The American Journal of Tropical Medicine and Hygiene - Volume 21, Issue 2, 1972

In a previous study we demonstrated that Plasmodium knowlesi-infected red cells have decreased deformability and suggested that this abnormality may be important in the pathophysiology of malaria. The present rheologic study was performed in monkeys infected by Plasmodium coatneyi in order to assess further the role of abnormal red cell deformability in the pathogenesis of disease. P. coatneyi is much more similar to P. falciparum than is P. knowlesi. Red cells infected by trophozoites and schizonts showed an increase of viscosity when suspended in Ringer's solution, caused increased resistance to flow through pores, 5 µ in diameter, in the polycarbonate sieve and were excluded from rouleaux formed in plasma. Ring forms produced less rheologic abnormality in the red cell than the more mature stages. These studies indicate that red cells infected by mature parasites of P. coatneyi have decreased deformability to the same extent as we observed in P. knowlesi. The possible relationship between the decreased deformability of infected red cells and cerebral malaria is discussed.

The need for adequate protection against chloroquine-resistant malaria led to the evaluation of diformyl diaminodiphenyl sulfone (DFD) as a chemoprophylactic agent. In this study the prophylactic value of weekly DFD (400 mg) and chloroquine (300 mg) against a chloroquine-resistant strain of Plasmodium falciparum is compared with that of two other commonly used regimens which require daily administration of 4,4′-diaminodiphenylsulfone (DDS; dapsone). Protection against mosquito-induced infections was achieved in 5 of 8 volunteers who received weekly DFD and chloroquine, 6 of 8 who received daily DDS (25 mg) and weekly chloroquine (300 mg), and 7 of 8 who received daily DDS (25 mg) and weekly chloroquine (300 mg) and primaquine (45 mg).

The purpose of this study was to evalute the antimalarial action of a new tetracycline analogue, minocycline, which is more potent and has a broader antibacterial spectrum than tetracycline. The study was conducted in an area endemic for chloroquine-resistant falciparum malaria. Acutely ill residents infected with P. falciparum were alternately assigned to one of two treatment groups. Subjects in one group were given 540 mg of quinine base, thrice daily for 3 days followed by 100 mg of minocycline, twice daily for 7 days. Subjects in the other group were given a similar course of quinine followed by 250 mg of tetracycline, 4 times daily for 10 days. Presumptive radical cures were achieved in all 29 patients treated with quinine-tetracycline and in 27 of 28 treated with quinine-minocycline. No significant toxic side-effects were observed. Although both treatments were highly effective, further studies are warranted to determine the optimal duration and dosage of minocycline and its potential human toxicity.

Rabbits infected with Trypanosoma gambiense develop large, spreading skin lesions. After intradermal injection of live trypanosomes there is considerable inflammation, characterized by swelling, hardness, and redness at the site of injection. Infected rabbits were treated daily with hydrocortisone and examined for skin lesions, agglutinating antibody titers, and parasitemia levels. This treatment eliminated the skin lesions, did not appreciably alter agglutinating antibody titers, and raised parasitemia levels. Treated animals also showed large weight loss and shortened survival time. Caution must therefore be used in treating human cases of African trypanosomiasis with hydrocortisone.

The indirect hemagglutination (IHA), complement fixation (CF), and agar gel diffusion (Gel) tests were evaluated in the diagnosis and management of amebiasis. Axenically-grown Entamoeba histolytica was used as antigen. A survey of 3,033 patients from our hospital population showed IHA titers indicative of infection in 32 patients (1.1%): 6 had parasitologic or clinical evidence of amebic infection and 10 others had additional serologic evidence of E. histolytica antibodies. Of 345 patients in another study with symptoms suggestive of amebiasis, 85% of 107 with proven infections had positive IHA tests. The three serologic tests were compared in 16 extraintestinal and 127 intestinal cases of amebiasis. All tests were positive in 88% of extraintestinal cases. The IHA test was positive in 95, 61, and 58%, respectively, of invasive, symptomatic and asymptomatic colon cases; the CF test in 85, 56, and 58%; and the Gel test in 86, 54, and 52%. The IHA test was somewhat more sensitive and tended to remain positive longer after cure, but all tests often remained positive for 6 to 12 months, and occasionally for 1 to 3 years. The titer was not helpful in differentiating extraintestinal from intestinal, nor even symptomatic from asymptomatic amebiasis. Skilled judgment is essential in clinical use of these serologic tests.

