[Microbial spectrum and microbiological diagnosis of infectious endocarditis]

Still streptococci play the most important role as causatives of infective endocarditis. As change in composition of patient groups has taken place gradually pathogens like Staphylococcus epidermidis, enterococci, gram-negative rods and Candida species become more and more important now. Providing high-level accuracy if applied according to current rules blood culture is yet the basis for endocarditis caused by popular bacterial pathogens. If infection due to Candida species is suspected additional measuring of antibody response may be helpful in supporting the tentative diagnosis. Rare pathogens like Rickettsiae and Mycoplasma sp. must be considered for differential diagnosis, as infections caused by these organisms are to be identified by serological methods in first line.

[Clinical-parasitological experiences in Cameroon]

Clinical-parasitological experiences collected 1989 in Cameroon during a 6-weeks lasting medical work are reported. Malaria tropica is by far the greatest problem due to the impossibility of an effective epidemiologic control, further to rising drug resistances. Beside malaria there are plenty of other parasitoses, but they are more restricted to lower social groups and to certain geographic regions--to the extreme Northern part of Cameroon in particular. Furthermore the actual situation depends also from epidemiologic control programmes. So the trypanosomiasis seems to be under epidemiologic control, the onchocerciasis in opposite to it has been increased again due to the absence of an effective control programme at present.

Infective endocarditis at a hospital of the University of Kiel, 1958-1987

The clinical courses of 214 patients with infective endocarditis treated between 1958 and 1987 at the First Medical Hospital of the University of Kiel (FRG) were analyzed retrospectively. A decrease in the incidence of endocarditis occurred during the 30-year observation period. The mean age of patients was 48 years, and men were more frequently affected than women. In the course of the investigation, a rise in isolated aortic valve disease was noted, whereas the number of patients with isolated involvement of the mitral valve and combined mitral-aortic valvular defects declined. Streptococci (57%) were the most frequent pathogens isolated; as opposed to their increase, the percentages of Staphylococcus aureus and enterococci decreased. Otolaryngological, dentogenic and urogenital diseases were most frequently held to be responsible for the development of infective endocarditis. Prior cardiosurgical interventions became increasingly significant as a cause of the disease. In this connection, a rising percentage of endocarditis cases was linked with prosthetically replaced heart valves. Complications and concomitant symptoms of endocarditis included the development of heart failure, cerebral embolism and encephalitis, splenomegaly, and renal inflammation. Finally, the marked decrease in mortality contrasted with a simultaneous rise in the number of endocarditis cases achieving full recovery.

Alcohol withdrawal syndrome--an auto-immune disease? A neuroimmunologic model for pathogenesis of alcohol withdrawal symptoms

A neuroimmunologic model of alcohol withdrawal symptoms is developed according to which these may be considered as an idiopathic auto-immune disease. During the alcohol abuse period of non-addicts, homeostasis may alter pathologically by gradual adaptation of the organism: auto-sensitisation develops and finally leads to the breakdown of auto-immune tolerance of the structural modifications set by alcohol withdrawal. The immunosystem regards the existing assimilation of alcohol as self, the withdrawal of alcohol as non-self. Alcohol withdrawal may be considered as an acknowledged physical stressor, and physical stressors as potential triggers of auto-immune diseases. Some so-called alcohol-induced diseases may originate in the pathogenic effects of preceding auto-immune responses to repeated alcohol withdrawals. Neuroimmunologic preconditions of potential auto-immune diseases exactly fit the alcohol withdrawal situation. Neuroimmunologic diseases themselves show close analogies respectively to alcohol withdrawal symptoms as well as to some alcohol-induced diseases. The myelin basis protein is assumed to be a potential auto-allergen. Finally withdrawal symptoms being the expression of physical dependence on alcohol, the model may highlight the very nature of physical dependence.

