The effect of isatin on the Echinococcus granulosus cyst in an experimental host

The effect of isatin on the E. granulosus cyst was studied. NMRI mice, which were infected with E. granulosus of sheep origin, were treated daily with isatin at a dose of 50 mg kg-1 for 18 days. Ultrastructural damage was observed in the treated cysts, including accumulation of lamellar stacks, electron-dense granules, autophagosomes and lipid vesicles. Moreover, a biochemical study showed an inhibition of alkaline phosphatase activity, with a decrease in carbohydrate storage and an increase in acid phosphatase activity. In spite of the short duration of the treatment, the results obtained allowed us to conclude that isatin acts on E. granulosus cysts. This activity appears as a process of degeneration linked to the alkaline phosphatase inhibitory effect of isatin.

Evaluation of a Candida antigen detection test (Cand-Tec) in the diagnosis of deep candidiasis in neutropenic patients

The diagnostic efficiency of a serum Candida antigen detection test Cand-Tec test) was prospectively investigated in 104 leukemic patients treated by intensive chemotherapy or allogeneic bone marrow transplantation. Candida antigen titers were determined on admission and then weekly as long as patients remained neutropenic. Nine patients had a proven disseminated yeast infection (diagnosed only at autopsy in five cases). The highest Candida antigen titers were 1:2 in two patients and 1:4 or more in seven patients (sensitivity: 76% for this last titer). This highest titer was observed 12 days before to 3 days after the diagnosis. Seven out of the 97 patients without proven deep candidiasis had a maximum titer of 1:4 (specificity: 93%). The positive predictive value was 50% for a titer of 1:4 and 24% for a titer of 1:2, whereas the negative predictive value was 100% for a titer of 1:4 and 97% for a titer of 1:2. Patients with elevated titers were mostly treated by chemotherapy, were older and had a worse prognosis than those with negative titers, although the duration of neutropenia was similar. It is concluded that Candida antigen detection is a reliable method of diagnosis of deep candidiasis in neutropenic patients. The clinical interest in this test, with special regard to empiric antifungal therapy, is discussed.

Enzyme-linked immunosorbent assay compared with indirect immunofluorescence test for detection of Pneumocystis carinii specific immunoglobulins G, M, and A

An ELISA to measure Pneumocystis carinii-specific IgG, IgM, and IgA has been developed. The antigen was prepared from purified cysts by sonication and ultracentrifugation. Antigen particles with sedimentation coefficients less than 165 S were used. The technique has been compared with indirect immunofluorescence, using whole cysts as antigen. Ninety human sera were assayed. The results were significantly correlated. The ELISA-technique was more sensitive, and owing to the soluble antigen the daily variation was less than 1 per cent. The technique is useful for quick and reliable detection of Pneumocystis carinii antibodies in a routine laboratory.

Improved diagnosis of strongyloides stercoralis by seven consecutive stool specimens

Seven consecutive stool cultures have been used in order to diagnose strongyloidiasis. The study took place in the follow up period after treatment and seventy patients participated. The diagnostic sensitivity of the seven consecutive cultures compared to a single examination was increased from two to five times.

Treatment of strongyloides stercoralis with albendazole. A cure rate of 86 per cent

A clinical trial concerning the efficacy of albendazole has been performed in an area outside the endemic zone. Sixty-eight patients were treated with albendazole in doses varying from 4-30 mg/kg/day for 3-6 days. A high cure rate of 86 per cent was obtained with albendazole 16 mg/kg/day for three days and repeated once after a fortnight. The albendazole was well tolerated and no side effects were imputed to the treatment. Successful treatment was confirmed by seven negative, consecutive coprocultures. The follow up period ranged from 35 to 615 days.

An experimental model for therapeutic trials of anthelminthic drugs

An experimental model of infection by Strongyloides ratti in the rat, which takes account of recent observations on the life cycle of the parasite, is described. The model is suitable for trial of anthelminthic drugs.

