Imported malaria (1985-95): trends and perspectives

Malaria is frequently imported into nonendemic industrialized areas. In this study we collated data on the reported malaria cases in industrialized countries during the period 1985-95, with the object of identifying trends and promising strategies. The main outcome measures were incidence, case-fatality rates (CFRs), and attack rates in tourists returning from Kenya. Our survey showed gross underreporting and marked heterogeneity in the type and availability of national data. The total incidence or reported numbers of malaria infections in Europe increased from 6840 in 1985 to 7244 in 1995, with a peak of 8438 in 1989. The principal importing countries were France, Germany, Italy, and the United Kingdom. In the former USSR, the reported annual incidence dropped from 1145 in 1989 to 356 in 1990 after cessation of activities in Afghanistan. Among the imported species of malaria parasite, Plasmodium falciparum was identified in an increasing proportion, the CFR ranging from 0% to 3.6%, with consistently high rates in Germany. The attack rates among travellers to Kenya in 1990-95 were high, ranging from 18 to 207 per 100,000 travellers. Our findings indicate that in industrialized countries malaria is associated with a high CFR and remains a public health problem. Irregular surveillance and lack of homogeneity in the collected data hinder the assessment of incidences, risk groups, and the efficacy of chemoprophylaxis.

Elective mutism: effect of dental treatment with N2/O2-inhalation sedation: review and report of case

Elective mutism in children is characterized by a marked, emotionally determined selectivity in speaking, such that the child demonstrates his or her language competence in some situations but fails to speak in other situations. An eight-year-old boy with elective mutism had to undergo restorative dental treatment. It was chosen to use relative analgesia to perform this treatment. The sedation with oxygen and nitrous oxide resulted in complete symptom remission as long as the sedation lasted.

Are preventive HIV interventions at airports effective?

BACKGROUND

Few empirical data exist on the impact of preventive human immunodeficiency virus (HIV) interventions on intended and actual sexual behavior of international tourists. The present cross-sectional study is based on a 2 3 2 design.

METHODS

The sample consisted of departing and arriving passengers (n = 3100) at Zurich Airport with destinations in countries where heterosexual HIV transmission is dominant. While 41% of the tourists obtained information about safer sex, the remaining 59% without such intervention served as control group. Departing passengers completed a short questionnaire focusing on their planned sexual behavior. Arriving passengers were asked about their actual behavior during the journey. Subjects of the intervention group also evaluated the impact of the consultation.

RESULTS

Most travelers appreciated the intervention and reported that they received important information. Members of the intervention group were better informed than those of the control group about the risk of heterosexually transmitted HIV infection (p <.01). They also indicated more often that they could imagine having casual sex abroad (23% vs 16%, p <.01). However, the two groups did not differ with regard to planned condom use or actual sexual behavior. Whereas most of departing passengers indicated that they would use condoms consistently, only half of the passengers who reported casual sex actually did so. Subjects who refused to participate in the intervention tended to consider it as irrelevant and reported less consistent condom use.

CONCLUSIONS

Although travel health interventions focusing on casual sex are appreciated and increase the knowledge, they failed to result in significant behavior modification. Future projects should attempt to approach possible risk groups more specifically and to have more impact.

Effectiveness of personal protection measures against mosquito bites for malaria prophylaxis in travelers

BACKGROUND

To determine the effectiveness of personal protection measures (PPM) against mosquito bites in travelers as tools of malaria prevention.

METHODS

Two step questionnaire survey conducted in European tourists who visited East Africa: cross-sectional evaluation during the return flight with follow-up 12 weeks after return home. Among 100,336 tourists participating in a malaria survey, 89,617 had answered all questions relating to PPM and to malaria occurrence. The main outcome measure was the occurrence of malaria.

