bluuebunny/crossref_metadata_2025 huggingface dataset:
Workshop Report on the Genotyping of Blood Cell Alloantigens
Authors: Kroll H. , Carl B. , Santoso S. , Bux J. , Bein G.
Published: March 2003

The immunization against alloantigens present on platelets, granulocytes and red blood cells (RBCs) is responsible for various clinical syndromes. Since the molecular basis of these antigens has become clear during the last decade, genotyping is nowadays used in several laboratories. However, many DNA‐based techniques still have to be evaluated. We therefore organized a workshop on the genotyping of the most relevant alloantigens on platelets and granulocytes as well as on selected RBC alleles.

DNA was isolated from peripheral blood lymphocytes or from B‐lymphoblastoid cell lines (B‐LCL). We distributed samples for the identification of platelet (n = 7), granulocyte (n = 6) and RBC (n = 4) polymorphisms, respectively. There were 33 institutions in Germany, Austria and Switzerland, which participated in at least one part of the workshop.

Twenty‐four laboratories reported results on HPA‐1, and 23 laboratories on HPA‐2, ‐3, and ‐5 typing. In addition, five laboratories typed for HPA‐4 and ‐6. The HNA‐1a/b (NA1/NA2) alleles were identified by eight laboratories, one of which also typed for HNA‐1c (SH). The most frequent genes of the ABO (A1, B, O) and Rh (D, C, c, E, e) systems were typed by 12 participating laboratories, and an additional four laboratories restricted their RBC typing to the RHD gene. The typing technique mainly used for all three cell lineages was the polymerase chain reaction with sequence‐specific primers. Other techniques were restriction fragment length analysis, oligonucleotide ligation assay, enzyme‐linked mini‐sequence assay or direct sequence analysis. The following typing errors were observed: HPA: 15/1442 (1·0%), HNA: 4/108 (3·7%), ABO: 5/96 (5·2%) RH 1/320 (0·3%).

Our workshop demonstrated the existence of a number of reliable techniques for the genotyping of blood cell alloantigens and a high standard in the participating laboratories. In addition, we could show the usefulness of B‐LCL as a source of reference DNA. However, the 5·2% rate of mistyping in the ABO system demonstrated that further efforts are needed to improve the precision of the genotyping techniques. Future workshops will have to challenge methods and participants with rare variants of RBC genes to guarantee reliable genotyping, e.g. in prenatal diagnosis of fetomaternal incompatibility.
Hydrops foetalis caused by anti‐Mur in first pregnancy – a case report
Authors: Wu K. H. , Chang J. G. , Lin M. , Shih M. C. , Lin H. C. , Lee C. C. , Peng C. T. , Tsai C. H.
Published: March 2003

Summary Anti‐‘Mia’ is the most common alloantibody of potential clinical significance in the Taiwanese population. The Mi.III phenotype is rare among Caucasians but has a high incidence in various Oriental populations. We describe a nulliparous woman with no history of transfusions, who had hydrops foetalis at 28 weeks gestation. Foetal haemoglobin was 4·4 g dL−1, and a positive direct antiglobulin test was positive in the foetal blood. Intrauterine intravascular transfusion was given, and the baby was discharged healthy.

Anti‐‘Mia’ was identified in the maternal serum, the cord blood serum and the eluate from red cells of the cord blood. Anti‐‘Mia’ in the maternal serum was confirmed to be anti‐Mur. The polymerase chain reaction‐restriction fragment length polymorphism method confirmed that both the baby and her father had the Mi.III gene. Therefore, our report documents that anti‐Mur has the potential to cause hydrops foetalis.
Mannan‐binding lectin and its role in innate immunity
Authors: Kilpatrick D. C.
Published: March 2003

Summary Mannan‐binding lectin (MBL) is a plasma collectin (C‐type lectin with a collagen‐like domain) and is considered an important component of innate immunity. Circulating MBL is genetically determined for the major part, but plasma concentration is also markedly influenced by nongenetic factors. The carbohydrate‐binding ability of MBL can be inhibited by simple sugars like mannose, fucose and N‐acetylglucosamine, but its greatest avidity appears to be for repeating mannose‐based structural patterns typical of microbial surfaces. By this means, MBL can bind to a wide variety of bacteria and other microbes, neutralizing them and/or opsonizing them by activating complement using the recently discovered lectin pathway of complement activation. Individual humans differ 1000‐fold in MBL concentration, and individuals with low circulating MBL appear to be more vulnerable to infections in a number of clinical settings, especially when combined with secondary immune deficiency. The best evidence that MBL deficiency or insufficiency is physiologically relevant comes from a rapidly expanding literature of clinical studies. MBL insufficiency appears to be a significant risk factor for infections in infants, and for individuals of any age undergoing chemotherapy or post‐transplant immunosuppression. Moreover, MBL appears to have a significant influence on the course of certain chronic diseases like rheumatoid arthritis and cystic fibrosis. Replacement therapy with a plasma‐derived product is safe and seems promising, while recombinant MBL provides hope for large‐scale therapeutic applications. Randomized clinical trials of MBL therapy, which are now on the horizon, should provide unambiguous evidence for the physiological significance of MBL in innate immunity.
Human lung fluke Paragonimus heterotremus: differential diagnosis between Paragonimus heterotremus and Paragonimus westermani infections by EITB
Authors: Dekumyoy P. , Waikagul J. , Eom K. S.
Published: March 2003