Albendazole and thiabendazole in murine strongyloidiasis

The activity of albendazole and thiabendazole, two derivatives of benzimidazole, were tested in an experimental model of Strongyloides ratti infestation in the rat. Two series of seven consecutive daily negative parasitic plate cultures, separated by four weeks of steroid therapy, confirmed cure of the infestation. Both drugs were inactive against larvae in the tissue phase, but completely effective in the intestinal phase.

The microscopic diagnosis of Pneumocystis carinii. An evaluation of the gram, the methylene blue, and the Ziehl-Neelsen procedures

An assessment of the Gram, the Methylene blue, and the Ziehl-Neelsen procedures in diagnosing Pneumocystis carinii has been performed. By using heat and methanol as fixatives and phase-contrast microscopy we found the procedures valuable in detecting the pneumocysts, especially in the Gram staining. The diagnosis should, however, be confirmed by a re-staining with a specific staining, viz. the toluidine blue 0 or the silver impregnation a.m. Gomori-Grocott. It is additionally shown that the staining a.m. Gomori-Grocott is dependent on the density of the preparation.

[Pneumocystis carinii infections]

In children, Pneumocystis carinii pneumonias occur mainly in cases of congenital or acquired immunodeficiencies. Definitive diagnosis rests on the visualization of the parasites, ideally by broncho-alveolar lavage. If the lavage is negative and the patient deteriorates, an open lung biopsy is the next best diagnostic method. Serological methods are unreliable. Treatment with trimethoprim-sulfamethoxazole (TMP) should be instituted as early as possible: a serum level of TMP between 5 and 10 micrograms/ml should be attained. If no improvement occurs after three days, pentamidine should be substituted. Systematic chemoprophylaxis should be given to all high-risk patients.

[Protein-energy malnutrition in an urban African milieu (Togo). Etiologic factors in kwashiorkor and marasmus-kwashiorkor]

The etiologic factors of protein-energy malnutrition (P.E.M.) have been studied in 59 children with kwashiorkor (KWK) or marasmus-kwashiorkor (MKWK) and living in an african urban area. The decline of breast feeding leads to an earlier P.E.M., mainly MKWK. This decline is linked to urbanization, mother's activities, dislocation of traditional structures and use of artificial formulas. Essentially based on cereals, the diet is responsible of the post-weaning P.E.M. Poverty, ignorance and food taboos are related to a lack in weaning food varieties. A small number of infants with KWK had a rich protein diet putting back the cause of an hypoproteic diet on the KWK onset. Infections play a determinant role in the onset of KWK and of some MKWK, after 2 years of age. Diarrhoea, measles, bronchopulmonary and parasitic diseases are the most prevalent infections. Among socio-cultural factors, conjugal disorders are predominating with child-mother break-up and father's bonding failure. At the opposite of rural areas, the family size is reduced. The three first birth ranges are specially concerned with young inexperienced mothers.

Ovicidal effects of albendazole in human ascariasis, ancylostomiasis and trichuriasis

Albendazole, a broad spectrum anthelmintic, was administered as a 400 mg single dose to 20 patients harbouring Ascaris (ten cases), hookworms (four cases each of Ancylostoma duodenale and Necator americanus) and trichuriasis (ten cases). Faeces were obtained before treatment and during the following five days. Coprocultures were made for 90 days for Ascaris and Trichuris eggs, hookworm eggs were cultured by the Harada-Mori technique for at least eight days. Albendazole was ovicidal against all four genera of nematodes.

Parasitological, serological, and clinical studies of Wuchereria bancrofti in Limbe, Haiti

A survey for Wuchereria bancrofti in Limbe, Haiti (est. pop. = 10,500) revealed that 17% (231/1,450) had a patent infection. Nearly half of those surveyed harbored fewer than 10 microfilariae (mf) per 20 mm3 of finger-prick blood; the median mf density for females and males was 12.4 and 9.5, respectively. Parasitemias occurred as early as age 4. Antibody titers greater than or equal to 1:20 against adult D. viteae antigen were observed in 38% of microfilaremic individuals and in 29% of amicrofilaremic individuals. Peak antibody responsiveness (40%) was observed between 5 and 9 years of age. In all age groups there was no correlation between mf density and antibody titer. Among the mf carriers, 5.6% had no clinical symptoms. Lymphangitis was a common feature with 14.3% having lymphedema, 8.2% with edema of the lower extremities, and 1.3% reporting episodes of chyluria. Genital involvement among women was rare, but in males 5.4% had genital swelling and 4.5% had hydroceles. Culex pipiens quinquefasciatus (Say) was observed to support the complete development of W. bancrofti in Limbe.

