bluuebunny/crossref_metadata_2025 huggingface dataset:
Morbidity and mortality due to ascariasis: re‐estimation and sensitivity analysis of global numbers at risk
Authors: de Silva N. R. , Chan M. S. , Bundy D. A. P.
Published: November 2003

This paper presents estimates of the global numbers of people at risk from morbidity related to infection with Ascaris lumbricoides and the numbers of deaths from this infection. Morbidity is classified into 4 types: deficits in growth and fitness which are contemporaneous with infection, or permanent, overt acute illness of mild to moderate severity, and complications involving hospitalization. The estimation of morbidity is based on theoretical models of parasite distributions developed in previous papers. A sensitivity analysis is carried out in which parameters of the model are varied using a Latin hypercube sampling technique. The results estimate ≈1300 million infections globally with 59 million at risk of some morbidity. The estimate for acute illness is 12 million cases per year with ≈10 000 deaths. Most morbidity is in children. Sensitivity analysis suggests that infection estimates will not vary greatly with changes in parameter values but that morbidity estimates may be highly variable.
Antifilarial activity of a synthetic marine alkaloid, aplysinopsin (CDRI Compound 92/138)
Authors: Singh Som Nath , Bhatnagar Sunita , Fatma Nigar , Chauhan P. M. S. , Chatterjee R. K.
Published: November 2003

CDRI Compound 92/138, a synthetic analogue of aplysinopsin, was evaluated in experimental filarial infections, Litomosoides carinii in cotton rats (Sigmodon hispidus) and Acanthocheilonema viteae in Mastomys coucha. The compound killed 63.8 and 90% of adult L. carinii and A. viteae at doses of 30 and 50 mg/kg (i.p.) respectively given for 5 days. By the oral route, at 100 mg/kg for 5 days the compound caused 50.9 and 57% mortality of adult L. carinii and A. viteae, respectively. At 200 mg/kg administered orally on days 0, 10 and 25 post‐infection, it reduced establishment of adult A. viteae by 68.5%. We also found 43.7 and 37.8% effect in vivo respectively on L3 and L4 stages of A. viteae at a single dose of 250 mg/kg, p.o. The compound was active in vitro at 100 μg/ml concentration and caused a significant decline in MTT reduction and 14C‐glucose uptake by adult filariids. Thus synthetic marine aplysinopsin could provide a new pharmacophore for the development of antifilarial agents.
Higher resistance to Plasmodium falciparum infection in patients with homozygous sickle cell disease in western Kenya
Authors: Aluoch J. R.
Published: November 2003

Sickle haemoglobin (HbS) is considered to be protective against malaria. Malaria is fatal in homozygous sickle cell (HbSS) disease. In a cross‐sectional survey by alkaline Hb‐electrophoresis of 766 residents of Western Kenya near Lake Victoria, 20 were found to have HbSS disease, 120 sickle cell trait (HbAS) and 626 the normal genotype (HbAA). Blood slides for malarial parasites (MPs) were performed in 728 cases, i.e. 592 HbAAs, 116 HbASs and all 20 HbSSs. Malaria parasites were found in 261 (35.8%) HbAAs, 42 (5.8%) HbASs and 4 (0.5%) HbSSs. Malaria prevalences per genotypic group were 44.1% (261 out of 592) in HbAAs, 36.2% (42 out of 116) in HbASs, and 20% (4 out of 20) in HbSSs. The relative risk of malarial infection was 0.33 in the HbSSs compared to both HbAAs and HbASs. It seems that the protection conferred by HbS against malaria is more marked in HbSS disease than in HbAS and is HbS‐content related, and that the balanced polymorphism in the HbS–malaria relationship is maintained by higher mortality risk of HbAAs due to malaria and high mortality risk of HbSSs caused by complications of HbSS.
The aetiology of low birthweight in a rural area of Tanzania
Authors: Walraven G. E. L. , Mkanje R. J. B. , van Asten H. A. G. H. , van Roosmalen J. , van Dongen P. W. J. , Dolmans W. M. V.
Published: November 2003

In a hospital‐based study, birthweights of 3162 consecutive births were related to perinatal mortality, multiple birth, and gestational age. Independent associations between 15 potential determinants and low birthweight, prematurity and small‐at‐term factors were also assessed. A newly constructed local curve of birthweight‐for‐gestational age is compared with the existing curves. The variables positively associated with low birthweight (<2500 g) were nulliparity, vomiting as a self‐reported complaint, spleen enlargement, sex of the infant and previous perinatal mortality. Nulliparity and spleen enlargement were positively associated with preterm birth, while small‐at‐birth was mostly associated with nulliparity and sex of the infant. Further study on spleen enlargement, the only modifiable factor in this study of posssible public health importance, is warranted. Other factors of potential importance which deserve further investigations are hard physical work, maternal morbidity and antenatal care.
Detection of the circulating antigens CAA and CCA in a group of Dutch travellers with acute schistosomiasis
Authors: van Lieshout L. , Polderman A. M. , Visser L. G. , Verwey J. J. , Deelder A. M.
Published: November 2003

