sulfadoxine-pyrimethamine, but not after mefloquine treatment. Laboratory tests of various haematological and biochemical parameters were not adversely affected in either group after drug administration.It can be concluded that mefloquine, given in a single oral dose of 1000 mg, is highly effective, well tolerated, and safe for the treatment of falciparum malaria in adult males in Brazil.

The chemotherapy of onchocerciasis V. A standard method for the determination of microfilarial density in skin snips.

The microfilarial density in 400 skin snips from 100 patients was determined using the standard technique of the Onchocerciasis Chemotherapeutic Research Centre (OCRC method), the method used by the Onchocerciasis Control Programme (OCP method), and also after collagenase digestion. The OCRC method was fairly consistent and detected 84% of the total microfilariae. The OCP method gave a density which was consistently 20% less than the OCRC method, indicating that the increase in weight in skin snips following incubation in saline was fairly predictable. It is concluded that collagenase digestion is not worthwhile as a routine technique in chemotherapeutic trials, for which the OCRC method is recommended.

Non-tuberculosis mycobacteria in Africa. 1. Isolation and identification.

In tropical and subtropical countries, the presence of non-tuberculosis mycobacteria may invalidate case-finding programmes; experience has shown that many of the acid-fast bacilli discovered on examination of sputum specimens are non-tuberculosis mycobacteria-either photochromogens, scotochromogens, unpigmented or rapid growers (Groups I to IV, respectively, of Runyon's classification) or saprophytes.Studies have recently been undertaken to determine the frequency of various types of non-tuberculosis strains in different parts of Africa. This paper describes the first of these studies, devoted to the isolation and identification of non-tuberculosis mycobacteria from seven countries.Of 18 568 cultures examined at the Central Tuberculosis Laboratory, Nairobi, in 1961-64, 1.9% were non-tuberculosis strains. However, valid conclusions as to prevalence cannot be drawn from this figure, since some specimens came from tuberculosis patients and others from general population surveys. An earlier comparison, based on 7580 cultures from tuberculosis patients and 657 from a random survey, had shown a significant difference in the frequency of non-tuberculosis strains, the figures being 1.1% and 19.8%, respectively.Of the identification tests studied, the formamidase test was found very useful for differentiating saprophytic mycobacteria from the other non-tuberculosis mycobacteria, particularly the rapid growers. This test is discussed in greater detail in the third study of the series.

Non-tuberculosis mycobacteria in Africa. 3. Formamidase activity--its evaluation and practical application.

The third study in a series on the prevalence of non-tuberculosis mycobacteria in Africa is devoted to the investigation of the formamidase activity of 288 cultures of mycobacteria, already typed by a battery of standard tests as pathogenic or atypical (184 strains) and saprophytic (104 strains). Of the latter, 96 (92.3%) were formamidase-positive, as compared with only 6 (3.3%) of the former. A close correlation was observed between the speed of growth on Löwenstein-Jensen medium and formamidase activity, 98 (96.1%) of the positive strains showing visible growth within 1-3 days. The relation between formamidase activity and growth on nutrient media was less clear-cut, however, and it was concluded that for the routine differentiation of saprophytic from other mycobacteria the formamidase test should be combined with simple tests such as speed of growth on L-J medium and ability to grow on nutrient media. Russel's method and Nessler's reagent for the detection of ammonia in the formamidase test were compared; the authors consider the former to be preferable, since the reaction is easier to read.