Serological investigation of the prevalence of anti-dengue IgM and IgG antibodies in Attapeu Province, South Laos.

The prevalence of dengue antibodies was determined in the Attapeu region of South Laos with 225 blood samples collected from mostly febrile patients during the rainy season August - October 2001. An IgM capture ELISA was positive for one (0.4%) sample, while 177 (79%) samples were positive in an indirect IgG ELISA. Of the positive IgG samples, 20 (11.3%) were also positive on blood slides for Plasmodium falciparum. Dengue fever seems to be widespread in this area, but clinical dengue diagnosis remains difficult, especially in the first days of illness when physicians have to discriminate between dengue and other febrile illnesses.

Prophylaxis failure due to probable mefloquine resistant P falciparum from Tanzania.

Failures of mefloquine prophylaxis in travellers returning from Africa have been reported repeatedly. Non-compliance to chemoprophylaxis is considered to be a major factor for failure. Only few reports on mefloquine prophylaxis failure in sub-Saharan Africa were able to report blood levels of the drug that were sufficient for prophylactic effectiveness. We report the case of a 44-year-old German female who travelled to Tanzania for 3 weeks. The patient reported that she never missed a dose of mefloquine during her weekly prophylaxis schedule. Four weeks after returning from Tanzania, the patient presented with fever, headache and myalgia. Only a few trophozoites of Plasmodium falciparum were found in a thick film. Blood levels of mefloquine at that stage were at 1400 ng/ml, thus largely excluding non-compliance and malabsorption. To our knowledge, this is the first case of confirmed prophylaxis failure due to mefloquine resistance in East Africa.

[Changes in the antibiotic sensitivity of urinary tract pathogens (author's transl)]. / Anderung der Empfindichkeit von Harnkeimen auf Antibiotika

The resistance of 2,314 bacterial strains from 1968 to 1972 was investigated drawing on case histories from the Munich University Urological Clinic. Using the disc-diffusion method 12,160 sensitivity tests were conducted with these strains against gentamicin, co-trimoxazole, ampicillin, tetracycline and chloramphenicol. The material was compiled from 35,000 individual data by means of modern electronic data processing and evaluated according to variable criteria. As expected the incidence of resistance in hospital-acquired pathogens was considerably higher than that in community-acquired pathogens; however, the resistance pattern of hosptial-acquired pathogens remained essentially unchanged from 1968 to 1972, whereas a significant increase of resistance in community-acquired infections was recorded. It can thus be concluded that the methods used in this clinic for combatting hospital infection and a more critical attitude towards anti-bacterial therapy have had positive results. An express warning is issued against unspecific antibacterial therapy which is often administered outside the clinic on the pretext of long-term therapy. In the light of the resistance situation of urinary tract pathogens, antibiotics should be used sparingly, keeping in mind the acidification of urine and the wash-out principle by means of high fluid intake.

Home based care in Kabarole District; Uganda

A district-wide; home-based care program was designed and implimented in Kabarole district (population 750;000); Uganda; to provide basic medical care; counselling and home-making services for the patients in their homes. The rationale for this program was to ease the economic burden of hospitalization for the patient's families; to facilitate treatmemt in remote areas without a health station and to reduce hospital congestion. All health agencies in the district participated with their own resources under the directive of the district medical officer. Ninety-five percent of patients treated by the programm were diagnosed with AIDS. Two years after the home-based care program was initiated;15 percent of all expected AIDS patients in the district were served. The home-based care teams were evaluated and found to provide satsfactory client assessments and care interventions. Weaknesses were identified to be program planning and organizational links to other district health programs. Average cost per home visit was 489 Ugandan shillings (40US cents) and average cost per AIDS case was 64;000 USH (53US dollars). Eighty percent of clients surveyed were satsfied with the program and reported that the home-based care staff were capable of solving medical problems and reducing ther psychological strain