Case report: effects of diethylcarbamazine and thiabendazole combination against Mansonella perstans filariasis.

Mansonella perstans filariasis is widely present in Africa and equatorial America and its pathogenicity has been recently reconsidered. Effective treatment is lacking and there is no consensus on optimal therapeutic approach. We present the results of a new combination treatment against M. perstans filariasis. Two cases of M. perstans filariasis were treated with the combination of diethylcarbamazine (DEC) and thiabendazole. The treatment was able to significantly reduce microfilaria burden in a case and to achieve complete clearance of blood microfilariae in another case.

[Mansonella perstans filariasis]. / La filariosi da Mansonella perstans.

Mansonella perstans filariasis is widely present in Africa and equatorial America and its pathogenicity has been recently reconsidered. Although M. perstans infection has been considered a minor filariasis, remaining asymptomatic in most of infected subjects, more recent studies have shown that M. perstans is capable of inducing a variety of clinical features, including angioedemas, swellings like the "Calabar swellings" of loiasis, pruritus, fever, headache, pain in bursae and/or joint synovia, or in serous cavities. It is likely that some of the pathological changes observed are induced by the immune response to the infection. Eosinophilia is present in many cases of infection. Moreover M. perstans filariasis is difficult to be treated. Effective treatment is lacking and there is no consensus on optimal therapeutic approach. The most commonly used drug is diethylcarbamazine (DEC) that is however often ineffective. Although other drugs have been tried (e.g. praziquantel, ivermectin), none has proven to be reliably and rapidly effective. Mebendazole seemed more active than DEC in eliminating the infection, with a comparable rate of overall responses. Thiabendazole evidenced a small, but significant activity against the infection. Combination treatments (DEC plus mebendazole) resulted in a significantly higher activity compared with the single drugs.

The 2001 meningitis epidemic in south Chad.

AIM: Bacterial meningitis is widespread in many areas of tropical countries, has a high mortality rate, and is often devastating. However, epidemiological studies in rural areas are quite rare, especially in Chad. We report data concerning the 2001 meningitis epidemic in the Moyen Chari district, in Southern Chad. METHODS: Five-hundred and ninety-five cases of meningitis were admitted in hospital from January to April 2001. Diagnosis was made on the basis of clinical presentation and/or by cerebrospinal fluid (CSF) specimen analysis. Antimicrobial treatment, time of recovery or death were recorded. Treatments most employed were oily chloramphenicol (CAP) and ampicillin, alone or combined. RESULTS: Two peaks of incidence have been observed: one in children aged below 1 year and the other in 6 year-olds with an overall lethality rate of 8.74%, particularly in children aged below 2 years. Incidence decreased over 13 years of age. Weekly incidence per 1 000 inhabitants, ranged from 0.21 to 1.69. Microbiological data indicated S. pneumoniae as the leading pathogen, but the epidemic nature of the disease suggests that this pathogen was probably overestimated. CONCLUSION: Our data suggest that an incidence of 10 cases per 100 000 appears most useful in predicting an epidemic. CAP was significantly the most effective treatment in terms of lethality, need for second-line treatment, and mean hospital stay, particularly if first administered at a primary health center. In case of lack of response to CAP treatment, the association of ampicillin and gentamicin seems more advisable than ampicillin alone.

Transfusional Mansonella perstans microfilariasis.

Mansonella perstans filariasis is widely distributed across the center of Africa and equatorial America. We describe a case of post-transfusional M. perstans microfilariasis in a young child, affected with severe Plasmodium falciparum malaria, admitted in Goundi Hospital in South of Chad. A decrease of M. perstans microfilariasis in the patient's blood was observed, with no subsequent development of either clinical symptoms or eosinophilia. We suggest that, in endemic areas, transfused M. perstans microfilariae may be cleared from the blood over relatively short periods of time. It is likely that only adult worms are responsible for symptoms and eosinophilia, whereas microfilariae in the bloodstream are unable to give clinical manifestations.

Effects of thiabendazole in Mansonella perstans filariasis.

Mansonella perstans is a human filarial parasite distributed across the center of Africa and equatorial America. Although M. perstans infection is asymptomatic in most individuals, a variety of symptoms have been described, including angioedema, pruritus, fever, ocular involvement, and serous cavities pain. Eosinophilia is found in many cases. Treatment with diethyl-carbamazine or mebendazole is often ineffective. We present a study on the effects of thiabendazole in the treatment of symptomatic M. perstans filariasis. Twenty-five patients were treated with thiabendazole at a single dose of 50 mg/kg for children and 3 g for adults. Sixteen out of 25 subjects repeated a second dose a week later. Parasite density, eosinophilia, and symptoms were significantly reduced after both one and two-step therapy in most patients. This study shows that thiabendazole may be effective in M. perstans infection. More studies are needed to determine a more effective dosage, or a putative combination treatment.