Detection of circulating anodic antigen (CAA) and circulating cathodic antigen (CCA) in serum and urine is a highly specific and sensitive alternative for the diagnosis of schistosome infections in endemic areas. However, it is not known how soon after the onset of infection these antigens can be detected in humans. Neither has there been much research on the detection of these antigens in individuals normally living in non‐endemic areas. We studied the kinetics of CAA and CCA in serum and urine of a group of 28 Dutch tourists, shortly after accidental exposure to a Schistosoma infection during a visit to Mali. Twenty‐seven were found to be positive for Schistosoma eggs and/or specific antibodies. From each individual, 1–4 serum samples were tested for circulating antigen level, 4–15 weeks after exposure, and urine samples were also tested from 22 subjects. CAA and CCA levels were quantified by monoclonal antibody‐based ELISAs and TRIFMAs. In serum, 23 individuals (85%) were positive at least once for one or both antigens, but titres were generally very low. CAA and CCA could be detected 5 and 6 weeks after exposure, respectively. Urines were all found to be negative. Almost all cases were negative at 7 months' follow‐up.
Plasmodium falciparum chloroquine and quinine sensitivity in asymptomatic and symptomatic children in São Tomé Island
Authors: Baptista João Luís , Das Neves Idalécio , D'Alessandro Umberto , Hendrix Luc , Wéry Marc
Published: November 2003

Plasmodium falciparum sensitivity to quinine in São Tomé was determined by in vivo and in vitro tests in 56 children with mild or cerebral malaria. Chloroquine sensitivity was assessed by in vitro tests in 105 parasitaemic asymptomatic children from the same community as the cases. The WHO standard methodology was used. No resistance to quinine was found by in vivo or in vitro tests in either group of patients or in asymptomatic children, although some degree of chloroquine resistance was found with the in vitro test. This was more common in patients than in asymptomatic children. Chloroquine resistance may be explained by the recent history of malaria in São Tomé Island, which caused an important decrease of immunity among the population and consequently the emergence of resistant strains. Implications of the use of in vivo/in vitro tests for determining the antimalarial drug policy within the primary health care system are discussed.
Selenium status in pregnant women of a rural population (Zaire) in relationship to iodine deficiency
Authors: Ngo D. B. , Dikassa L. , Okitolonda W. , Kashala T. D. , Gervy C. , Dumont J. , Vanovervelt N. , Contempré B. , Diplock A. T. , Peach S. , Vanderpas J.
Published: November 2003

Endemic myxoedematous cretinism has been associated with combined selenium and iodine deficiency in several areas of Zaire. To determine selenium and iodine status across the country, serum selenium and thyroid function parameters including urinary iodide were determined at prenatal clinics in 30 health centres of rural villages distributed over the whole country. Only in Bas‐Zaire was the mean serum selenium level similar to that in non‐deficient areas (80–120 ng/ml); in the regions of Bandundu and Kasai levels were marginally decreased (55–80 ng/ml), and in Kivu, Haut‐Zaire, Equateur and Shaba they were marginally or moderately decreased (<55 ng/ml). The frequency of abnormally low urinary iodide (<5 μg/dl) varied from 20% in the region of Bas‐Zaire to 50% in Kasai (P<0.001), and to still higher percentages in the 5 other regions of Zaire (Bandundu, 57%; Kivu, 63%; Equateur, 72%; Shaba, 76%; Haut‐Zaire, 84%). With the exception of Bas‐Zaire, biochemical maternal hypothyroidism (serum TSH >5mU/l) was present in every region, with a frequency ranging from 3% in Kivu to 12% in Equateur. Iodine deficiency affects most of the Zairean population and requires public health measures on a larger scale than previously estimated. Combined iodine and selenium deficiency affects Equateur, Haut‐Zaire and Kivu, where endemic myxoedematous cretinism occurs, but also Shaba, where it was not previously described. Besides combined iodine and selenium deficiency which is permissive, another factor (thiocyanate?) must be taken into account to explain the peculiarly elevated prevalence of endemic myxoedematous cretinism in Central Africa.
Reproductive and socio‐economic correlates of maternal haemoglobin levels in a rural area of Papua New Guinea
Authors: Tracer David
Published: November 2003

The effects of pregnancy, lactation, and socio‐economic status on maternal haemoglobin levels among the Au, a foraging and small‐scale horticultural population of Papua New Guinea, are examined. The sample consists of 259 parous women, 41 of whom reside in wage‐earning households and 218 of whom reside in households practicing traditional subsistence activities. The haemoglobin level among the total sample averages an extraordinarily low 8.6 g/dl and the prevalence of anaemia as defined using current WHO standards is just over 98%. Wage‐earning Au, however, have significantly higher haemoglobin levels and lower rates of anaemia than their traditional counterparts. Haemoglobin levels decline significantly during pregnancy by just over 1 g/dl among both socioeconomic groups, but soon return to pre‐gravid levels postpartum. No significant effects of lactation on haemoglobin levels are found, nor does the population show any long‐term, parity‐specific trends in haemoglobin levels.
Viral haemorrhagic fevers in ancient Mesopotamia
Authors: Coleman M. , Scurlock J.
Published: November 2003

In the course of preparing a book on ancient Mesopotamian medicine, the authors found descriptions of signs and symptoms compatible with viral haemorrhagic fevers.
Geophagy among school children in Western Kenya
Authors: Geissler P. W. , Mwaniki David L. , Thiong'o Frederick , Friis Henrik
Published: November 2003

A cross‐sectional study was conducted among 285 school children aged 5–18 years in Nyanza Province, Western Kenya, to determine the prevalence of geophagy and the types and amounts of soil eaten. Stool samples were taken from a subsample of 53 (19%) and their silica content determined to compare the results with the reported geophagy. Geophagy was practised by 73% of the children. The prevalence decreased with age for both sexes up to age 15, then remained stable for girls between 15 and 18 years but continued to decrease for boys in that age range.