The specificity of three major polypeptides (35, 33 and 32.5 kD) from Paragonimus heterotremus antigens prepared from ether‐extracted adult worms was tested against sera from heterologous infections as well as against P. westermani‐infected sera. Only the 35 kD polypeptide was not present, its antigenic determinant being bound to the antibodies from all P. westermani‐infected cases. Its cross‐reactivity against various sera from heterologous helminthiases and other lung infections showed that it is not bound to these antigenic polypeptides. These major bands cannot be detected by Concanavalin A detector. Our research encourages the pattern (35, 33 and 32.5 kD) of immunoblot reactions for the diagnosis of P. heterotremus infections; the 35 kD antigen is specific for corresponding species and able to differentiate infections between both species of Paragonimus.
Human occult loiasis: field evaluation of a nested polymerase chain reaction assay for the detection of occult infection
Authors: Touré Fousseyni S. , Mavoungou Elie , Kassambara Lalla , Williams Tim , Wahl Goetz , Pascal Millet  , Egwang Thomas G.
Published: March 2003

A nested polymerase chain reaction (nested PCR) assay, targeted on the repeat 3 region (15r3) of the gene coding for a Loaloa 15 kD polyprotein, was developed to detect L. loa infection. The assay has a sensitivity of 95% and is 100% specific with regard to sympatric filarial parasites: Mansonella perstans, Onchocerca volvulus and Wuchereria bancrofti. In this field study in a mixed filarial (L. loa and M. perstans) endemic region of Gabon, 157 L. loa amicrofilaraemic blood samples (AMF; diagnosed by leucoconcentration followed by standard microscopic examination) from the residents from four villages were screened by the 15r3‐nested PCR assay. The assay detected 106 occult infected subjects among the 157 AMF individuals (68%), including 59 of 87 adults (68%) and 47 of 70 children (67%). In each village the prevalence of occult infection was, respectively, 38%, 52%, 79% and 80% for Moyabi, Djoutou, N'djokaye and Okoumbi. The annual transmission potential (ATP) of loiasis has been estimated to be 250 infective larvae (L 3) per man per year for Moyabi and Djoutou, 1800 for N'djokaye and 43000 L3/man/year for Okoumbi. This implies a correlation between occult infection of loiasis and the intensity of transmission. By contrast, the prevalence of L. loa microfilariae was 21% for Okoumbi, 22% for N'djokaye and 19% for Djoutou and Moyabi. These results show that the prevalence of loiasis in this region of Gabon is higher than previously described by standard microscopic examination and that the application of this assay will be significant in the development of control strategies for loiasis.
Willingness to pay for community‐based ivermectin distribution: A study of three onchocerciasis‐endemic communities in Nigeria
Authors: Onwujekwe O. E. , Shu E. N. , Nwagbo D. , Akpala C. O. , Okonkwo P. O.
Published: March 2003

Objective To determine the willingness to pay (WTP) for local ivermectin distribution in a community financing framework.

Method Contingent valuation in three communities in Nigeria, using randomly selected household heads. WTP was elicited using a bidding game, and for collecting information on the households' socio‐economic status, level of knowledge, priority ranking and perception of risk of contracting the disease, structured questionnaires were used. Ordinary least squares (OLS) multiple regression analysis was used to analyse factors associated with WTP.

Results Between 92.1% and 93.3% of respondents were willing to pay amounts ranging from 5 Naira (US$ 0.06) to 100 Naira (US$ 1.25) (median: 20 Naira, US$ 0.25) in the three communities, more than three times the modelled unit direct cost of distributing ivermectin by the communities themselves. Occupation of the respondent, marital status, average monthly expenditure on health care, manifestations of onchocerciasis, the type of savings scheme embarked on by the respondent, age‐group, level of education and type of property were statistically significant (P < 0.05) variables affecting WTP.

Conclusion This study shows that there is WTP for local ivermectin distribution in the three study communities, and that it should be assessed before instituting community‐directed treatment with ivermectin.
Strategies for reducing maternal mortality in developing countries: what can we learn from the history of the industrialized West?
Authors: De Brouwere Vincent , De Brouwere Vincent , Tonglet René , Van Lerberghe Wim
Published: March 2003

Ten years of Safe Motherhood Initiative notwithstanding, many developing countries still experience maternal mortality levels similar to those of industrialized countries in the early 20th century. This paper analyses the conditions under which the industrialized world has reduced maternal mortality over the last 100 years. Preconditions appear to have been early awareness of the magnitude of the problem, recognition that most maternal deaths are avoidable, and mobilization of professionals and the community. Still, there were considerable differences in the timing and speed of reduction of maternal mortality between countries, related to the way professionalization of delivery care was determined: firstly, by the willingness of the decision‐makers to take up their responsibility; secondly, by making modern obstetrical care available to the population (particularly by encouragement or dissuasion of midwifery care); and thirdly, by the extent to which professionals were held accountable for addressing maternal health in an effective way. Reduction of maternal mortality in developing countries today is hindered by limited awareness of the magnitude and manageability of the problem, and ill‐informed professionalization strategies focusing on antenatal care and training of traditional birth attendants. These strategies have by and large been ineffective and diverted attention from development of professional first‐line midwifery and second‐line hospital delivery care.
Increased prevalence of malaria in HIV‐infected pregnant women and its implications for malaria control
Authors: Verhoeff Francine H. , Brabin Bernard J. , Hart C. Anthony , Chimsuku Lyson , Kazembe Peter , Broadhead Robin L.
Published: March 2003

