Cercarial dermatitis contracted via contact with an aquarium: case report and review.

Cercarial dermatitis ('swimmer's itch') is an itchy inflammatory response to the penetration of the skin by non-human Schistosoma parasites. It is commonly contracted while swimming or wading in lakes. We report a biology teacher who developed the dermatitis after cleaning the school aquarium in which he kept a water snail and some fish.

The past and present role of the Sabin-Feldman dye test in the serodiagnosis of toxoplasmosis.

The dye test for the detection of Toxoplasma-specific antibodies was first described by Sabin and Feldman 50 years ago. The test is highly specific and sensitive and considerable information is available on the development and persistence of dye test antibodies after primary Toxoplasma infection. However, the test uses live Toxoplasma gondii and is now only employed in a few laboratories. It is still the reference method for the serodiagnosis of toxoplasmosis, and a multicentre study comparing dye test results between different laboratories was much needed. We report in this article the results of a multicentre evaluation of the test involving nineteen laboratories in eight countries. The study revealed overall satisfactory standardization between the laboratories, but there were differences in the test protocols, the use of reference/standard preparations and the interpretation of results. There is still no agreement on the level of dye test values which reflect infection with the parasite, and conversion from titres to international units (IUs) did not improve standardization. However, the results indicated that a value of > 4 IU or a titre of 1:16 met the definition of positivity of most participants. We recommend that the dye test be retained as a reference method and that interlaboratory standardization be improved by the use of a common protocol and the expression of results in titres.

High predictive value of Toxoplasma gondii IgG antibody levels in HIV-infected patients for diagnosis of cerebral toxoplasmosis.

The results of serological tests for Toxoplasma gondii IgG in 31 HIV-infected patients with toxoplasmic encephalitis (TE) and 49 HIV-infected patients seropositive for Toxoplasma gondii but without TE were compared. All patient had a CD4+ lymphocyte count < 150/microliters. Of the TE patients, 22 (71%) were designated as having relatively high IgG levels on the basis of the following Toxoplasma IgG titre combination: Sabin-Feldman test > or = 1:256, indirect hemagglutination test > or =1:1024, direct agglutination test > or = 1:14,580. Only 3 patients without TE had relatively high IgG titres. Relatively high IgG titres indicated TE with a positive predictive value of 88% in HIV-infected patients with CD4+ cell counts < 150/microliters, and could be observed in most patients several months prior to the first clinical and radiological signs of TE.

[Cercaria dermatitis (swimmer's itch). Case report of cercaria dermatitis caused by Trichobilharzia (Digena, Schistosomatidae)]. / Zerkariendermatitis (swimmer's itch). Fallbericht einer Zerkariendermatitis durch Trichobilharzia (Digena, Schistosomatidae).

A 63-year-old woman developed a pruritic exanthema on the extremities after one hour of work in her garden pond in Planegg, Southern Bavaria. As the appropriate vectors (ducks and snails) were present, we made the tentative diagnosis of cercarial dermatitis (swimmer's itch). By different serological methods (cercarial fluorescent antibody test, cercarial Hüllen reaction, circumoval precipitin test) antibodies against cercariae could be demonstrated in the serum of the patient 14 days later. Cercarial dermatitis appears worldwide, but in Central Europe the disease is often not recognized.

Ectopic enterobiasis: a case report and review.

Enterobius vermicularis ('pinworm') is rarely found outside the gastro-intestinal tract. We describe a case of extra-intestinal pinworm abscess associated with an inguinal hernia in an adult. A brief review of the literature is given and possible mechanisms of tissue invasion are discussed.

Intraocular in vivo immunofluorescence. A new technique for visualizing structures of the ocular fundus.

A new noninvasive technique for observing structures in the living eye has been developed: the technique is based on intravenous application of specific antibodies, labeled with fluorescein. The immunologically marked substructures of the fundus of the eye, the only transparent organ in mammals, are photographed directly using high speed film. Combined with a digital image processor to enhance low contrast contours, this technique can be used for diagnostic purposes, as shown in rabbits with experimental toxoplasmic chorioretinitis.

