The American Journal of Tropical Medicine and Hygiene - Volume 38, Issue 3, 1988

This list terminated as of 31 January 1988, when the May issue of the Journal was completed. Each of the 101 articles in Volume 38 has been seen by two or more of the colleagues listed below. These referees also have seen manuscripts that are still under review or have been rejected.

Current members of the Editorial Board are A. S. Benenson, Charles H. Calisher, Allen W. Cheever, Joel M. Dalrymple, James L. Hardy, Rodney C. Jung, Llewelyn J. Legters, Edgar J. Martin, Harry Most, Franklin A. Neva, Robert E. Shope, Mette Strand, Diane W. Taylor, Harold Trapido, Thomas H. Weller, and Thomas M. Yuill. Each of these individuals has served as referee on an average of 6 manuscripts, one having seen as many as 15. Often this has required that the same manuscript be seen more than once. They also have served, either collectively, as members of ad hoc groups, or singly to advise the Editor on a variety of problems.

Members of the American Society of Tropical Medicine and Hygiene and guests, I am pleased to have the opportunity to introduce Joseph A. Cook, President of our Society. I have known Joe Cook for almost 18 years. During this time I have learned from him, worked with him, and philosophized with him, while watching him progress through several different professional roles.

Joe did not give me much prior notice regarding this introduction. I believe this was done deliberately. Thus, I have not had time to collect embarrassing old photographs and maudlin quotes from his high school teachers. But, Joe went to medical school at Vanderbilt University, and several of his old classmates are faculty colleagues of mine. This has given me the opportunity to try to dig up a little dirt to tell you about Joe. Unfortunately, the most I could get from anyone was: “Sure, I remember him. He was always such a nice guy.”

Let me begin by telling you that it has been a privilege to be entrusted with the affairs of the Society for these 12 months, so much so that I leave it with regret. It was my feeling at the time of Harry Hoogstraal's death, before he could serve as your president, that Franz von Lichtenberg should serve for 2 years and thereby begin a new policy of 2-year terms. The Council rejected this option and I am honored by their having selected me. Even as the only nonelected president in the Society's history—that is, as the Gerald Ford of this Society—I cannot overlook the great honor it is to be numbered among the eminent former presidents.

Despite what you might think, a pleasant perquisite of the job has been the stimulus to review some of our history. Most of you who have listened to these perorations in the past know that reading past presidents' speeches is considered mandatory.

The ability of Plasmodium falciparum to accumulate 3H-clindamycin, 3H-tetracycline, and 3H-dihydrostreptomycin was determined in synchronized trophozoites and schizonts in 87% parasitemia 5% hematocrit cultures. Accumulation was time-dependent and modestly concentration-dependent. At 0.1 mM initial external drug concentration, the ratio of drug concentration in cells:medium after 120 min was 5.5 for 3H-clindamycin, 2.8 for 3H-tetracycline, and 0.95 for 3H-dihydrostreptomycin. Corresponding values for uninfected erythrocytes were 3.2, 2.3, and 0.78, respectively. These data may explain the lack of antimalarial activity of the aminoglycosides and may partially explain the slow onset of therapeutic action of clindamycin and tetracycline. The low intracellular concentrations attained for the latter two drugs have important implications for understanding the kinetics and mechanism of their antiplasmodial effects.

Exoerythrocytic stage parasites of Plasmodium malariae were obtained in vitro by inoculating primary cultures of hepatocytes from a chimpanzee (Pan troglodytes) and a monkey (Aotus lemurinus griseimembra) with sporozoites. Schizonts were observed in chimpanzee hepatocytes 8, 11, and 13 days after inoculation. Only 1 schizont was seen in Aotus hepatocytes at day 13. The morphology and development rates of P. malariae exoerythrocytic stages obtained in vitro were similar to those previously described in vivo.

In an in vitro study, IgG was synthesized in large amounts by tissue from cutaneous leishmaniasis lesions. IgA and IgM were produced in the minority of the cultures in distinct and small amounts, respectively. Synthesis of complement (C3 and C4) could not be detected, but lysozyme was produced sporadically. The significance of these findings is discussed.