Summary objectives  To examine in pregnant women the relationship between HIV infection and malaria prevalence and to determine, in relation to HIV infection, the effectiveness of sulphadoxine‐pyrimethamine in clearing P. falciparum infection.

method  Descriptive cross‐sectional analysis of P. falciparum prevalence in pregnant women at first antenatal visit and of women at delivery who had received two sulphadoxine‐pyrimethamine treatments for malaria. HIV status was assessed in 621 women who attended for antenatal care and for delivery at two rural hospitals in southern Malawi in 1993–94. Information was collected on maternal age, parity and gestational age. Prevalence of P. falciparum was measured at first antenatal visit and delivery. Women were given two routine treatment doses of sulphadoxine‐pyrimethamine (SP), at first antenatal visit and between 28 and 34 weeks gestation, conforming to Malawi government policy on antimalarial control during pregnancy.

results  Prevalence of HIV infection was 25.6% and all infections were HIV type‐1. In primigravidae malaria prevalence at recruitment was 56.3% in HIV‐infected and 36.5% in HIV‐uninfected women (P= 0.04). The corresponding figures for multigravidae were 23.8% and 11.0%, respectively (P < 0.01). HIV‐infected primigravidae had increased malaria prevalence at all gestational ages. Peak parasite prevalence occurred earlier in gestation in HIV‐infected primigravidae (16–19 weeks if HIV‐infected; 20–23 weeks if HIV‐uninfected). The relative risk for parasitaemia in HIV‐infected compared to HIV‐uninfected women was significantly increased in three of five parity groups, including the two highest ones (parity >3), indicating parity‐specific immunity to malaria was impaired. Malaria prevalence at delivery remained high in HIV‐infected women despite prior routine treatment with sulphadoxine‐pyrimethamine in pregnancy. There was no significant difference in parasite prevalence at delivery between women who did or did not use sulphadoxine‐pyrimethamine.

conclusions  HIV infection is associated with a significant increase in malaria prevalence in pregnant women of all parities with the effect apparent from early in gestation. Two treatment doses of sulphadoxine‐pyrimethamine were inadequate to clear parasitaemia in many women by the time of delivery and this occurred independently of HIV status and despite high sensitivity to SP in this area. There is a need to undertake longitudinal studies to determine the incidence of P. falciparum infection in HIV‐infected and uninfected pregnant women and to re‐assess the frequency and timing of sulphadoxine‐pyrimethamine treatment doses in these women. Late pregnancy re‐infections with P. falciparum probably explain the high parasite prevalence at delivery following sulphadoxine‐pyrimethamine treatment at 28–34 weeks gestation.
Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream
Authors: Syed T. A. , Qureshi Z. A. , Ali S. M. , Ahmad S , Ahmad S. A.
Published: March 2003

Summary The prevalence of onychomycosis, a superficial fungal infection that destroys the entire nail unit, is rising, with no satisfactory cure. The objective of this randomized, double‐blind, placebo‐controlled study was to examine the clinical efficacy and tolerability of 2% butenafine hydrochloride and 5%Melaleuca alternifolia oil incorporated in a cream to manage toenail onychomycosis in a cohort. Sixty outpatients (39 m, 21 f) aged 18–80 years (mean 29.6) with 6–36 months duration of disease were randomized to two groups (40 and 20), active and placebo. After 16 weeks, 80% of patients using medicated cream were cured, as opposed to none in the placebo group. Four patients in the active treatment group experienced subjective mild inflammation without discontinuing treatment. During follow‐up, no relapse occurred in cured patients and no improvement was seen in medication‐resistant and placebo participants.
Distribution of fluoride and fluorosis in Ethiopia and prospects for control
Authors: Kloos Helmut , Haimanot Redda Tekle
Published: March 2003

Summary A review and mapping of fluoride test data for 270 water sources in 126 communities and examination of the literature of fluorosis distribution in Ethiopia show that this health problem extends beyond the Rift Valley into some highland communities. Fluoride concentrations above 5.0 mg/l in the Rift Valley were found mostly in hot springs (100% of all sources), lakes (78%), shallow wells (54%) and boreholes (35%) and the lowest concentrations (below 1.5 mg/l) in springs and rivers. Analysis of hydrochemical, economic and demographic factors in the spatial distribution of high‐fluoride domestic water sources indicates that the fluorosis problem has become more serious in the Rift Valley in recent decades. Considerable spatial variation in the occurrence of fluoride, even within the same communities, and the presence of some low‐fluoride water sources in the Rift Valley offer possibilities for geochemical exploration for acceptable domestic sources. The defluoridation programme in the Wonji irrigation scheme illustrates the problems faced by a large rural community in a developing country. Possibilities for control are examined and recommendations made for the development of alternative water sources and promising defluoridation methods using locally available materials and technologies.
Lung function, blood gases, pH and serum electrolytes of small‐scale miners exposed to chrome ore dust on the Great Dyke in Zimbabwe
Authors: Osim E. E. , Tandayi M. , Chinyanga H. M. , Matarira H. T. , Mudambo K. K. , Musabayane C. T.
Published: March 2003

