The decentralization of the health system in Colombia and Brazil and its impact on leprosy control.

Decentralization policies are an integrated component of health sector reform in an increasing number of countries. The ability of such policies to improve the health system's quality and efficiency is backed up by limited scientific evidence. This study intends to evaluate the impact of decentralization on a specialized field of disease control (leprosy control) in Colombia and Brazil. It analyses the respective juridical base, epidemiological indicators and local publications. Furthermore, 39 semi-structured interviews with key informants were conducted. In both countries, the devolution of technical responsibility and financial resources to the municipalities was the implemented form of decentralization. Access to preventive and curative health care and the community participation in decision-making improved clearly only in Brazil. The decentralization to private providers in Colombia had dubious effects on service quality in general and still more on public health. The flow of finances (including finance collection through state-owned taxes instead of insurance companies) seemed to be better controlled in Brazil. Leprosy control in Brazil took advantage of the decentralization process; in Colombia, it came close to a collapse.

Branched filaments no fungus, ovoid bodies no bacteria: Two unusual cases of mycetoma.

We describe a 58-year-old man presenting with necrotizing panniculitis of the lower right leg and a 64-year-old woman with a clinically similar lesion combined with pustular eruptions and subsequent ulceration on the forehead. In the first patient, Giemsa staining showed small ovoid bodies and Grocott staining revealed hyphae. Histology from the process on the forehead showed branched filaments in the periodic acid-Schiff (PAS) staining. In the first case, Madurella mycetomatis, a fungus, was the pathogenic agent, whereas in the other case white colonies of filamentous organisms resembling fungi could be cultivated that turned out to be the bacterium Nocardia brasiliensis. Since the initial clinical appearance of these two forms of mycetoma were almost identical and histopathologic findings were inconclusive, only sophisticated microbiologic work-up of material from lesional skin led to the correct diagnosis. In times of global tourism, these unusual cases impressively document the necessity to become more familiar with mycetoma to make accurate therapeutic decisions with effective results, possibly saving a limb.

Imported Lassa fever in Germany: surveillance and management of contact persons.

This study sought to assess the risk of secondary transmission after import of Lassa fever into Europe. A total of 232 persons exposed to a case of Lassa fever imported into Germany were identified. The level of exposure was determined for 157 persons (68%), and 149 (64%) were tested serologically. High-risk or close contact was reported by 30 (19%) of 157 persons. No symptomatic secondary infections were observed. However, Lassa virus-specific immunoglobulin G antibodies were detected in a serum sample obtained from a physician who examined the index patient on day 9 of illness. The physician received ribavirin prophylaxis and did not develop symptoms of Lassa fever. On the basis of these data, the contact was classified as having a probable secondary infection. The study indicates a low risk of transmission during the initial phase of symptomatic Lassa fever, even with high-risk exposures. The risk may increase with progression of disease and increasing virus load.

Tanapox: first report in a European traveller and identification by PCR.

Tanapox is a rare pox disease endemic in East Africa. We report the first case of tanapox in a European traveller who contracted the disease in 1999 during a short visit to Tanzania. The diagnosis was made on clinical grounds and confirmed by electron microscopy and a tanapox virus-specific PCR assay.