[Histoplasmosis: not only a tropical disease]. / Istoplasmosi: una malattia non solo tropicale.

Histoplasmosis is a fungal infection resulting from inhalation of spores from the fungus Histoplasma capsulatum; it is known to be endemic in various parts of the world, especially in North and Latin America, and can produce a spectrum of illness, from subclinical infection to progressive disseminated disease. The majority of infected persons have an asymptomatic, self-limiting illness. Clinical pneumonia occurs in those with exposure to a large number of infecting spores. Disseminated histoplasmosis usually occurs in immunosuppressed patients or in patients with chronic illness. Diagnosis is best made by visualization of yeast in tissue or by culture. In most cases, amphotericin B is the initial drug of choice, followed by one of the azoles for lifelong maintenance therapy. Itraconazole is the drug of choice for treatment of disseminated histoplasmosis in less severe cases, while fluconazole therapy for histoplasmosis is only moderately effective.

[Imported malaria in Emergency Department]. / La malaria d'importazione nel Dipartimento di Emergenza-urgenza.

It occasionally happens that patients don't suspect to have malaria and diagnosis becomes difficult for the Emergency Department physicians. Since September 1995 to February 1999, 8 cases of malaria have been diagnosed in our first aid station; 5 occurred in european and 3 in extraeuropean immigrants. Incidence of imported malaria was greater after holiday period for european, and equally distributed along the year for immigrants. Patients' provenience was sub-Saharian Africa and Asia. Standard blood examination and thick and thin blood smears were performed showing P. falciparum and P. malariae infection. All patients were successfully treated with mefloquine as recommended. The aspecificity of the symptoms and signs makes diagnosis difficult if malaria is not suspected, in presence of fever in people returning from the tropics. Even in presence of symptoms and abnormal laboratory examinations, diagnosis is possible only with microscopic blood examination.

Azithromycin in the treatment of Plasmodium falciparum gametocytes. Preliminary observation.

BACKGROUND: Treatment of malaria represents a problem as antimalarial drugs are relatively few, and because of the increasing widespread resistance of Plasmodium falciparum to most of these drugs. A partial efficacy of azithromycin against Pl. falciparum hepatic stage and against trophozoytes in the erythrocytic stages of the disease has been demonstrated. No data concerning the activity against gametocytes are available, and primaquine stands as the only therapy against Pl. falciparum gametocytes. Primaquine causes haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, so primaquine therapy is usually avoided. A better tolerated therapy against gametocytes would be useful to reduce malaria transmission. We present the results of a study concerning the efficacy of azithromycin in the treatment of P. falciparum gametocytes. METHODS: A prospective study was performed: 4 patients with Pl. falciparum gametocytes (3 children, 1 adult) were treated with azithromycin for concomitant bacterial infections; in the meantime two children with gametocytes were taken as control. Azithromycin was administered as recommended. RESULTS: Gametocytes were detectable in children thick blood smears after 8, 5 and 6 days respectively after the beginning of azithromycin therapy, while they were undetectable in the adult thick blood smear 5 days after the beginning of the therapy. The gametocytes spontaneously disappeared in the two controls 4 to 6 days after the beginning of observation. CONCLUSIONS: These data suggest that azithromycin seems ineffective against Pl. falciparum gametocytes. Further studies are needed in order to determine whether azithromycin treated gametocytes are infective to mosquitoes or not, and to confirm this first observation.

Mefloquine-induced grand mal seizure in tubercular meningitis.

Mefloquine represents a promising antimalarial drug against Plasmodium falciparum. It has been related to an increase in seizure frequency in epileptic patients and should not be administered to patients with a history of convulsions, epilepsy in first degree relatives, or serious psychiatric disorders. We report a case of a man from the Ivory Coast complaining of fever, headache and anemia treated with chloroquine and subsequently with mefloquine in the suspicion of malaria, even in the absence of laboratory confirmation. When the patient came to our division, malaria was excluded, but the patient developed two convulsive episodes, respectively 4 and 7 days after the ingestion of the second therapeutic dose of mefloquine. Further investigation was performed; particularly an EEG showed abnormalities compatible with tendency for seizures, diffuse waves and spikes. CSF culture was positive for M. tuberculosis as well as urine, sputum and blood cultures. Anti-HIV antibodies were positive, so the final diagnosis was tuberculosis in HIV infection. As seizures are common signs of cerebral tuberculomas, but not of meningitis it is possible that tubercular meningitis might have enhanced severe neuropsychiatric side effects of mefloquine. Physicians should be aware that treatment with mefloquine with concomitant meningitis could have a risk of development of grand mal seizure.

