[Blister beetle dermatitis: Dermatitis linearis]. / Blasenkäfer-Dermatitis: Dermatitis linearis.

Several families of beetles cause toxic reactions on exposed human skin. Cantharidin provokes nearly asymptomatic vesicles and blisters, while pederin leads to itching and burning erythema with vesicles and small pustules, later crusts. Paederi are attracted by fluorescent light especially after rain showers and cause outbreaks in regions with moderate climate. Clinical findings and patient history lead to the diagnosis: dermatitis linearis.

[Epidemiology and prevention of leishmaniasis in northern Afghanistan]. / Epidemiologie und Prophylaxe der Leishmaniasis in Nordafghanistan.

BACKGROUND: Leishmaniasis is estimated to cause the ninth largest disease burden among infectious diseases worldwide and it is not preventable by vaccination or chemoprophylaxis, but only by personal protective measures preventing bites of infectious arthropod vectors. OBJECTIVES: Which leishmania species are endemic in northern Afghanistan, what are the clinical characteristics of skin lesions produced by cutanizing leishmania species, what are their epidemiological characteristics, and which preventive measures are feasible? METHODS: The medical literature was reviewed, knowledge gaps were analyzed and completed by our own data collected locally. RESULTS: Four Leishmania species are considered endemic in northern Afghanistan, of which Leishmania tropica, L. major, and L. donovani can produce skin lesions while L. donovani and L. infantum visceralize. Transmission modes and seasons vary markedly among focally epidemic urban anthroponotic L. tropica and rural enzootic L. major. Combined preventive measures may reduce the infection rate by more than 10,000-fold. CONCLUSION: Cutaneous as well as visceral leishmaniasis can occur among returnees from Afghanistan. Atypical, poorly healing skin lesions can be caused by L. donovani. Extensive use of personal protective measures against arthropod vectors is strongly recommended for all travelers.

Compliance with antimalarial chemoprophylaxis in German soldiers: a 6-year survey.

PURPOSE: Since 1992, German soldiers have been deployed in areas where malaria is endemic. Antimalarial chemoprophylaxis (CP) is directed according to the assessed risk and is provided free of charge. Compliance is crucial if its effect is to be reliable. This study analysed compliance with directed CP in German soldiers as well as its determinants. METHODS: Between 2003 and 2009, standardized questionnaire-based interviews were performed with 2,149 out of approximately 100,000 German soldiers who were deployed during this period in areas where malaria is endemic. The questionnaires dealt with information that the soldiers had received about malaria prior to their missions, with their adherence to mosquito-protective and antimalarial chemoprophylactic procedures, and their estimations of their individual level of exposure. RESULTS: About 1,308 out of 2,149 interviewed soldiers had been ordered to take CP, allowing for an assessment of the outcome parameter "CP-compliance". About 76.9 % out of 1,308 soldiers to whom regular CP was directed took it regularly. The exposure variables "age", "satisfaction with malaria counselling", "perceived threat due to insects or mosquitoes" and "use of insect repellents" were positively associated with compliance with directed antimalarial CP. CONCLUSIONS: The study confirms the findings of the French and US armies that even free-of-charge access to antimalarial medication will not lead to 100 % acceptance. The compliance problem is aggravated by the generally low age of deployed soldiers. Adequate counselling is crucial to increase adherence to antimalarial CP.

Probable involvement of vascular angiotensin II formation in the beta 2-adrenoceptor-mediated facilitation of the neurogenic vasopressor response in the pithed rat.