RESULTS

Only 2% of tourists visiting East Africa regularly take all four of the most important PPM. Regular use of PPM resulted in a small, but significant reduction of malaria incidence when travelers were interviewed 12 weeks after returning home. Air-conditioned rooms and clothing which covered arms and legs were effective, whereas repellants, insecticides, coils, etc. showed no significant effect.

CONCLUSIONS

In general, advice relating to all possible PPM in travelers should be concentrated on those who are at greatest risk of bites, and thus of malaria. For those at low and intermediate risk, preference should be given to convenient measures with proven effectiveness, such as using air-conditioned rooms and appropriate clothing.

Sarcophytolide: a new neuroprotective compound from the soft coral Sarcophyton glaucum

Bioactivity-guided fractionation of an alcohol extract of the soft coral Sarcophyton glaucum collected from the intertidal areas and the fringing coral reefs near Hurghada, Red Sea, Egypt resulted in the isolation of a new lactone cembrane diterpene, sarcophytolide. The structure of this compound was deduced from its spectroscopic data and by comparison of the spectral data with those of known closely related cembrane-type compounds. In antimicrobial assays, the isolated compound exhibited a good activity towards Staphylococcus aureus, Pseudomonas aeruginosa, and Saccharomyces cerevisiae. Sarcophytolide was found to display a strong cytoprotective effect against glutamate-induced neurotoxicity in primary cortical cells from rat embryos. Preincubation of the neurons with 1 or 10 microg/ml of sarcophytolide resulted in a significant increase of the percentage of viable cells from 33 +/- 4% (treatment of the cells with glutamate only) to 44 +/- 4 and 92 +/- 6%, respectively. Administration of sarcophytolide during the post-incubation period following glutamate treatment did not prevent neuronal cell death. Pretreatment of the cells with sarcophytolide for 30 min significantly suppressed the glutamate-caused increase in the intracellular Ca2+ level ([Ca2+]i). Evidence is presented that the neuroprotective effect of sarcophytolide against glutamate may be partially due to an increased expression of the proto-oncogene bcl-2. The coral secondary metabolite, sarcophytolide, might be of interest as a potential drug for treatment of neurodegenerative disorders.

Comparative study to determine the optimal melatonin dosage form for the alleviation of jet lag

To compare the impact of various dosage forms of melatonin and placebo on jet lag symptoms, 320 volunteers who had flights over 6 to 8 time zones were recruited for a double-blind, randomized, placebo-controlled study. The volunteers received either melatonin 0.5-mg fast-release (FR) formulation, melatonin 5-mg FR formulation, melatonin 2-mg controlled-release (CR) formulation, or placebo. The study medication was taken once daily at bedtime during 4 days after an eastward flight. The volunteers completed the Profile of Mood States (POMS), sleep log, and symptoms questionnaires once daily and the Karolinska Sleepiness Scale (KSS) three times daily prior to departure and during the 4 days of medication intake postflight. A total of 234 (73.1%) participants were compliant and completed the study. The FR melatonin formulations were more effective than the slow-release formulation. The 5-mg FR formulation significantly improved the self-rated sleep quality (p < .05), shortened sleep latency (p < .05), and reduced fatigue and daytime sleepiness (p < .05) after intercontinental flight. The lower physiological dose of 0.5 mg was almost as effective as the pharmacological dose of 5.0 mg. Only the hypnotic properties of melatonin, sleep quality and sleep latency, were significantly greater with the 5.0-mg dose.