Prevention of interleukin-2-induced thrombocytopenia during the immunotherapy of cancer by a concomitant administration of the pineal hormone melatonin.

Thrombocytopenia is a frequent haematologic complication of IL-2 immunotherapy of cancer. Preliminary results suggest a role of melatonin in the regulation of platelet production, so a study was started to evaluate the influence of the pineal hormone on IL-2-induced thrombocytopenia. Of 25 lung cancer patients, 10 were treated with melatonin alone, 7 received IL-2 alone and 8 patients were concomitantly treated with IL-2 and melatonin. Thrombocytopenia occurred in 3/7 patients treated with IL-2 alone, and in none of those treated with IL-2 plus melatonin; this difference was statistically significant. Platelet number increased during IL-2 plus melatonin, even though not significantly; on the contrary, platelet number decreased during IL-2 alone. Platelet number observed in patients treated with IL-2 plus melatonin was significantly higher than in those who received IL-2 alone. Finally, melatonin alone did not substantially influence platelet number. These results show that melatonin may abolish IL-2-induced thrombocytopenia. This might be due to an inhibitory effect of melatonin on macrophage-mediated platelet destruction, with a following increase in platelet number due to an enhanced IL-3 production in response to IL-2.

[Multiple myeloma. Role of prognostic factors and staging in a therapeutic program]. / Il mieloma multiplo. Ruolo dei fattori prognostici e della stadiazione in un programma terapeutico.

Patients affected with multiple myeloma constitute an heterogeneous population with very different clinical patterns, varying from asymptomatic to very compromised patients with severe and uncontrolled disease. Most common clinical and biological staging systems have been in use for many years. Recently new prognostic factors have been identified; among them, serum levels of beta-2 microglobulin, C-reactive protein and interleukin-6 employed with already known parameters have been useful in the new staging system, permitting a more focalized therapy. As today is not yet possible to define the best treatment schedule, as the most common treatments are incapable to eradicate myeloma neoplastic clone even in responsive patients. Nevertheless extensive use of biologic response modifiers in the last years, as alpha interferon, have added new powerful and hopeful therapeutic tools even if the results need to be confirmed in future trials. It is important to remind the primary role of bone marrow transplantation associated with high dose polychemotherapy even if just a minority of patients is eligible for this therapeutic chance.

Atrial flutter followed by sick sinus syndrome as presenting symptoms of B-cell malignant non-Hodgkin lymphoma involving the heart.

A case of non-Hodgkin lymphoma involving the heart is described; the patient suffered for atrial flutter, followed by sick sinus syndrome for one year before diagnosis was made. Although it is not possible to demonstrate primary cardiac onset, the clinical history is highly suggestive. Most recent cases described occurred in immunodeficient patients. Interestingly our patient showed no evidence of immunodeficiency. Our patient received conventional chemotherapy followed by radiotherapy, obtaining complete remission without complications, and remains in this condition after a 3-year follow-up. The patient's good condition may be responsible for this successful outcome.

Antiphospholipid antibodies and splenic thrombosis in a patient with idiopathic myelofibrosis (antiphospholipid antibodies and thrombosis).

A case of idiopathic myelofibrosis and hepatosplenic myeloid metaplasia associated with antiphospholipids antibodies is described. The patient developed a lethal complete splenic vein thrombosis in spite of an intravenously heparin treatment had been started soon after a clinical pattern of "acute abdomen".

[Oncogenes and malignant hemopathies]. / Oncogeni ed emopatie maligne.

In the last ten years molecular biology has defined the role of oncogenes in the pathogenesis of malignant blood diseases. Included among these are: chronic myelogenous leukemia, with abl oncogene; Burkitt's lymphoma, where myc oncogene is translocated from chromosome 8 to chromosomes 2, 14 or 22 near immunoglobulin genes; some acute myelogenous leukemias; myelodysplastic syndromes with deletion of the long arm of chromosome 5.

[Recent findings on the role of oncogenes in neoplasms]. / Recenti acquisizioni sul ruolo degli oncogeni nelle neoplasie.

Oncogenes are one of the most important structures in tumor pathogenesis. Both extracellular (growth factors, membrane receptors, tyrosine kinase) and intracellular (phospholipids and nuclear phosphoproteins) signals are involved in cell proliferation. New data are becoming available that will allow a better understanding of tumor etiology.