Most children ate soil from the surface of termitaria; others preferred the edges of paths and gullies, material from the wall of huts, and a chalk‐like, soft stone commonly found in the area. The soil was eaten dry and was occasionally ground, but not processed in other ways. All but 4 of the children practising geophagy reported to eat soil at least once daily. The median amount reported eaten was 28 g daily, ranging from 8 to 108 g. The reported amount of soil eaten daily was significantly correlated to the results of the stool silica determinations. Using the median of 1% silica of faecal wet weight as a cut‐off point to distinguish geophageous children from non‐geophageous, the examination of a single stool sample had a sensitivity of 76% and a specificity of 80% to detect a geophageous child compared to the interview method.

The cultural context of geophagy and its potential health impact in terms of infection and nutrition need to be further investigated, and it is suggested that more school and community‐based studies on geophagy in different societies should be undertaken.
Laboratory diagnosis of acute measles infections in hospitalized children in Zambia
Authors: Oshitani H. , Suzuki H. , Mpabalwani M. , Mizuta K. , Kasolo F. C. , Luo N. P. , Numazaki Y.
Published: November 2003

Laboratory diagnosis of measles infection is rarely performed in developing countries and tends to depend on clinical symptoms alone. We evaluated detection of immunoglobulin M (IgM) antibodies for confirmation of acute measles infection in Zambia. In 149 hospitalized children with clinical diagnosis of measles, IgM antibodies were detected in 88.6% (132/149). The IgM‐positive rate increased with time after onset of skin rash and all samples were positive after 4 days. In addition to IgM antibody test, virus isolations from throat swabs using B95a cells were also performed. These were positive in only 20.9% (14/67), and both IgM and virus isolation in combination increased the positive rate to 92.5% (62/67). Vaccinated children had higher neutralizing (Nt) antibody responses and, among IgM‐negative patients, all 4 vaccinated children had high Nt antibodies while all 10 unvaccinated children had negative or low Nt results. The IgM antibody test was proved to be a sensitive method for laboratory confirmation of measles virus infection in developing countries.
Artemether treatment of recrudescent Plasmodium falciparum malaria in children
Authors: Sowunmi Akintunde , Odulola Ayoade M. J.
Published: November 2003

Intramuscular artemether given for five days was evaluated prospectively in 32 patients with acute recrudescent Plasmodium falciparum malaria. All patients had experienced one or more treatment failures with one or more courses of the following drugs: chloroquine, amodiaquine, sulphadoxine‐pyrimethamine and erythromycin given alone or in combination. There was a prompt response to treatment with fever and parasite clearance times of 10.7 (3.6) h (range 6–24) and 32.3 (8.3) h (range 24–48) respectively. Parasite reduction at 24 h was 93.2 (7.8)% (range 75–100). The cure rate on day 14 was 100%. The drug was well tolerated. These results suggest that artemether is rapidly effective in acute recrudescent Plasmodium falciparum malaria and is without deleterious side effects.
Geophagy (soil consumption) and iron supplementation in Uganda
Authors: Abrahams Peter W.
Published: November 2003

Despite the often limited awareness of geophagy, the deliberate consumption of soil by humans, it is common in certain areas of the world. This paper reports the mineralogical and geochemical composition of geophagical materials collected from Uganda, and indicates the potential of such soils in supplying iron to the geophagist. In countries like Uganda where modern pharmaceuticals are either unobtainable or prohibitively expensive, ingested soils may therefore be very important as a mineral supplement for the health of individuals providing they are consumed sensibly. Alongside this argument is the fact that individuals in such poor countries are frequently iron‐deficient.
Antigenicity and specificity of very low molecular weight Onchocerca volvulus polypeptides in the range 2.2–12.5 kD
Authors: Hoffmann Wolfgang H. , Blanke Christoph H. , Maier Jens M. , Lüder Carsten G.K. , Schulz‐Key Hartwig , Soboslay Peter T.
Published: November 2003

Onchocerca volvulus polypeptides in the molecular mass range of 2.2 to 12.5 kD were separated by Tricine‐SDS‐PAGE and the serological recognition of these very low molecular weight antigens (VLMW‐OvAg) was then investigated by immuno‐blotting. Sera from 21 onchocerciasis patients as well as from 53 individuals with other filariases were used to determine the sensitivity and specificity of detection of individual VLMW‐OvAg. In onchocerciasis patients, up to 16 VLMW‐OvAg were recognized predominantly by IgG1 and IgG4, while only few antigens were recognized by IgG2 and IgG3. The antigen recognition pattern varied individually, but 4 VLMW‐OvAg of 8.6, 6.2, 5.4, and 5.1 kD, respectively, were bound by IgG4 from more than 90% of the onchocerciasis patients. Six VLMW‐OvAg of 7.3, 5.8, 5.4, 4.0, 3.8, and 3.6 kD were recognized exclusively by IgG1 from onchocerciasis patients. In amicrofilaraemic filariasis patients with lymphatic pathology, a strong reactivity of IgG3 to an OvAg of 2.2 kD was observed, indicating a possible contribution of this antigen to the pathogenesis. In the molecular mass range below 13 kD, no specific carbohydrate residues or phosphorylcholine‐containing (PC) determinants could be identified by lectin‐blotting or PC‐specific immunoblotting, respectively. Two‐dimensional separation and immunoblotting distinctly resolved more than 40 antigenic polypeptides, the majority focusing at acidic isoelectric points. In O. volvulus‐infected chimpanzees the IgG1‐ and IgG4‐reactivity against OvAg below 13 kD appeared concurrently with onset of patent infection. These data suggest that some of these VLMW‐OvAg might be associated with the production and release of microfilariae from gravid female worms as well as be involved in immune‐mediated pathogenesis during filarial infections.
pOVEX vector: prokaryotic expression and purification of onchocerciasis vaccine candidate antigens as fusion proteins with the 24 kD Onchocerca volvulus glutathione S‐transferase
Authors: Liebau Eva , Spillner Edzard , Henkle‐Dührsen Kimberly
Published: November 2003