Summary We measured and compared lung function indices and some blood parameters (gases, electrolytes, glucose, pH, red cell indices) of 54 male small‐scale miners (SSM) chronically exposed to chrome ore dust to those of 50 nonmining control subjects (NMC) and 46 large‐scale chrome miners (LSM) who had taken internationally recommended precautionary measures (secondary control). The respirable dust level in the SSM environment (6.0 ± 0.5 mg/m3) was significantly higher (P < 0.001) than in the NMC and LSM environments (0.3 ± 0.1 mg/m3 and 0.5 ± 0.3 mg/m3, respectively). There were no significant differences in neither dust levels nor lung function status between NMC and LSM environments. The values of FVC, FEV1, PEFR and FEV1% of the SSM were 3.5 ± 0.09 l, 2.61 ± 0.09 l, 6.07 ± 0.36 l/second and 76.19 ± 2.36%, respectively. These values were significantly lower than those of NMC (P < 0.01, respectively). However, the blood parameters of the SSM and NMC were not significantly different. The results are indicative of both restrictive and obstructive ventilatory defects in the SSM which may be attributed exposure to chrome ore dust in the environment. Associated risk factors appear to be advancing age, prolonged exposure to chrome ore dust and acid base disturbance.
Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya
Authors: Molyneux C. S. , Mung'ala‐Odera V. , Harpham T. , Snow R. W.
Published: March 2003

Summary Urbanization is an important demographic phenomenon in sub‐Saharan Africa, and rural‐urban migration remains a major contributor to urban growth. In a context of sustained economic recession, these demographic processes have been associated with a rise in urban poverty and ill health. Developments in health service provision need to reflect new needs arising from demographic and disease ecology change. In malaria‐endemic coastal Kenya, we compared lifelong rural (n = 248) and urban resident (n = 284) Mijikenda mothers' responses to childhood fevers. Despite marked differences between the rural and urban study areas in demographic structure and physical access to biomedical services, rural and urban mothers' treatment‐seeking patterns were similar: most mothers sought only biomedical treatment (88%). Shop‐bought medicines were used first or only in 69% of the rural and urban fevers that were treated, and government or private clinics were contacted in 49%. A higher proportion of urban informal vendors stocked prescription‐only drugs, and urban mothers more likely to contact a private than a government facility. We conclude that improving self‐treatment has enormous potential to reduce morbidity and mortality in low‐income urban areas, as has frequently been argued for rural areas. However, because of the underlying socio‐economic, cultural and structural differences between rural and urban areas, rural approaches to tackle this may have to be modified in urban environments.
Outcome in three groups of patients with typhoid fever in Indonesia between 1948 and 1990
Authors: Bergh Eric T.A.M. , Hussein Gasem M. , Keuter Monique , Dolmans M. V.
Published: March 2003

The outcome in three groups of patients with bacteriologically confirmed typhoid fever caused by Salmonella typhi, treated during three episodes between 1948 and 1990 in Java, Indonesia, was compared by retrospective analysis of hospital records. The study population consisted of three groups of patients. Group I (n= 50) was treated in Batavia (the present Jakarta) from 1948 to 1950, Group II (n= 61) in Yogyakarta from 1952 to 1956, Group III (n= 105) in Semarang from 1989 to 1990. Main outcome measures were days until defervescence, early relapses during hospitalization, duration of hospital stay, complications and mortality. Group I received supportive treatment only, Group II low doses of chloramphenicol (total 12.5 g) and Group III full doses of chloramphenicol (total 27 g); occasionally other antibiotics were used. In Group I, II and III the mean number of days until defervescence was 16, 8 and 6 and the mean number of days in hospital 43, 47 and 15, respectively. Mortality was 26%, 10% and 5% and complications occurred in 38%, 18% and 13%, respectively. Between Group I and Group II the differences in mortality and complications were statistically significant (P < 0.05). Compared to Group I the proportion of early relapses was higher in Group II, but was zero in Group III. There were significantly fewer gastrointestinal complications in Group II than in Group I (P < 0.01) and even fewer in Group III. When no antibiotic against S. typhi was available, typhoid fever had a protracted course, and only 74% of patients survived. Even with low dosages of chloramphenicol, defervescence was earlier and mortality and complications decreased dramatically, but early relapses were frequent. Full doses of chloramphenicol for a sufficient period of time only slightly reduced mortality and complications further, but eliminated early relapses completely.
Rebound mortality and the cost‐effectiveness of malaria control: potential impact of increased mortality in late childhood following the introduction of insecticide treated nets
Authors: Coleman P. G. , Goodman C. A. , Mills A.
Published: March 2003