Necropsy studies were done on ten adult Filipinos, five women and five men, who died of intestinal Capillaria philippinensis infection. All of the bodies were severely emaciated and skin turgor was markedly reduced. Transudate was found in the pericardial, pleural, and peritoneal cavities. Large numbers of adults, larvae, and eggs of the parasite were found in the small bowel, particularly in the jejunum. The adults were partially embedded in the mucosa adjacent to the lumen. Larval forms were frequently near adults in the mucosa. Large numbers of the eggs, larvae, and adults were in the luminal fluid. Lesser numbers were found in the larynx, esophagus, and stomach but were not attached to the mucosa. The same was true for the colon. The parasite was also found near the portal areas in the liver in one case. Vacuolization of striated muscle indicative of hypopotassemia was present. Vacuolization of proximal renal tubular lining cells was also found.

Visceral larva migrans, widely reported elsewhere, has not been reported in Malaya, though it was suspected in children with persistent hypereosinophilia of unproved etiology in Singapore. Earlier surveys of helminths in dogs and cats in West Malaysia and Singapore showed a high prevalence of Toxocara infection in these animals. In the present study persistent hypereosinophilia, hyperglobulinemia and epidemiological considerations led to a presumptive diagnosis of visceral larva migrans in a 2-year-old boy and this was confirmed by finding a larva of T. canis in a liver biopsy. Visceral larva migrans therefore does occur in Malaya. Its recognition in this region where eosinophilic lung (tropical eosinophilia) is also common indicates that visceral larva migrans will need to be considered in the differential diagnosis of persistent hypereosinophilia, especially in children.

Metronidazole was used to treat 116 patients infected with Dracunculus medinensis. The patients had lesions of all four basic types: cryptic, preblister, blister, and ulcer. The drug was given orally, in three 200-mg doses a day, for 7 days. Fever, pain and swelling subsided and disability ceased within the week of therapy in 108 patients, and in the remaining 8 during the following week. Of 96 patients with moderate to severe lesions, healing was complete in 26 within the first week, in 41 in the second, in 18 in the third, and in 8 in the fourth; there were 3 failures. Patients with mild lesions (20) became symptomless in a few days. Subcutaneous worms appeared to be irritated by the drug, sometimes migrating and disappearing. Worms were either expelled from ulcer lesions (46) during the first two weeks (25) or were painlessly extracted (21). Cellulitis in 12 patients seemed to interfere with the action of the drug and required procaine penicillin therapy and minor surgery. Side-effects were mild and did not persist beyond the treatment period. Although metronidazole appears to be more effective than diethylcarbamazine, niridazole, or thiabendazole in the treatment of dracunculiasis, controlled, comparative trials of the four drugs should be done.

A young Puerto Rican male presented acutely ill with a neurogenic bladder, fecal incontinence and weakness of the lower extremities without sensory disturbances. Studies revealed Schistosoma mansoni involvement of the upper lumbar spinal cord. Histological examination of the involved portion of cord suggested the presence of an ectopic female adult worm in an adjacent spinal vein may have been responsible. The patient recovered with stibophen and corticosteroid therapy. A review of the pertinent literature indicates that biopsy-proven schistosomiasis of the spinal cord is rare. The present report is the third biopsy-proven case of S. mansoni of the spinal cord in continental United States.