Bloodmeal analysis of Triatoma dimidiata collected in peridomestic habitats of western Panama showed that avian feedings comprised 25% of this species' host selections; opossums, the principal reservoir of Chagas' disease in the republic, were not among mammalian feedings. These findings may account for the low infestation rates of Trypanosoma cruzi in the bugs and the hypoendemicity of Chagas' disease in western Panama.

Axenically cultivated Entamoeba histolytica, trophozoites, strains HM-1:IMSS and HM-38, were suspended in solutions of NaCl, 330 mOsm, of varying pH and ammonium concentrations. Short-term viability was inversely proportional to the ammonia concentration of the medium and was independent of the ammonium concentration and pH. The NH3-induced ameba killing was associated with a cellular alkalosis and cell swelling. While short-term trophozoite viability was unaffected by changes in the medium pH over the range 5.5–8.0, long-term viability was reduced by high pH, and of three pH values tested (6.27, 7.27, and 8.27), trophozoite growth was greatest at the lower value. Chemotaxis was observed in media over the pH range 5.5–8.0, and attenuated chemotaxis was observed in trophozoites in media containing NH3 (0.1 mM). The cecal content total ammonia concentration and pH and the in vivo mucosal microclimate pH were measured in young adult male rats, hamsters, and gerbils. Ceca of the three rodent species were also inoculated with HM-38 trophozoites and 7 days later the cecal contents were studied for signs of amebic infection. Infections were absent in the rat, the species with highest luminal total ammonia concentration and mucosal microclimate pH. All gerbils were infected. This species had the lowest mucosal microclimate pH. The hamster, with the intermediate microclimate pH, had a low infection rate (1 of 5). It is proposed that when ammonium diffuses from the large intestinal lumen into a more basic mucosal microclimate, it is converted to ammonia, and the combination of this ammonia and the high microclimate pH threatens Entamoeba trophozoite viability and reduces the probability of a given ameba penetrating the mucus blanket and invading the mucosal epithelium.

From June 1982 to May 1986 in a small village in Kwale, Kenya, we studied seasonal fluctuations in populations of Bulinus globosus, prevalence of Schistosoma haematobium infection in this snail, and effects of chemotherapy and piped water supply on infection rate of snails. In the perennially-flowing Pemba River, relatively small numbers of snails were collected; they were found only during the hot dry season (December to March). In a tributary stream, the Kadingo River, whose flow ceased at the end of both the cool and hot dry seasons, snail numbers peaked at the end of the cool dry season (October to November) and at the beginning of the hot dry season (January). Large numbers of infected snails were found in the Kadingo River from November to January (short rainy season and beginning of dry season). Selective mass chemotherapy with metrifonate and provision of piped water were begun in February and March 1984. These control measures achieved a significant reduction in the infection rate of snails (P < 0.001); the annual infection rate for the 2 years before treatment was 9.3% and 13.1%, and for the 2 years after treatment was 3.5% and 3.4%.

Ultrasonography was used in a village in the Gezira-Managil scheme in the Sudan to identify patients with Symmers' fibrosis. In a random sample from patients with active Schistosoma mansoni infection, 238 patients were found to have no liver involvement while 59 had Symmers' periportal fibrosis. Patients were treated with a single dose of 40 mg/kg body weight of praziquantel. Six months after dosing, 51% and 58% were cured of the infection with 81% and 84% reduction in egg burden in the Symmers' and non-Symmers' patients, respectively. The drug was equally well tolerated by the two groups. It is concluded that patients with Symmers' fibrosis respond to praziquantel and tolerate the drug in a similar manner to patients without Symmers'.

Eleven wild-caught nine-banded armadillos were infected with cercariae of the Kenyan strain of Schistosoma mansoni for 1–25 weeks. Distribution of eggs along and within the gut and liver was similar to that seen in human schistosomiasis. However, egg excretion was poor, eggs were small, rate of infection was low, and the prepatent period was long. From these data it is concluded that Dasypus novemcinctus is an inefficient reservoir host of S. mansoni.