An expression vector, pOVEX, has been designed and constructed, combining the advantages of the expression vectors pGEX‐3X and pJC20. The pOVEX vector produces a fusion protein with the 24 kD Onchocerca volvulus glutathione S‐transferase (OvGST2) which is easy to purify in one step from bacterial extracts under non‐denaturing conditions using glutathione‐sepharose chromatography. High yields of fusion protein were produced from this T7 RNA polymerase‐dependent expression vector, which were then cleaved by digestion with the factor Xa protease to separate the OVGST2 polypeptide from the expressed protein of interest. This vector will be particularly useful to O. volvulus investigators for the production of O. volvulus antigens for the analyses of host humoural and cellular responses to these proteins and for immunization studies.
Diethylcarbamazine: effect on lysosomal enzymes and acetylcholine in Wuchereria bancrofti infection
Authors: Bhattacharya C. , Singh R.N. , Misra S. , Rathaur S.
Published: November 2003

We measured the levels of lysosomal enzymes and acetylcholine in Wuchereria bancrofti– infected asymptomatic microfilaraemic human serum, and found a significant decrease in the activity of β‐glucuronidase and acid phosphatase compared to normal serum. Acetylcholine levels were also decreased during infection. However, after giving diethylcarbamazine (6 mg/kg body wt/day) the level of lysosomal enzymes and acetylcholine increased and reached a normal value after two weeks of therapy. It is proposed that parasites secrete acetylcholinesterase in the circulation which degrades acetylcholine. Since acetylcholine stimulates the release of lysosomal enzymes and phagocytosis, the immune response of the host is suppressed during infection. During diethylcarbamazine (DEC) therapy the parasitic enzyme is inhibited by the drug and the normal level of acetylcholine is resumed, which again stimulates the release of lysosomal enzyme and the process of phagocytosis.
Circulating anodic and cathodic antigen in serum and urine of mixed Schistosoma haematobium and S. mansoni infections in Office du Niger, Mali
Authors: De Clercq D. , Sacko M. , Vercruysse J. , Vanden Bussche V. , Landouré A. , Diarra A. , Gryseels B. , Deelder A.
Published: November 2003

In Office du Niger, an area endemic for both Schistosoma haematobium and S. mansoni in Mali, circulating anodic (CAA) and cathodic (CCA) antigen detection assays were performed on pre‐treatment serum and urine samples from two villages, Rigandé and Siguivoucé, and compared with egg counting methods. The highest prevalence was obtained with the urine‐CCA assay which also had the highest sensitivity to S. haematobium, S. mansoni or mixed infection. A single urine‐CCA assay was as sensitive as repeated egg counts (one stool + two urine examinations per individual). When the different assays were tested in parallel, several combinations including assays on serum were found to be highly sensitive. As urine sampling is widely accepted, urine assays will be used for further monitoring these villages one and two years after chemotherapy.
Compliance with malaria chemoprophylaxis and preventative measures against mosquito bites among Dutch travellers.
Authors: Cobelens Frank G. J. , Leentvaar‐Kuijpers Anne
Published: November 2003

Self‐reported compliance with a malaria chemoprophylaxis regimen of proguanil (PG) plus chloroquine (CQ) was assessed in a cohort of 547 Dutch travellers who visited a single travel clinic when travelling to various areas endemic for falciparum malaria. 503 (92%) had taken PG/CQ prophylaxis, but only 326 (60%) reported regular and uninterrupted use throughout the journey and 4 weeks afterwards. Compliance differed by travel destination and was 45% in South America, 52% in West Africa, 53% in South‐east Asia, 60% in the Indian Subcontinent and 78% in East Africa. Parasitologically confirmed falciparum malaria occurred in 5 travellers (0.9%), including 3 of 24 non‐compliant travellers to West Africa (12.5%). Apart from destination, independent risk factors for non‐compliance were young age, extensive travel experience and adventurous travel. Compliance with protection against mosquito bites was 80% for wearing long‐sleeved shirts and long‐legged trousers after sunset, 73% for use of repellents, 56% for sleeping under bednets and 37% for keeping the sleeping quarters free of mosquitoes. Although 440 travellers (80%) reported to have taken two or more of these measures at least once, only 88 (16%) had done so on a daily basis. Daily use of bednets was reported more frequently among subjects who were non‐compliant with chemoprophylaxis. Compliance regarding malaria chemoprophylaxis should be improved, particularly in high‐risk areas such as Sub‐saharan Africa, with extra attention to young, adventurous travellers. More emphasis should be placed on prevention of Anopheles bites.
Coping with Africa's increasing tuberculosis burden: are community supervisors an essential component of the DOT strategy?
Authors: Wilkinson David , Davies Geraint R.
Published: November 2003