[Pneumocystis carinii pneumonia in children. Apropos of 33 cases]

From 1964 to 1983, thirty-three children have developed Pneumocystis carinii pneumonia (18 boys and 15 girls). The affection appears before 1 year of age in 73% of the cases (mean +/- SD: 6,12 +/- 4,6 months). The predisposing factors for the disease include hypotrophy (7), immune deficiency (26: 79%) (12 congenital and 14 acquired). The thymodependant lymphocytic system is concerned in 15 cases (46%) with only 5 neoplasic origins. The onset of the disease is in the first year of immuno-suppresive treatment in 71% of the cases. It is acute in 27% of the cases. Polypnea is found in 94% of the cases, cyanosis 73%, fever 70%, respiratory distress 64%. Distal endobronchial brushing associated with distal bronchopulmonary lavage and surgical pulmonary biopsy seem the best methods of direct positive diagnosis. The specific serology is less useful. Among the 20 treated children, 7 were cured (35%). The global mortality rate is still high (79%). The new proposed therapeutic schema includes either pentamidine as a "starter" effect (4 mg/kg/d IM/ X 5 d) associated with pyrimetamine-sulfadoxine (1,25 mg PYR/25 mg SUL/kg/d every 8 days) or trimethoprim-sulfamethoxazole (20 mg TMP/100 mg SMZ/kg/d X 14 d; efficient plasmatic TMP: 5 to 10 micrograms/ml). Chemoprophylaxy must be followed by all "high risk" patients during the totality of the immunosuppressive period (PYR-SUL every 15 days associated with folinic acid).

Albendazole: a new broad spectrum anthelmintic. Double-blind multicenter clinical trial

A new anthelmintic drug, albendazole, has been tested in a multicenter double-blind placebo controlled study in 392 patients from France and West Africa in children and adults with single or mixed infections caused by roundworms, hookworms, whipworms, threadworms and tapeworms. All patients were closely observed before and after treatment for clinical side effects, hematological or clinical blood chemical changes. Fecal samples obtained before, and 7 days and 21 days after treatment were examined using a concentration technic (Ritchie), a coproculture (Harada-Mori) and an egg count (Kato). Following a single dose of 400 mg in adults, cure rates of 96% in ascaridiasis, 96% in ancylostomiasis caused by dose of 400 mg in adults, cure rates of 96% in ascaridiasis, 96% in ancylostomiasis caused by Ancylostoma duodenale, 90% in ancylostomiasis caused by Necator americanus and 76% in trichuriasis were recorded. About 48% of the patients infected by Strongyloides stercoralis were cured following administration of 400 mg per day for 3 consecutive days. The efficacy of half of the adult dose (200 mg) was much lower in children. None of the patients who received placebo were cured. The drug did not produce any significant side effects and approximately the same numbers were reported in the albendazole and the placebo groups. No variations of the hematology and clinical blood chemistry values were recorded.

[Albendazole. Evaluation of tolerance and efficacy in oxyuriasis, trichocephaliasis, ankylostomiasis, ascaridiasis, anguilluliasis]

Albendazole was given to some men for the first time. 131 patients (43 children) received different dosages, without clinical intolerance. Biological parameters were normal. Each study was made in two parts: - determination of the good dosage, - administration in a double-blind study (except for Strongyloides Stercoralis). Albendazole has a good efficiency against Enterobius Vermicularis, Trichuris trichiura, Ascaris lumbricoides and Necator americanus. Strongyloides Stercoralis seems to be killed by this drug, but complementary studies will be necessary.