The serologic activity of a cationic fraction (denoted CEF6) of Schistosoma mansoni soluble egg antigen was compared in an ELISA with that of the unpurified soluble egg antigen for the ability to detect human infections and for the prediction of chemotherapeutic success in patients followed up to 5 years post-treatment with oxamniquine. The cationic fraction correctly identified 100% of 20 patients as infected with S. mansoni; moreover, 50% (10 of 20) seroconverted to negative by 2 years post-treatment and 100% of 15 patients tested were negative 5 years post-treatment. In general, the cationic fraction was superior to the unpurified soluble egg antigen for the detection of infection and for the prediction of chemotherapeutic success. The cationic fraction also exhibited greater immunologic specificity over the unpurified soluble egg antigen in that the latter exhibited higher titers than the former to antibodies against heterologous parasite antigens (Fasciola hepatica, Clonorchis sinensis, Paragonimus westermani adult worms; Trichinella spiralis larvae). Moreover, rabbit antisera raised against egg antigens isolated from the precipitation formed when fresh S. mansoni eggs are incubated with S. mansoni infection of immunization sera (known as circumoval precipitin reactions or COP) reacted strongly with the cationic fraction in ELISA. In addition, antiserum to the cationic fraction as well as antisera against either of the two antigenic components of this fraction, known as antigens α1 and θ1, all give positive COP reactions when incubated with fresh S. mansoni eggs. This suggests that the cationic fraction antigens are a subcomponent of the COP reaction, a phenomenon which has been used as a highly sensitive and specific serological assay for the detection of S. mansoni infections.

Induction of resistance to a Schistosoma mansoni infection was analyzed following injections of glutaraldehyde-fixed parasites or of subfractions prepared from nonfixed parasites killed by repeated freeze-thaw cycles. The parasites were isolated from mice infected 4 weeks previously and the subfractions were prepared by extraction in buffered saline or in detergent. A variety of immunization protocols were conducted in rats and mice. These included different sites of injection, dose size, and number of booster injections; different adjuvants; and the effects of boosting with live infections. Induction of a partial resistance is observed in rats, but has not been achieved in mice immunized by the same procedures. The alum-precipitated detergent-solubilized fraction was superior at lower doses. Exposure of rats to a low dose cercarial infection 3 weeks prior to challenge did not boost the resistance if the rats were already partially resistant through vaccination with worm subfractions in adjuvant. Serum from vaccinated rats transfers partial protection to a challenge infection of naive rats.

Potential mechanisms causing elimination of lung stage schistosomula were investigated in normal C57BL/6 mice and C57BL/6 mice previously vaccinated with irradiated cercariae. Autoradiography was used to measure the proportion of radiolabeled schistosomula which could be recovered from lung tissue by mincing and incubation. There was no difference between the two sets of mice at each time point, and no substantial diminution in the proportion recovered over the sampling period of 7 to 17 days postinfection. By this in vitro criterion, the emergence of schistosomula from lung fragments was not influenced by inflammation. However, we are unable to rule out the possibility that migration is impeded by inflammation in vivo. The migratory potential and viability of schistosomula recovered after residence in the lungs for increasing lengths of time was assessed by their introduction into the vasculature of naive recipients. The results indicate that significant numbers of schistosomula are capable of maturation, but fail to mature if left in situ in the lungs of both normal and vaccinated mice. No evidence was found that schistosomula suffer cytotoxic injury in the skin, subsequently dying in the lungs, or that they are damaged by the pulmonary inflammatory reactions which develop in vaccinated mice. Schistosomula delivered to the alveoli have a limited capacity to reenter tissues and mature. We suggest that in normal C57BL/6 mice the deflection of parasites into the alveoli during migration is the reason why many fail to mature. In vaccinated C57BL/6 mice a similar but augmented process may account for the elimination of a greater proportion of challenge parasites.

Recombinant DNA techniques were employed to address the problem of specificity in a serodiagnostic test for schistosomiasis. Immunoprecipitation of in vitro translation products of adult Schistosoma mansoni RNA with sera from Egyptian donors revealed that the human IgG response to schistosome proteins is highly heterogeneous, does not correlate with clinical status, and remains essentially unaltered 6 months after chemotherapeutic cure; peptides of 38 and 70 kDa are recognized by sera from patients infected with S. mansoni or S. haematobium but not by sera from individuals harboring other helminth infections. Using serum from C57BL/6J mice acutely infected with S. mansoni, which strongly reacts with these peptides and very weakly with other worm proteins, portions of the 70 kDa peptide were cloned from an expression cDNA library. The value and limitations of using recombinant schistosome antigens in serodiagnostic assays is discussed.