Tuberculosis incidence in Africa is increasing dramatically and fragile health systems are struggling to cope. Potential coping capacity may lie within affected communities but this capacity needs to be harnessed if tuberculosis is to be controlled. Since 1991 all patients with tuberculosis in Hlabisa health district, South Africa have been eligible for community‐based directly observed therapy (DOT). Patients are supervised either by a health worker (HW) in a village clinic, or in the community by a community health worker (CHW) or a volunteer lay person (VLP). Tuberculosis incidence increased from 312 cases in 1991 to 1250 cases in 1996. By December 1995, 2622 (87%) of 3006 patients had received DOT, supervised mainly by VLP (56%) but also by HW (28%) and CHW (16%). The proportion supervised by HW fell from 46% in 1991 to 26% in 1995 (P < 0.0001). More patients supervised by VLP (85%) and CHW (88%) than by HW (79%, P= 0.0008) completed treatment. Case‐holding by HW declined more between 1991 and 1995 (84% to 71%, P= 0.02) than did case‐holding by both CHW (95% to 90%. P= 0.7) and VLP (88% to 84%, P= 0.4). Mortality was similar (4–6%) and stable over time, irrespective of the supervisor. High tuberculosis treatment completion rates are achievable and sustainable for several years in resource‐poor settings despite a massively increased case load if community resources are harnessed. Patients may be more effectively supervised by voluntary lay people than by health workers under these circumstances, without being placed at increased risk. These findings suggest that community supervisors may be an essential component of any DOT strategy.
Exchange blood transfusion in severe falciparum malaria: retrospective evaluation of 61 patients treated with, compared to 63 patients treated without, exchange transfusion
Authors: Burchard G. D. , Kröger J. , Knobloch J. , Hartmann W. J. , Eichenlaub D. , Moling O. , Fleischer K. , Van den Ende J. , Demey H. , Weber R. , Pichler H. , Francioli P. , Lüthy R. , Nothdurft H. D. , Weincke Th. , Schmutzhard E. , Kretschmer H. , Dietz K.
Published: November 2003

The rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presumptive ‘toxic’ factors, and improvement of the rheological quality of the blood. We evaluated the records of 61 patients treated with ET to describe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of 61 patients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exchange transfusion is applied according to the clinician’s subjective impression rather than strict guidelines. Logistic regression analysis adjusting for the differences in clinical parameters between patients treated with or without ET did not identify treatment as a prognostic indicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4–4.9). Exchange transfusion did not significantly improve the unfavourable prognosis in cases of severe falciparum malaria. However, failure to reach statistical significance may be due to the retrospective design of the study and therefore non‐systematic approach.
Social and cultural factors affecting rates of regular retreatment of mosquito nets with insecticide in Bagamoyo District, Tanzania
Authors: Winch Peter J. , Makemba Ahmed M. , Makame Viola R. , Mfaume Mfaume S. , Lynch Matthew C. , Premji Zul , Minjas Japhet N. , Shiff Clive J.
Published: November 2003

Insecticide‐treated mosquito nets have an impact on mortality and morbidity in young children under controlled conditions. When integrated into larger control programs, there is the danger that rates of regular retreatment of the nets with insecticide will drop, greatly limiting their effectiveness as a public health intervention. In Bagamoyo District, Tanzania, rates of retreatment dropped significantly when payment for the insecticide was introduced. A series of neighbourhood (hamlet) meetings were held in all study villages to discuss people's concerns about the insecticide and ways to increase rates of retreatment. Although changes were made in the procedure for retreatment, rates of retreatment remained lower than expected and showed marked variation within as well as between villages. We then conducted unstructured key informant interviews as well as informal discussions in a village with strong variation between different sectors of the village in rates of retreatment. While logistical problems were most frequently cited as reasons not to bring nets for retreatment, political and social divisions within the community provided a better explanation. This is borne out by the low response to rearrangements in logistics which made retreating the nets significantly easier for households, and the higher response when changes were made in the channels of communication as well as the logistic features. It is clearly more difficult for villagers to appreciate the benefits of the insecticide than those of the nets. Great emphasis needs to be placed on the insecticide and its beneficial effects from the outset for any large‐scale programme to be sustainable.
Anti‐malarial drug resistance, malnutrition and socio‐economic status
Authors: Hess F. I. , Nukuro E. , Judson L. , Rodgers J. , Nothdurft H. D. , Rieckmann K. H.
Published: November 2003

To investigate the relationship between nutritional status and resistance to chloroquine treatment, we designed a nested case‐control study prospective with respect to the outcome of Plasmodium falciparum‐infected school children aged 5–14 years from Honiara, Solomon Islands. 38 chloroquine‐resistant cases were compared with treatment‐susceptible controls with respect to current nutritional status, behavioural characteristics, medical and demographic data. The overall prevalence of moderate malnutrition was 28%. The incidence rate of chloroquine resistance was 23%. Malnourished children were generally at higher risk for treatment failure than well‐nourished ones (OR: 3.6; 95%CI: 1.6–8.4; P= 0.001). This effect was modified by socio‐economic status. Stratified analysis by logistic regression resulted in an eightfold risk of resistance for malnourished children in the higher socio‐economic category (OR:8.1; 95%CI: 2.4–27.9; P= 0.0001). In children from the lower socio‐economic group, the effect of malnutrition was not significant (OR:1.5; 95%CI:0.4–5.6). Socio‐economic differences may affect the immune status. The treatment response in children of lower socio‐economic status, which are more exposed to malaria, may therefore be less affected by malnutrition.
Neurocysticercosis: a major aetiological factor of late‐onset epilepsy in Madagascar
Authors: Andriantsimahavandy A. , Lesbordes J. L. , Rasoaharimalala B. , Peghini M. , Rabarijaona L. , Roux J. , Boisier P.
Published: November 2003