The efficacy and relative cost‐effectiveness of insecticide‐treated nets (ITNs) for the control of malaria in children under 5 years of age have recently been demonstrated by several large‐scale trials. However, it has been suggested that long‐term use of ITNs in areas of high transmission could lead to mortality rebound in later childhood, which would reduce the cost‐effectiveness of the intervention, and at the extreme could lead to negative overall effects. A model is presented in which the cost and disability adjusted life years (DALYs) per child aged 1–119 months were estimated for a sub‐Saharan African population with and without an ITN intervention. The rebound rate, defined as the percentage increase in age‐specific all‐cause mortality and malaria specific‐morbidity, was varied to estimate the threshold at which the intervention was no longer cost‐effective. Rebound was considered over two possible age ranges: 5–9 years and 3–6 years. With mortality and morbidity reductions due to ITNs in children aged 1–59 months and rebound in the 5–9 years age class, one could be reasonably certain that the cost per DALY averted is below $150 up to a rebound rate of 39%. Up to an 84% rebound rate it is highly likely that the intervention will be DALY‐averting, that is the DALYs averted by the intervetion outweigh DALYs incurred through rebound effects. These thresholds are sensitive to the age range over which reductions and rebound in morbidity and mortality occur. With reductions confined to children aged 1–35 months and rebound in the 3–6 years age class, the cost per DALY is highly likely to fall below $150 only up to a 2.5% rebound rate, and with a rate in excess of 11% one can no longer be reasonably certain that the intervention is DALY‐averting. These rates apply to the whole population. If there is no rebound amongst children who did not comply with the intervention, the actual increases in morbidity and mortality required to reach these thresholds amongst compliers would be much higher. The age range over which rebound occurs is a critical determinant of the thresholds at which one can no longer be reasonably certain that ITNs remain cost‐effective in the long term. Based on empirical estimates of age‐specific malaria mortality in sub‐Saharan Africa, it appears unlikely that this threshold rate would be reached if rebound occurs over the 5–9 years age range. By contrast, if rebound occurs over the ages of 3–6 years, the increase in mortality rates required to reach this threshold falls within the observed range of malaria‐specific mortality rates for this age group. It is essential that long‐term surveillance is included as part of ITN interventions, with particular attention to the age range over which rebound may occur.
Land use change alters malaria transmission parameters by modifying temperature in a highland area of Uganda
Authors: Lindblade Kim A. , Walker Edward D. , Onapa Ambrose W. , Katungu Justus , Wilson Mark L.
Published: March 2003

Summary As highland regions of Africa historically have been considered free of malaria, recent epidemics in these areas have raised concerns that high elevation malaria transmission may be increasing. Hypotheses about the reasons for this include changes in climate, land use and demographic patterns. We investigated the effect of land use change on malaria transmission in the south‐western highlands of Uganda. From December 1997 to July 1998, we compared mosquito density, biting rates, sporozoite rates and entomological inoculation rates between 8 villages located along natural papyrus swamps and 8 villages located along swamps that have been drained and cultivated. Since vegetation changes affect evapotranspiration patterns and, thus, local climate, we also investigated differences in temperature, humidity and saturation deficit between natural and cultivated swamps. We found that on average all malaria indices were higher near cultivated swamps, although differences between cultivated and natural swamps were not statistically significant. However, maximum and minimum temperature were significantly higher in communities bordering cultivated swamps. In multivariate analysis using a generalized estimating equation approach to Poisson regression, the average minimum temperature of a village was significantly associated with the number of Anopheles gambiae s.l. per house after adjustment for potential confounding variables. It appears that replacement of natural swamp vegetation with agricultural crops has led to increased temperatures, which may be responsible for elevated malaria transmission risk in cultivated areas.
The epidemiology of human hookworm infections in the southern region of Mali
Authors: Behnke J. M. , De Clercq D. , Sacko M. , Gilbert F. S. , Ouattara D. B. , Vercruysse J.
Published: March 2003

Summary Two surveys of hookworm (Necator americanus) infections, conducted three years apart (December 1994 and January 1998) in a village in the Sikasso region of Mali, revealed that overall prevalence of infection was 68.7% and 53%, respectively. In both years there was a highly significant difference between the sexes in the prevalence and abundance of infection, with male subjects carrying heavier infections than females. Both prevalence and abundance of infection increased with age, although in 1998 there was a strong interaction between sex and age, arising from the declining egg counts among 16–20‐year‐old females and the continuing increase among males, reinforced by the subsequent reduction among the older males (≥ 61 years) and concomitant increase among females. After controlling for the effects of age, sex and their interaction, a highly significant positive relationship was detected between faecal egg counts of individuals who were examined in both 1994 and 1998 (n = 134), indicating predisposition to infection. This relationship remained significant in each of 4 age classes spanning 7–79 years. The members of some family compounds were shown to carry heavier infections than expected whilst others were less infected, suggesting compound‐related clustering of hookworm infections. The use of footwear increased with age but there was no significant relationship between the extent of use of footwear and the abundance of hookworm infection. Eyesight deteriorated with age and impaired vision was particularly prominent among the older sectors of the community, a legacy from the time when onchocerciasis was widely prevalent in the region. Although men with partially damaged eyes carried lower infections than expected for their age, no overall significant relationship was found between quality of vision and hookworm infections. These results are discussed in relation to hookworm epidemiology in general and in Mali in particular.
Hyperreactive malaria in expatriates returning from sub‐Saharan Africa
Authors: Van den Ende J. , van Gompel A. , van den Enden E. , Taelman H. , Vanham G. , Vervoort T.
Published: March 2003