Neuroactive compounds produced by bacteria from the marine sponge Halichondria panicea: activation of the neuronal NMDA receptor

Previous studies revealed that the marine sponge Halichondria panicea habors symbiotic- and commensalic bacteria (Althoff et al., 1998. Marine Biol. 130, 529-536). In the present study the hypothesis was tested whether some of those bacteria synthesize neuroactive compounds. For the first time the effect of bacterial bioactive compounds on the neuronal ionotropic glutamate receptors [iGluR], subtype N-methyl-d-aspartate (NMDA) receptor, was checked. In cortical neurons from rats as cell system the supernatant of two bacterial cultures isolated from H. panicea proved to agonize the NMDA receptor. The response of the NMDA receptor to the bioactive compounds was determined by measuring the intracellular Ca(2+) level. The supernatants of cultures 697 and 698 were found to upregulate the intracellular Ca(2+) level. To validate the specificity of the effects, inhibition studies with Memantine and d-AP5 were performed. The two bacteria were identified by polymerase chain reaction-amplification of the 16S rDNA genes and subsequent sequencing; they displayed highest identity to Antarcticum vesiculatum and to Psychroserpens burtonensis, respectively. Based on these data first experimental evidence is presented indicating that bacteria associated with sponges display neuroactivity by agonizing the NMDA receptor.

Primmorphs generated from dissociated cells of the sponge Suberites domuncula: a model system for studies of cell proliferation and cell death

Sponges (Porifera) represent the lowest metazoan phylum; they have been shown to be provided with the characteristic metazoan structural and functional molecules. One autapomorphic character of sponges is the presence of high levels of telomerase activity in all cells (or almost all cells, including somatic cells). In spite of this fact previous attempts to cultivate sponge cells remained unsuccessful. It was found that dissociated sponge cells do not replicate DNA and lose their telomerase activity. In addition, no nutrients or metabolites have been detected that would stimulate sponge cells to divide. In the present study we report the culture conditions required for the formation of multicellular aggregates from dissociated single cells of Suberites domuncula, termed primmorphs. These primmorphs are formed in seawater without addition of further supplements, and have an organised tissue-like structure; they have been cultured for more than 5 months. Cross-sections revealed a distinct external layer covered by a continuous pinacoderm, and a central zone composed primarily of spherulous cells. After their association into primmorphs, the cells turn from the telomerase-negative state into the telomerase-positive state; a telomerase level of 4.7 total product generated (TPG) units/5 x 10(3) cell equivalents has been determined. Moreover, a major fraction of the cells in the primmorphs undergoes DNA synthesis and hence has the capacity to grow. Applying the BrdU-labelling and detection assay it is demonstrated that up to 33.8% of the cells in the primmorphs are labelled with BrdU after an incubation period of 12 h. It is proposed that the primmorph system described here is a powerful novel model system to study basic mechanisms of cell proliferation and cell interaction, as well as of morphogenesis, ageing and apoptosis.

The putative sponge aggregation receptor. Isolation and characterization of a molecule composed of scavenger receptor cysteine-rich domains and short consensus repeats

Porifera (sponges) are the oldest extant metazoan phylum. Dissociated sponge cells serve as a classic system to study processes of cell reaggregation. The reaggregation of dissociated cells is mediated by an extracellularly localized aggregation factor (AF), based on heterophilic interactions of the third order; the AF bridges two cells by ligating a cell-surface-bound aggregation receptor (AR). In the present study we report cloning, expression and immunohistochemical localization of a polypeptide from the marine sponge Geodia cydonium, which very likely represents the AR. The presumed AR gene gives rise to at least three forms of alternatively spliced transcripts of 6.5, 4.9 and 3.9 kb, as detected by northern blotting. Two cDNA clones corresponding to the shorter forms were already reported earlier; here we present an analysis of the largest. All three putative polypeptides feature scavenger receptor cysteine-rich (SRCR) domains. The largest form, SRCR-SCR-Car, is a cell-surface receptor of molecular mass 220 kDa, which is assumed to be the cell-adhesion receptor AR; the second form, SRCR-Re, is also a putative receptor of 166 kDa, while the third form, SRCR-Mo, is a soluble molecule of 129 kDa. The SRCR-SCR-Car molecule consists of fourteen SRCR domains, six short consensus repeats (SCRs), a C-terminal transmembrane domain and a cytoplasmic tail; its fourteenth SRCR domain features an Arg-Gly-Asp tripeptide. To obtain monoclonal antibodies, a 170-amino-acid-long polypeptide that is found in all three forms of the SRCR-containing proteins was expressed in E. coli. In a western blot of sponge cells lysate the monoclonal antibody raised against the recombinant polypeptide recognized two major immuno-reacting polypeptides (220 and 117 kDa) and two minor bands (36 and 32 kDa). The antibody was found to react with antigen(s) predominantly localized on the plasma membranes of cells, especially those of spherulous cells. In a functional assay Fab' fragments of the antibodies suppressed AF-mediated cell-cell reaggregation. Additionally, a recombinant SRCR-soluble fragment effectively inhibited AF-mediated cell-cell reaggregation. We conclude that the 220 kDa SRCR-containing protein of the sponge G. cydonium is very likely the AR.

