Hepatic amebiasis: diagnostic counterimmunoelectrophoresis and metronidazole (flagyl) therapy.

In an ongoing study of obscure fevers in Cairo, Egypt which is presently in its 6th year, 12 cases of hepatic amebiasis have been diagnosed. Three were diagnosed during the period 1971-1974. With the introduction of amebic serologic techniques, particularly counterimmunoelectrophoresis, nine additional cases have been diagnosed in 1975-1976. Of 9 patients treated with metronidazole 6 were rapidly cured, 2 had a recurrence of fever necessitating surgical drainage of the abscess, and 1 died suddenly on the 3rd day of therapy.

Treatment of schistosomiasis mansoni with oxamniquine--five years' experience.

During a 5-year period (1975-1980), 171 male patients aged eight to 58 years infected with Schistosoma mansoni have been treated with oxamniquine on an in-hospital basis. The patients comprised three clinical groups--uncomplicated S. mansoni infection, colonic polyposis due to S. mansoni, and hepatic decompensation due to S. mansoni--all with active infection. After treatment all patients were observed for 12 weeks then evaluated for cure. In the uncomplicated group 40 of 73 children (55%) and 39 of 45 adults (87%) were cured. In the polyps group 24 of 29 patients (83%) were cured and in the decompensated group all 24 patients were cured. The only side effect was a febrile reaction occurring in 65 patients (38%) 3-4 days after treatment was started. This 5 years' experience showed that oxamniquine results in a low cure rate in children but is effective in adults with uncomplicated S. mansoni. In patients with colonic polyposis oxamniquine is safe and well tolerated as initial therapy, particularly in the very ill, debilitated patient. Oxamniquine is clearly the drug of choice in patients with decompensated liver disease and active S. mansoni infection.

Levamisole compared to mebendazole in the treatment of Ancylostoma duodenale in Egypt.

Ancylostoma duodenale in 74 patients and Ascaris lumbricoides in 41 were treated with a single 150 mg dose of levamisole, a single 300 mg dose of mebendazole or the standard three-day regimen of 200 mg mebendazole daily. Levamisole cured all of the 25 hookworm patients and all of the seven Ascaris carriers to whom it was given and is recommended as the drug of choice in Egypt.

Ameobic liver abscess presenting as fever of unknown origin (FUO). Serology, isotope scanning and metronidazole therapy in diagnosis and treatment.

In a study of obscure fevers in Cairo, Egypt, 24 cases of hepatic amoebiasis were diagnosed during a 3-year period from 1977-1980. The counterimmunoelectrophoresis amoebic serologic test was positive in 20 of the 24 patients and was very useful in confirming the diagnosis. The four patients in whom the test was negative had been ill for between 1 and 5 months and had been treated with antibiotics and amoebicidal drugs. Technetium-99 liver scanning localized the site and extent of the abscess and was essential for planning therapy. Treatment with metronidazole and tetracycline resulted in rapid clinical improvement in all except one patient. However, improvement did not indicate cure as our results show: nine patients required needle aspiration of the liver abscess, and seven others had to be referred to surgery for abscess drainage. Large abscesses over 10 cm in diameter should be aspirated to avoid relapse or rupture.