bluuebunny/crossref_metadata_2025 huggingface dataset:
Pneumococcal and Haemophilus influenzae meningitis in a children's hospital in Ethiopia: serotypes and susceptibility patterns
Authors: Muhe Lulu , Klugman K.P.
Published: March 2003

Summary Streptococcus pneumoniae and Haemophilus influenzae are responsible for most pyogenic meningitis cases in children in Ethiopia. Resistance of S. pneumoniae and H. influenzae to penicillin and chloramphenicol respectively has been reported globally. Resistance has been related to specific serotypes of S. pneumoniae or to beta‐lactamase‐producing H. influenzae strains. This study describes the serotypes/ serogroups and susceptibility pattern of the two organisms causing meningitis in Ethiopian children. There were 120 cases of meningitis caused by S. pneumoniae (46) and H. influenzae (74) over a period of 3 years (1993–95). Nineteen children died from pneumococcal and 28 from haemophilus meningitis. Penicillin‐resistant pneumococcal meningitis (4/8 = 50%) caused a greater mortality rate than penicillin‐susceptible pneumococcal meningitis (15/38 = 39%). Common serotypes accounting for 76% of S. pneumoniae were type 14, 19F, 20, 1, 18 and 5; and serotypes 14, 19F and 7 (accounting for 17% of strains) showed intermediate resistance to penicillin G. 97% of the H. influenzae isolates were type b, and in only two cases beta‐lactamase‐producing. 72% of isolates of the S. pneumoniae we identified belong to serotypes preventable by a 9‐valent vaccine. Our study highlighs the possibility of resistant pyogenic meningitis in children in Ethiopia due to emerging resistant strains of S. pneumoniae and H. influenzae isolates.
Comparative clinical trial of four regimens of dihydroartemisinin‐mefloquine in multidrug‐resistant falciparum malaria
Authors: Na‐Bangchang K. , Tippanangkosol P. , Ubalee R. , Chaovanakawee S. , Saenglertsilapachai S. , Karbwang J.
Published: March 2003

Summary We conducted a randomized, comparative trial at the Bangkok Hospital for Tropical Diseases during 1996–98 to evaluate the clinical efficacy and tolerability of four combination regimens of dihydroartemisinin‐mefloquine. 207 male patients aged 18–25 years, weighing 49.3–55.1 kg were randomized to receive a single oral dose of 300 mg dihydroartemisinin plus one or two doses of mefloquine as follows: regimen I (n = 26): 750 mg mefloquine concurrently, or regimen II (n = 22): 750 mg mefloquine 24 h later, or regimen III (n = 78): 750 and 500 mg mefloquine at 24 and 30 h, or regimen IV (n = 81): 750 and 500 mg mefloquine (at 0 and 24 h). All patients improved clinically within 24 h of initiation of treatment. The initial therapeutic response was rapid and identical in all treatment groups (median PCT vs. FCT: 36 vs. 24, 36 vs. 28, 36 vs. 26, and 34 vs. 26 h, for regimen I, II, III and IV, respectively). All combination regimens generally showed acceptable tolerability profiles. Compliance with follow‐up (42 days) was achieved by 86.5% (179 cases). Recrudescent parasitaemia was significantly higher in patients treated with low‐dose mefloquine combinations (regimens I, II:8/23, 9/16) than in those who received high‐dose mefloquine (regimens III, IV: 2/70, 3/70). No RII or RIII type of response was observed. There were no significant differences in susceptibility to mefloquine between primary and recrudescent isolates. Dose‐adjusted whole blood mefloquine concentrations were significantly higher in high‐dose mefloquine regimens (III and IV). Patients who vomited within the first hour of mefloquine administration had markedly lower whole blood mefloquine concentrations than those who did not vomit.
Treating neurocysticercosis medically: a systematic review of randomized, controlled trials
Authors: Salinas R. , Counsell C. , Prasad K. , Gelband H. , Garner P.
Published: March 2003

Summary objective To summarize the evidence from randomized controlled trials on the effects of cysticidal therapy used for treating human cysticercosis.

methods Published and unpublished studies in any language identified through MEDLINE (1966 – June 1999) specialized databases, abstracts, proceedings and contact with experts were analysed. Those which compared, using randomized or quasi‐randomized methods, any cysticidal drug with placebo or symptomatic therapy were entered in the study. Data were extracted independently by two reviewers and trial quality assessed. Meta‐analysis using fixed effects models calculated provided there was no significant heterogeneity, expressed as relative risk.

results Four trials met the inclusion criteria, treating intraparenchymatous neurocysticercosis with either albendazole or praziquantel compared to placebo or no treatment. In the two trials reporting clinical outcomes, treatment was not associated with a reduction in the risk of seizures, although numbers were small (RR 0.95, 95% CI 0.59–1.51). Four trials reported radiological outcomes, and cysticidal treatment was associated with a lower risk of cyst persistence of scans taken within six months of start of treatment (RR 0.83, 95% CI 0.70–0.99). Subsidiary analysis assuming different outcomes in patients lost to follow‐up did not alter the findings of the main analysis.

conclusions There is insufficient evidence to determine whether cysticidal therapy is of any clinical benefit to patients with neurocysticercosis. The review does not exclude the possibility that more patients remain seizure‐free when treated with cysticidal drugs. Further testing through placebo‐controlled trials is required.
A new strategy for treating nets. Part 1: formulation and dosage
Authors: Miller J. E. , Buriyo A. , Karugila A. , Lines J. D.
Published: March 2003

