The chest radiograph in leptospirosis in Jamaica

A consecutive series of 44 patients with proven leptospirosis was studied to document the radiographic pulmonary abnormalities, assess their prevalence, correlate them with the clinical signs amd symptoms and determine their prognostic significance. Abnormalities were found in ten patients (23 percent), this prevalence being less than previously noted. The abnormalities shown were non-segmental opacification (consolidation-eight cases), basal linear opacities (collapse-five cases) and pleural effusions (four cases). The first radiographic demonstration of a large pleural effusion in leptospirosis is recorded. Non-jaundiced patients had a higher prevalence (43 percent) of these abnormalities than jaundiced (13 percent). No other correlation with clinical signs or symptoms was found. The presence of these abnormalities had no prognostic significance. It is concluded that the presence of radiographic pulmonary abnormality in in-patients with leptospirosis is common. These abnormalities are non-specific and can mimic other diseases leading to diagnostic difficulty. Such abnormalities may be extensive in the absence of clinical signs and symptoms. (AU)

Symptoms and clinical and laboratory findings in 123 cases of Schistosomiasis mansoni in St. Lucia

The presenting symptomatology and clinical and laboratory findings in 123 patients, referred to a clinic for the treatment of schistosomiasis mansoni, are reported and discussed. Thirty-three patients (26.8 per cent) had no complaint when seen initially. The complaints of the others, in order of frequency, were abdominal pain, weakness, diarrhoea (with or without blood in faeces), giddiness, anorexia, dyspnoea and fever. The mean faecal egg load of patients with bloody diarrhoea was not significantly higher than that of patients with diarrhoea alone. Eighteen patients had clinical enlargement of the liver (14 or 11.4 percent) and of the spleen (4 or 3.2 percent) which could be ascribed to schistosomiasis. Hepatosplenomegaly in three other patients as ascribed to other conditions. The mean faecal egg concentration was significantly higher in patients with hepatosplenomegaly than in those with hepatomegaly alone. Ranges and mean values of haemoglobin and eosinophilia are given by age group. Alteration in plasma proteins was found in patients who had spleen and/or liver enlargement, the latter group having a reversed albumen/globulin ratio which, in the two instances in which electroporesis could be carried out, was found to be the result of a tremendous increase in the gamma globulin fraction.(Summary)

Suppressive treatment of schistosomiasis mansoni with spaced doses of lucanthone hydrochloride

From 60 children infected with S. mansoni who started treatment on 500 mg. lucanthone hydrochloride a week for 10 weeks, 49 were observed for 26 weeks and 20 for 10 weeks longer. At the end of treatment a mean reduction in egg output of 83.4 percent had been obtained, but this increased to 89.5 percent at the 14th week and remained at this level through the 26th and 36th weeks. An overall parasitological "cure" rate of 36.7 percent was recorded but all "cures" came from the group of 27 children who had initial egg loads of less than 10,000 per whole stool. The mean reduction in egg output was, however, essentially the same irrespective of initial egg load. Two smaller control group given ferrous fumarate and observed over the same period; showed significant increases in egg output by the 26th week of the observation period; the mean egg load increased from 0 to 1,900 per stool in one group and from 6,300 to 9,500 per stool in the other. There were no side effects; the drug was given by a nurse (Summary)

Yaws control: report of a mass juvenile sweep in St. Lucia

In 1963 one pocket of high yaws remained on St. Lucia, 533 new cases being notified in that year from a total population of approximately 9,000 people. 77 percent of these cases occurred in children under the age of 15 years and consequently a mass juvenile sweep with treatment of all cases and contacts was made late in 1964. Because of differing environmental circumstances, the District was divided into urban, Dennery Village, and rural, Richfond Valley, sections. The findings during the sweep have been analysed separately for the two sections and different age distribution patterns were noted although the sex and lesion distributions were similar. In all, 3,422 children were examined and treated and 294 clinically evident cases were found. The prevalence rates were 131.7/1,000 children examined in the Valley and 35.1/1,000 in the Village. Serological testing of 157 children from both areas indicated a latency rate of 23 percent in children who were not exhibiting clinical evidence of active disease at the time of examination. Following this juvenile sweep, one case was notified from the District in 1965 and two cases were notified in 1966 (AU)

Trial of an enteric-coated preparation of lucanthone hydrochloride in Schistosoma mansoni infection

Standard 250 mg. tablets of luncanthrone hydrochloride were coated with acetate phthalate and given to 50 out-patients suffering from S. mansoni infections with pre-treatment egg loads of up to 75,000 per 24 hours. The purposes of the trial were to assess this oral preparation, which proved to have a low incidence of side effects, was widely accepted by the patients, and was efficient enough for use within a schistosomiasis control programme. At the end of the 12 weeks, 16 patients were classed as "cured," but a mean overall reduction in egg output of 81.5 percent was obtained. 18 patients had completed 26 weeks of follow-up at the time of writing. The "cure" rates and mean percentage reduction in egg output obtaining at 12 weeks were maintained during this extended period. The recorded side effects were few compared with those encountered with the ordinary tablet (24 percent vs. 90 percent) and were minimal, nausea being the commonest. There were no cases of vomiting although this occurred in 41 percent with the uncoated, standard tablet in an earlier series (Summary)