To assess the impact of cysticercosis on public health in Madagascar, we compared patients < 15 years with late‐onset epilepsy to non‐epileptic controls in a matched case‐control study. The association between epilepsy and cysticercosis was studied by enzyme‐linked immunoelectrotransfer blot (EITB) assay for antibodies specific to Taenia solium. The EITB assay was performed on 104 pairs of sera specimens and on 95 pairs of cerebrospinal fluid (CSF) specimens. Depending on whether we consider the results obtained from sera or from CSF, we obtain for the population attributable risk percent of cysticercosis in late‐onset epilepsy two slightly different estimates: 22.3% and 17.6%. Therefore cysticercosis is a major aetiological factor of late‐onset epilepsy in Madagascar. In the control group, the frequency of positive results, especially in CSF specimens (7.4%), confirms the existence of asymptomatic cases of neurocysticercosis.
From their own perspective. A Kenyan community's perception of tuberculosis
Authors: Liefooghe R. , Baliddawa J.B. , Kipruto E. M. , Vermeire C. , De Munynck A. O.
Published: November 2003

Early passive case finding and treatment compliance are the cornerstones of tuberculosis (TB) control programs. As human behaviour plays a critical role in both strategies, a better understanding of it is important for the planning and implementation of a successful TB programme, especially for the health education component. Our qualitative study in Uasin Gishu, Kenya, aimed at a better understanding of the community's beliefs and perceptions of TB, recognition of early symptoms and health‐seeking behaviour. Five focus groups with a total of 49 people were held: one with hospitalised TB patients, two with rural and two with urban participants.

Tuberculosis is well known in the communities and many vernacular names for the disease exist. TB is perceived as a contagious, ‘sensitive’ disease difficult to diagnose and treat. Community members believe that TB should be diagnosed and treated in a hospital or by a medical doctor and not at the peripheric level. TB treatment is perceived as long, agonising and cumbersome. Traditional treatment is considered a valid alternative to modern treatment, believed to be as effective and much shorter. Initial symptoms such as cough and fever are often overlooked and/or confused with malaria or a common cold. Symptoms associated with the disease refer to the later stage of TB. TB is attributed to causes such as smoking, alcohol, hard work, exposure to cold and sharing with TB patients. Many participants believe TB is hereditary. Prolonged self‐treatment and consultation with the traditional health sector as well as the social stigma attached to the disease increase patient’s delay. Only after symptoms persist for some time and/or the suspect’s health deteriorates, are modern health services consulted. These social conditions necessitate culturally sensitive health education, taking into account local perceptions of TB.
Alveolar hydatidosis (Echinococcus multilocularis) in a captive rhesus monkey (Macaca mulatta) in Germany
Authors: Brack M. , Conraths F. J. , Rensing S.
Published: November 2003

A naturally occurring E. multilocularis infection in an 11‐year‐old female rhesus monkey is described. The infection most probably was acquired from foxes of the Göttingen area through contaminated branches or foliage taken from the nearby forest. The most severely affected organs were the liver and the lung. A limited serological survey using the Em2plus ELISA revealed 5 more animals which so far remain clinically healthy as possibly infected.
Hospitals in sub‐Saharan Africa: why we need more of what does not work as it should
Authors: Van Lerberghe W. , De Béthune X. , De Brouwere V.
Published: November 2003

This paper analyses the origins of today's crisis in the hospital sector in sub‐Saharan Africa. Present trends in availability of hospital services are extrapolated to the future in order to provide a low‐end estimate of the need for expansion of first referral level hospitals. This will not be possible without giving due priority to this sector, a commitment to considerable investments and reorientation of resources from tertiary to first referral level hospitals. It is to be feared that if this is not done, the backlog will increase, and, given the time lag before investments translate into operational services, there will be a major shortage of hospital services in sub‐Saharan Africa within a decade.
Characterization of human immune responses to the cytosolic superoxide dismutase and glutathione S‐transferase from Onchocerca volvulus
Authors: Brattig N. W. , Henkle‐Dührsen K. , Hounkpatin S. , Liebau E. , Kruppa T. F. , Zipfel P. F.
Published: November 2003

In onchocerciasis patients and in O. volvulus‐exposed individuals without signs of onchocerciasis, T‐ and B‐cell responses to two recombinantly expressed O. volvulus enzymes were analysed and compared to responses to total protein extract of adult parasites. The cytosolic enzymes Cu/Zn superoxide dismutase 1 (OvSOD1) and glutathione S‐transferase 2 (OvGST2) represent 2 detoxifying molecules which may play an important role in parasite defense against host‐induced oxidative stress. The T‐cell response to the two recombinant proteins was analysed by investigating the cytokine responses of peripheral blood mononuclear cells. Induction of IL‐5 at the mRNA level and IL‐5 and IL‐10 at the protein level was demonstrated in patients with the generalized form of onchocerciasis and endemic normals without clinical manifestations. IFN‐γ was not found to be induced by either antigen. This pattern of lymphokine expression is indicative of a Th2‐type response. Compared to patients with the generalized form, a higher level of cytokine induction was observed in the group of endemic normals. Low but significant IgG levels were observed against OvSOD1 in patients with onchocerciasis; higher antibody levels were found against OvGST2 in patients and endemic normals. The highest IgG levels were detected against the crude O. volvulus extract. These results indicate that the two recombinant O. volvulus proteins induce moderate T and B cell responses.
Molecular epidemiology and transmission dynamics of Mycobacterium tuberculosis in rural Africa
Authors: Wilkinson David , Pillay Manormoney , Crump John , Lombard Carl , Davies Geraint R. , Sturm A. Willem
Published: November 2003