A fatal case of indigenously acquired echinococcosis is reported from Herriman, Utah. The patient, an 8-year-old boy, is known to have had contact with animals on his grandfather's ranch, and subsequent studies traced infected sheep back to this ranch, where a dog carrying Echinococcus granulosus tapeworms was also identified. Skin-test, serologic, and X-ray studies of almost 400 of the town's 500 inhabitants failed to uncover other human cases, although five skin-test reactions were considered positive. This is the 17th known human case of locally acquired echinococcosis in Utah and the first in which a complete transmission cycle for the disease was identified.

Apparently, nonspecific inhibitors of Western and Venezuelan equine encephalitis viruses were found in cattle sera from Hawaii by plaque-reduction neutralization (N) tests in avian cell cultures and by hemagglutination-inhibition (HI) tests. Yet the islands were presumably free of these viruses in 1964 to 1966 when the sera were collected, and no inhibitors were detected in sera from Hawaiian goats and pigs and in more than 98 percent of sheep sera. Specific HI and N, but not complement-fixing, antibodies, developed in the serum of one cow sequentially inoculated with Sagiyama, Western and Eastern equine encephalomyelitis viruses of group A.

Patois, Zegla, and Shark River-like arboviruses in the Patois group were isolated in Mexico, Guatemala, Honduras, and British Honduras during 1963 to 1968. Twenty-three Patois viruses came from mosquitoes, sentinel hamsters, and suckling mice, 21 Zegla viruses from sentinel hamsters and mice and from a wild cotton rat, and two Shark River-like viruses from sentinel hamsters. Hemagglutination-inhibition (HI) and neutralizing antibody tests with Patois virus were positive with human sera from each country, and HI antibody tests were positive with sera from pigs in Mexico, Guatemala, and British Honduras and from small wild mammals, wild birds, and cattle in Mexico.

This communication presents a summary of all virus isolations made at the Epidemiology Research Center from specimens gathered throughout the Tampa Bay area of Florida from 1963 to 1970. A total of 697 isolations was made. Seven different virus groups were represented with three arbovirus groups accounting for 608 (87%) of all isolates: California encephalitis virus group, 313 isolates (44.9%), 220 Keystone and 93 Trivittatus; Bunyamwera group, 179 isolates (25.6%), all Tensaw; and Group A, 115 isolates (16.5%), 94 Eastern equine encephalitis, and 21 Western equine encephalitis. Minimal infection ratios and isolation trends are discussed.

In order to prospectively evaluate the relation between serum antibody and protection against smallpox, blood was drawn from 146 contacts of Pakistani smallpox cases before the end of the usual incubation period. Most were well vaccinated, and after follow-up only three cases of secondary smallpox appeared. Hemagglutination inhibition antibody titers proved to have virtually no predictive value for assessing susceptibility against smallpox, since most contacts, despite their protection, had undetectable antibodies. Neutralizing antibodies were present in high titer in most contacts and no contacts with a titer of 1:32 or higher developed smallpox. Two of the cases, however, did have detectable neutralizing antibody at the time of exposure and some persons with no detectable neutralizing antibody were spared. The role of humoral antibody in protection against pox-viruses is still unclear.

The decimating effects of bovine paralytic (vampire) rabies in Latin America have been recorded on many occasions since the diagnosis was first established some 50 years ago by Haupt and Rehaag in southern Brazil. Rabid vampire bats cause an estimated 500,000 cattle deaths a year in Latin America, with 90,000 to 100,000 of these occurring in Mexico. Although the disease is one of the area's most important animal health problems, no epizootiological studies on it have been published, and up to now there have been no detailed incidence estimates. The only study on the location of outbreaks was made in 1936 by de Verteuil and Urich in Trinidad.

In Mexico (where the disease is commonly called “derriengue”) attempts have been made on a country-wide basis to find out in which areas most vampire bites occur and the approximate total number of cases per year (the first as determined by reports of screwworm infestations after vampire bites and the second by the amount of bovine rabies vaccine distributed).