Malnutrition: the infant at risk

Following the reduction in the number of deaths from malnutrition in young children in St. Lucia, a simple survey was conducted to define the socio-economic factors, if any, having a role in the aetiology of the condition. The survey was conducted among the families of 42 unselected cases which were found in the northern third of the island during the period of the survey. Both urban and rural areas were involved. Almost all of the cases came from the lowest social group but it was found that, within this group, the household per capita income was of no significance as a causative factor. Three main factors, which would define the "at risk" child, were found: a) illiteracy in the mother, b) the working mother and c) previous family history of malnutrition or death of a child under the age of two years. One or more of the factors a) b) or c) was present in 85.6 percent of the cases studied and all three factors were present in 33.3 percent. These three criteria of risk will enable the Public Health Nurse to defect the infant (even before his birth) who is susceptible to developing a state of severe undernutrition and will enable her to select the mothers on whom her health educational effort should be intensified remembering that, with the illiterate mother, special techniques and patience will be necessary (AU)

Lucanthone hydrochloride in the treatment of Schistosoma mansoni infection

Most reports on lucanthone hydrochloride in the treatment of schistosomiasis have come from Africa and have recorded the efficiency of the drug against infection with S. hematobium. In St. Lucia, British West Indies, S. mansoni infection is prevalent but no cases of S. heamotabium have ever been noted. The trial of lucanthone hydrochloride was conducted for two reasons:- to assess the theraputic effacacy of the drug when used against the St. Lucian strain of S. mansoni (strain variations have been noted between different areas of the world and between countries lying close to each other), and to evaluate its possible suppressive or theraputic use within a program of schistosomiasis control on the island (Summary)

S. Mansoni and other Helminthiasis within one watershed in St. Lucia

A small survey was undertaken among school children living within the Cul-de-Sac watershed to ascertain the prevalence of infection with S. mansoni; concurrently the prevalence of infection with N. americanus, A. lumbricoides and T. trichiura was record fed. Using a faecal concentration technique on a single faeces sample, the prevalence of S. mansoni among 640 children between the ages of 4-14 years was found to be 45.9 percent but the rate in different localities varied from 11.2 percent to 73.5 percent; an attempt was made briefly, to relate the prevalence of invection to the topography, hydrology and agricultural practices of the five locallities under consideration. The rates of infection with the other helminths were found to be: N. americanus-31.4 percent, A. lumbricoides-61.4 percent and T. trichiura 69.1 percent. Extension of cultivated land and the introduction of improved agricultural methods are creating conditions favourable to the spread of schistosomiasis. The recent extension of this disease from the vicinity of the town of Soufriere to almost all parts of the island, and the fact that children are most prone to acquire the infection which is generally of a chronic nature exerting its effects after a period in excess of 15 years, has prevented the full impact of the disease being felt up to the present time (AU)

Malnutrition: the pattern and prevention in St. Lucia

The problem of malnutrition is discussed with particular reference to St. Lucia where it is a disease of children under the age of 3 years and where 86 percent of the cases occur in children between the ages of 4 and 24 months; the peak incidence is found between 10 and 15 months. A programme directed at the prevention of malnutrition was begun in December 1962 and, after only one year in operation, the annual deaths had fallen by 42.5 percent; more striking was the comparison of the deaths in the last 5 months of 1963 and 1962 where there was a reduction of 62 percent in the deaths in 1963 compared to those of 1962. This is almost certainly due to the fact that some time must elapse before public acceptance of such a project can be fully obtained, as is indicated by the numbers of infant beneficiaries each month of 1963 and shown in Table II. It is the author's opinion that malnutrition can be prevented, in the Eastern Caribbean, only by education but the distribution of free skimmed milk powder is a most useful weapon, not only to assist the education programme, but to achieve a rapid reduction in the mortality if it is used wisely by the Medical Authorities (AU)

Skin disease in school children in St. Lucia

A survey of skin diseases conducted in a rural and urban school is reported and comparisons between the incidence of each disease in two groups are given. In all 1,239 children were examined, 641 from the rural and 598 from the urban school; the incidence of skin disease was found to be 27 percent and 17.4 percent respectively. In conditions appearing in both schools, only in the case of impetigo was the incidence found to be higher in the urban children. Social economic and environmental conditions are probably all implicated in determining the results found in this survey. We have attempted only briefly to explain the part played by each since the idea behind this paper is merely to present the findings obtained, and not to attempt to give a detailed explanation of them (AU)

Review of yaws in St. Lucia five years after an eradication campaign

The incidence of yaws infection in a community is discussed with reference to the 10-year period 1954-1963 during which time (1957) a campaign was operated to attempt the eradication of yaws from the island of St. Lucia. Recent figures of notification show that during the past three years the incidence of infection has been increasing following a period of reduced activity after the 1957 campaign. A survey was conducted among 1,314 children, between the ages of 4-15 years, attending two schools in rural areas of the island. The results of this survey revealed an incidence of early yaws lesions of 46/1,000 and 13/1,000 in these two schools while the notification rates, for the communities of these areas as a whole, were 23.1/1,000 and 3.6/1,000 respectively (AU)