[Results and experiences with several methods for the immunodiagnosis of amebiasis]

Results and experiences of some immunodiagnostic methods for amebiasis. Experiences concerning the laboratory diagnosis of invasive amebiasis are described and discussed. Technics used include the Passive Hemagglutination Test with E. histolytica antigen (Behring FRG) and sheep erythrocytes as carrier and the Indirect Fluorescence Antibody Reaction (IFAR) with corpuscular antigen prepared from cultures of E. histolytica strain HK 9. Comparatively for a part infected hamster liver (Dr. Richle strain) has been used as antigen. We conclude that IFAR with HK 9 antigen is more sensitive than the other tests. It has been proved useful in the diagnosis of extraintestinal amebiasis (antibody titer greater than or equal to 1:160).

Influence of Ly146032 on chemotaxis, chemiluminescence of PMN and lymphocyte transformation in vitro

The influence of Ly146032, a new acidic lipopeptide, on chemotaxis, luminol-dependent chemiluminescence of human polymorphonuclear leukocytes (PMN) and phythemagglutinin induced lymphocyte transformation of murine cells was investigated. At therapeutic range there was no remarkable effect on the parameters tested. Incubation with more than 20 mg/l Ly146032 was followed by depression of chemiluminescence, whilst transformation of maximally PHA stimulated lymphocytes was suppressed by more than 32 mg/l Ly146032.

Field studies towards intestinal helminthoses from north Ethiopia (1982) by means of microscopic and seroimmunologic methods

In two villages of north Ethiopia (Gorgora and Zerema) helminthologic stool analyses were performed and compared with seroimmunologic examinations. Regional difference could be obtained. The infection rate of males was slightly higher than that of females (except Schistosomiasis in Gorgora). Ascaridiasis, Ancylostomiasis and Trichuriasis are probably life-long accompanying parasitoses--they were slightly more frequent in higher than in lower age in Zerema--in contrast to Schistosomiasis which was slightly more frequent in younger people (differences not significant, likely due to the small number of examined persons). Toxocariasis in man is probably not very common in this region. The values of such pilot studies and of seroimmunologic findings for epidemiologic field investigations are discussed.

Complex control of schistosomiasis

The main problems of complete Schistosomiasis control in endemic areas are eradication of intermediate host snails, large-scale treatment and health education of the population. Health education seems to be the most important factor in maintaining the standard of control. The introduction of very cheap, effective and fast screening methods and the development of very efficacious and easily applicable drugs have made large-scale treatment one of the most important methods of epidemiological combat. The eradication of snails has lost importance, with chemical and, to a growing extent, biological means of snail control becoming the focus of interest. In view of recent success in combating Schistosomiasis, it can be assumed that this disease will cease to be a major threat to public health in endemic areas.

Active extrusion of protons into deionized water by roots of intact maize plants

The investigations were focussed on the question as to whether roots of intact maize plants (Zea mays L. cv Blizzard) release protons into deionized H(2)O. Plants in the six to seven leaf stage depressed the pH of deionized H(2)O from 6 to about 4.8 during an experimental period of 4 hours. Only one-third of the protons released could be ascribed to the solvation of CO(2) in H(2)O. The main counter anions released were Cl(-), NO(3) (-), and SO(4) (2-). At low temperature (2 degrees C), the H(+) release was virtually blocked while a relatively high amount of K(+) was released. The presence of K(+), Na(+), Ca(2+), and Mg(2+) in the external solution increased the H(+) secretion significantly. Addition of vanadate to the outer medium inhibited the H(+) release while fusicoccin had a stimulating effect. Substituting the nutrient solution of deionized H(2)O resulted in a substantial increase of the membrane potential difference from -120 to -190 millivolts. The experimental results support the conclusion that the H(+) release by roots of intact maize plants is an active process driven by a plasmalemmalocated ATPase. Since the net H(+) release was not associated with a net uptake of K(+), it is unlikely to originate from a K(+)/H(+) antiport.