The conventional dosages of pyrethroid insecticides on mosquito nets assume that nets will be retreated at 6–12 month intervals. However, dosage should be related to washing of nets; if nets are only washed once or twice a year, their dosage requirements will be different to those which are washed fortnightly. A ‘low‐dose, frequent‐wash’ retreatment system might be technically more appropriate and more affordable where nets are washed frequently, as they are in Dar es Salaam. Moreover, for use as a domestic insecticide, water‐based formulations of pyrethroid are preferable to the more commonly used emulsifiable concentrates (ECs). This paper reports laboratory evaluations of three formulations (ECs, Flowable, CS) of three pyrethroids (deltamethrin, lambdacyhalothrin, permethrin). Insecticidal activity was tested using serial bioassays at a range of dosages using Anopheles gambiae. The water‐based formulations were no less effective than the ECs, even at the lowest dosages. Nets treated with 3 mg/m2 and then repeatedly washed and retreated after each wash with either 3 mg/m2 or 1 mg/m2 were subjected to gas chromatography analysis. This showed that the amounts of pyrethroid in the nets accumulated rapidly over the first few wash‐retreatment cycles and then remained fairly stable over subsequent cycles. These nets gave consistently high bioassay mortalities throughout the experiment, while the mortality declined rapidly after several washes with the nets that were treated at 3 mg/m2 but not retreated. Experimental huts were used to compare the effectiveness of these 2 net retreatment regimes and nets which were not retreated. All nets caused high mortality rates amongst Anopheles females, but had negligible effects on culicines; either in killing them or in preventing feeding. Therefore use of a high ‘loading’ dose for initial treatment with lower ‘maintenance’ doses for retreatment may be preferable to ensure that net users promptly perceive the benefits of the insecticide against culicines.
Aggressive Kaposi's sarcoma in a 6‐month‐old African infant: case report and review of the literature
Authors: Manji K. P. , Amir H. , Maduhu I. Z.
Published: March 2003

Summary Kaposi's sarcoma (KS), known to exist in Africa for a century now, was rare in children and unknown in the newborn. With the onset of the HIV/AIDS epidemic, a more aggressive, disseminated type of KS (AKS) was recognized. Recently KS was diagnosed in a 6‐month‐old infant in Tanzania. Data support the notion that HHSV8 infectivity can be potentiated with HIV infection and thus produce multiple lesions in different anatomical sites early in life. Furthermore, the available evidence would suggest a nonsexual route of HHSV8 infection, possibly from mother to fetus.
Targeting of Wolbachia endobacteria in Litomosoides sigmodontis: comparison of tetracyclines with chloramphenicol, macrolides and ciprofloxacin
Authors: Hoerauf Achim , Volkmann Lars , Nissen‐Paehle Kerstin , Schmetz Christel , Autenrieth Ingo , Büttner Dietrich W. , Fleischer Bernhard
Published: March 2003

Summary Endobacteria of the genus Wolbachia in filarial nematodes are related to Rickettsiaceae and can be depleted by tetracycline antibiotics. This depletion blocks female worm development as well as early embryogenesis, in contrast to the currently used microfilaricidal ivermectin which blocks only the last stage of embryogenesis. Since targeting Wolbachia is becoming an area of research for the treatment of human filariases, it was investigated if antibiotics other than tetracyclines are able to deplete Wolbachia from filariae. BALB/c mice infected with the rodent filaria Litomosoides sigmodontis were treated with erythromycin, chloramphenicol or ciprofloxacin. All drugs were well resorbed and resulted in serum levels clearly above breakpoint levels for bacteria susceptible to the respective antibiotic. However, contrary to tetracycline, none of these antibiotics depleted Wolbachia or altered worm development and fertility, as evidenced by immunohistology, immunoelectron microscopy and semiquantitative PCR.
Heterogeneity in cyst morphology within isolates of Acanthamoeba from keratitis patients in Thailand
Authors: Jongwutiwes Somchai , Pariyakanok Lalida , Charoenkorn Malee , Yagita Kenji , Endo Takuro
Published: March 2003

Summary We isolated Acanthamoebae from the first two keratitis patients identified in Thailand in 1988 and 1990. The patients developed decreased vision, severe photophobia, severe eye pain and foreign body sensation after minor corneal trauma. The lesions included generalized superficial punctate keratitis, stromal corneal ulcer with keratic precipitate and uveitis in one case, and corneal ulcer with abscess in the other. Both cases were diagnosed by isolation of characteristic trophozoites and cysts of Acanthamoeba from corneal tissue by non‐nutrient agar culture method. Based on cyst morphology, A. castellanii and A. polyphaga were detected in one case, and A. castellanii and A. triangularis in the other. Restriction fragment length polymorphism analysis of mitochondrial DNA (mtDNA‐RFLP) revealed that each patient harboured a single parasite population. One shared mtDNA‐RFLP with an authentic strain of A. castellanii, and the other gave a new unique pattern. Thus species identification of Acanthamoeba based on cyst morphology per se can be arbitrary, and mtDNA‐RFLP may be more appropriate for accurate species/strain differentiation amongst morphologically heterogeneous populations of Acanthamoebae.
Protection from cholera by adding lime juice to food – results from community and laboratory studies in Guinea‐Bissau, West Africa
Authors: Rodrigues Amabélia , Sandström Anita , Cá Tomé , Steinsland Hans , Jensen Henrik , Aaby Peter
Published: March 2003