Recent attempts to institute health care measures against tuberculosis in the Vietnamese population have been hindered because of insufficient information regarding the magnitude of the problem, continuing insecurity in the countryside, and inadequate facilities and manpower. Analysis of existing health statistics reveals that tuberculosis may be emerging as the leading infectious cause of disability and mortality; however, only 1 bed per 22,535 civilians exists for inpatient care, and few outpatient facilities operate effectively. In the densely populated Mekong Delta, tuberculin skin testing of 631 children, ages 1 through 18, showed an increasing number of positive reactions with age; 47.5% of the 17- to 18-year-old group reacted. Tuberculin negative children, retested 9 months later, showed increasing conversion rates with age, up to 13.5% in the 17- to 18-year-old group. It is concluded that a high prevalence of tuberculosis exists in the Mekong Delta and that older children have a 17% chance annually of acquiring infection.

A case of rhinophycomycosis entomophthorae occurring in an immature chimpanzee living in the wild in the Gombe Stream Reserve of Western Tanzania is described. The fungus Entomophthora coronata was cultured from the lesion. Treatment with small doses of iodide, sulphadoxine (Fanasil, Roche), and sulphamethoxazole/trimethoprin (Bactrim, Roche) failed to affect the lesion. With the onset of sexual maturity the lesion appeared to undergo an exacerbation. This case is discussed in relation to the disease occurring in humans and it is suggested that if infection can be induced in chimpanzees this might prove to be a model for the further study of the disease.

A passive hemagglutination inhibition (PHI) technique to identify arthropod blood meals is described. The antisera for this test were prepared in chickens using chemically purified antigens. The antibody obtained was purified by immunoadsorption. The blood meals of several laboratory-fed, as well as several hundred field-collected mosquitoes were identified by this test. These field-collected mosquitoes were previously identified by the precipitin test as feeding on Leporids, Ruminants or Passeriformes. More definitive host identifications were obtained using the PHI test.

Adams & Maegraith: Clinical Tropical Diseases, 5th edition, by B. G. Maegraith, Liverpool School of Tropical Medicine. ix + 588 pages, illustrated. F. A. Davis Co., Philadelphia, Pa. 19103. 1971. $17.50.

Amino Acid Fortification of Protein Foods, edited by Nevin S. Scrimshaw, Department of Nutrition and Food Science, Massachusetts Institute of Technology, and Aaron M. Altschul, Special Assistant for Nutrition Improvement, U. S. Department of Agriculture. xxv + 664 pages. MIT Press, 28 Carleton Street, Cambridge, Mass. 02142. 1971. $25.00.

Foreign Travel Immunization Manual, by Hans H. Neumann, Department of Health, New Haven, Connecticut. ix + 56 pages, paper bound. Charles C Thomas, 301–327 East Lawrence Avenue, Springfield, Illinois. 1971. $3.75.

Korean Hemorrhagic Fever and Related Diseases: A Critical Review and a Hypothesis, by William J. Jellison, U. S. Public Health Service (retired). 79 pages, paper bound. Mountain Press Publishing Company, 287 West Front Street, Missoula, Montana 59801. 1971. No price.

This concise standard medical parasitology text book from India has two outstanding features: its illustrations and its unbelievably low price for a hardcover book of its size. There are 37 color plates and 144 black and white illustrations, considerably more than the sixth edition contained.

The text is divided into two sections with six chapters on protozoology and three chapters on helminthology. There is an appendix on diagnostic procedures for fecal, blood and tissue parasites, including cultural methods and procedures for obtaining biopsies. Another appendix deals with the treatment of parasitic infections, listing the drugs, dosages, and methods of administration. This is followed by an index.

This new edition incorporates new knowledge that has been gathered in the past few years about the importance of the so-called free-living amebae in the production of meningoencephalitis. A mention of the axenic cultivation of Entamoeba histolytica introduced by Diamond will not be out of place, this being quite a milestone in medical protozoology.