Summary The extreme presentation of hyperreactive malaria is hyperreactive malarial splenomegaly syndrome (HMS). Some patients present with a less pronounced syndrome. To investigate whether the degree of splenomegaly correlates with the degree of immune stimulation, whether prophylaxis or recent treatment play a role, and whether short therapy alone is effective, we examined retrospectively the medical records of expatriates with exposure to P. falciparum who attended our outpatient department from 1986 to 1997, particularly subacute symptoms or signs, strongly elevated malarial antibodies and elevated total serum IgM. We analysed duration of stay, prophlyaxis intake, spleen size, serum IgM levels and response to antimalarial treatment. Serum IgM levels were significantly higher in patients with larger splenomegaly. The use of chloroquine alone as treatment for presumptive or proved malaria attacks was correlated with larger spleen size. Short adequate antimalarial therapy resulted in marked improvement or complete recovery. In nine patients the hyperreactive response reappeared after re‐exposure, in four of them twice. We conclude that patients with subacute symptoms but without gross splenomegaly may have very high levels of IgM and malarial antibodies, and relapse on re‐exposure, suggesting the existence of a variant of the hyperreactive malarial splenomegaly syndrome without gross splenomegaly.
The impact of weekly iron supplementation on the iron status and growth of adolescent girls in Tanzania
Authors: Beasley N. M. R. , Tomkins A. M. , Hall A. , Lorri W. , Kihamia C. M. , Bundy D. A. P.
Published: March 2003

Summary We evaluated the effect of weekly doses of 400 mg of ferrous sulphate for 4  months on the iron status of adolescent girls in a controlled trial in Tanga, Tanzania. Supplementation led to a significantly greater increase in serum ferritin compared with the control group (+ 15.6 μg/l vs. 8.6 μg/l) (P= 0.002) but there was no significant difference in change in haemoglobin. Children given iron showed a significantly greater weight gain than controls (+ 2.4 kg vs. + 1.4 kg) (P= 0.03). Weekly iron supplementation may be an effective means of increasing iron stores and growth in children vulnerable to iron deficiency.
Field evaluation of the ICT Malaria P.f/P.v immunochromatographic test for diagnosis of Plasmodium falciparum and P.vivax infection in forest villages of Chhindwara, central India
Authors: Singh Neeru , Saxena Ajay , Valecha Neena
Published: March 2003

Summary A rapid new immunochromatographic test (ICT malaria P.f/P.v) for diagnosis of Plasmodium falciparum and P.vivax was evaluated against thick blood smears in forest villages of Chhindwara, Madhya Pradesh, where both Plasmodium falciparum and P.vivax are prevalent. 344 symptomatic patients (Gond ethnic tribe) in five villages were screened by field staff of the Malaria Research Centre in October 1999. For P.falciparum, the ICT was 97.5% sensitive and 88% specific, with a positive predictive value (PPV) of 87.6% and a negative predictive value (NPV) of 97.6%. For P.vivax the sensitivity was only 72%, the specificity 99%, with a PPV of 92% and an NPV of 96%. Although a negative test result was inadequate to exclude parasitaemia ≤ 300/μl for P.falciparum and ≤ 1500/μl for P.vivax, the test is potentially useful in remote areas.
Non‐invasive management of Ascaris lumbricoides biliary tract migration: a prospective study in 69 patients from Ecuador
Authors: González Abad Horacio , Regalado Victor Crespo , Van den Ende Jef
Published: March 2003

Summary Ascariasis is one of the most common helminthic diseases. Its most feared complication is migration into the biliary tree. Some authors recommend immediate duodenoscopy in all cases of biliary migration, with sphincterotomy for the extraction of the parasites, and a surgical extraction in case of intrahepatic ascariasis. We followed prospectively 69 patients with ultrasonographical evidence of migration. Initial treatment consisted of intravenous analgesics and antispasmodics, and albendazol 800 mg by mouth. Only patients with persisting symptoms or with high amylasaemia underwent duodenoscopy, with extraction in case of a visible worm. Surgery was limited to cases with persistent or progressive complications. In 97% of our cases the worms disappeared with noninvasive therapy alone. A duodenoscopy was done in 30 (42%) cases; in 10 (14.4%) a worm was found in the ampula of Vater and extracted without sphincterotomy. In none of the 6 cases with A. lumbricoides in the intrahepatic biliary tree did the parasite persist. Only one patient required surgical intervention. Treatment of A. lumbricoides migration to the biliary tract should be principally medical. Duodenoscopy with extraction of a visible worm should be limited to cases with persisting pain and/or hyperamylasaemia. Invasive methods like sphincterotomy and surgery should be restricted to patients who do not respond to conservative treatment.
Short communication: Paracheck‐Pf®: a new, inexpensive and reliable rapid test for P. falciparum malaria
Authors: Proux Stephane , Hkirijareon Lily , Ngamngonkiri Chatee , McConnell Stephen , Nosten François
Published: March 2003

We compared the performance of Paracheck‐Pf®, a new and cheap rapid malaria test, with ICT‐Pf/Pv® and microscopy in two malaria surveys in Thai villages on the Thai‐Burmese border. The specificity, sensitivity, predictive positive and negative values of the Paracheck‐Pf® and ICT‐Pf® tests were calculated taking microscopy results as the gold standard. The 294 ICT‐Pf/Pv tests resulted in two invalid (no control line) and 11 doubtful results. Both the ICT‐Pf/Pv® and Paracheck‐Pf® tests reliably detected P. falciparum infections. However, Paracheck‐Pf® failed to detect three P. falciparum cases and likewise, ICT‐Pf/Pv® failed to detect the same three cases and an additional four cases. These seven cases were detected by microscopy and had a parasitaemia under 150 parasites/μl. At a cost of c. US $1.00, the Paracheck‐Pf® test, based on the detection of the P. falciparum specific HRP‐2 protein, is a reliable, easy to use and affordable tool for the diagnosis of P. falciparum malaria.
Re‐emergence of epidemic sleeping sickness in southern Sudan
Authors: Moore A. , Richer M.
Published: March 2003