[Autochthonous pulmonary dirofilariasis in Europe]. / Autochthone pulmonale Dirofilariose in Europa.

The chest X-ray of a 39-year-old woman who had an acute onset of fever, cough, dyspnoea and thoracic pain revealed two peripheral round opacities (about 1.5 cm in diameter) in the right lower lobe. Extensive further studies having failed to discover the cause, a diagnostic thoracotomy was performed and the two pleura-adjacent tumours were removed. Histological examination revealed granulomatous encapsulated filariae, species Dirofilaria immitis. This was confirmed by a positive ELISA test with Dirofilaria immitis antigen. As the patient had been on holiday in Corsica three months before onset of symptoms, it is most likely that the pulmonary dirofilariasis was acquired autochthonously in Europe.

[Disseminated histoplasmosis after a tropical visit in a patient with known sarcoidosis]. / Disseminierte Histoplasmose nach Tropenaufenthalt bei bekannter Sarkoidose.

A 40-year-old man with grade II sarcoidosis went on a two-week visit to Ecuador. Afterwards he was treated with low-dose corticosteroids because of slight deterioration on the X-ray film. Unilateral hilar enlargement followed by bouts of high fever and a greatly increased erythrocyte sedimentation rate, suggested an acute exacerbation of the sarcoidosis and was, therefore, treated with an increase in steroid dosage plus azathioprine. Bronchoalveolar lavage fluid and tissue samples from lung, bone-marrow and spleen were suggestive of an infection with Histoplasma capsulatum. There was now bilateral hilar enlargement with right upper lobe infiltration, marked hepatosplenomegaly and thrombocytopenia (17,000/microliters), but serological tests remained negative. The fulminant course with dissemination could not be arrested despite administration of fluconazole (400 mg/d) and amphotericin B (total dosage 1.14 g). Histoplasma capsulatum was cultured from lung and spleen tissue post-mortem.

[Tarsonemus hominis in skin connective tissue]. / Tarsonemus hominis im Hautbindegewebe.

Histological examination of a skin biopsy from a 30-year-old male patient which had been performed because of a naevus-like lentigo revealed the presence of a mite within the upper part of the corium. To our knowledge, this may be the first description of such a finding. This mite was identified as a subspecies of Tarsonemus hominis Dahl. Basically, the possibility of a transport of viral material in this way cannot be excluded.

[Investigations on periodic phenomena in the snail Biomphalaria glabrata (author's transl)]. / Versuche zum periodischen Verhalten von Biomphalaria glabrata.

A method was developed to measure the locomotive activity of Biomphalaria glabrata over long periods of time. A snail, radioactively marked with a Co57-source, moves on a circular path. Beneath the experimental vessel a lead disc with a slit revolves (one revolution per minute) over a counter tube. Once every minute the amount of radioactivity emitted falls through the slit onto the counter tube. The position and thence the locomotive activity of the snail is determined from the intervals between the impulses. Under constant conditions the experiments show a distribution of crawling activity over the whole day that is the same for animals infected with Schistosoma mansoni and non-infected molluscs. The snails have more locomotive activity by day than by night, with a distinct maximum in the second hour after exposure to light. Experiments using food marked with I125-labelled fibrinogen revealed that feeding activity is three times as high at night as by day. The experiments also show that Biomphalaria glabrata tends to prefer night-time for egg laying. The results are compared with other known periodic phenomena in B. glabrata in a phase-chart.

[The diagnosis of amebic liver abscesses. A study of 107 cases (author's transl)]. / Zur Diagnose des Amöben-Leberabszesses. Eine Studie an 107 Fällen.

We have investigated the serum antibodies of 107 patients with extra-intestinal amebiasis and 72 control subjects without demonstrable infection with E. histolytica. It was shown that by means of countercurrent immuno-electrophoresis and indirect hemagglutination scintigraphy and taking into consideration the clinical picture, the diagnosis of extraintestinal amebiasis can be made with the necessary high degree of probability.