Total RNA containing messenger RNA has been isolated from adult Fasciola hepatica and translated in vitro using the rabbit reticulocyte lysate system. L-[35S]-methionine labeled translation products have been immunoprecipitated with sera collected from rabbits infected with F. hepatica, rabbits immunized with adult worm homogenate, and a rabbit and 5 calves immunized with a Fasciola/Schistosoma cross-reactive, cross-protective antigen, denoted FhSmIII(M). Precipitated antigens were analyzed by SDS-polyacrylamide gel electrophoresis. The major antigens recognized by hyperimmune sera had apparent molecular weights of 12,500, 13,500, 14,000, 26,500, and 27,000. The rabbit anti-FhSmIII(M) serum precipitated a 13,500 Mr antigen. Sera collected from calves immunized with FhSmIII(M) also precipitated a 13,500 Mr antigen together with a 26,500 Mr molecule. Antibody with specificity for F. hepatica mRNA translation products could be detected in rabbit serum 2 weeks after infection.

Eight patients from Uganda, Sudan, Nigeria, and Zaire presented with swelling of the eyelids, proptosis, or conjunctival granulomas. In 5 patients the cause was Mansonella perstans; in 1, it was a Wuchereria bancrofti-like worm; and in 2, an unidentifiable worm. The morphologic features and histopathologic changes in the conjunctiva and periorbital fat are described and illustrated.

A cryopreservation protocol for Trichinella spiralis muscle stage larvae is described. Larvae are pretreated in 10% bile at 37°C for 1 hr to induce an increase in surface permeability, then incubated in 20% v/v ethanediol at 37°C for 10 min, transferred to 0°C for a second incubation step of 15 min in a v/v mixture of 33% ethanediol: 33% methanol: 34% saline at 0°C followed by rapid cooling (≈5,100°C min-1) of aliquots distributed onto glass coverslips. The larvae are thawed by dropping the coverslips into 2 ml saline at room temperature (20°C) and immediately agitating, which simultaneously dilutes (1:100) the cryoprotectants. Groups of 6 mice were infected with muscle stage larvae by gastric intubation. Five days post-infection 14.5 ± 3.2% of control untreated unfrozen MSL and 16.5 ± 4.1% of unfrozen bile and cryoprotectant treated controls were recovered as adult worms from the small intestine. Of the cryopreserved larvae, 1.1 ± 0.4% were recovered as adults, which represents 7.6% compared to the untreated unfrozen controls. When the bile pretreatment step was omitted fewer adult worms (0.09 ± 0.04%) were recovered and no second generation muscle stage larvae were produced. Modifying this technique by omitting the first incubation step in 20% ethanediol and extending the second incubation step to 25 min yielded 72.3% recovery of T. nativa adult worms 5 days post-infection compared to unfrozen controls. The reproductive capacity index of bile treated cryopreserved T. spiralis was 2.5 ± 0.6 compared to 51.8 ± 18.8 for normal muscle stage controls.

Twenty of 94 (21.4%) Rattus norvegicus trapped in New Orleans, Louisiana, between April 1986 and February 1987 were infected with Angiostrongylus cantonensis (3–62 worms per rat). This is the first report of the parasite from North America. A carnivorous snail, Euglandina rosea, was found experimentally to be able to serve as both an intermediate and a paratenic host. Other locally occurring gastropods that were successfully infected experimentally included Mesodon thyroidus, Anguispira alternata, Bradybaena similaris, Subulina octona, Polygyra triodontoides, Vaginulus ameghini, Philomycus carolinianus, Deroceras laeve, Limax flavus, and Lehmannia poirieri. Laboratory reared, 4- to 5-week-old M. thyroidus and D. laeve were able to support the development of small numbers of larvae to the third stage. First stage larvae of A. cantonensis in the feces of experimentally infected rats were found not to migrate out of the fecal pellet; this behavior favors the infection of feces-consuming gastropods. Twenty heavily infected L. flavus were observed over a period of 2 months, and shedding of third stage larvae of A. cantonensis was never seen. While factors support the spread of A. cantonensis in rats in the southern United States, the probability of human infection is uncertain since the parasite is transmitted primarily by ingestion of raw intermediate and paratenic hosts.