A resurgence of sleeping sickness developed in southern Sudan during the past decade. Prevalence of confirmed Trypanosoma brucei gambiense infection in humans now exceeds 5% in several foci. From 1997 to 1999, trypanosomiasis control programmes in three counties of Western Equatoria Province detected 3785 new cases among 67 181 persons screened. A major contributing factor in the re‐emergence of epidemic sleeping sickness was the lack of active case‐finding throughout the 1990s. Although the situation is improving in sites where trypanosomiasis programmes have been recently implemented, co‐ordination and additional international assistance are needed to bring sleeping sickness under control in Sudan.
Tract microflora in Saudi patients with cholelithiasis
Authors: Al Harbi M. , Osoba A. O. , Mowallad A. , Al‐Ahmadi K.
Published: March 2003

OBJECTIVES To identify the microflora in the gallbladder of patients undergoing laparoscopic cholecystectomy for gallstones, and the antibiotic susceptibility pattern of the isolates, as well as the usefulness of Gram staining of bile at the time of operation.

METHODS Bile samples were obtained from 112 patients undergoing elective laparoscopic cholecystectomy for gallstones and inoculated directly into aerobic and anaerobic blood culture bottles in the operating theatre. Samples were also collected in sterile universal containers for Gram staining of a centrifuged deposit. Isolates were identified and their in‐vitro susceptibilities determined by Kirby Bauer technique.

RESULTS Of 112 bile samples examined, 28 (25%) were culture positive, four of which contained more than one organism. The most common organisms isolated were Escherichia coli 9 (28.1%), Enterococcus faecalis 5 (15.6%) and Pseudomonas aeruginosa 3 (9.4%). In one sample we found Aeromonas hydrophilia and Enterobacter cloacae. No anaerobes were detected but Candida albicans was isolated in one case. In 19 bile samples (67.8%) organisms were identified on Gram stain. Positive bile cultures were found statistically significant (P < 0.05) in patients over the age of 50 (13/32), in patients who developed post‐operative fever (6/12) and patients who developed leucocytosis (5/6).

CONCLUSION Age over 50 years was the only significant pre‐operative factor associated with positive bile cultures (P < 0.05). In view of the microflora of the gallbladder and the susceptibility pattern of our isolates we would suggest that antibiotic prophylaxis recommended for laparoscopic cholecystectomy for gallstones needs to be reviewed and the role of bacteribilia in the surgical management of cholelithiasis requires further study.
Seasonal variation in prevalence of antibody to hantaviruses in rodents from southern Argentina
Authors: Cantoni G. , Padula P. , Calderón G. , Mills J. , Herrero E. , Sandoval P. , Martinez V. , Pini N. , Larrieu E.
Published: March 2003

We conducted a small mammal trapping study to investigate temporal variation in prevalence of infection in hantavirus reservoir populations in the Patagonian Andes mountain range, Rio Negro province, Argentina. Rodent blood samples collected in natural and periurban habitats and at the home of an hantavirus pulmonary syndrome (HPS) case patient were analysed by enzyme‐linked immunosorbent assay. Organ tissue samples were tested by polymerase chain reaction (PCR) and nucleotide sequence analysis. Eight species of 1032 rodents were captured in 15 551 trap nights, giving an overall trap success of 6.6%. Hantavirus antibody was detected in 30 of 555 Oligoryzomys longicaudatus (reservoir of Andes virus), three of 411 Abrothrix longipilis, and one of 10 Loxodontomys micropus. Antibody prevalences in O. longicaudatus were 13.7% in spring 1996, 59.3% in summer 1996, 2.1% in autumn 1997, 12.4% in winter 1997 and 3.1% in spring 1997. A much higher antibody prevalence (33%) was found during trapping around the residence of an HPS case patient. Higher prevalences were found in older male O. longicaudatus. There was no apparent correlation of antibody prevalence with rodent population density, or of rodent population density or antibody prevalence with numbers of human cases. For an HPS case that occurred in our study area in 1997, we identified the probable rodent reservoir and likely site of exposure by matching the genetic sequences of virus obtained from a rodent and the HPS case patient.
Short communication: Erythrocyte binding antigen (EBA‐175) of Plasmodium falciparum: improved genotype determination by nested polymerase chain reaction
Authors: Touré Fousseyni S. , Mavoungou Elie , Me Ndong Jérôme Mezui , Tshipamba Paul , Deloron Philippe
Published: March 2003

We have designed primers to the conserved region of the erythrocyte binding antigen (EBA)‐175 gene which amplify specifically the two alleles by polymerase chain reaction (PCR) and by nested PCR. This approach provides a specific, sensitive and rapid method for genotype determination in a large number of Plasmodium falciparum field isolates.
Phenothiazines: potential alternatives for the management of antibiotic resistant infections of tuberculosis and malaria in developing countries
Authors: Amaral Leonard , Viveiros Miguel , Kristiansen Jette Elisabeth
Published: March 2003