Summary Epidemiological studies have shown that food plays an important role in the transmission of Vibrio cholerae, and different foods have been incriminated in many epidemic outbreaks of cholera. Storing contaminated meals at ambient temperatures allows growth of V. cholerae. Some ingredients such as lime juice may inhibit the survival of V. cholerae in foods. During an epidemic caused by V. cholerae O1 in Guinea‐Bissau in 1996, a case control study was conducted in the capital Bissau, the main affected region with an attack rate of 7.4%. Cases were hospitalized patients and controls were matched for area, gender and age. Lime juice in the sauce eaten with rice gave a strong protective effect (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.17–0.56), and tomato sauce was also protective (OR = 0.36, 95% CI = 0.24–0.54). On the other hand, use of a bucket for storage of water in the house was associated with increased risk (OR = 4.4, CI = 2.21–8.74). Laboratory experiments to elucidate the inhibitory effect of different concentrations of lime juice on survival of V. cholerae in meals showed that V. cholerae thrives in rice with peanut sauce, but lime juice inhibited its growth. Since lime juice is a common ingredient of sauces, its use should be further encouraged to prevent foodborne transmission in the household during cholera outbreaks.
Occupational injuries with captive lance‐headed vipers (Bothrops moojeni): experience from a snake farm in Brazil
Authors: de A. Nishioka Sérgio , Silveira Paulo Vitor P. , Peixoto‐Filho Fernando M. , Jorge Miguel T. , Sandoz Adelheid
Published: March 2003

Summary We studied occupational injuries with captive lance‐headed vipers (Bothrops moojeni) that occurred in a snake farm in south‐eastern Brazil from February 1981 to May 1999. The risk of injury, taking into account 13 cases of snake‐associated injuries (12 of them snake bites) was 2.73 per 10000 person‐days of work, and 3.51 per 100000 venom extractions. Thirteen cases of injury occurred in seven workers, whereas 18 workers were never injured, suggesting that some individuals have a higher risk of injury than others perhaps due to lack of concentration or overconfidence. Eight episodes of occupational injuries occurring in four technicians, including a case of eye injury due to splashed venom during extraction, are reported. Assessment of whether envenoming occurred was facilitated by knowledge of the snake species and size, history of recent venom extraction and snake feeding, and examination of snake venom glands. Hypersensitivity reactions (anaphylaxis and serum sickness) to antivenom are a risk particularly to those workers who were bitten more than once and medicated previously. Antivenom therefore should not be administered to these individuals unless there is clear evidence that envenoming occurred or is likely to have occurred. Hypersensitivity to the venom is also a health concern for workers from snake farms.
Inhibitory effects of 9‐anilinoacridines on Plasmodium falciparum gametocytes
Authors: Chavalitshewinkoon‐Petmitr P. , Pongvilairat G. , Ralph R. K. , Denny W. A. , Wilairat P.
Published: March 2003

Summary Two gametocyte‐producing isolates of Plasmodium falciparum, KT1 and KT3, were cultivated in vitro. On day 11 of cultivation, pure gametocytes containing stage II, III and IV were used to test the gametocytocidal activity of 9‐anilinoacridines that had previously demonstrated their activity against the asexual stage of the parasite. After drug exposure for 48 h, gametocytes were maintained without drugs for another 2 days before thin films were prepared for parasite counting. Gametocytocidal activities of 13 analogs of 9‐anilinoacridine were observed with 50% inhibitory concentrations in the range of 0.6 μm to > 100 μm. The most active compound was 1′‐CH2NMe2‐9‐anilinoacridine. Anilinoacridine derivatives with 3,6‐diamino substitution had reduced gametocytocidal activity in contrast to their enhancing effect against the asexual forms. Morphological abnormalities of gametocytes were observed following drug exposure.
Cultural and biomedical meanings of the complaint of leukorrhea in South Asian women
Authors: Trollope‐Kumar Karen
Published: March 2003

Among women in South Asia, the complaint of vaginal discharge (often called leukorrhea) is extraordinarily common. From a biomedical perspective, this symptom suggests that reproductive tract infection (RTI) is prevalent in the subcontinent; however, several recent studies provide evidence that the prevalence of RTI is relatively low. Women who do not have RTI frequently report the symptom of vaginal discharge. An anthropological perspective on the cultural meanings of leukorrhea can shed light on this puzzling phenomenon. According to Ayurvedic concepts of health and illness, genital secretions are considered a highly purified form of dhatu, or bodily substance, and loss of this precious substance is thought to result in progressive weakness or even death. Many South Asian women who complain of vaginal discharge also report a variety of somatic symptoms such as dizziness, backache and weakness. The link between unexplained gynaecological symptoms and mental health concerns has been explored by both psychiatrists and anthropologists in South Asia. Leukorrhea may represent a culturally shaped ‘bodily idiom of distress’, in which concerns about loss of genital secretions reflect wider issues of social stress. Problems may arise when a symptom with deep cultural meaning is interpreted in a purely biomedical framework. In the syndromic approach to the treatment of sexually transmitted infections (STIs), health workers are trained to treat women presumptively based on history and a risk assessment, but without clinical or laboratory confirmation of infection. A recent evaluation of this approach demonstrates that many women who complain of vaginal discharge do not have RTI, and are inappropriately treated with antibiotics. It seems likely that women are over‐reporting vaginal discharge because of its deep cultural meanings, meanings that need to be understood within an anthropological rather than biomedical framework.
Therapeutic efficacy of sulphadoxine/pyrimethamine and susceptibility in vitro of P. falciparum isolates to sulphadoxine‐pyremethamine and other antimalarial drugs in Malawian children
Authors: Takechi Miho , Matsuo Mikiko , Ziba Charles , Macheso Allan , Butao Doris , Zungu Innocent L. , Chakanika Isaach , Bustos Ma. Dorina G.
Published: March 2003

