Additional Notes from the ASTMH Meeting
Conference Coverage
By Lin H. Chen, MD
Emerging Infections and Outbreaks
Abstract #274. Marcos LA, et al. A case-control study of human fascioliasis in the province of Azangaro, Puno (Peru). Marcos et al evaluated epidemiological and clinical indicators, laboratory results (including hematocrit, eosinophil counts, Fas2-ELISA, and Fasciola hepatica egg counts in feces), animal feces, and relationship of fascioliasis to other intestinal parasites. Compared to controls, subjects with F hepatica had a greater degree of eosinophilia. The main risk associated with F hepatica infection appeared to be drinking alfalfa juice. Patients frequently presented with periods of jaundice. Ascaris lumbricoides was the only intestinal parasite associated with fascioliasis. The diagnosis of fascioliasis should be considered in assessing eosinophilia in returned travelers, especially if specific epidemiologic risks exist.
Abstract #359. McLaughlin JB, et al. Outbreak of echovirus 18 meningitis in a summer camp—Prince William Sound, Alaska, 2001 (national implications). McLaughlin et al conducted telephone interviews with attendees of a summer camp and ill contacts to determine the causes of a viral meningitis outbreak. A total of 79 case patients were identified, and echovirus 18 was identified from 11 case patients. Water sources for the camp were found to be untreated and contained high fecal coliform counts. State regulations may be needed to protect the health of camp attendees.
Abstract #527. Miller RS, et al. Serologic evidence of unusual JE complex flaviviruses along the Thai-Myanmar border. Miller et al studied unspecified febrile illnesses in the Thai-Myanmar border in Sangkhlaburi, Thailand. Screening of villagers has shown very high antibody titers against West Nile Virus (WNV) and lower titers against Japanese Encephalitis. Sentinel surveillance in animals during 2001 showed seroconversion to flavivirus in 50% of ducks and most pigs, most of which occurred following 21 days in the field. Some samples showed high titers to WNV, and further identification is being conducted. This report indicates the possible presence of WNV in Thailand.
Malaria
Abstract #51. Maguire JD, et al. Therapeutic efficacy of chloroquine or mefloquine for uncomplicated Plasmodium falciparum and P vivax malaria in Javanese migrants to Papua, Indonesia. Between November 1996 and July 1999, 698 P falciparum and 723 P vivax infections in migrants were studied. Chloroquine failed in 80% of P falciparum infections and in 60% of P vivax infections. Maguire et al found no mefloquine treatment failures; thus, mefloquine is effective against chloroquine-resistant P falciparum and P vivax.
Abstract #199. Dev V. Emergence of multidrug-resistant malaria in the northeastern India. P falciparum causes roughly 60% of malaria cases (and P vivax causes the rest) in northeastern India. Chloroquine and sulfadoxine-pyrimethamine (SP) were evaluated for treatment efficacy against P falciparum. Dev et al reported chloroquine sensitivity in 57% of cases, whereas 35% showed late treatment failure, and 8% showed early treatment failure. Among the cases that received SP, 79% responded and 21% failed. Failures to chloroquine and SP were treated with quinine and all responded. Multidrug-resistant strains of P falciparum appears to have been introduced in India at the border with Myanmar and can spread further with migration of people.
Abstract #567. Miller RS, et al. Azithromycin-quinine combination therapy for the treatment of uncomplicated falciparum malaria in Thailand. Combinations of azithromycin (500 mg b.i.d. for 3 days, 500 mg b.i.d. for 5 days, or 500 mg t.i.d. for 3 days) and oral quinine (30 mg/kg/d divided q8 hours) were evaluated for treatment efficacy against P falciparum on the Thai-Myanmar border, using quinine-doxycycline for 7 days as control. Azithromycin 500 mg b.i.d. for 5 days or 500 mg t.i.d. for 3 days in combination with oral quinine led to 100% cure. However, there was 10% recrudescence at 28 days following the regimen with azithromycin 500 mg b.i.d. for 3 days. This combination has potential uses in falciparum malaria patients for whom doxycycline is contraindicated, such as young children and pregnant women.
Schistosomiasis
Abstract #263. Jackson F, et al. Schistosomiasis prophylaxis using DEET. Fifteen subjects applied 50% DEET during an expedition to Lake Malawi, an area known to have schistosomiasis. The group’s average contact with water was 48 hours. The subjects were followed up 3 months later with urine microscopy, eosinophil count, and schistosomal egg antigen ELISA. Thirteen subjects were found to be free of schistosomiasis. Two subjects whose tests showed schistosomiasis were found to have positive tests on blood samples taken before their exposure in Lake Malawi. This report suggests that application of DEET 8-12 hours after exposure may prevent schistosomiasis.
Bacterial Infections
Abstract #36. Mohamed MA, et al. Rapid diagnosis of typhoid fever by enzyme immunoassay (EIA) detection of Salmonella serotype typhi antigens from urine. Investigators developed an EIA using monoclonal antibodies to detect somatic antigen 9, flagellar antigen d, and Vi capsular polysaccharide antigen from urine. The test detected Vi antigen from 73% of 44 patients with typhoid fever. The sensitivity increased to 100% when testing was done during the first week of fevers. False-positive results occurred in patients with brucellosis, but the test can be useful in the diagnosis of typhoid fever.
Abstract #414. Dualan ARA, et al. Bacteriology of drinking water in the greater Manila area of the Philippines. Coliform and bacteriological tests performed at the University of the Philippines College of Public Health in 1998 were analyzed retrospectively. Analysis of drinking water from Metro Manila and surrounding provincial areas showed that provincial water was more likely to have higher coliform and total bacteriological counts (TBC). Filteration of water improved the coliform content and TBC. Surprisingly, bottled water was more likely to have coliforms and higher TBC than public water. Boiling the water may be advised!
Dr. Chen, Clinical Instructor, Harvard Medical School, Director, Travel Resource Center, Mt. Auburn Hospital, Cambridge, Mass., is Associate Editor of Travel Medicine Advisor.
Conference coverage: emerging infections and outbreaks, malaria, schistosomiasis, bacterial infections
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