Rats were pithed, vagotomized and adrenalectomized and the effect of procaterol on the pressor response to electrical stimulation of the thoracolumbar preganglionic sympathetic outflow from the spinal cord or to exogenous noradrenaline was studied in the absence and presence of beta-adrenoceptor antagonists and drugs interfering with the renin-angiotensin system. 1. Basal diastolic blood pressure was decreased by captopril, ramiprilate (angiotensin converting enzyme inhibitors), saralasin (an angiotensin II receptor antagonist), pepstatin A (a protease inhibitor with renin antagonistic properties) and by functional nephrectomy (ligation of both renal hili), but was not affected by procaterol (a beta 2-adrenoceptor agonist), nebivolol (a beta 1-adrenoceptor antagonist) and ICI 118,551 (erythro-dl-1-(7-methylindan-4-yloxy)-3-isopropylaminobut an-2-ol; a beta 2-adrenoceptor antagonist). 2. The vasopressor response induced by electrical stimulation of the preganglionic sympathetic nerve fibres was increased by procaterol, whereas the increase in blood pressure evoked by exogenous noradrenaline was not affected. The pressor response to both electrical stimulation and exogenous noradrenaline was decreased by captopril, ramiprilate, saralasin and nephrectomy but was not affected by nebivolol and ICI 118,551. 3. The facilitatory effect of procaterol on the neurogenic, electrically induced pressor response, which was also obtained when basal blood pressure was decreased by nephrectomy and increased by Lys8-vasopressin, was abolished by ICI 118,551 but not affected by nebivolol. Under none of these experimental conditions did procaterol alter the vasopressor response to exogenous noradrenaline. 4. The facilitatory effect of procaterol on the neurogenic, electrically induced rise in blood pressure was abolished by captopril, ramiprilate, saralasin and pepstatin A.(ABSTRACT TRUNCATED AT 250 WORDS)

[Risks posed by venomous animals -- accidents due to snakebite envenomation]. / Gefahren durch Gifttiere -- Unfälle mit Giftschlangen.

In regions where poisonous animals are widely distributed, the management of injuries due to these animals is part of the routine medical care. Personnel e. g. deployed for humanitarian aid missions in these areas have to be prepared to face these challenges as well. Beside this group zoo personnel and snake charmers here in Europe are also endangered. The most common form of animal poisoning is due to snake bites. There are approximately 600 different species of poisonous snakes, commonly found in the warm climatic regions. But poisoning from spiders, scorpions and some marine animals can also be life threatening. There are different kinds of snake venoms, which result into different clinical presentations depending on the components of the venom. The venom may be cytotoxic, hematotoxic, neurotoxic, rhabdomyolytic, cardiotoxic, renotoxic or may cause an autoimmune reaction by complement activation. In the management of injuries following animal poisoning, besides the first aid measures taken, the injured is supposed to be managed according to the poison component in the venom with specific antivenin treatment and supportive therapeutic care. There are mono- and polyvalent antivenins available. Noneffective first-aid measures or measures which can cause further trauma must always be avoided. In general adapted behaviour in the field can prevent envenomation. Education on preventive measures with the aim of behaviour change are central components for pre-deployment preparations.

[Histoplasmosis group disease in bat researchers returning from Cuba]. / Histoplasmose-Gruppenerkrankung bei Fledermausforschern nach Kubaaufenthalt.

CASE HISTORY: Four males (age 25 to 40 years) and one female (age 25) were admitted to our hospital almost simultaneously with symptoms of fever up to 38 degrees C, dry cough, thoracodynia, dyspnoea, myalgia and arthralgia. All patients belonged to a team of eight German bat researchers who had returned from Cuba 10 days before, where they had investigated bats in caves. Another member of the team had only mild histoplasmosis and was followed in our outpatient clinic. Two scientists who wore their breathing masks continuously during their work in the caves did not fall ill. EXAMINATIONS: Chest X-rays of all in-patients showed pulmonary infiltrates correlating with the severity of their illness. In all patients specific IgG antibodies against Histoplasma capsulatum-antigen were found in the Western Blot assay, confirming the diagnosis of histoplasmosis. TREATMENT: Treatment with oral itraconazole 200 mg b.d was given to four inpatients for 6 weeks, in the fifth patient itraconazole was discontinued because of an increase of liver transaminases. CONCLUSION: Antimycotic treatment of advancing histoplasmosis seems appropriate also in immunocompetent patients. The high number of patients within this group suggests high numbers of Histoplasma capsulatum in the caves. Wearing breathing masks throughout the work in the caves may prevent histoplasmosis even in case of high infectious doses. Pre-travel recommendations for cave researchers have to emphasize the continuous use of breathing masks and vaccination against tetanus and rabies.