The correlation between magnetic resonance imaging and the operative and clinical findings after lumbar microdiscectomy

Fifty-four consecutive patients were studied prospectively with magnetic resonance imaging before microdiscectomy, and the findings correlated with clinical symptoms before and after operation. A sequestrated fragment was found in 59% of cases, a subligamentous disc sequestration in 25% and a disc protrusion in 16%. The levels operated on were L4/5-36%, L5/S1-62.5%, and one at L3/4; 71% were laterally placed, 10% lay intraforaminal and 10% medial. The diameter of the protrusion was 4 mm to 13 mm for the craniocaudal extension, and 5 mm to 18 mm for the anteroposterior extension. No correlation could be found between a neurological deficit and the size of the prolapse. A positive correlation was present between the increasing degree of canal obstruction and the degree of disc degeneration determined by imaging for extrusions, subligamentous disc sequestrations and free sequestrations. Nerve root inflammation and enlargement was seen in 36% of the images, corresponding to an operative finding of 32%. Magnetic resonance imaging is a helpful pre-operative diagnostic investigation which shows structural changes in the disc and the correct localisation and size of the disc sequestration, but there was no correlation between the imaging findings and the clinical symptoms.

Safety of mefloquine and other antimalarial agents in the first trimester of pregnancy

BACKGROUND

Safe and effective antimalarials are required to protect pregnant women from the harmful effects of malaria.

METHODS

Data were collected from two separate prospective cohorts to ascertain the safety of chloroquine-proguanil, sulfadoxine-pyrimethamine (SP), and mefloquine taken in the first trimester of pregnancy.

RESULTS

In a traveler cohort of 236 pregnant women, spontaneous abortions were reported in 7.6% of 99 women taking chloroquine-proquanil, 0% of 19 taking sulfadoxine-pyrimethamine, and 9.1% of 118 women taking mefloquine. Anomalies were identified in 1.7%, 0% and 0% of the same cohort, respectively. Differences in rates of adverse outcomes between the three groups were not statistically significant. In a pharmaceutical database of 331 and 153 women exposed to mefloquine and SP, respectively, the overall rate of abnormal outcomes (spontaneous abortions plus fetal anomalies) was not significantly different (p=.29). Spontaneous abortions were significantly higher with mefloquine than SP (9.1% and 2.6%, respectively; p=.01), but the higher rate was comparable to background rates (7%-11%). Fetal anomalies in the mefloquine group (4.8%) were lower than the SP group (7.8%), but this was statistically not significant (p=.19), and was comparable with the background rate of 4.6% (p=.84). However, mefloquine exposure resulted in a significantly higher rate of therapeutically induced abortions, undertaken for perceived risk to the fetus, compared with SP (p<.0001).

CONCLUSION

From the clinical data available, there is no indication that the risk of taking mefloquine in the first trimester of pregnancy is greater than that from any of the other antimalarials studied and the risk is considerably lower than that associated with falciparum malaria.