Since 1993 sulphadoxine/pyrimethamine (SP) has been used as the first‐line drug for uncomplicated Plasmodium falciparum malaria in Malawi. To investigate the current efficacy of SP and other antimalarial drug resistance, we studied in vivo and in vitro responses to SP, chloroquine (CQ), mefloquine (MF), quinine (QN), and halofantrine (HF) in Salima, central Malawi. In a follow‐up of 14 days, nine (13.8%) of 65 children under five showed RII/RIII parasitological resistance, and in in vitro microtests 18 (62.1%) of 29 isolates showed <90% inhibition of schizont maturation at pyrimethamine 75 nmol/l blood medium mixture, indicating resistance. The discrepancy between in vivo and in vitro results might be partially explained by acquired immunity in this holoendemic area. In vitro one (3.4%) of 29 isolates failed schizont inhibition at 1.6 μmol/l blood of CQ, indicating resistance. Compared with an in vitro study conducted in 1988 in another region of Malawi using the same cut‐off point, the proportion of resistant isolates had decreased significantly (P < 0.01). Although 31% of isolates were borderline, showing schizont maturation at 0.8 μmol/l blood but no schizonts at 1.6 μmol/l in our study, the results suggest possible recovery of CQ sensitivity after long‐term absence of drug pressure. Resistance remains a major problem in malaria control. Monitoring resistance patterns in vitro provides early warning signs of impending loss of therapeutic efficacy of the standard treatment, and may detect changing patterns in alternative drug resistance.
Increased trypanolytic activity in sera of sleeping sickness patients after chemotherapy
Authors: Fischer Antje , Simarro Pere P. , Franco José R. , Becher Heiko , Steverding Dietmar
Published: March 2003

We tested sera from patients previously treated for human African trypanosomiasis, from patients infected with trypanosomes, and from individuals never diagnosed with African trypanosomiasis living in the Trypanosoma brucei gambiense sleeping sickness focus of Mbini in Equatorial Guinea for their trypanolytic activity against bloodstream forms of T. b. rhodesiense expressing a metacyclic and bloodstream variant surface glycoprotein (VSG). Nearly 80% of the sera from treated patients showed high trypanolytic activity against trypanosomes expressing a metacyclic VSG. The trypanolytic activity of part of these sera was mediated by IgM while that of the other part was antibody‐independent. On the other hand, only 40% of the sera exhibited high trypanolytic activity against trypanosomes expressing a bloodstream VSG which also was almost completely abolished by heat‐inactivation. In contrast, most sera from infected and negative individuals displayed only low to moderate trypanolytic activity against either trypanosomes expressing a metacyclic or a bloodstream VSG. These results suggest that trypanolytic activity of sera increases after African sleeping sickness and is directed against trypanosomes expressing metacyclic VSG.
How many patients with a sexually transmitted infection are cured by health services? A study from Mwanza region, Tanzania
Authors: Buvé Anne , Changalucha John , Mayaud Philippe , Gavyole Awene , Mugeye Kokungoza , Todd James , Clayton Tim , Mosha Frank , Grosskurth Heiner , Mabey David , Laga Marie , Van Lerberghe Wim , Hayes Richard J.
Published: March 2003

OBJECTIVES To estimate the proportion of symptomatic patients with a bacterial sexually transmitted infection (STI) cured by primary health care services in Mwanza Region, Tanzania, and to compare the cure rate achieved by health centres before and after the introduction of improved STI treatment services.

METHODS A model was used that describes the different hurdles patients with an STI take before they can be considered cured by the health services. The values for the input parameters for the model were taken from different studies. Data from an intervention trial as well as from a population‐based study on male urethritis were used to estimate the proportion of symptomatic patients with an STI who seek care from a health centre. An observational study in four health centres where improved STI treatment services had been introduced provided estimates of the proportions of patients with an STI correctly diagnosed and treated. Patients who returned to the health centres after 1 week were interviewed about compliance. An estimate of the efficacy of treatments prescribed for STIs in health centres before the introduction of improved STI services was obtained from a study on prescription patterns for genital discharge syndrome (GDS) and genital ulcer disease (GUD).

RESULTS It was estimated that in the catchment area of health centres offering improved STI services, 51–72% of patients with STI symptoms sought care from those health centres. About 76–85% of cases were correctly diagnosed, and of these 69–80% received efficacious treatment. Compliance with full treatment was estimated at 84%. The estimated overall cure rate achieved by the health centres offering improved STI services ranged between 23 and 41%. The proportion of symptomatic STI patients who attended a health centre before improved STI services were introduced was estimated at 39%. The estimated efficacy of the treatments prescribed was 28%. The overall cure rate achieved by these health centres was less than 10%.