The relative contribution of reactivated and recently acquired tuberculosis to the disease burden in developing countries is unknown, as are the settings within which most transmission occurs. In an attempt to answer these questions, we combined molecular techniques (restriction fragment length polymorphism analysis) and conventional epidemiology (risk factor analysis and contact tracing) to study 246 consecutive cases of smear‐positive tuberculosis in rural South Africa. We estimate that 29–43% of the cases were recently acquired, as they were clustered. We were unable to identify firm transmission links between 73% of clustered cases. Our findings suggest that most smear‐positive tuberculosis in rural Africa is both recently acquired and casually transmitted. Tuberculosis control may therefore depend more on promoting early presentation, rapid diagnosis and vaccine development than on chemotherapy.
Besnoitiosis in a miniature donkey
Authors: DAVIS WENDELL P. , PETERS DUNCAN F. , DUNSTAN ROBERT W.
Published: November 2003

A 1‐year‐old male miniature donkey (Equus asinus) from a herd of eight was presented with a 9‐month history of pruritic dermatitis, lethargy and anorexia. Physical examination revealed diffuse lichenification and scales involving the skin of the face, head and dorsum from the neck to the pelvis. The main histological alteration within the superficial and deep dermis was the presence of multiple large, spherical, thick walled, protozoal Besnoitia cysts. In addition, the inflammatory response consisted of a moderate, superficial and deep perivascular, mixed mononuclear cell infiltrate, with epidermal hyperplasia and compact orthokeratosis. Based upon the large size of the protozoal cysts and the ultrastructural features of the bradyzoites contained therein (conoid, polar ring, rhoptries, micronemes and microtubules), a diagnosis of cutaneous besnoitiosis was established. Treatment with trimethoprim‐sulphamethoxazole resulted in significant clinical improvement. To our knowledge, this is the first reported case of besnoitiosis in a miniature donkey in North America.
A double‐blind placebo‐controlled trial of an evening primrose and fish oil combination vs. hydrogenated coconut oil in the management of recurrent seasonal pruritus in horses
Authors: Craig J. Mark , Lloyd David H. , Roger D. Jones C.P.
Published: November 2003

Clinical status and plasma phospholipid fatty acids of 33 horses with seasonal pruritus were investigated following fatty acid supplementation. Principal areas affected by pruritus were mane, tail, head and rump. There were no significant differences in clinical status between horses receiving test and placebo capsules. Horses receiving the test preparation showed significant reduction (weeks 0–12) in linoleic acid (P < 0.05) and significant increases (weeks 0–24) in dihomogammalinolenic acid and alpha linolenic acid (P < 0.05). Placebo‐treated horses showed significant reductions (weeks 0–12) in linoleic acid, dihomogammalinolenic acid, arachidonic acid (P < 0.01), eicosapentaenoic acid and docosahexaenoic acid (P < 0.05) and a significant increase (weeks 0–24) in dihomogammalinolenic acid (P < 0.05). Significant differences in the change in plasma phospholipid concentration between test and placebo groups were seen for dihomogammalinolenic acid and docosahexaenoic acid (P < 0.01) between weeks 0 and 12 and for alpha linolenic acid (P < 0.05) between weeks 0 and 24.
The histology of normal llama skin
Authors: Atlee Barbara A. , Stannard Anthony A. , Fowler Murray E. , Willemse Ton , Ihrke Peter J. , Olivry Thierry
Published: November 2003

Skin biopsy specimens of normal llama skin were examined histologically. Adnexal structures similar to those of most other domestic mammals included epitrichial sweat glands, sebaceous glands and arrector pili muscles. Unique features of normal llama skin included a very thick dermis with marked differences between superficial and deep dermis, prominent cutaneous vascular plexuses, unidentified cells with eosinophilic granules within the adventitia of the vascular plexuses, both simple and compound hair follicles, ‘metatarsal glands’, ‘interdigital glands’, footpad glands and the absence of eyelid tarsal glands.
Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96)
Authors: White Stephen D. , Bordeau Patrick B. , Blumstein Philippe , Ibisch Catherine , GuaguÈre Eric , Denerolle Philippe , Carlotti Didier N. , Scott Katherine V.
Published: November 2003

Clinical and diagnostic parameters, and response to topical mupirocin in 25 cats with feline acne are described. The chin was the most common area affected, but the lower lip, upper lip and the commissure of the lips also frequently had lesions. The most common clinical sign was the presence of crusts, followed by comedones, erythema, alopecia, pruritus and nodules/fistulas. Deep skin scrapings for ectoparasites, cytological examination of superficial skin scrapings, and fungal cultures from the chin were performed on all cats. Dermatophytes were cultured from two cats and Malassezia pachydermatis was cultured (n = 2), seen on cytology smears (n = 1), or noted on histopathology (n = 1). Skin biopsies were obtained from three of the cats and most commonly showed dilatation of sebaceous gland ducts, neutrophilic or pyogranulomatous infiltration of the sebaceous glands, and pyogranulomatous inflammation of the dermis.

All cats were treated with topical 2% mupirocin ointment twice daily for 3 weeks as the sole treatment. Treatment response was excellent in 15 cats and good in nine cats. One cat had a contact reaction to the mupirocin, necessitating stopping treatment. The response to treatment of the six cats with dermatophyte or years involvement was good (n = 3) or excellent (n = 3).
Absent expression of collagen XVII (BPAG2, BP180) in canine familial localized junctional epidermolysis bullosa
Authors: Olivry Thierry , Poujade‐Delverdier AGNÈS , Dunston Stanley M. , Fine Jo‐David , Ortonne Jean‐Paul
Published: November 2003

Hereditary junctional epidermolysis bullosa (JEB) represents a subset of mechanobullous diseases associated with defective hemidesmosome/anchoring filament proteins leading to cleavage in the lamina lucida of the epidermal basement membrane. In humans, most cases of JEB have been related to a deficiency of either laminin‐5, collagen XVII (BPAG2, BP180) or integrin β4.