Effects of a synthetic allosteric modifier of hemoglobin oxygen affinity on outcome from global cerebral ischemia in the rat

BACKGROUND AND PURPOSE

Neuronal injury results from an insufficient supply of oxygen to the brain. This experiment examined whether a pharmacologically induced rightward shift of the partial pressure of oxygen at which 50% of hemoglobin is saturated (P50) would improve outcome from either incomplete and/or near-complete forebrain ischemia-induced hypoxia in the rat.

METHODS

For incomplete ischemia (attenuated electroencephalogram), fasted rats (n = 17 to 19 per group) were given a synthetic allosteric modifier of hemoglobin affinity for oxygen (RSR13; 150 mg/kg IV) before or immediately after 20 minutes of bilateral carotid occlusion combined with a decrease in mean arterial pressure to 40 mm Hg. For near-complete ischemia (isoelectric electroencephalogram), rats (n = 15 per group) were given RSR13 (150 mg/kg) at onset of reperfusion after 10 minutes of bilateral carotid occlusion combined with a decrease in mean arterial pressure to 30 mm Hg. In both experiments, control rats were given vehicle (0.9% NaCl IV) only. Outcome (defined as percent dead hippocampal CA1 neurons) was determined at 5 days after ischemia.

RESULTS

RSR13 (150 mg/kg) produced a 68% rightward shift of P50 (34+/-3 to 57+/-8 mm Hg). RSR13 reduced CA1 damage resulting from incomplete ischemia by 28% (P=0.02), but only when administered at the onset of reperfusion. RSR13 had no effect on outcome from near-complete ischemia.

CONCLUSIONS

A postischemic pharmacologically induced increase in P50 may improve outcome from incomplete global cerebral ischemia. More severe (near-complete) ischemia negates this benefit.

The effects of a psychological preparation program on anxiety in children and adolescents undergoing gastrointestinal endoscopy

BACKGROUND

Like adults, children often experience anxiety associated with medical procedures. The purpose of this study was to investigate the effects of a program of psychological preparation for children undergoing endoscopy.

METHODS

Sixty patients aged 6 to 19 years (mean, 12.2 years) were randomized into one of two groups. Group 1 received routine preparation before endoscopy. Group 2 received psychological preparation consisting of demonstration of materials that would be encountered during the procedure, use of a doll as a model, or use of a book with photographs of a child who had previously undergone endoscopy. Patients in both groups completed the Spielberger State-Trait Anxiety Inventory in the clinic and just before endoscopy. The Observational Scale of Behavioral Distress was completed by a blinded observer during each procedure. The attending physician (blinded) assessed patient cooperation. Vital signs were recorded in clinic and just before endoscopy. Parents and patients completed questionnaires after endoscopy.

RESULTS

Analysis of the Spielberger State-Trait Anxiety Inventory showed patients in group 2 were significantly less anxious before endoscopy (p < 0.0001). They also required less meperidine (p < eq 0.04) per kilogram body weight and were more cooperative during the examination (p = 0.042). There was significantly less autonomic nervous system stimulation in those who had undergone psychological preparation (change in heart rate, p < 0.001; change in systolic blood pressure, p = 0.04). Statistically significant differences were found in the patients' response to questions after endoscopy regarding perceived anxiety during the procedure (p = 0.003) and the parents' response to questions regarding their own conditions (p = 0.026) and that of their child (p < 0.001).

CONCLUSION

Psychological preparation before endoscopy significantly decreases patient and parental anxiety. Such preparation may allow for a reduction in sedative medications and thereby enhance procedural safety.

Impact of melatonin on driving performance

BACKGROUND

Because millions of people are self-prescribing melatonin for various indications, the safety aspects of this substance have become very important. The aim of our study was to determine whether or not melatonin impairs driving-related performance.