CONCLUSIONS When assessing the performance of STI case detection and management all steps have to be taken into account that are taken by patients with an STI before they can be considered cured by the health services. The intervention to improve STI services in Mwanza Region has resulted in an improvement of the cure rate of STIs achieved by primary health care centres.
Detection of antigen B of Cysticercus cellulosae in cerebrospinal fluid for the diagnosis of human neurocysticercosis
Authors: Das Sanchita , Mahajan R. C. , Ganguly N. K. , Sawhney I. M. S. , Dhawan Veena , Malla Nancy
Published: March 2003

Neurocysticercosis (NCC) is a major cause of morbidity and mortality in developed and developing countries. The diagnosis of this disease remains a problem. We report the detection of specific antigenic fraction (antigen B) ofCysticercus cellulosae by enzyme‐linked immunosorbent assay (ELISA) in various fractions of cerebrospinal fluid (CSF) obtained by high performance liquid chromatographic (HPLC) separation, for the diagnosis of human NCC. Forty patients attending or admitted to Nehru Hospital, Chandigarh were included in the study: 10 with suspected NCC, 20 with other neurological diseases and 10 undergoing surgery under spinal anaesthesia for non‐neurological conditions, who served as controls. CSF samples collected from all patients and controls were subjected to chromatographic separation on an HPLC system. Antigen B (AgB) was detected in separated fractions by an ELISA test and compared with the detection of antibody response in CSF samples by indirect haemagglutination (IHA) technique. Antigen B was detected in 9 out of 10 patients with suspected NCC based on clinical symptoms and radioimaging reports, but in none of the control subjects. However, antigen B was also detected in 9 out of 20 patients with other neurological disorders, mostly tubercular meningitis. Antibody response by IHA was found positive in only 2 of 10 cases clinically suspected of NCC. In conclusion, antigen B detection in CSF samples may be a useful adjunct to clinical suspicion and radiological reports for the diagnosis of NCC as there is no gold standard criteria to confirm this disease. However, the test needs to be evaluated on more patients in countries where tuberculosis and cysticercosis are endemic due to the high cross reactivity with samples from tubercular meningitis patients.
Supply‐level measures to increase uptake of family planning services in Niger: the effectiveness of improving responsiveness
Authors: Bossyns P. , Miyé H. , VLerberghe W.
Published: March 2003

OBJECTIVE To show that low‐cost attitudinal, structural and procedural changes aimed at improving responsiveness to patients have the potential to increase uptake of family planning (FP) even among populations considered reluctant to do so by health personnel.

METHODS Intervention study with before–after comparison of contraceptive acceptance, couple‐years of protection (CYP) and an `index of contraceptive uptake' (IUC) in rural health centres in Niger. The intervention consists of a package of instructions to actively propose family planning, integrated within curative and under‐fives consultations, coupled with measures to increase the health centres' responsiveness to their clients.

RESULTS Implementation of the intervention package was followed by marked increases in family planning uptake.

CONCLUSION Health services in Niger present an untapped potential for improving family planning through low‐cost supply‐side measures.
Comparison of nasopharyngeal aspirate and nasal swab specimens for detection of respiratory syncytial virus in different settings in a developing country
Authors: Stensballe L. G. , Trautner S. , Kofoed P.‐E. , Nante E. , Hedegaard K. , Jensen I. P. , Aaby P.
Published: March 2003

OBJECTIVE To compare detection of respiratory syncytial virus (RSV) for diagnostic purposes using nasopharyngeal aspirate (NPA) and nasal swabs (NS) in different clinical settings in a community study in Guinea‐Bissau.

METHOD During 1996–98 paired specimens were obtained from 635 children under 5 years of age (median: 274 days; interquartile range: 144–453 days) with symptoms of lower respiratory infections (LRI). The specimens were analysed by an enzyme‐linked immunosorbent assay for RSV antigen in Guinea‐Bissau and re‐analysed in Denmark using the same assay. The gold standard for RSV antigen detection was defined as any test being positive.

RESULTS RSV antigen was detected in 84 (13%) children, the prevalence being 19% (41/219) among infants aged < 6 months, 12% (22/184) in infants aged 6–11 months, and 9% (21/230) in older children. Sensitivity of antigen detection was higher in NPA (92% in analyses in Guinea‐Bissau and 98% in Denmark) than in NS (63% in analyses in Guinea‐Bissau, 71% in Denmark). Specificity of RSV antigen detection was equally high in NPA and NS (99–100%). Time since onset of symptoms was significantly shorter in RSV antigen positive than negative samples. Sensitivity did not depend on clinical setting or age of the child.

CONCLUSION Using NS samples was associated with a 27–31% reduction in sensitivity compared with NPA specimens. As NPAs are costly and considered a nuisance by the population, it might be cost‐effective in larger epidemiological studies to lose 25–30% in sensitivity but be able to collect samples from a much larger population.
IgM quantification in the cerebrospinal fluid of sleeping sickness patients by a latex card agglutination test
Authors: Lejon V. , Legros D. , Richer M. , Ruiz J. A. , Jamonneau V. , Truc P. , Doua F. , Djé N. , N'Siesi F. X. , Bisser S. , Magnus E. , Wouters I. , Konings J. , Vervoort T. , Sultan F. , Büscher P.
Published: March 2003

An increased IgM concentration in cerebrospinal fluid (CSF), occurring as a consequence of massive intrathecal IgM synthesis, is a marker of interest for diagnosis of the meningo‐encephalitic stage in human African trypanosomiasis. However, in current practice, IgM in CSF is not determined because of the lack of a simple and robust test that is applicable in African rural regions where the disease prevails. We describe the development of a sensitive semiquantitative card agglutination test, LATEX/IgM, for IgM quantification in CSF. The test is simple and fast and the lyophilized reagent remains stable even at 45 °C. CSF end‐titres obtained with LATEX/IgM parallel the IgM concentrations determined by nephelometry and enzyme‐linked immunosorbent assay. Detection of intrathecal IgM synthesis is the most sensitive marker for CNS involvement in sleeping sickness. At a cut‐off value of ≥ 8, the sensitivity and specificity of LATEX/IgM for intrathecal IgM synthesis are 89.4 and 92.7%. As a consequence, patients with LATEX/IgM end‐titres ≥ 8 are likely to have intrathecal IgM synthesis, thus central nervous system involvement and therefore should be treated accordingly. Further studies should concentrate on the relationship between the LATEX/IgM end‐titres, presence of intrathecal IgM synthesis and occurrence of treatment failures in patients treated with pentamidine.
In vivo drug resistance of falciparum malaria in mining areas of Venezuela
Authors: Aché A. , Escorihuela M. , Vivas E. , Páez E. , Miranda L. , Matos A. , Pérez W. , Díaz O. , Izarra E.
Published: March 2003

