Choleriform enteritis

1. A brief review of the historical background of the El Tor Vibrio and possible mechanism of action is presented2. 200 cases of Choleriform Enteritis admitted into the San Lazaro Hospital from September 22, 1961 to October 16, 1961 are studied and incidences according to sex, age, immunization and symptomatology are shown3. Pathology and management are also discussed. (Summary)

A comparative clinical study of mefloquine and chloroquine in the treatment of vivax malaria.

Forty-six patients with Plasmodium vivax malaria were evaluated for their clinical and parasitological response to the two single doses of mefloquine in comparison with the standard 3-day treatment with chloroquine. The patients were randomly distributed into 3 groups. Group 1 with 13 patients were treated with a single dose 250 mg mefloquine, Group 2 with 15 patients were treated with a single dose 500 mg mefloquine and Group 3 with 18 cases were treated with the standard 3-day treatment course of 1,500 mg chloroquine. All patients in the three treatment group showed similar parasite, clearance time, fever clearance time and clearance time of signs and symptoms. There were no statistically significant differences between any of the groups. The age and weight, as well as the initial parasite count of the three groups were comparable. This study shows that mefloquine at the dosages used were as effective as the 3-day standard treatment with 1,500 mg chloroquine.

An obstinate case of intestinal capillariasis.

A patient who experienced episodes of intestinal capillariasis caused by Capillaria philippinensis 16 times is presented. The patient was first seen in July 1967 with the parasitosis and was treated with thiabendazole. He experienced a relapse in October 1967. He was readmitted to the hospital again in 1969, twice in 1971, twice in 1972, twice in 1973, once each in 1975, 1976, three times in 1978 and twice in 1979. During this period he was treated with various dosages of thiabendazole, mebendazole and flubendazole. At the final admission he was treated with mebendazole, 600 mg per day for 49 days, 200 mg per day for 30 days and 100 mg daily for 6 months. The patient was cured and had no further relapses in 5 years. The recommended dosage of mebendazole is 200 per day for 20 days for new cases and 30 days for relapses. It is advised to over-treat the infection rather than under-treat because of the problem of relapses. Internal autoinfection occurs and it is believed that the drug acts selectively on the adults and not the larval forms of the parasite.

Studies of resistance to chloroquine, quinine, amodiaquine and mefloquine among Philippine strains of Plasmodium falciparum.

One hundred cases of slide-confirmed Plasmodium falciparum malaria admitted to the San Lazaro Hospital, Manila, Philippines were screened for in vitro resistance to chloroquine, quinine, amodiaquine and mefloquine using the microtechnique. 59 of the 100 primary parasite isolates produced schizonts, whereas the remaining 41 isolates did not. 51 of the 59 isolates tested were resistant in vitro to chloroquine and eight were sensitive. In contrast, three of the primary isolates were resistant to quinine, three showed resistance to amodiaquine and four were mefloquine-resistant. 43 of the strains judged chloroquine-resistant in vitro were fully in vitro sensitive to amodiaquine, quinine and mefloquine. One chloroquine-resistant isolate was also resistant to quinine alone. Three isolates that were resistant to chloroquine were also resistant to amodiaquine. An additional three were cross-resistant to chloroquine and mefloquine. A single isolate was found to be resistant to chloroquine, quinine and mefloquine and another was cross-resistant to chloroquine, quinine and amodiaquine. All strains demonstrating in vitro resistance to amodiaquine, quinine or mefloquine also showed in vitro resistance to chloroquine. The parasites in 22 patients showed in vivo resistance to chloroquine therapy. 86% were of the R1 type, 9% were R2 and 5% R3. All 22 patients demonstrating in vivo resistance to chloroquine showed in vitro resistance.

Pivmecillinam, co-trimoxazole and oral mecillinam in gastroenteritis due to Vibrio spp.

The comparative efficacy of antibacterial therapy with pivmecillinam or cotrimoxazole and general supportive care only was studied in patients with severe bacterial gastroenteritis. Overall, treatment with antibiotics proved significantly superior to rehydration alone in 42 children. Active therapy also had a statistically beneficial effect in children infected with Vibrio cholerae and V. parahaemolyticus. Pivmecillinam and co-trimoxazole were equally effective. Pivmecillinam and oral mecillinam appeared to be of equal value in a further 22 adults infected by Vibrio spp. No side-effects were recorded in any of the subjects treated. Further investigations with pivmecillinam and oral mecillinam are advocated.

Evaluation of sodium polyanethanol sulfonate as a blood culture additive for recovery of Salmonella typhi and Salmonella paratyphi A.

