Detection of Vibrio cholerae biotype El Tor by purging.

Previous studies have demonstrated the value of purging in detecting inapparent cholera infection, but the technique has not been generally accepted. The present study shows that the method can be recommended as a routine procedure to determine when convalescent cholera patients should be discharged from hospital. It may also be useful in detecting carriers of Vibrio cholerae and for evaluating chemotherapy. In this study, five of the eight patients who excreted vibrios after purging had been treated with 2 g of chloramphenicol daily for three days, a finding that throws doubt on the adequacy of this treatment. Purging with magnesium sulfate is simple, well tolerated and ideal for hospitalized patients or for subjects whose stools can be promptly cultured. Since magnesium sulfate is inhibitory to Vibrio cholerae, this purgative is not well suited for field studies, where there may be delays in culturing.

Search for a mass chemotherapeutic drug for cholera control. A study of Vibrio excretion following single and multiple dose treatment.

In a study designed to seek a suitable drug for mass chemotherapy during a cholera epidemic, four drugs were administered in single doses to patients with cholera in Iran. Streptomycin was administered orally; penicillin, parenterally; and chloramphenicol and a long-acting sulfa drug, both orally and parenterally. No drug consistently eliminated vibrios from the intestinal tract. Chloramphenicol was also administered in multiple doses for three days; this also failed to eliminate vibrios in one-third of 25 patients studied. The major problem with these drugs administered orally seems to be rapid elimination and poor absorption by patients with diarrhoea. The authors do not recommend any of these drugs for single-dose mass chemotherapy and consider that chloramphenicol cannot be recommended for multiple-dose mass chemotherapy.

Imported cases of chloroquine-resistant falciparum malaria in Iran.

Six imported cases of chloroquine-resistant Falciparum malaria have been studied since October 1984. In five cases including two Iranian men, returned from India, two Afghan and one Bengalee immigrants came to Iran through Pakistan, recrudescence occurred following treatment with chloroquine. In these five cases resistance of P. falciparum to chloroquine was clinically (by the in vivo test) at R1 level in all patients. The resistance was also confirmed by the macro in vitro susceptibility test which was carried out in four of them. These five chloroquine-resistant cases were treated, one with Sulfadiazine-Pyrimethamine, three with Quinine-Sulfadiazine-Pyrimethamine and one with Sulfadoxine-Pyrimethamine (Fansidar) successfully. In the sixth case who was a Pakistani tourist the parasites showed resistance in the macro in vitro test, but apparently responded to chloroquine treatment in three days. It seems the resistance in this case was also at R1 level as other cases.