Mucosal mast cell numbers are modulated in the intestines of rodents during parasitic infections. These mast cells can degranulate in response to worm antigens, and this event has been suggested to play a protective role for the host. To examine whether mast cells in higher animals play a role in protecting from disseminated parasitic disease, mast cell numbers and responsiveness to parasite antigens were evaluateed in 5 Erythrocebus patas infected with the human intestinal nematode Stronglyoides stercoralis. Initial infection and subsequent challenge infections were associated with increases in jejunal histamine and mast cell numbers, and these mast cells could release histamine in response to parasite antigens. Jejunal mast cell numbers returned to normal during a chronic phase of infection. The cells lost their ability to respond to antigenic stimulation following limited steroid treatment. Subsequent activation of chronic infections to fatal disseminated disease by more prolonged steroid treatment was associated with a marked decrease in jejunal mast cell numbers and histamine. In one animal which succumbed to severe disease without steroid treatment, jejunal mast cells were refractory to worm antigens.

Mass drug administration via 3 modes of delivery reduced the incidence and prevalence rates and intensity of Brugia malayi infection in 3 rural villages in the Bengkoka Peninsula, Sabah, in 1982–1983. A dosage of 6 mg diethylcarbamazine citrate (DEC-C)/kg body weight was administered either daily or weekly (total of 6 doses, 36 mg/kg body weight), and impact on B. malayi cases were comparable in the 3 villages. A total of 384 people participated in the DEC-C regimens, and all pregnant women and children under 2 years were excluded from the study. Bekessy's method of estimation of incidence and recovery rates was applied to data on B. malayi microfilaremia before drug administration. Treatment with DEC-C by any of the 3 modes of delivery drastically reduced the number of episodes of patent microfilaremia, incidence and prevalence, and median microfilarial density. Reduction was sustained for at least 18 to 24 months after treatment.

This study was designed to reexamine the efficacy of diethylcarbamazine for bancroftian filariasis with special reference to changes in serum parasite antigen levels and antifilarial antibody titers after treatment. Patients with asymptomatic microfilaremia were treated with 6 mg/kg diethylcarbamazine daily for 12 days. Microfilaria counts fell dramatically after treatment, as expected. IgG antibody titers to adult and microfilarial antigens of B. malayi were increased 1 month after treatment in most patients. Titers fell slowly to or below pretreatment levels, but remained positive during subsequent months. Parasite antigen levels, measured by monoclonal antibody-based enzyme immunoassay, decreased to 72%, 58%, 53%, and 48% of pretreatment values 1, 3, 6, and 12 months after diethylcarbamazine treatment, respectively. Parasite antigen levels decreased similarly in subjects with and without residual microfilaremia after treatment. These results suggest that diethylcarbamazine has only partial macrofilaricidal activity against W. bancrofti with this dosage schedule. The sustained, impressive reductions in microfilaria counts after treatment despite significant persistence of parasite antigenemia may be explained by sublethal effects of the drug on adult worms. We believe that parasite antigen detection represents a valuable new approach for monitoring the efficacy of antifilarial drug therapy which we hope will lead to improved use of existing drugs and aid in the evaluation of new drugs for filariasis.

Laboratory-derived Simulium yahense and S. sanctipauli females were used to produce large numbers of Onchocerca volvulus infective stage larvae (L3) for use in assessing the possible chemoprophylactic potential of ivermectin in the chimpanzee model. Engorgement rates and subsequent post-prandial survival were correlated with the time at which adult flies were offered a carbohydrate source following emergence and the age of flies that fed on microfiladermic volunteers.

A painless lump in the breast in a 43-year-old Chinese woman was found on surgical excision to be a cysticercus presumed to be that of Taenia solium. Routine investigations failed to reveal infection at any other site.

