A case of dengue from Pune, India.

Dengue is an acute infectious disease, caused by a single stranded ribonucleic acid (RNA) virus of the family of Flaviviridae, genus Flavivirus, transmitted by Aedes mosquitos, the most important vectors being Aedes aegypti and Aedes albopictus. There are four serotypes, DEN-1, DEN-2, DEN-3, DEN-4 that are nearly human specific. The geographical distribution of dengue is pantropical, except for Madagascar and some African regions. It is endemo-epidemic in tropical and subtropical countries included between 25 degrees north latitude and 25 degrees south latitude, particularly in southeast Asia and epidemic in the Caribbean, West-Africa, tropical American and Pacific Islands. Further spread will depend on the invasion of Aedes aegypti into new areas in South America. Maintenance of dengue is supported by an increasing demography, uncontrolled urbanization and climatic conditions favorable to the vectors. Spread of dengue is primarily caused by modern transportation, especially aircraft. No vaccine and no specific treatment exist so that mosquito control is the only way to reduce the incidence of dengue around the world. Dengue is, obviously, an important risk for travelers going to endemic areas.

Interferon alpha-2B and ribavirin in combination for patients with chronic hepatitis C who failed to respond to, or relapsed after, interferon alpha therapy: a randomized trial.

PURPOSE: To assess the efficacy of interferon alpha-2b and ribavirin in combination in the treatment of patients with chronic hepatitis C who had either failed to respond to therapy with interferon alpha (nonresponders), or who had relapsed after interferon therapy (relapsers). SUBJECTS AND METHODS: Four hundred patients with chronic hepatitis C (200 nonresponders and 200 relapsers) were randomly assigned in equal numbers to receive either subcutaneous administration of recombinant interferon alpha-2b (3 million units three times per week) and ribavirin (1,000 to 1,200 mg/daily orally) or interferon alpha-2b alone (6 million units three times per week). Both ribavirin and interferon alpha-2b were given for 24 weeks. The patients were then followed for an additional 24 weeks. RESULTS: At the end of the treatment period, normalization of serum alanine aminotransferase levels and absence of hepatitis C virus RNA were seen in 21% of nonresponders and in 39% of relapsers who were treated with interferon alpha-2b and ribavirin, compared with 5% of nonresponders (P = 0.001) and 9% of relapsers treated with interferon alpha-2b alone (P <0.001). At the end of follow-up, 14% of nonresponders and 30% of relapsers treated with the combination therapy had a sustained response, compared with 1% of nonresponders (P = 0.001) and 5% of relapsers treated with interferon alpha alone (P <0.001). CONCLUSIONS: A 24-week course of treatment with interferon alpha-2b and ribavirin offers a chance of sustained response, whereas retreatment with interferon alpha-2b alone does not give satisfactory results. The role of long-term therapy in inducing prolonged remission remains to be explored.

Anti-HBV vaccination before therapy with interferon (IFN) in chronic B hepatitis.

Thirty-five outpatients (7 F, 28 M, mean age 39.8 years) with histologically confirmed active chronic B hepatitis, have been immunised with specific anti-HBV vaccine (Engerix B 20 mcg, SmithKline Beecham Biologicals, Rioxensart, Belgium) on days 0, 30 and 60. Hepatitis B markers, HBV-DNA and anti-HDV antibodies were determined on the same day of vaccination. One week after the last dose of anti-HBV vaccine, 15 and 10 patients have been treated respectively with alpha-leukocyte-IFN and beta-natural-IFN at the dose of 6 mU three times/week for one year; the remaining 10 patients were included in the control group. Hepatitis B and D markers and transaminases were monitored monthly during IFN therapy. Within one month from the last dose of anti-HBV vaccine, 20 patients out 35 have shown a transitory disappearance of HBV-DNA. After the 2nd dose in 4 patients a marked increase in AST and ALT levels was observed (up to 10 times the normal values). After the 3rd dose (last dose) five HBV-DNA-negative patients have shown transitory low levels of anti-HBs antibodies; moreover, after the last dose of anti-HBV, one HBV-DNA-negative patient resulted HBV-DNA-positive. After one year of IFN-therapy, 8 patients out 15 treated with alpha-leukocyte-IFN and 2 treated with beta-natural-IFN, have shown normalisation of transaminases. These results confirm the effectiveness of an anti-HBV vaccination before an IFN treatment and a better response achieved with alpha-leukocyte-IFN.

[Two clinical cases of zoonotic filariasis probably caused by Dirofilaria repens: I. Passage of the nematode under the bulbar conjunctiva. II. Subcutaneous abscessed nodule]. / Due casi clinici di filariasi zoonotica da probabile Dirofilaria repens: I. Passaggio del nematode sotto la congiuntiva bulbare. II. Nodulo sottocutaneo ascessuato.

Two new human cases of zoonotic filariasis are reported, one subconjunctival and the other subcutaneous, occurred both in 67 and 73 year-old women, respectively, living in the provinces of Alexandria and Pavia (Northern Italy). The morphology of the nematodes could not be examined. Nevertheless, the anamnesis, the course of infection, the symptomatology and the geographic area where the cases occurred, suggested that they were associated with Dirofilaria repens.

[The use of erythropoietin in HIV myelodysplasias. Preliminary study]. / Uso dell'eritropoietina nelle mielodisplasie da HIV. Studio preliminare.

The authors gave recombinant human erythropoietin to four anaemic patients with HIV-infection treated with zidovudine. After erythropoietin administration an increase in haemoglobin, erythrocytes and haematocrit was observed and patients could continue AZT therapy.

In vitro adherence of Neisseria gonorrhoeae to human epithelial cells.

Gonococcal adherence was studied in vitro using buccal epithelial cells (BEC). In smears stained with the Gram method, a progressive decrease in gonococcal adherence to the BEC after some culture passages was observed. There was a parallel decrease to almost total disappearance in the number of fimbriated bacteria. An electron microscopy study showed that adherence to the epithelial cells was mediated by fimbriae and, in part, by a polysaccharide component of the bacterial cell wall which seems to guarantee persistent adherence ability, even after the loss of fimbriae.

[Seroepidemiology of HIV-1 and HIV-2 in the USSL 76 area--Casale M.To. Preliminary study]. / Sieroepidemiologia di HIV-1 ed HIV-2 nell'area dell'USSL 76--Casale M.to. Studio preliminare.

The reported results show a prevalence of HIV-1 antibodies in drug addicts by ELISA and Western Blot. In this case report the presence of persons (drug addicts) whose sera have antibodies to HIV-1 and HIV-2 by ELISA and Western Blot advise that further epidemiological studies are necessary to assess the real HIV-2 circulation in Italy.

[Imported malaria. Clinico-epidemiologic and therapeutic observations]. / Malaria d'importazione. Osservazioni clinico-epidemiologiche e terapeutiche.

The authors notice a prevalence of P. falciparum in eight observed cases of imported malaria and confirm the increasing polychemioresistance of plasmodium and its prophylactic and therapeutic problems.