The Lot Quality Assurance Double‐Sampling Plan (LQADSP) technique was used in three areas, Maripa, Kilómetro 88 and Ikabaru, to assess the efficacy of antimalarials used routinely by the VenezuelanMalaria Programme. The use of chloroquine (25 mg/kg), chloroquine (40 mg/kg) and the combination of sulfadoxine (500 mg) and pyrimethamine (25 mg) registered treatment failures above the threshold level of 25% in Maripa and Kilómertro 88. In Ikabaru the use of chloroquine (40 mg/kg) did not surpass that quality level and could possibly be less than 10%. Quinine (30 mg/kg) was totally effective in curing patients in all three areas. The use of this technique seems adequate for rapid field evaluations and in this case for providing appropriate information to assist this health programme. However, whilst being an ideal technique for surveying areas in which considerable variation may exist among lots and particularly for Plasmodium falciparum infections in these areas, repeated surveys should be carried out in the same areas over time to monitor changes in the susceptibility of this parasite to first‐, second‐ and third‐line drugs. In that way, national drug policies can be modified adequately.
Myocardial damage in falciparum malaria detectable by cardiac troponin T is rare
Authors: Günther A. , Grobusch M. P. , Slevogt H. , Abel W. , Burchard G. D.
Published: March 2003

objectives  To estimate the prevalence of myocardial damage in falciparum malaria by serum concentration of cardiac troponin T.

methods  Retrospective study of stored sera and patient files; assessment of acute myocardial damage by serum concentration or activity of cardiac troponin T, creatine kinase, creatine kinase MB and myoglobin and by routine electrocardiography.

results  A total of 161 patients with falciparum malaria were included in the study; troponin T was elevated in one case (0.6%), no CK‐MB elevations were found, myoglobin was elevated in 10 of 161 patients (6.2%), all of whom were elderly and had concomitant elevated serum concentration levels of cystatin C; ECG abnormalities were seen in 23 patients.

conclusion  Assessed by troponin T, myocardial damage in falciparum malaria is rare.
Prescribing practices of rural primary health care physicians in Uzbekistan
Authors: Pavin Melinda , Nurgozhin Talgat , Hafner Grace , Yusufy Farruh , Laing Richard
Published: March 2003

Doctors prescribe medications for therapeutic indications and to meet patient expectations. Understanding the pattern of prescribing is a necessary precursor for any intervention and for improving prescribing practices. Using the WHO standard methodology, we investigated the prescribing practices of doctors in rural primary health care (PHC) clinics in the Ferghana region of Uzbekistan. Doctors in these clinics may have over‐prescribed, prescribing 2.9 drugs per patient per encounter. Fifty‐seven per cent of these were for injectable drugs, and 57% for antibiotics. Most prescriptions were for name brand (62%) rather than generic drugs.
Cutaneous soft tissue tumours in dogs: classification, differentiation, and histogenesis
Authors: WILLIAMSON† MARK McCOLL , MIDDLETON DEBORAH JOAN
Published: March 2003

Particular difficulty is regularly encountered in differentiating on routine morphological grounds between soft tissue tumours in dogs, especially fibrosarcoma, including myxosarcoma; haemangiopericytoma; and schwannoma. In this study we report the findings of the immunohistochemical examination of 74 canine tumours classified as soft tissue tumours by routine light microscopy. As a consequence, we propose that the morphologic diagnosis of cutaneous fibrosarcoma, haemangiopericytoma or schwannoma carries little precision in respect of tumour cell differentiation, and would support use of the term ‘spindle cell tumour of canine soft tissue’ to encompass this group of lesions.
Mast cell distribution, epidermal thickness and hair follicle density in normal canine skin: possible explanations for the predilection sites of atopic dermatitis?
Authors: Auxilia S.T. , Hill P.B.
Published: March 2003

Mast cell counts, epidermal thickness and hair follicle density were quantified in toluidine blue stained sections of normal skin from 20 different body regions in 10 dogs and compared to the predilection sites of canine atopic dermatitis. Mast cell distribution varied significantly from site to site (P < 0.0001) and counts in the superficial dermis were significantly higher than the deeper dermis (P < 0.05). Mast cell counts were highest in the medial and lateral pinna (mean 10.4–11.3 per high power field, HPF) and in the ventral interdigital skin of the hind and fore feet (mean 9.2–9.5 per HPF). Counts in these regions were at least 150% higher than all the other sites (means ranging between 2.9 and 6.0 per HPF). Variations in mast cell counts, epidermal thickness or hair follicle density did not adequately explain the predilection sites of canine atopic dermatitis. However, the results provide some evidence that cutaneous mast cell distribution may be involved in the frequent occurrence of ear and foot pruritus in this disease.
Intradermal skin testing in Hispaniolan parrots (Amazona ventralis)
Authors: Colombini S. , Foil C.S. , Hosgood G. , Tully Jr T.N.
Published: March 2003