The Siphonapteran genus Thrassis is such a large and complex taxon that, despite its obvious importance in the ecology of sylvatic plague, it has remained in marked need of revision ever since it was erected in 1933 by Jordan. Systematists, and scientists interested in plague, are therefore indebted to Dr. Stark for undertaking such a worthy and difficult project, and for handling it so capably. As a result, it is now relatively easy to identify the species and subspecies of this Nearctic genus of rodent-fleas, and to determine their host-relationships, geographic range, and known association with plague infection.

In the introductory section the author reviews the taxonomic history of Thrassis, explains some of his concepts in systematics, and introduces some new terminology, as well as discusses possible modes of evolution within the genus.

Dr. K. C. Kates, in a review of the second edition of this textbook, stated that “there has long been a need for a reasonably comprehensive, up-to-date textbook covering the field of animal parasitology largely from the zoological point of view, rather than with primary emphasis upon the medical and/or veterinary aspects of the subject, although some discussion of applied parasitology is desirable in such a book” (J. Parasitol., 51: 127–128, 1965). Even though others have been attempting to meet this need since 1964, this reviewer believes that the Noble brothers' textbook is still the best one available.

The second edition consisted of 24 chapters, 18 of which were devoted to a systematic account of the taxonomy, morphology, and biology of animal parasites. In the new edition, there are 25 chapters divided into 10 sections. Sectional titles are: Introduction (I), Phylum Protozoa (II), Phylum Platyhelminthes (III), Phylum Acanthocephala (IV), Phylum Nematoda (V), Phylum Arthropoda (VI), Miscellaneous Phyla (VII), Parasite-Host Responses (VIII), Ecology of Parasites (IX), and Evolution of Parasitism (X).

This text is a valuable source of information on pesticides, but Part I does not deal significantly with environment. Robert L. Metcalf's chapter on The Chemistry and Biology of Pesticides occupies more than half the book and is typically efficient, effective, and understandable. This chapter alone makes purchase worthwhile. The extensive chapter on Metabolism of Insecticides and Fungicides by T. Roy Fukuto and James J. Sims is accurate, understandable, and well organized. The much shorter chapter on Metabolism of Herbicides by J. E. Loeffler and J. van Overbeek is highly informative and provides a clear description of the whys, hows, and whats of pesticide metabolism studies. The introduction by editor Robert White-Stevens, overbiased in favor of widespread pesticide usage, does disservice to the more carefully balanced presentations developed in the chapters. The text describes the status of pesticides as of 1966 to 1967, reflecting an overly long publishing lag.

As Medicine changes, so does Pathology. Over the last half dozen years, the summary articles appearing in “Pathology Annual” have reflected the “Explosion of Knowledge” which is taking place; increasingly, background information on physiology, biochemistry, microbiology, or epidemiology is being incorporated to bring the core subject matter into clearer context. The major emphasis is still on the interpretation of tissue changes by the working pathologist, but many articles should be useful reading matter for other scientists or physicians.

In the latest (1971) volume, three articles are directly relevant to tropical medicine: those on Anthrax, by W. Dutz and E. Kohout of Shiraz University, on Burkitt's Lymphoma by D. H. Wright, and on Melanoma by M. G. Lewis. All three can be well recommended.

The anthrax article is perhaps the most unique; it reflects a substantial personal experience in a subject which to most of us is merely textbook knowledge.

The authors and publishers of this bibliography are to be congratulated for a simple, yet straight-forward, useful and inexpensive publication. It consists of 2,035 references on Chagas's disease and its etiologic agent, Trypanosoma cruzi, plus an author index in a slim, paper-covered volume. References are arranged in numerical order and grouped in 14 practical subject headings such as taxonomy, cultivation, pathology, therapy, etc. The subject of epidemiology is further subdivided into four appropriate sections such as vectors, reservoir hosts, etc., and the final of the 14 principal subject headings is devoted to references concerning T. rangeli. In the author index an asterisk marking serves to distinguish entries of principal vs. joint authorship.

This bibliography has been compiled from entries between 1909 and late 1970 in the well-known and high quality abstracting journal, Tropical Diseases Bulletin (TDB). For each entry the TDB reference as well as the original citation is included.