Fever in the returning traveller: the importance of sensitivity.

We report the case of a 28-year-old man, presenting with episodes of fever and rigours, having recently returned from Cameroon and Uganda. Initial investigations for malaria were negative, and the patient was sent home without a clear diagnosis. Subsequent review of the blood film revealed the presence of Plasmodium ovale. This case highlights the importance of repeated and careful inspection of blood films, given the relatively low sensitivity of rapid diagnostic tests in P. ovale infection. It also illustrates the importance of the travel history in the diagnosis of malaria.

Nutrient contribution of infant cereals used as fluid thickening agents in diets fed to the elderly.

OBJECTIVE: To evaluate whether a nutrient-fortified fluid-thickening agent (Pablum, H. J. Heinz Co of Canada, North York, Ontario, Canada) replaces nutrients lost to food displacement associated with its use. DESIGN: Seven-day, investigator-weighted, food intake records were evaluated to determine the prevalence of nutrient inadequacy. Nutrient intakes, including and excluding those associated with Pablum, were assessed to determine the ability of Pablum to protect from nutrient inadequacy. SUBJECTS/SETTING SUBJECTS: (19 women and 2 men aged 69 to 109 years) were residents of a home for the aged or a chronic-care hospital who required pureed food and thickened fluids. STATISTICAL ANALYSES PERFORMED: Probability analysis was used to estimate the prevalence of nutrient inadequacy for micronutrients and protein. RESULTS: Approximately 15% of consumed energy (mean +/- standard deviation: 1.534 +/- 310 kcal/day; 1.38 +/- 0.37 and 1.46 +/- 0.26 multiplied by basal metabolic rate for men and women) came from the thickener. If a nonfortified thickener was used, risk of inadequacy (percentage of sample) would be apparent for protein (16%), calcium (95%), thiamin (57%), riboflavin (28%), niacin (55%), and folate (47% for women and 97% for men); no risk was estimated for iron and vitamins A and C. The nutrients contained in Pablum reduced or eliminated the risk of inadequacy for some nutrients, including protein (8%), calcium (9%), thiamin (0%), riboflavin (0%), and niacin (0%). In contrast, inadequate consumption of water and folate occurred even when the contribution of Pablum was considered. APPLICATIONS: The use of a nutrient-fortified thickening agent has merit; however, the current formulation of Pablum does not allow for complete protection against nutrient inadequacy.

A not so simplex case of genital herpes.

We report the case of a 28-year-old, HIV-positive woman presenting with painful vesicular and ulcerating lesions in the ano-genital region caused by varicella zoster virus that appeared similar to herpes simplex infection. The case highlights that herpes zoster needs to be considered in the differential diagnosis of genital lesions, particularly in HIV-positive individuals, and the importance of virological diagnosis by PCR to direct appropriate management.