The purpose of this study was to develop and standardize a protocol for intradermal skin testing in birds. Forty clinically normal Hispaniolan Amazon parrots were anaesthetized and tested by intradermal injection with 0.02 mL of phosphate‐buffered saline, histamine phosphate, compound 48/80, codeine phosphate, deionized water, antiavian IgG and rabbit serum. Injection sites were evaluated at 5, 10 and 15 min, 4–6, 24 and 48 h following injection using callipers to measure the diameter of the wheals. A second intradermal skin test was repeated in 20 birds with 0.03 mL of saline, compound 48/80 and codeine phosphate. This study provides the basis for an appropriate protocol for intradermal skin testing in parrots, including recommended site (proventer region), volume of injection (0.02 mL), negative control (saline), positive control (codeine phosphate 1 : 100 000 w/v) and optimum reading time (5 min). Further study to establish appropriate dosages for test antigen will be required.
Sulphido‐leukotriene production from peripheral leukocytes and skin in clinically normal dogs and house dust mite positive atopic dogs
Authors: Marsella R. , Nicklin C.F.
Published: March 2003

Pathogenesis of canine atopy has not been completely elucidated. In humans, sulphido‐leukotrienes (s‐LT) play a role in atopy, and increased production of s‐LT occurs in the skin and peripheral leukocytes after allergen challenge. The study population included 16 clinically normal and 13 atopic dogs. All atopic dogs had in common a positive reaction (4+) to the intradermal injection of house dust mite (allergen of reference). Blood samples and skin biopsies were collected. Sulphido‐LT synthesis by peripheral leukocytes after stimulation was measured, and no statistically significant difference was found between clinically normal and atopic dogs. Sulphido‐LT concentrations in skin samples from stimulated and unstimulated sites were measured, and no statistically significant difference was detected between clinically normal and atopic dogs or between lesional and nonlesional skin within the atopic group. Clinical signs of atopic dogs were graded by owners and no correlation was found between their severity and cutaneous concentrations of s‐LT. In this study there was no increase in s‐LT synthesis in atopic dogs.
Evaluation of the dermatophyte test medium RapidVet‐D
Authors: Guillot J. , Latié L. , Deville M. , Halos L. , Chermette R.
Published: March 2003

The performance of the dermatophyte test medium (DTM) RapidVet‐D was assessed using hair samples collected from experimentally infected guinea pigs. Three dermatophyte species were included in the study: Microsporum canis, Trichophyton mentagrophytes and Trichophyton equinum. DTM substrates were inoculated with infected hairs and scales, incubated at 18, 21, 24, 27 or 37 °C and examined daily for 15 days. The rapidity of colour change was clearly related to the incubation temperature and to the number of infected hairs deposited on the reactive substrates. With the optimum incubation temperature 27 °C, a systematic colour change could be observed only a few days post‐inoculation: 3 days with M. canis infected hairs, 4 days with T. equinum and 5 days with T. mentagrophytes.
Canine atopic dermatitis: a retrospective study of 169 cases examined at the University of California, Davis, 1992–1998. Part II. Response to hyposensitization
Authors: Zur Gila , White Stephen D. , Ihrke Peter J. , Kass Philip H. , Toebe Nina
Published: March 2003

AbstractOne hundred and sixty‐nine dogs were diagnosed with atopic dermatitis, and treated with hyposensitization for at least 1 year based on the results of either intradermal skin tests (IDST) or enzyme‐linked immunosorbant serum assays (ELISA). Excellent (i.e. hyposensitization alone controlled clinical signs), good (> 50% improvement), moderate (< 50% improvement) and no (clinical signs were unchanged) responses were seen in 19.5, 32.5, 20.1 and 27.8%, respectively. Age of onset, age when treatment was initiated or the duration of clinical signs had no influence on response to hyposensitization. Dogs having concurrent flea allergy dermatitis were statistically more likely to respond better than dogs with concurrent food allergies. Although not statistically significant, there were trends for Golden Retriever and male dogs to respond better than other breeds and female dogs, respectively. Dogs having more than 21 positive reactions in allergy tests and treated with more than 21 allergens had lower response scores, and a longer time course before achieving beneficial response. Lower response scores were seen in dogs having positive reactions to cultivated plants, grasses, trees or insects. There was no difference in response to hyposensitization whether based on IDST or ELISA results.
Evaluation of the clinical and serum IgE responses to oral challenge with cornstarch, corn, soy and a soy hydrolysate diet in dogs with known food allergy
Authors: Jackson H. A. , Hammerberg B. , Jackson M. W. , Coblentz L.
Published: March 2003

Hydrolysate diets have been advocated in the management of the food‐allergic dog, but little information is available on their performance in dogs with known allergies. Fourteen dogs with known allergies to soy and corn were maintained on a limited antigen diet exclusively for 80 days (Hills d/d Rice and Duck, Hills Pet Nutrition, Topeka, KS). This diet was continued during oral challenge with 200 mg kg−1of cornstarch, corn and soy respectively on two occasions each at 24‐h intervals. There was a minimum period of 15 days between each challenge. A diet containing hydrolysed soy protein and cornstarch (CNM HA, Ralston Purina Co., St. Louis, MO) was then introduced. Before and after each oral challenge the dogs were examined and a clinical score was determined; serum was also collected for measurement of allergen‐specific and total IgE concentrations. Statistical analysis employed the use of a longitudinal mixed model and was performed using SAS software (Cary, NC). Significant increases in clinical scores were seen after oral challenge with cornstarch, corn and soy (P = 0.04, 0.002, 0.01 respectively) but not with HA (P = 0.5), although three dogs did develop clinical signs after this latter challenge. Allergen challenge did not affect total serum IgE concentrations. Although increases in soy‐ and corn‐specific serum IgE were measured in individual dogs post‐challenge they were not statistically significant, and could not be used to predict clinical hypersensitivity.

