Urological manifestations of chronic schistosomal myeloradiculopathy.

OBJECTIVE: To describe the clinical and urodynamic features of patients with chronic voiding dysfunction secondary to schistosomal myeloradiculopathy (SM), as the clinical involvement of the spinal cord is a well recognized complication of Schistosomiasis mansoni infection. PATIENTS AND METHODS: We reviewed the records and urodynamic studies of 26 consecutive patients (17 males and nine females, aged 8-58 years) with chronic neurological and urinary symptoms secondary to SM. The voiding function history, radiological and urodynamic findings and therapeutic approaches were reviewed. Patients with and without upper urinary tract complications were compared in terms of age, duration of voiding dysfunction and urodynamic pattern. RESULTS: The most common urinary symptoms were difficulty in emptying the bladder (17 patients, 65%), urinary incontinence (14, 54%), and urgency and frequency (13, 50%). Laboratory and radiographic evaluation showed urinary tract infection in eight (30%) patients, bilateral hydronephrosis in five (19%) and bladder calculi in five (19%). Urodynamics showed detrusor overactivity with detrusor-external sphincter dyssynergia (DESD) in 14 patients (54%), detrusor arreflexia in six (23%), detrusor overactivity with no dyssynergia in four (15%), and detrusor underactivity in two (8%). Comparing patients with and without upper tract complications showed no differences in age and duration of urinary symptoms, but there was a significant association of detrusor overactivity with DESD and upper urinary tract complications (P = 0.04). Urological management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication and stone removal, as appropriate. Conservative treatment failed in three patients and they required an injection with botulinum-A toxin into the detrusor (two) or ileocystoplasty (one). CONCLUSION: Patients with chronic SM behave clinically like those with other causes of spinal cord disease and neurogenic bladder dysfunction requiring lifelong surveillance. The severity of illness in these patients should re-emphasize the need for early recognition and treatment of this condition, to prevent or reverse the neurological deficits.

Trichomonas vaginalis: intrastrain polymorphisms within the ribosomal intergenic spacer do not correlate with clinical presentation.

Trichomoniasis presents a broad spectrum of clinical patterns ranging from asymptomatic to severe vaginitis and cervicitis. Despite its importance, very little is known about the genetic relatedness of its causative agent, Trichomonas vaginalis, and the clinical phenotypes. To address this question, analysis of restriction length polymorphism (RFLP) within the intergenic spacer of the ribosomal DNA (IGS) from 60 clinically defined isolates of T. vaginalis was performed. This is the first description of the IGS polymorphism of T. vaginalis. As expected, a considerable number of patients were asymptomatic (28%) while only 12% presented both leukorrhea and macular colpitis, the most evident symptoms of trichomoniasis. The IGS-RFLP with the use of eight restriction enzymes showed absence of correlation between the genetic relatedness of the isolates and symptomatology. Further studies are necessary to evaluate the importance of the IGS polymorphism to the parasite virulence and clinical phenotype.

Clinical and laboratory aspects of malaria among children with fever in a low transmission area of Sudan.

A cross-sectional study explored the clinical and laboratory aspects of malaria among children presenting with fever to 2 paediatric hospitals in Khartoum state during the low transmission season. Out of 655 febrile patients, 35.9% were recorded as having malaria based on hospital laboratory results. However, re-examination of slides at the National Malaria Control Programme referral laboratory confirmed malaria in only 32.8% of those diagnosed with malaria at hospital level. Analysis of symptoms and signs revealed great variability in clinical presentation. Although some findings were associated with malaria, developing a sensitive clinical algorithm was difficult. Further investment is needed to improve microscopic diagnosis facilities in local hospitals to overcome the problem of over-diagnosis of malaria.

Behavioural dominance and Taenia crassiceps parasitism in BALB/c male mice.

Behavioural dominance relationships in mouse populations are based upon fighting and antagonistic behaviour. Social rank is affected by the physiological states present in the mice. Experimental infection by Taenia crassiceps cysticerci induced physiological disorders and disrupted the dominant-subordinate status. Infected male mice showed strong perturbations in territorial behaviour and aggressiveness. Infected dominant male mice did not show a significant reversal of dominance order compared to uninfected mice. In addition, during confrontation between naive infected and healthy mice, infected animals more often assumed a subordinate status than healthy ones. The effects of the infection by T. crassiceps were more likely to prevent adult male mice from becoming behaviourally dominant than to reverse existing dominance relationships. The results are discussed on the basis of the parasite manipulation hypothesis and host optimal foraging and decision-making theories.

Molecular typing of Trichomonas vaginalis isolates by HSP70 restriction fragment length polymorphism.

Subtyping isolates of Trichomonas vaginalis is an essential tool for understanding the epidemiology of this common sexually-transmitted disease. Restriction fragment length polymorphism (RFLP) analysis employing a probe from the heat-inducible cytoplasmic HSP70 gene family hybridized with EcoR I-digested genomic DNA was used in the molecular typing of Trichomonas isolates. Analysis of five American Type Culture Collection (ATCC) reference strains and 31 Jackson, Mississippi, isolates from six male and 21 female patients, revealed 10 distinct RFLP pattern subtypes of Trichomonas. The subtypes were temporally stable and cosmopolitan. The RFLP profiles seen in Maryland, Ohio, Massachusetts, and New York ATCC strains were identical to those of some Mississippi isolates, even though the samples were isolated 10-35 years apart. There was no correlation between metronidazole resistance and RFLP subtype with resistant isolates from eight patients distributed among six different subtypes.

[Analysis of the relations between selected symptoms of inflammation of the genital and urinary organs and invasion of Trichomonas vaginalis]. / Analiza zbieznosci miedzy wybranymi objawami zapalenia narzadów plciowych i moczowych u dziewczat a inwazja Trichomonas vaginalis.

Data concerning 604 girls up 18 year old were analysed. On the basis clinical symptoms and results of culture of various biological materials on selected media--the monofocal Trichomonas infection concerning the most often vulva and vagina, rarely urethra or other regions of urinary organ as well as the multifocal Trichomonas infection, particularly complicated by mycosis were proved. It was found the convergence statistically significant (P less than or equal to 0.5) of the invasion of T. vaginalis with some symptoms of inflammation of genital and urinary organs; the highest values of Pearson-Bravais coefficient was obtained in Trichomonas infection of genital organs and vaginal discharges, pain of vulva and vagina, the picture of colpitis maculosa, but in the multifocal one also with itching and pain in urethra and dysuria. T. vaginalis without symptoms occurred very seldom in the girls.