Necrotizing haemorrhagic colitis caused by resistant shigella flexneri. Report of a case

A case of fatal infection with shigella flexneri is reported. The 19-year-old male patient who presented with fulminating haemorrhagic colitis died nine days after the onset of symptoms. The infecting strain of shigella flexneri was resistant to multiple antimicrobial agents, including amoxycillin, co-trimoxazole and chloramphenicol (AU)

Trichuriasis: the clinical picture - abstract

Human trichuriasis is a disease of clinical importance. This study reaffirms its status as such, highlighting the spectrum of manifestations presenting in individuals with Trichuris dysentery syndrome. Individuals with and without the syndrome, having in common a history of bloody, mucoid diarrhoea, were compared. Thirty-one patients (age range 2-10 years) were admitted to the Tropical Metabolism Research Unit. Anthropometry was preceded by full history and physical examination. The cause of dysenteric symptoms in each case was determined by stool analyses and colonscopy. Twenty-six of the patients had colitis secondary to massive Trichuris trichuriura infection. Worm burden was assessed by antihelminthic expulsion following colonoscopy. We present data (Table) from which an index of the diagnostic likelihood of Trichuris dysentery syndrome can be derived. When one or more of the symptoms are present in a child with over 3 months' history of diarrhoea, a diagnosis of the disease, confirmable by stool examination, and suitable antihelminthic treatment are indicated (AU)

Tumour necrosis factor/cachectin may mediate growth suppression in children with Trichuris colitis - abstract

As we have argued before (Cooper et al, CCMRC, 1989) the association between chronic Trichuris colitis and linear growth retardation is specific: the variability in the degree of wasting, the pattern of post-treatment catch-up growth in which weight-for-height often remains constant or actually falls and the accelerated height velocity without a change in environment, all point to the existence of some endogenous growth-suppressing factor. A candidate for this factor is the cytokine and mediator of systemic inflammation tumour necrosis factor alpha (TNF), also known as cachectin. Thirteen children with the Trichuris dysentery syndrome had a mean height-for-age of -2.3 (SD 1.34) NCHS Z-scores. Plasma TNF was assayed by ELISA. 9/13 were positive (>20 pg ml-1). Values ranged from 0 to 99 pg/ml,-1, similar to those reported in acute but uncomplicated attacks of malaria. Controls: 10 paediatric surgery follow-up patients (height Z-score + 0.1) had plasma TNF < 20 pg ml-1; in 9 stunted but parasite-free children from the community (study of Grantham-Mcgregor) TNF was undetectable. Culture of colonic mucosal mononuclear cells from four of the Trichuris colitis children yielded higher concentrations of TNF in the supernatants than those of four non-Trichuris mild, non-specific colitis patients. This suggests that the source of the increased plasma TNF may be the lamina propria macrophages, increased in number in trichuriasis as we have already described (MacDonald et al, CCMRC. 1989) (AU)

Epidemiological aspects of Trichuris and trichuriasis in Caribbean communities

The review argues for a reappraisal of the health significance of the human whipworm, Trichuris trichuria. Infections with this geohelminth are at least as prevalent as Ascaris lumbricoides in many localities, and are associated with significant morbidity. Infection may result in severe trichuriasis syndrome or, more frequently, in a chronic colitis associated with growth stunting. Under-reporting of the chronic manifestations of disease has resulted in a gross under-estimation of the health impact of trichuriasis. Furthermore, estimation of the population dynamical parameters of T. trichiura transmission suggests that whipworm infections are intrinsically more resistant to control than those of other common geohelminths. A major determinant of the transmission dynamics and morbidity characteristics of this helminthiasis is the aggregation of worm burdens in certain predisposed individuals and age groups. It is suggested that improved understanding of the factors generating this distribution of infection intensity is a pre-requisite for effective control of both infection and morbidity.(AU)

Rectal lymphogranuloma venereum in Jamaica

Lymphogranuloma venereum is a major public health problem in Jamaica. With improvement in the standard of living, better housing, better general education, a healthier sex education, and a more active programme of venereal disease control, the incidence of rectal lymphogranuloma should diminish. The early diagnosis and treatment of the proctocolitis by drugs is effective and should reduce the incidence of stricture. Major operations should be reserved for cases in which the more conservative methods of treatment are unlikely to succeed or have failed. At present, in Jamaica, operation necessitating a permanent colostomy should be considered more carefully than in this country. Unfortunately our attempts to eradicate the disease by operation and leave the patient with a functioning anus have been attended with only very limited success. Some of the failures may be attributed to insufficent experience with these operations, but involvement of the sphincter in the dense fibrotic process is probably responsible for the majority. In these fibrotic sphincters functional control is impossible. In a small number of cases intra-sphincter proctectomy in one stage by the method described by Dimitrui and Gregoresco (1933) has given promising results where the sphincter is free. The disease appears to be self-limiting. There has been no evidence of reactivation after removal of the affected gut even though this is rarely a complete en bloc excision or indeed even after colostomy only. Our follow up has been short. I have deliberately avoided the term "cure" because rarely has the compliment fixation reaction been reversed to negative. The significance of a persistently positive serological reaction in the absence of clinical evidence of disease is yet to be assessed. We have come a long way since John Hunter described the bubo 175 years ago and Frei placed the study of the disease on a firm aetiological basis 140 years later. In the past 35 years our knowledge of the lympho-granuloma venereum virus has increased, but the problem of treatment of rectal stricture, the most disabling complication of the disease, awaits solution. Morte (1933) stated: "The study of the stricture of the rectum is as fascinating as the treatment is discouraging. " In 1960 we can say: "Treatment of rectal stricture is often disappointing, but the results are encouraging" (Summary)

Review of the relationship of water supplies to the health of the inhabitants of British Guiana (abstract only)

Owing to the ribbon-like housing developments in the inhabited coastlands and riverain areas it is not, at present, with the exception of Georgetown, economically feasible to deliver piped water to houses. Because of the long distances which must be travelled in order to transport water for drinking and domestic purposes and because the high iron content of many artesian wells which renders such water impalatable, recourse is often had to water from doubtful but more accessible sources. Many householders use the absolute minimum amount requisite for survival. Thirty-two per cent of the artesian wells have also been found to be contaminated. These factors operate to make gastro-enteritis and colitis among the leading causes of death in British Guiana and account for the comparitively high incidence of typhoid fever (AU)