METHODS

Twenty healthy men and women aged 21-57 years volunteered for this randomized, placebo-controlled, double-blind, crossover study. The crossover arms were separated by an interval of at least 4 weeks. On each testing day, melatonin 5 mg or placebo was taken at 1630 h; 60 minutes later a test series was performed, consisting of a medical examination, body sway measurement, and a standardized driving computer test battery to assess attention, reaction time, power of concentration, and sensomotor coordination. Subjective sleepiness was measured on three occasions during the test session using the Stanford Sleepiness Scale questionnaire.

RESULTS

Just one of the 16 main variables of the driving computer test battery, the selective attention tested by signal-detection, was significantly affected by melatonin (p &lt; .05). However, even those values were still within the normal range. Subjective sleepiness was increased by melatonin, although the result was significant only after the prolonged concentration task (p &lt; .05). Neither the clinical examination nor the body sway test showed signs of any drug influence.

CONCLUSIONS

The overall result of the computer test battery showed no objective adverse impact of melatonin on driving performance. However, due to the increased subjective sleepiness after administration of this hormone, caution should be exercised when driving under the influence of melatonin.

Infectious diseases presentations of Munchausen syndrome by proxy: case report and review of the literature

Munchausen syndrome by proxy is a form of abuse, usually of a child by a parent, in which a factitious illness is reported or produced in the child, resulting in unnecessary medical evaluations and treatments. A dramatic case of a 17-month-old infant with recurrent polymicrobial bacteremia prompted a review of cases diagnosed by the Pediatric Infectious Diseases consultation service at our referral children's hospital and a review of the infectious diseases presentations in the medical literature. The infectious diseases presentations of the syndrome as well as criteria for the diagnosis are reviewed and discussed.

[Reserve treatment for malaria: pros and cons]

Any discussion of stand-by treatment will raise several questions: to whom should it be prescribed? which drugs are advised for stand-by treatment, according to the expected sensitivity of the parasites, the chemoprophylaxis and the possible side effects of the drugs chosen? what information should be given to a potential user? under what circumstances should stand-by treatment be used? how can the use of stand-by treatment and its efficacy be evaluated? are there any data for the stand-by treatment in literature? what are the pros and cons for the use of stand-by treatment? what is the place for stand-by treatment in today's array of antimalarial treatment? All of these questions were discussed at a round table stating that while stand-by treatment is an important element in malarial prevention for travellers, it must not become synonymous with self-treatment. An initial prescription of stand-by treatment is essential with the physician informing the user of the conditions for its use and its risks. The use of stand-by treatment does not exempt the traveller from rigourously carrying out the extensive recommended preventive measures. If, in spite of these precautions, a traveller does come down with a presumed malarial fever, the use of stand-by treatment should not prevent him from consulting a physician. A physician is in the best position to indicate an available stand-by treatment which should be considered as a back-up treatment. Self-treatment should only be considered as a last resort given its limitations. In all cases, it is indispensable to consult a physician.

Reproducibility of 24-hour intraesophageal pH monitoring in pediatric patients

OBJECTIVE

Despite the widespread use of 24-hour intraesophageal pH monitoring for evaluation of gastroesophageal reflux in infants and children, there is little published information regarding the reproducibility of ambulatory pH studies in this patient population. The purpose of our study was to evaluate the reproducibility of 24-hour intraesophageal pH monitoring in pediatric patients.

METHODS

We prospectively investigated 26 patients with symptoms suggestive of gastroesophageal reflux (14 females and 12 males) ranging in age from 1 month to 18 years (mean, 9.2 years). The patients underwent extended intraesophageal pH monitoring over two consecutive 24-hour periods.

RESULTS

Data analysis revealed that the overall reproducibility of ambulatory 24-hour pH monitoring is only 69% (r = 0.32). Eight of 26 patients had conflicting results on day 1 compared with results on day 2. Of the 8 patients with conflicting results on day 1 versus day 2, 5 had normal studies on day 1, but demonstrated pathologic reflux on day 2. Thus, the false-negative rate for day 1 was 19.2%. The kappa statistic calculated for the total time the pH was abnormal was 0.32, with values < 0.4 representing poor correlation. Spearman correlation coefficients indicated that the percentage of time with pH < 4 (r = 0.64) and the number of reflux episodes (r = 0.71) per 24-hour period are the most reproducible pH parameters.

