A four-year-old Danish boy developed kala-azar 18 months after a holiday in Malta. Splenectomy, with liver biopsy, was performed six months after onset of symptoms because of hypersplenism, and the diagnosis of kala-azar was only made four months later, when the histopathological specimens were reviewed. Previous bone marrow biopsies did not show Leishmania. Treatment with sodium stibogluconate was successful. The development of kala-azar after one week's stay in an endemic area stresses the importance of including this potentially fatal disease in the differential diagnosis of cases presenting with fever, splenomegaly, and pancytopenia.
We studied the patients admitted to the ICU at a Danish university hospital during 1 year with respect to nosocomial pneumonia (NP). Among 242 patients, who stayed more than 48 h, 23 (10%) developed NP. Patients with NP had significantly higher mortality (43% vs. 19%, p less than 0.05), longer median stay (276 h vs. 99 h, p less than 0.05) and a longer median intubation period (256 h vs. 74 h, p less than 0.05). In the NP group surgical patients were overrepresented as compared to medical patients (74% vs. 45%, p less than 0.05). Thoracotomy, treatment with H-2 blockers and immunosuppression represented significant risk factors. Considering the etiology, Enterobacteriaceae and Pseudomonas aeruginosa constituted 43% of the cases in strong contrast to the low frequency of these pathogens in community-acquired pneumonia. NP in the ICU patient is a resource consuming disease associated with a high mortality (43%), which is related to the frequent severe underlying diseases of these patients.
Congenital complement deficiency states occur very rarely. These deficiencies are associated with a high risk of meningococcal disease (MD). We suggest that the following groups of individuals with MD are examined for complement deficiencies: 1. Individuals belonging to families, in which more than one case of MD has occurred with an interval exceeding one month. 2. Individuals infected with the low-virulent meningococcal serogroups W-135, 29E, X, Y, Z. 3. Individuals with recurrent MD. Since properdin deficiency probably is the most common deficiency associated with MD it is important that the screening includes the alternative complement pathway.
Eight patients with hydatidosis treated with albendazol in daily doses of 10 mg/kg daily in courses of 28 days (4-6 courses) were analysed. The patients came from Morocco, Spain, Turkey and Yugoslavia. Seven patients had a cyst (or cysts) in the liver and one had also cysts in the kidneys. One patient had cysts in the muscles of the extremities. As assessed by ultrasonic scanning, computed tomography of the cysts, general condition, serology and the presence of hydatid antigen in the serum, treatment was effective in six patients. One patient developed an allergic reaction to albendazol. All of the patients had varying degrees of liver involvement which were reversible. Neutropenia did not occur. Various parameters for assessing the therapeutic effect are mentioned. Albendazol appears to be effective in the treatment of non-operable hydatid disease and to prevent recurrence after surgery.
At the Department of Communicable and Tropical Diseases, Rigshospitalet, Denmark, mefloquine has been used since 1982 for the treatment of patients with suspected or verified chloroquine and sulfadoxine-pyrimethamine resistant P. falciparum malaria. Eighty-one patients treated with mefloquine are reviewed. Forty patients had complicated malaria; 18 were initially treated with IV quinine. Mefloquine dose for adults was 1,500 mg in one dose or divided in two with six hourly intervals. Mild gastrointestinal side effects were common; in 10 patients, the medication had to be repeated because of vomiting. No neurological or neuropsychiatric side effects were recorded in relation to treatment or during the follow up period (30 days). Temperature subsided with a mean of 2.7 days after initiation of treatment and trophozoites cleared with a mean of 3.6 days. One patient had recrudescence. Mefloquine is found safe and effective for the treatment of P. falciparum malaria and is recommended for treatment of worldwide acquired P. falciparum malaria, although patients should be monitored closely to disclose resistance.