 This study was funded by a grant from Ralston Purina Co., St. Louis, MO.
Comparative sequence analysis of three canine type 2 keratins
Authors: Credille K. M. , Murphy K. E. , Venta P. J. , Page L. , Harville M. A. , Tucker K. A. , Miller A. B. , Mruthyunjaya A. , Barnhart K. A. , Dunstan R. W.
Published: March 2003

In order to better define the cornification process in dogs and to understand how it is similar or different from cornification in other mammals, we are sequencing the major molecules of cornification in the dog. In this report, we describe the complete genomic sequence of three superficial type 2 canine keratins: K1, K2e and K2p. Oligonucleotide primers for PCR were designed from homologous regions of previously reported human or murine cDNA sequences of the genes of interest. DNA sequencing and evaluation with blast confirmed that the primers amplified the respective canine genes. These primers were then used to screen a subset of a canine genomic library known to contain basic keratin genes. Selected clones were sequenced to obtain the complete DNA sequence. K1, K2e and K2p each had nine exons and eight introns characteristic of the type 2 keratins that code for proteins with variable glycine‐rich head and tail regions and a central α‐helical rod domain. K2p encoded a protein of 659 amino acids, larger than both K1 and K2e (620 and 634 amino acids, respectively). Amino acid sequence homology with humans was 81, 74 and 81% for K1, K2e and K2p, respectively, with homology greatest at the central rod region and decreasing dramatically at the head and tail. Comparisons of the amino acid sequences of these keratins within the canine species defined K2e and K2p as having a slightly higher degree of similarity. In contrast, in humans K2e has greater sequence homology with K1.

 This study was funded in part by the Morris Animal Foundation.
Cutaneous lesions in dogs with Dirofilaria (Nochtiella) repens infestation and concurrent tick‐borne transmitted diseases
Authors: Tarello Walter
Published: March 2003

Abstract  A pruritic dermatitis characterized by the presence of erythema, papules, focal or multifocal alopecia, crusting and nodules was seen in 28 dogs with Dirofilaria repens microfilariae infestation in an endemic area in north‐west Italy. Previous unsuccessful nonspecific antipruritic treatments, flea control and restricted diet were recorded in 53.6% of the patients. Both the Knott and the antigen tests were negative for Dirofilaria immitis and Acanthocheilonema reconditum. Concurrent babesiosis and/or canine granulocytic ehrlichiosis was also diagnosed in many affected dogs. Preliminary treatment of the concurrent diseases was followed by specific filaricide treatment. The cutaneous lesions, although slightly improved with the initial treatment, resolved completely with macro‐ and microfilaricide treatment. Although D. repens may be an opportunistic pathogen, this parasite should not be considered as harmless as previously thought and its potential pathogenic role in causing cutaneous lesions in dogs should be considered. Furthermore, it has a zoonotic importance as human cases have been reported worldwide.
Detection of papillomavirus‐DNA in mesenchymal tumour cells and not in the hyperplastic epithelium of feline sarcoids
Authors: Teifke Jens P. , Kidney Beverly A. , Löhr Christiane V. , Yager Julie A.
Published: March 2003

Abstract We examined 12 formalin‐fixed paraffin‐embedded feline skin tumours which had the histopathological features of fibropapillomas for the presence of papillomavirus (PV) DNA using touchdown polymerase chain recation (PCR), DNA sequencing and nonradioactive in situ hybridization. Nine of the tumours contained a 102‐bp PCR product demonstrated using consensus PV primers that amplify a portion of the L1 gene. The nucleotide sequences are closely related, but not identical to that of ovine PV type 2, rabbit oral PV and reindeer PV. The deduced amino acid sequences had strong homologies with the major capsid protein L1 of deer PV, bovine papillomavirus (BPV) 1 and BPV 2, and European elk PV. Although PV antigens were not detected in any of the tumours by immunohistochemistry, PV DNA was demonstrated in individual mesenchymal cells or cell nests of 4/12 tumours by in situ hybridization. A nonproductive infection of mesenchymal fibroblast‐like tumour cells with a papillomavirus would explain the lack of PV antigen expression and the absence of PV DNA in the hyperplastic epithelium. Because these tumours and their pathogenesis are similar to equine sarcoids, we suggest that they should be reclassified as ‘feline sarcoids’ instead of fibropapillomas.
Paraquat‐resistant biotypes of Hordeum glaucum from zero‐tillage wheat
Authors: ALIZADEH  , PRESTON  , POWLES
Published: March 2003

There has been a significant increase in the area seeded to minimum‐ and zero‐tilled crops worldwide over the past two decades. These cropping systems rely primarily on the non‐selective herbicides glyphosate or paraquat/diquat to control weeds before seeding the crop. Both glyphosate and paraquat/diquat are regarded as low‐risk herbicides in the ability of target weeds to develop resistance to them. Following 10–15 years of once annual applications of paraquat and diquat for weed control in zero‐tilled cereals, failure of these herbicides to control Hordeum glaucum Steud. in two separate fields occurred. Dose–response experiments demonstrated high‐level resistance to paraquat and diquat in both populations; however, the resistant biotypes are susceptible to other herbicides. This is the first report, worldwide, of paraquat resistance following the use of this herbicide in zero‐tillage cropping systems and is therefore a harbinger of future problems in minimum‐tillage systems when there is exclusive reliance on a contact herbicide for weed control.