We describe the existence of a previously unreported form of familial localized non‐lethal JEB in German Shorthaired Pointer littermates. Acral, auricular and oral erosions and ulcers were observed. Severe ulceration of the footpads was present.

Skin biopsy specimens of non‐lesional and lesional skin of affected dogs were screened for a defect in basement membrane proteins using indirect immunofluorescence and immunoperoxidase testing. Epidermal staining for laminin‐5 and integrin α6β4 was similar in affected and normal control dogs. Lack of expression of collagen XVII was uniquely identified in all sections of JEB probands compared with normal control dogs.

The defective expression of collagen XVII is likely to be caused by mutation(s) of the COL17A1 gene, as previously reported in humans. This is, to date, the first report of a deficient basement membrane protein in canine JEB.
Systemic lupus erythematosus in a cat: fulfillment of the American Rheumatism Association criteria with supportive skin histopathology
Authors: VITALE CARLO , IHRKE PETER , GROSS THELMA LEE , WERNER LINDA
Published: November 2003

Systemic lupus erythematosus (SLE) was diagnosed in a 9‐year‐old castrated male Persian cat. The cat described is the first to fulfil four of 11 American Rheumatism Association criteria for the diagnosis of SLE in humans (symmetrical facial dermatitis, thrombocytopenia, positive antinuclear antibodies, oral ulceration) with supportive skin histopathology. Haematological abnormalities included a mild anaemia and severe thrombocytopenia. Skin disease consisted of symmetrical multifocal alopecia with crusting, predominantly on the face. Histopathology of the skin revealed interface dermatitis and interface folliculitis with follicular atrophy. Complete remission was obtained with corticosteroid therapy.
Subepidermal bullous dermatosis due to topical corticosteroid therapy in dogs
Authors: GROSS THELMA LEE , WALDER EMILY , IHRKE PETER
Published: November 2003

Six adult dogs were presented with an unusual bullous dermatosis affecting the glabrous skin of the ventral abdomen and medial thighs. Clinically, flaccid bullae were accompanied by erythema, ulceration, haemorrhage and hyperpigmentation in four of six dogs; the remaining two dogs had thin skin without grossly apparent bullae. Histologically, subepidermal bullae and clefting, vascular proliferation and dilatation (phlebectasia), and alteration in the density and staining of superficial dermal collagen were seen in all dogs. In all cases, corticosteroid‐containing topical products had been applied to the affected areas prior to the development of the dermatosis; skin lesions resolved when topical corticosteroids were withdrawn. Follow‐up biopsy of three dogs showed resolution of the previously abnormal collagen and subepidermal clefting. Residual lesions included phlebectasia, comedones and hyperpigmentation. The authors postulate that subepidermal clefting was due to local, corticosteroid‐induced skin fragility. This is the first report, to our knowledge, of bullous skin disease in dogs resulting from topical corticosteroid therapy.
Use of pentoxifylline in the treatment of allergic contact reactions to plants of the Commelinceae family in dogs
Authors: MARSELLA ROSANNA , KUNKLE GAIL , LEWIS DIANE
Published: November 2003

The effects of pentoxifylline (10 mg kg−1 orally [PO] twice daily) in three dogs with a confirmed contact allergy to plants of the Commelinceae family are described. Pentoxifylline inhibited the development of clinical signs in all three dogs despite extensive challenge with the offending plants. The protective effect was evident after 2 days of treatment and appeared to be dose related in one dog. The immunomodulatory properties of pentoxifylline are reviewed.
The effect of topical minoxidil treatment on hair follicular growth of neonatal hairless descendants of Mexican hairless dogs
Authors: KIMURA TOHRU , DOI KUNIO
Published: November 2003

The effect of daily topical minoxidil treatment on hair growth was investigated in eight neonatal hairless pups. After 21 days of minoxidil treatment, hair growth occurred in the minoxidil‐treated areas of each neonatal hairless pup. The numbers of hairs in the treated areas increased as compared with that in the areas treated with vehicle only. Histological findings revealed that the skin treated with minoxidil contained many hair follicles derived from epidermal ingrowths (hair germs) projecting into the dermis. These hair follicles showed various stages of neofolliculogenesis. After 31 days of treatment, terminal hair growth was observed. In the minoxidil‐untreated areas, epidermal ingrowths remained undifferentiated. These results revealed that hairless dogs developed hair growth reactions following minoxidil‐treatment when such treatment is applied in the early neonatal period. Neonatal hairless pups are a useful model for evaluating the effectiveness of hair growth stimulators.
Oral conidiobolomycosis in a dog
Authors: BAUER RUDY , LEMARIÉ STEPHEN , ROY ALMA
Published: November 2003

Conidiobolomycosis was diagnosed via culture from an oral lesion in a 1.5‐year‐old German Shepherd dog. Clinically, the lesion consisted of a large, irregularly shaped, ulcerative focus on the caudal hard palate. Microscopically, the lesion was characterized by an eosinophilic granulomatous stomatitis with hyphal organisms surrounded by eosinophilic sleeves (Splendore–Hoeppli material) suggestive of an entomophthoramycosis. The fungus was cultured and identified with features consistent with Conidiobolus sp. Treatment with itraconazole at 10 mg kg−1 twice daily for 61 days resulted in clinical and radiographic resolution of the lesion.