A total of 640 blood specimens from patients in an area endemic for enteric fever were cultured in parallel in tryptic soy broth with and without sodium polyanethanol sulfonate (SPS). A total of 95 specimens were positive for Salmonella spp., 54 for Salmonella typhi, and 41 for Salmonella paratyphi A in one or both bottles of a set. Significantly higher rates of recovery were obtained from the SPS-containing medium (P less than 0.01) upon subculturing blindly at 24 h and 3 days of incubation. Subcultures performed at 7, 14, and 21 days also yielded a greater number of positive cultures with SPS than without it, although the differences between the two media were not significant (P greater than 0.05). Neither of the media yielded 100% of the positive cultures. Moreover, even if the results of the two media were combined, 34 and 19% of the isolates would have been missed if the specimens had not been incubated to 14 and 21 days, respectively. The data indicate that SPS aids in early recovery of S. typhi and S. paratyphi A from blood cultures, and additionally, that under the conditions used in the study, incubation beyond a 1-week period is required for efficient isolation of these organisms from blood.

Chloroquine resistant Plasmodium falciparum: effect of rabbit serum and incubation time on the in vitro (microtechnique) prediction of in vivo resistance.

A study of chloroquine resistance of 54 isolates of Plasmodium falciparum is reported. Sixty-four percent of the isolates tested produced schizonts in vitro (micro-technique), whereas the remaining 36 percent did not. The accuracy of the in vitro test to predict in vivo resistance was increased when the primary parasite isolates were cultured in the presence of rabbit serum and when the cultures were allowed to incubate for more than 48 hours. Thirteen isolates of P. falciparum that showed in vitro resistance were confirmed in vivo resistant. Eleven of these cases were identified as R-I and two as R-II. Only one case of in vivo resistance (R-II) was observed among the 19 isolates that failed to produce schizonts in vitro.

Malaria at San Lazaro Hospital, Manila, Philippines, 1979-1981.

Results are presented from the 1,000 slide-confirmed malaria cases seen during the period August 1979-September 1981 at San Lazaro Hospital, in Manila, Philippines; 56% were caused by Plasmodium falciparum, 38% by P. vivax, 6% were mixed infections, and 0.1% by P. malariae. The overall case fatality rate was 1%, all due to P. falciparum. Cerebral involvement occurred in 7% and the case fatality rate was 20% compared to a case fatality rate of 0.2% among P. falciparum cases without cerebral involvement. In vivo chloroquine-resistant P. falciparum was seen in 4% of the cases, but of those treated in 1981, 9% of the cases showed resistance. The distribution of chloroquine-resistant cases by province in the Philippines is shown, with resistance being reported for the first time from Isabela, Bulacan, Zambales, Rizal and Bataan provinces. Diagnostic, clinical, and epidemiologic aspects of the cases are discussed, as well as the trend in malaria cases over the last 20 years.

Cerebral malaria at San Lazaro Hospital, Manila, Philippines.

Forty cases of cerebral Plasmodium falciparum malaria seen at San Lazaro Hospital, Manila, Philippines from 1979-1981 were reviewed. These cases represented 7% of all Plasmodium falciparum cases seen during this period. All of the patients had fever and headache, 73% confusion, 70% chills, 68% jaundice or abdominal pain, 60% sweats. Findings more frequent in the fatal compared to the non-fatal cases were: the presence of schizonts in the peripheral smear, oliguria, coma, convulsions, urinary incontinence, jaundice, pulmonary symptoms and vomiting. Fatal cases were less likely to be clinically diagnosed as malaria and more likely to be diagnosed as hepatitis than malaria. The treatment and management of these cases is discussed.

A double-blind, placebo-controlled evaluation of ribavirin in the treatment of acute measles.

In this double-blind, placebo-controlled study, treatment of measles patients with ribavirin resulted in shorter and less severe disease, as well as fewer complications, compared with patients in the placebo, group. Ribavirin was well tolerated. There were no side effects or changes in laboratory values that could be associated with drug-related toxicity. Since reported vaccine failures may increase as immunization levels rise, the use of a safe and effective therapeutic agent, such as ribavirin, will be necessary to treat these cases, as well as those occurring in unvaccinated individuals.

Study of the adrenocortical reserve function in paediatric cholera patients.

The adrenocortical reserve function of 20 cases of paediatric cholera was studied by intravenous ACTH tests. The findings indicate the presence of adrenocortical hyperactivity, and the poor response to ACTH stimulation shows that the adrenocortical reserve in these cases had been already stimulated to the maximum extent by salt depletion at the time of admission. These findings do not support the value of adrenocortical hormone treatment in cholera.