[Echinococcosis.--Current problems of diagnosis and epidemiology (author's transl)]. / Echinokokkose. Aktuelle Probleme der Diagnose und Verbreitung.

The indirect hemagglutination-test (IHA) and the indirect immunefluorescence-test are two modern methods for the serological diagnosis of an echinococcosis. If both tests are employed, the disease can be diagnosed with great reliability. A titer of 1 : 128 in the IHA makes the diagnosis of an echinococcosis very likely; a titer exceeding 1 : 1000 is significant. Serological tests of 36 patients with E. cysticus and E. alveolaris are evaluated; the interpretation of the results is discussed. In all patients the diagnosis was established between October 1977 and October 1978. In Germany the complement fixation test is commonly used to diagnose an echinococcosis. This test, however, is unreliable and fails in one third of all cases. It should be--as well as the Casoni skin-test--replaced by more sensitive and specific reactions. If the complement fixation test is positive, it might be used for postoperative controls. Compared to previous years the disease-rate among Germans is rising. The main reason seems to be the increasing tourism to foreign countries. Serological tests in small laboratories are unreliable and make an evaluation difficult. The diagnosis should be established in specialized centres.

[Cryosurgery in the treatment of Echinococcus alveolaris. Animal experiments]. / Kryochirurgie in der Behandlung des Echinococcus alveolaris. Tierexperimentelle Untersuchungen.

The influence of cryosurgery on echinococcus alveolaris is studied in 100 mice. In a second series cryosurgical effects on structures of the hepatic portal (hepatic artery, portal vein, hepatic duct) were examined. The experiments showed that echinococcus alveolaris can be devitalized by cryosurgical measures at temperatures between -100 degrees C and -190 degrees C. No damage of the hepatic artery, portal vein, and hepatic duct occurred. Clinical application of cryosurgery for the treatment of inoperable echinococcus alveolaris of the hepatic portal appears to be justified.

[Experimental studies on the affinity of Toxoplasma gondii to various organs of mice (author's transl)]. / Tierexperimentelle Untersuchungen zur Organaffinität von Toxoplasma gondii.

In response to their alleged "uterus affinity" the organotropism of various Toxoplasma strains was investigated in the female mouse. Using quantitative histological (immunofluorescence) and serological (Sabin-Feldman-dye test, complement fixation test), we examined the brain, heart, lung, spleen, striated muscle, uterus and ovaries. The following results were obtained: All four of the Toxoplasma strains (ALT, DX, WEISS, GAIL) showed a definite neurotropism. Located in the brain were one hundred times as many cysts as in the sexual organs and ten times as many as in the reamining organs. The uterus and ovary show a low susceptibility, invasion rarely occuring. An "uterus affinity" could not be confirmed. All four Toxoplasma strains showed the same affinity for the various organs. The strain ALT showed the most virulence and formed the most cysts.

A method of mass cultivation of Toxoplasma gondii in cell culture.

Large quantities of Toxoplasma gondii were cultivated in human larynx carcinoma cells (H.Ep 2, heteroploid). Virulent Toxoplasma gondii, strain RH, which were obtained from the peritoneal exsudate of mice 2 days after infection served as inoculum. As culture medium for the cells and for growth medium, Minimum Essential Medium (MEM) supplemented by 5% foetal calf serum and 200,000 IE/1 Penicillin plus 20 mg/1 Sulmycin was used. 2--3 days after inoculation, 150--200 times the amount of the inoculated Toxoplasmas could be harvested in one or several harvests.

An automatic method for recording the emergence of cercariae of Schistosoma mansoni from the snail Biomphalaria glabrata.

In order to study the pattern of emergence of trematode larvae from the snail hosts (S. mansoni from B. glabrata) an automatic apparatus was developed. This apparatus allows the snails, each suspended by a thread, to be transported at intervals of at least half an hour into different beakers into which the cercariae are shed. This "eclosion clock" is essentially a carriage driven on perlon wheels along steel bars.