Thein vitroandin vivoactivity of phenothiazines against antibiotic susceptible and antibiotic resistantMycobacterium tuberculosisand malaria‐causing Plasmodia is reviewed. Given the facts that pulmonary tuberculosis and malaria are the major causes of death in developing countries, that both of these infections continue to escalate in their resistance to antibiotics, that the cost for the management of these infections is beyond that afforded by most developing nations, and lastly, that new and effective agents are not forthcoming from the pharmaceutical industry, the scientific rationale for the potential use of select phenothiazines for the management of these infections is presented.
Patterns in age‐specific malaria incidence in a population exposed to low levels of malaria transmission intensity
Authors: Kleinschmidt Immo , Sharp Brian
Published: March 2003

The population of the northern part of the province of KwaZulu Natal in South Africa has experienced low levels of malaria transmission intensity for many years. We investigated the widely held assumption that individuals in this population do not develop clinical tolerance to infection with Plasmodium falciparum. We calculated malaria incidence rates by 5‐year age groups from a comprehensive small area malaria reporting system and from national census data for the period from mid‐1990 to mid‐1999. Incidence rates were plotted against age groups for each of the nine malaria seasons, and by quintile of crude incidence rate. These show that age‐specific incidence varied considerably in areas of high incidence and in years of high incidence. In these areas malaria incidence rose with age until the late teens, and either remained constant or decreased in young adults. This finding appears to be consistent with results from settings of much higher transmission intensities which show that clinical tolerance to infection with P. falciparum in adults may be acquired as a result of a small number of infective bites in early childhood and implies that even in this relatively low transmission area, there is an asymptomatic reservoir of infection in older people. The results also show that in high incidence subregions the lowest incidences are reported for children under 5 years of age, which may be the result of greater protection offered to this age group by malaria vector control through indoor house spraying.
Resurgence in filarial transmission after withdrawal of mass drug administration and the relationship between antigenaemia and microfilaraemia – a longitudinal study
Authors: Sunish I. P. , Rajendran R. , Mani T. R. , Munirathinam A. , Tewari S. C. , Hiriyan J. , Gajanana A. , Satyanarayana K.
Published: March 2003

Seven village units endemic for filariasis were assigned randomly into three arms with different intervention strategies in the years 1995 and 1996. Villages in Group A received two annual mass drug administrations (MDAs) of diethylcarbamazine (DEC) plus ivermectin (IVR). Group B received the same MDAs in combination with vector control; in Group C only placebo was administered. Post‐treatment evaluation in 1997 revealed marked reductions in microfilaraemia prevalences (MFP) and geometric mean intensities (GMI). Subsequently, vector control in Group B was continued by the community. Groups A and B received no MDAs between 1997 and 1999 and were re‐evaluated in 1999. During this evaluation, antigenaemia prevalence (AGP) was estimated along with MFP, using immunochromatographic test (ICT) kits. The gains of the MDAs were sustained in Group B, while resurgences occurred in Group A, where annual transmission potential (ATP) rose from 21 to 631.6 and MFP doubled. Group C continued to have high ATPs (1057–1617), while Group B had very low ATPs (0–63). After Mulla’s corrections, the reductions in MFP were 62.7 and 83.5% and for GMI 72.1 and 91.4% in Group A and B, respectively, compared with Group C. Vector control preserved the gains of MDAs and accounted for 55.8% and 67.1% reductions in MFP and GMI in Group B compared with Group A. The reductions in AGP were 29.4% in Group A and 39.2% in Group B against Group C. The differences between MFP and AGP were nearly uniform across all villages and there was a significant correlation (r=0.98) between the two variables. A similar significant relationship was observed between MFP and AGP values across age groups (r=0.95). Prediction of AGP values from MFP values was proposed with regression equations. We conclude that vector control would be useful as an adjuvant to chemotherapy to prevent resurgences.
Incidence and risk factors of probable dengue virus infection among Dutch travellers to Asia
Authors: Cobelens Frank G. J. , Groen Jan , Osterhaus Albert D. M. E. , Leentvaar‐Kuipers Anne , Wertheim‐van Dillen Pauline M. E. , Kager Piet A.
Published: March 2003

We studied the incidence of dengue virus (DEN) infections in a cohort of Dutch short‐term travellers to endemic areas in Asia during 1991–92. Sera were collected before and after travel. All post‐travel sera were tested for DEN immunoglobulin M (IgM) [IgM capture (MAC)‐enzyme‐linked immunosorbent assay (ELISA)] and IgG (indirect ELISA). Probable DEN infection was defined as IgM seroconversion or a fourfold rise in IgG ratio in the absence of cross‐reaction with antibody to Japanese encephalitis virus (JEV). Infections were considered clinically apparent in case of febrile illness (> 24 H) with headache, myalgia, arthralgia or rash. Probable DEN infection was found in 13 of 447 travellers (incidence rate 30/1000 person‐months, 95% CI 17.4–51.6). One infection was considered secondary; no haemorrhagic fever occurred. The clinical‐to‐subclinical infection rate was 1 : 3.3. The risk of infection showed marked seasonal variation. DEN infections are frequent in travellers to endemic areas in Asia; most remain subclinical.