In South America programs to control hydatidosis caused by Echinococcus granulosus include the active search for asymptomatic patients through population surveys for the detection of antibodies against arc 5 antigens using the double diffusion arc 5 test (DD5). Though simple to perform and highly specific, DD5 is not practical for population studies due to the time lapse between testing and receiving results. This work evaluates the application of an enzyme immunoassay to screen sera for subsequent processing using DD5. The efficiency of an enzyme immunoassay screening/DD5 confirmation scheme vs. DD5 alone was compared within the framework of a control program. A total of 5,839 sera from residents of endemic areas was processed and 47 hydatid patients were detected by both schemes. The proposed enzyme immunoassay identified all sera having antibody activity against arc 5 antigens detectable by DD5 and ruled out 95.3% of sera which tested by DD5 would have produced negative results.

Leukocyte subsets present in the granulomatous response produced after the inoculation of a mixture of Mycobacterium leprae and BCG in lepromatous leprosy patients were characterized in situ using monoclonal antibodies and an immunoperoxidase technique. The granuloma produced after M. leprae-BCG inoculation showed a distribution pattern similar to tuberculoid granulomas. T lymphocytes bearing the CD8 phenotype (T cytotoxic/suppressor) were sequestered to the periphery of the epithelioid tubercles and T helper-inducer CD4+ lymphocytes were distributed throughout the infiltrate. Langerhans cells CD1 + were increased in the epidermis, and in dermis they were localized mainly in the mantle surrounding the granuloma. Most of the dermal infiltrate produced after the inoculation or M. leprae-BCG expresses the HLA-DR antigen. Similarly, most keratinocytes were also positive to this MHC antigen. The granulomatous response to BCG was similar to the inoculation of a mixture of M. leprae-BCG, however acid-fast bacilla were still present. The inoculation of M. leprae produced a macrophage granuloma with no clearing of the bacilla which resembles the lepromatous leprosy granuloma.

An outbreak of shigellosis associated with swimming at a human-made lake during the Labor Day weekend occurred in Los Angeles County in 1985. Sixty-eight persons had onset of diarrheal illness within 1 week following exposure at the recreational site. Thirty-three of these cases were culture-confirmed as shigellosis (29 Shigella sonnei, 4 Shigella boydii). Fifteen persons were hospitalized. Illness was highly associated with water contact, specifically swallowing water while swimming (P < 0.001) and age < 15 years (P < 0.001). Water samples from the swimming area had high fecal coliform counts; however, dye testing showed no evidence of sewage contamination. Direct bather contamination of the swimming area may have occurred in the context of large crowds, inadequate restroom facilities, poor water exchange, and the absence of a mechanism of disinfection.

The effects of tourniquet application were prospectively studied in 36 hospitalized patients who developed neurotoxic symptoms after bites by the Philippine cobra (Naja naja philippinensis). Tourniquets had been applied in 94% of cases and delayed the onset of symptoms. Four patients were asymptomatic prior to the release of their tourniquet and in 11 patients symptoms worsened precipitously. Most importantly, 4 patients developed complete respiratory paralysis requiring artificial ventilation on its removal. Medical personnel seeing patients after a possible cobra bite should remove any tourniquet very gradually with both specific therapy and ventilatory support at hand. We recommend tourniquet application in the Philippines only after the bite of a definitely identified cobra and when removal can take place under controlled hospital conditions.

In some areas of endemic trachoma, muscoid flies may play a significant role in transmission of this serious eye infection. A simple and practical method of quantifying the relative household density of synanthropic flies has been developed for use in epidemiological field surveys. The method uses two boards moistened with a 10% sucrose solution. The fly scores showed good reproducibility at the same sampling site during the day and on different days. The only flies identified were Musca sorbens, showing their local density and a significant association of this fly with the presence of inflammatory trachoma in children.

An outbreak of icteric non-A non-B (NANB) hepatitis occurred in a residential community of urban Karachi, Pakistan, from August 1986 through October 1986. Of the 114 cases reported from this community during the 1986 calendar year, a clustering of 85 cases was seen during the above period. Twenty-seven percent of 226 households and 9% of 1,250 individuals were affected. Five persons were hospitalized and 1 death occurred in a young pregnant woman. Cases occurred predominantly in the ≤29-year-old age group (72%), with a male: female ratio of 1.8:1. Thirty-four cases occurred singly within households, while in 28 households multiple cases were seen. Analysis of the epidemic curve and intervals of onset of multiple cases within households suggested prolonged common source exposure rather than secondary person-to-person transmission. No single water source was implicated but a contaminated municipal supply was presumed. Information collected from several other communities and from a university hepatitis reference laboratory suggested that the outbreak was part of a larger urban epidemic of NANB hepatitis. Based upon this investigation and data from recently published reports, it is concluded that NANB hepatitis is endemic in Pakistan.

