Case Report: Cutaneous Leishmaniasis due to Leishmania (Viannia) panamensis in Two Travelers Successfully Treated with Miltefosine

We present two cases of Leishmania (V) panamensis in returning travelers from Central America successfully treated with miltefosine. The couple presented with ulcerative skin lesions nonresponsive to antibiotics. Skin biopsy with polymerase chain reaction (PCR) revealed L. (V) panamensis. To prevent the development of mucosal disease and avoid the inconvenience of parental therapy, we treated both patients with oral miltefosine. We suggest that miltefosine represents an important therapeutic alternative in the treatment of cutaneous lesions caused by L. panamensis and in preventing mucosal involvement.

Heterogeneous infectiousness in guinea pigs experimentally infected with Trypanosoma cruzi

Guinea pigs are important reservoirs of Trypanosoma cruzi, the causative parasite of Chagas disease, and in the Southern Cone of South America, transmission is mediated mainly by the vector Triatoma infestans. Interestingly, colonies of Triatoma infestans captured from guinea pig corrals sporadically have infection prevalence rates above 80%. Such high values are not consistent with the relatively short 7-8 week parasitemic period that has been reported for guinea pigs in the literature. We experimentally measured the infectious periods of a group of T. cruzi-infected guinea pigs by performing xenodiagnosis and direct microscopy each week for one year. Another group of infected guinea pigs received only direct microscopy to control for the effect that inoculation by triatomine saliva may have on parasitemia in the host. We observed infectious periods longer than those previously reported in a number of guinea pigs from both the xenodiagnosis and control groups. While some guinea pigs were infectious for a short time, other "super-shedders" were parasitemic up to 22 weeks after infection, and/or positive by xenodiagnosis for a year after infection. This heterogeneity in infectiousness has strong implications for T. cruzi transmission dynamics and control, as super-shedder guinea pigs may play a disproportionate role in pathogen spread.

An assessment of the ability of routine restaurant inspections to predict food-borne outbreaks in Miami-Dade County, Florida

OBJECTIVES

This study sought to determine the usefulness of restaurant inspections in predicting food-borne outbreaks in Miami-Dade County, Fla.

METHODS

Inspection reports of restaurants with outbreaks in 1995 (cases; n = 51) were compared with those of randomly selected restaurants that had no reported outbreaks (controls; n = 76).

RESULTS

Cases and controls did not differ by overall inspection outcome or mean number of critical violations. Only 1 critical violation--evidence of vermin--was associated with outbreaks (odds ratio = 3.3; 95% confidence interval = 1.1, 13.1).

CONCLUSIONS

Results of restaurant inspections in Miami-Dade County did not predict outbreaks. If these findings are representative of the situation in other jurisdictions, inspection practices may need to be updated.

Enteric virus infections and diarrhea in healthy and human immunodeficiency virus-infected children

Forty-three stool samples from 27 human immunodeficiency virus (HIV)-seropositive children and 38 samples from 38 HIV-negative children, collected during a 15-month period, were examined for enteric viruses. Diagnostic assays included enzyme immunoassays for rotavirus, adenovirus, and Norwalk virus; polyacrylamide gel electrophoresis for picobirnavirus and atypical rotavirus; and PCR for astrovirus and enterovirus. Specimens from HIV-positive children were more likely than those of HIV-negative children to have enterovirus (56 versus 21%; P < 0.0002) and astrovirus (12 versus 0%; P < 0.02), but not rotavirus (5 versus 8%; P > 0.5). No adenoviruses, picobirnaviruses, or Norwalk viruses were found. The rates of virus-associated diarrhea were similar among HIV-positive and HIV-negative children. Enteroviruses were excreted for up to 6 months in HIV-positive children; however, no evidence for prolonged excretion of poliovirus vaccine was observed. These results suggest that although infection with enterovirus and astrovirus may be frequent in HIV-infected children, enteric viruses are not associated with the diarrhea frequently suffered by these children.