CONCLUSION

The reproducibility of 24-hour intraesophageal pH monitoring in the pediatric population is suboptimal. The investigation should be extended or repeated if the result does not correlate with the patient's clinical history.

Sponges (Porifera) model systems to study the shift from immortal to senescent somatic cells: the telomerase activity in somatic cells

Sponges (Porifera) represent the lowest metazoan phylum, characterized by a pronounced plasticity in the determination of cell lineages. In a first approach to elucidate the molecular mechanisms controlling the switch from the cell lineage with a putative indefinite growth capacity to senescent, somatic cells, the activity of the telomerase as an indicator for immortality has been determined. The studies were performed with the marine demosponges Suberites domuncula and Geodia cydonium. It was found that the activity for the telomerase in the tissue of both sponges is high; a quantitative analysis revealed that the extract from S. domuncula contained 10.3 TPG units per 5000 cell equivalents and the one from G. cydonium 8.3 TPG units; hence the activity reached approximately 30-20% of the activity seen in telomerase-positive reference cells. In contrast, dissociated spherulous cells from G. cydonium, after an incubation period of 24 h, contained no detectable telomerase activity. From earlier studies it is known that isolated sponge cells do not proliferate. Based on these findings it is assumed that the separation of the senescent sponge cell lineage from the immortal germ/somatic cell lineage is triggered by the loss of contact with cell adhesion factors. First evidence is included which suggests that the final progress of the senescent, telomerase-negative cells to cell death is caused by apoptosis.

Cathepsin, a major protease of the marine sponge Geodia cydonium: purification of the enzyme and molecular cloning of cDNA

Sponges are suspension-feeders that are devoid of body cavities. Phagocytosis is the major route of nutrition in these animals. In an attempt to understand protein digestion, cathepsin was identified in crude extracts from the sponge Geodia cydonium. This enzyme was purified from lysosomes by a two-step procedure--pH precipitation and FPLC separation--to apparent homogeneity; it showed an M(r) of 26,000. Inhibitor as well as substrate studies showed that the sponge cathepsin belongs to the subfamily L of these cysteine proteases. The complete cDNA coding for cathepsin L was isolated and characterized. The deduced aa sequence contains 322 residues, has an M(r) of 36,085, and shows the characteristic signatures known from other cathepsins of the L subfamily: e.g., cleavage site for the proregion, the ERFNIN motif, and the conserved regions forming the catalytic triad of cysteine proteases. Phylogenetic analyses revealed that the sponge sequence groups with the cathepsin L subfamily and branches off first from the other metazoan members. The sponge sequence shows high homology to that isolated from Dictyostelium discoideum and only low similarity to the protozoan cathepsins L from Paramecium tetraurelia and Tetrahymena thermophila. From the data presented it is concluded that cathepsin L is the major digestive protease in sponges.

Update on the Epidemiology of Traveler's Diarrhea in East Africa

Background: Traveler's diarrhea (TD), the most frequent health problem in visitors to subtropical and tropical regions, needs to be reassessed in view of the development of vaccines against its most frequent causative agent, enterotoxigenic Escherichia coli. Methods: Passengers returning from Mombasa to Europe were interviewed by self-applied questionnaires during the flights. Main outcome measures were subjective TD, defined as having had more diarrhea in East Africa than at home, objective TD as traditionally defined, and the cumulative incidence calculated by the method of Kaplan-Meier survival analysis. Results: Subjective TD was reported by 1117 (49.3%) of the 2268 tourists. The cumulative incidence of subjective TD reached 36.7% after a 1-week stay and 47.6% after 2 weeks. Conclusion: Subjective TD attack and incidence rates continue to be high even at frequently visited destinations.