Prophylactic immunisation against traveller's diarrhoea caused by enterotoxin-forming strains of Escherichia coli and against cholera: does it make sense and for whom?

Traveller's diarrhoea (TD) constitutes the most common disease relevant to travel medicine with ETEC as the leading causative pathogen. Cholera is the most serious, but very rare form of TD. ETEC and cholera share pathogenic mechanisms by producing a toxin that has an 80% amino acid homology. A consensus of German-speaking experts sees the indication to use the whole cell/B subunit oral cholera vaccine (WC--BS) if cholera is a risk for aid workers or travellers with an anticipated threat of cholera who stay under poor hygienic conditions. The use of the vaccine should be considered in the indication to avoid ETEC TD for travellers with predisposing illness or medication or for travellers at risk to develop a serious course.

[Tetanus immunity in an urban population: gaps in the vaccination of senior citizens and foreign guest workers]. / Tetanusimmunität einer Grossstadtbevölkerung: Impflücken bei Senioren sowie bei ausländischen Gastarbeitern.

Immunity against tetanus in an urban population: gaps of immunity among elderly persons. In a sero-epidemiological survey we investigated the immunity against tetanustoxoid in an urban population. Children and adolescents born in Germany (n = 193) showed an excellent immunity, negative findings being the exception. Among soldiers of the army (n = 136), negative findings were rare too. In these both groups the antibody titiers averaged 4,5 IU/ml. It is generally agreed that an antibody titer of 0,01 IU/ml protects against tetanus. Adults born in Germany (n = 295) had a good immunity: 84% showed antibody - titers against tetanus. Among elderly persons, however, above 60 years of age (n = 1576) there was a striking incidence of negative findings: in 1043 persons (65%) no antibodies could be detected. The remaining 533 persons with positive findings (35%) had antibody-titers in the lower range (average 0,482 IU/ml). Also among foreigners and immigrant labourers from mediterrean countries (Greece, Turkey, Yugoslavia) the frequency of negative findings was high: 183 persons were examined, 70 (39%) were negative 113 (61%) were positive. The incidence of negative findings was highest among women from the mediterrean countries. Several small studies published in Switzerland show a similar tendency. Our paper will encourage further seroepidemiological studies.

[Furuncles on the scalp after a trip to Brazil]. / Furunkulöse Hauterscheinungen nach Brasilienaufenthalt.

HISTORY AND CLINICAL FINDINGS: A 68-year-old woman suffered for six weeks from four skin eruptions on her head after returning from Brazil. The skin manifestations resembled furuncles, grew continually in size until they were about 2 cm in diameter and [corrected] she finally developed intermittent sharp pain on her head. On presentation she had a mild lymphadenopathy on her neck but no other systemic complaints. INVESTIGATIONS: Each skin eruption had a central porus with seropurulent discharge and on examination within the central opening a whitish, tender moving mass could be detected. TREATMENT, COURSE AND DIAGNOSIS: We cautiously infiltrated each skin eruption with lidocaine. Immediately after infiltration a whitish maggot appeared from each nodule and could be easily extracted with a forceps. The maggots were identified as Dermatobia hominis larvae. After extraction a local antiseptic dressing was applied and the wounds healed without complications. CONCLUSION: Dermatobia hominis is a common cause of myiasis in Central- and South-America and should be taken into account in furuncular skin eruptions of returning travelers. The typical appearance of the skin eruption with a central porus, seropurulent discharge and a whitish, tender moving mass within the nodule is quite characteristic for myiasis. The patients often have [corrected] intermittent sharp pain in the area of the affected skin and report continuing growth of the nodules and a sensation of slight movement within the skin eruption. Extraction is accomplished with a forceps after lidocaine infiltration, alternatively an occlusive dressing could be applied by means of which the larvae can be removed easily from the cavity.

[Tetanus antibodies in conventional gamma globulin preparations]. / Tetanus-Antikörper in konventionellen Gammaglobulin-Präparaten.

Different specimens of one of the most common polyvalent immunoglobulin-preparations in the Federal Republic of Germany contain tetanus-antitoxin with an average titer of 40 I.E.Hml. The injection of 5 ml of this conventional gammaglobulin effects in an adult person a titer of ca. 0,75 I.E. Tetanus-antitoxin/ml serum (minimal protectin level = 0,01 I.E./ml). The prophylactic application of 5 ml of the conventional IgG-preparation (gammaglobulin) in travelers against epidemic hepatitis results in a protection against tetanus, too, at least for 3-4 weeks.

[Treatment of persistent diarrhea with S. boulardii in returning travelers. Results of a prospective study]. / Behandlung der persistierenden Diarrhöe mit S. boulardii bei Reiserückkehrern. Ergebnisse einer prospektiven Untersuchung.

AIM: The efficacy and tolerability of Saccharomyces boulardii (S.b.) were investigated in patients with diarrhea contracted while travelling abroad. METHOD: The efficacy of S.b. was determined on the basis of the frequency and consistency of stools (fewer than 3 unformed stools a day), and symptom changes. A total of 95 patients (49 females, 46 males) aged between 19 and 69 (mean age 32) years were treated with S.b. at a daily dose of between 150 and 450 mg (mean 428 mg) (3 x 1-3 capsules). RESULTS: Prior to admission to the study, diarrhea had persisted for an average of 11 days; under treatment with S.b. it cleared up after a mean of 5 days. A tendency towards greater efficacy in patients returning from The Middle East and South America was noted. Tolerability was assessed to be very good or good by almost all participants, with side effects occurring in only 2 cases. CONCLUSION: The study demonstrates that S.b. is both effective and well tolerated when used for the treatment of persistent diarrhea (mean duration 11 days) that had often failed (67% of the cases) to respond to previous antidiarrheal or antibiotic drugs.

[Tetanus immunity in old age]. / Tetanusimmunität im Alter.

Among 1546 elderly persons (above 60 years of age) from a large town the immunity against tetanus was tested. 1043 persons (66.18%) had no antibodies against tetanus-toxoid in their serum. Almost half of the remaining positive sera (33.82%) showed antibody titers between 0.01 and 0.1 IU/ml. It is open to discussion if these titers warrant complete protection against the disease. On the contrary, children or young men serving in the army showed good immunity with high antibody titers. Tetanus has become a rare disease in the western countries, but cases still occur. The disease affects nowadays mainly adults. The older the patient the higher is its mortality. According to our study, many old people are not protected against tetanus. The risk of infection is widespread. It is strongly recommended to immunize also elderly persons at regular intervals. The vaccination against tetanus is cheap, well tolerated and yields a good immunity even in old age.