Remarks on gastroenterologic diagnostics of amoebic liver abscess, peritoneal tuberculosis and tropical splenomegaly

The amoebic liver abscess, the peritoneal tuberculosis and the "tropical splenomegaly" belong to diseases which are frequent in warm countries but single cases appear also in moderate climate by intercontinental communications. False diagnoses especially in the first both can lead to severe rsp. fatal consequenses. Therefore experiences are dealed with, which have been gained within nearly one year in Ethiopia and which shall illustrate the diagnostic procedures under field conditions in warm countries as well as under conditions of modern hospitals in moderate climates. Amoebic liver abscess is quickly detected and confirmed by sonography and immunodiagnostic. Contrary to it in the fields there is the puncture by means of a i. v.-needle often not only the sole diagnostic but also the first and sometimes life-saving therapeutic procedure in advanced cases. It allows X-ray in double contrast technique if equipment is available. In suitable cases such approved technique shall be used also in modern clinics disposing of methods like sonography and computerized tomography. Concerning peritoneal tuberculosis our examinations agreed with the opinion of literature that the laparoscopy seems to be the most suitable method for quickly detection and safe discrimination from decompensated portal hypertension in liver cirrhosis. By the way the "cope needle" are mentioned which is distributed in warm countries for searching for peritoneal tuberculosis by performance of a blind peritoneal biopsy. It is easier than laparoscopy but not so efficient. - In this connection 31 cases examined by laparoscopy are presented in a table in order to give an impression on further indications to laparoscopy existing in such areas of warm countries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Current status of malaria in Ethiopia]

During the least years also in Ethiopia the number of cases of malaria increased despite intensive control measures. There does not yet exist a chloroquine resistance, but, however, special attention must be paid, since it became known from other East-African countries that there were chloroine resistances. DDT has a still sufficient effect. The most important carrier anophelines are A. gambiae S. 1, A. pharoensis, A. funestus and A. nili. M. tropica and M. tertiana nearly exclusively occur. The severest lesions are caused by M. tropica, when it affects malnourished population groups. In contrast to other descriptions a risk of malaria is temporarily existing also at an attitude of more than 2,000 m, though it is here clearly more insignificant than in lower regions. a seasonal accumulation is found from September to November. In contrast to the high rate of incidence of the native population in endemic districts the number of diseases GDR citizens in Ethiopia was extremely low in recent years. Chloroine is further on recommended for medicamentous prophylaxis.

[Assessment of late complications of malaria in travelers to the tropics]

Irreparable late lesions after a malaria infection are rare. They occur mainly after infection of tropical malaria. As ascertained late lesions are regarded cerebral disturbances, e.g. epilepsy after cerebral tropical malaria, cardiac disturbances, e.g. arrhythmia after cardiac tropical malaria and chronic renal insufficiency after quartan malaria. Chronic liver diseases, e.g. cirrhosis, are not known as ascertained late lesions of malaria. Bodily lesions may be recognized by experts as malaria-depending, when kind and form of the course of malaria may be considered as cause meanwhile appearing symptoms anticipate a connection and other causes were excluded with regard to these lesions.

[Problems in the differential diagnosis of intestinal diseases in patients who have traveled in the tropics]

Taking into consideration the increasing intercontinental tourist traffic we are in an increasing degree confronted with diseases which above all or exclusively acquired in warm countries. Besides the diseases which occur in our country they must find differential diagnostic consideration in disturbances of the health. On account of their frequency gastrointestinal disturbances they are essential for these travellers. On the basis of the following instances of diseases problems of the differential diagnosis and the evaluation of findings are shortly demonstrated: colon amoeboma; colon carcinoma; colon polyposis; ascaridasis; lambliasis; trichuriasis, affection with fasciola hepatica; affection with fasciolopsis buski; schistosomiasis intestinalis. It is referred to peculiarities in inhabitants of the tropics who transitorily live in our climatic zone.

[Hyperlipoproteinemias in diabetes mellitus]

Among 200 diabetics 63 patients (31.5%) with primary and 44 patients (22%) with secondary hyperlipoproteinaemias were found. The secondary hyperlipoproteinaemias belonged to the types IV and V, the primary hyperkipoproteinaemias to the types IIa, IIb, IV and V. In primary hypercholesterolaemias (IIa, IIb) the retinopathia diabetica by far more frequently occurs than in primary hypertriglyceridaemias.