Cotyledonoid dissecting leiomyoma (Sternberg tumor): an unusual form of leiomyoma

Smooth muscle tumors are the most common neoplasms of the female genital tract. While most are usually easy to diagnose, several variants pose considerable diagnostic difficulties. Recently, a new form of uterine smooth muscle tumor was described that has an infiltrative character, which was named "cotyledonoid dissecting leiomyoma" or "Sternberg tumor" due to its macroscopic similarity to the gross architecture of the placental cotyledon. This report, the second such of this tumor, describes the macroscopic, microscopic, immunohistochemical and ultrastructural features of one of these unusual cases.

Endomyocardial disease in South America--report on 23 cases in Venezuela

Twenty-three cases of endomyocardial disease (ED) are presented, studied in Venezuela, a tropical country in northern South America. The diagnosis was confirmed in 18 cases by means of pathological studies, and in 5 cases by angiocardiography which showed the characteristic obliterative ventricular lesions. Eosinophilia was present in 35% of the patients. The most frequent clinical feature was heart failure associated with mitral regurgitation. Systemic embolism was the first clinical feature in 5 cases. In 2 cases, ED was associated with autoimmune haemolytic anaemia or vasculitis. Necropsy revealed a predominance of the left-sided (9/16 cases) and biventricular (6/16 cases) types. The pathological lesions were characterised by fibrous thickening of the endocardium at the apex and the ventricular inflow tracts extending to the myocardium and involving the atrioventricular valves. ED is frequently misdiagnosed as rheumatic valvular cardiopathy. The two-dimensional echocardiogram is a very useful procedure for determining the spatial anatomy of ED. The echo findings were closely correlated with ventriculographic and necropsy findings. Even though ED is widely spread around the world, it is most frequently found in tropical and subtropical countries in Africa, Asia and America, such as Venezuela and Brazil. This suggests that there are aetiological factors in these latitudes, about which little is known.

Primary cardiomyopathy in identical twins

Seventeen year old identical twin brothers with no family history of cardiopathy began experiencing palpitations almost simultaneously. In both, examination revealed marked cardiomegaly and hypokinesia of the ventricular walls, and clinical and radiologic signs of progressive cardiac failure developed a few days later. Both boys died suddenly, 49 days and 5 months, respectively, after the initial examination. Electrocardiographic and vectorcardiographic studies revealed a severe intraventricular conduction disturbance that coincided with histologic changes in the myocardial tissue, including profuse interstitial fibrosis, hypertrophy and degeneration of the myocardial fibers, aberrant arrangement of the muscular fibers and considerable alteration of the structure of cardiac tissue. In the absence of hereditary and chromosomal factors, and excluding possible viral intervention during fetal life, it is believed that a teratogenic factor can produce the structural alterations of the tissue and derangement of the fibers observed in these hearts. The irregular contractions of the heart at the level of the net-like meshwork, disarrangement of myocardial fibers, and adaptative mechanisms of the heart inherent in the destruction of the contractile tissue contributed to the functional cardiac disorders that resulted in congestive heart failure and sudden death in these twins.

Disturbances in the A-V conduction system in Chagas' myocarditis in the dog

Atrioventricular (A-V) conduction and the functional refractory period (FRP) of the A-V system were studied in 13 dogs chronically infected by T. cruzi that had ECG disturbances indicative of myocarditis. Histopathologic findings at the A-V node and the bundle of His were correlated with the FRP and with conduction times of the A-V propagation system. Retarded conduction was related to inflammatory and fibrotic processes localized at the bundle of His. At relatively slow rates of stimulation, conduction time was prolonged, but the ventricle was capable of following high atrial rates. With augmented FRP, mononuclear cell infiltrates were observed in the A-V node or in the septal muscle around the node. This suggests that the node was included in the inflammatory process. No correlation was found between inflammatory infiltrates of the bundle of His and changes in the FRP. At relatively slow rates of stimulation, normal A-V conduction time corresponded to prolonged FRP. A-V conduction became slow as the atrial rate increased. A point was reached when the ventricle could not follow the moderately increased atrial rates.

Excitability of cardiac tissues was so markedly altered in 5 dogs with severe inflammatory infiltrates that a similar study of the A-V system could not be made.