A house-to-house survey was carried out to determine the prevalence of poliomyelitis. During the survey 37,219 households were visited and 17,941 children 5–9 years old were found. Of 231 lame children, lameness compatible with paralytic poliomyelitis was found in 131, of these 91% had their condition before the age of 3 years. Nineteen percent ndeded a stick support for walking while 12% were unable to walk even with support. This problem was more common in rural populations. The prevalence of paralytic poliomyelitis was 7.3/1,000 children 5–9 years old.

Hantaan, Seoul, and Puumala viruses were transmitted to 12–16-week-old female Wistar Rattus norvegicus by inhalation. The rodent infectious dose for each virus by intramuscular inoculation and by inhalation was determined, as was the infectious dose for Vero E-6 cells by direct plaque assay.

The sensitivity and specificity of an enzyme-linked immunosorbent assay (ELISA), absolute numbers of T-helper cells, and T-helper: T-suppressor cell ratios were compared in asymptomatic controls and IgG Western blot-confirmed patients with the acquired immune deficiency syndrome (AIDS) in Kinshasa, Zaire, between August 1984 and May 1985. Two hundred sixteen (97.7%) of 221 IgG western blot-positive AIDS patients and 4 of 97 (4%) controls were ELISA-positive, 3 of whom were Western blot-positive. The sensitivity and specificity of the ELISA was 97.7% and 99.0%, respectively, compared to Western blot results. Detection of the human immune deficiency virus using absolute number of T-helper cells (<400 cells/mm3) was as sensitive (98.2%), but less specific (90.7%). A T-helper: T-suppressor ratio of <0.9, had a sensitivity of 97.3%, and specificity of 94.8%. The ELISA test had the highest predictive value and greatest utility in an African clinical setting for detecting HIV infected patients were a wide range of other immunocompromising diseases are seen.

Developments in Veterinary Virology: Avian Leukosis, edited by G. F. De Boer. x + 292 pages, illustrated. Kluwer Academic Publishers Group, P.O. Box 989, 3300 AZ Dordrecht, The Netherlands. 1987. $70.00.

Community Health Aide/Practitioner Manual, by Robert D. Burgess. viii + 464 pages, illustrated. Alaska Area Native Health Service, 1345 Rudakof Circle, Suite 206, Anchorage, Alaska 99504. 1987. $34.00.

WHO Expert Committee on Onchocerciasis, Third Report. Technical Report Series, No. 752, by the World Health Organization. 167 pages, illustrated. World Health Organization, 1211 Geneva 27, Switzerland. 1987. $14.40, paperbound.

Vector Control in Primary Health Care, Report of a WHO Scientific Group. Technical Report Series, No. 755, by the World Health Organization. 61 pages. World Health Organization, 1211 Geneva 27, Switzerland. 1987. $5.40, paperbound.

Plant Molluscicides, edited by Kenneth E. Mott. xi + 326 pages, illustrated. Published for UNDP/World Bank/WHO by John Wiley & Sons, Inc., 605 Third Avenue, New York, New York 10158. 1987. Paperbound.

A recent Journal article by Martinez and others, concerned the determination of the efficacy of pentavalent antimony, the primary agent for leishmaniasis, against Leishmania braziliensis and L. donovani amastigotes in a human macrophage cell line (U937). The dose of Pentostam (sodium stibogluconate) expected to 50% inhibit growth (ED50) of both species was “10 and 6 ng/ml, respectively.” Doses >100 ng/ml were not tested and there was no dose that inhibited >70% of parasite growth.

In the Discussion section of this article, the authors state that “the growth inhibition of L. b. braziliensis and L. donovani (Khartoum) by sodium stibogluconate is similar to that reported in other established systems.14” Reference 14 is work of our group. As the title indicates, it concerns the antileishmanial activities of experimental purine analogs, not of Pentostam. However, we have reported the activity of Pentostam against L. tropica (now called L. major) and L. donovani amastigotes in human monocyte-derived macrophages in other work.