By Carol A. Kemper, MD, FACP

Eco-Unfriendly Cow Dung

Source: San Francisco Chronicle. September 2, 2001.

Authorities met in the French Alps recently to discuss the growing problem of "poisonous" dung in pastures. With the increased use of ivermectin (and other avermectins) as parasiticides in cows, sheep, and horses, the ecotoxicity of drug excreted in feces is creating a significant problem (which has largely been ignored for years). Apparently up to 90% of ivermectin can be excreted in feces and is not significantly changed over a long period of time. Unfortunately, the drug is toxic to many flies and beetles—a single cow pat can kill up to 20,000 dung-eating beetles in one week! A recent study documented significant reductions in dung-eating beetles in feces of sheep treated with ivermectin but not in those treated with albendazole. The result being that cow pats and sheep feces in pastures and hillsides are not decomposing but are left to dry rock-solid in the field where they remain for years. The potential toxic effects on smaller invertebrate creatures is not known, but apparently earthworms are not affected—they just don’t eat dried dung. A colleague once described the world as covered by a thin layer of feces—now maybe it really will be true. 

Albendazole in Echinococcus

Source: Keshmiri M, et al. Trans R Soc Trop Med Hyg. 2001;95:190-194.

Keshmiri and colleagues in Mashhad, Iran, evaluated the effectiveness of albendazole in the treatment of echinococcus in patients with inoperable disease, multiple cysts, or who refused surgery. Twenty-nine patients were randomized to receive albendazole vs. placebo in a 2:1 ratio. Albendazole was administered 10-15 mg/kg per day in 2 divided doses for 3 6-week cycles with 2 weeks off between cycles. The 29 patients had a total of 240 cysts (1-46 per patient). The groups were fairly balanced with regard to age and cyst size and number.

By 6 months, 21 patients remained on study (8 were lost to follow-up). The difference in the frequency of response between the 2 groups was significant. Of 17 patients completing the course of albendazole, 8 (47%) were cured, 7 (41%) showed improvement, and 2 (12%) were unchanged for an overall response rate of 88%. In contrast, only 1 of 4 control patients showed spontaneous improvement at 6 months. Cyst number and volume was significantly reduced in patients receiving albendazole (and many of those remaining may have represented "dead" cysts). While only 8.7% increased in size in treated subjects, about two-thirds of cysts increased in size in controls. Although Keshmiri et al were disappointed that the response rates were not higher despite the increased number of weeks of drug exposure than previously examined, these data support the administration of albendazole as a safe and effective first-line therapy thereby obviating the need for surgical intervention in many patients.

Hepatitis B Tops 75% in Guangdong

Source: ProMED-mail post August 28, 2001; promed@promedmail.org.

Based on screening blood samples obtained from hospital patients in Guangdong, China, medical experts fear that up to 75% of the people (~10 million) in this southernmost province of China have been infected with Hepatitis B virus. Although earlier reports suggested that up to two-thirds of the population in some areas of China might have been infected, the Guangdong Province may be the most heavily infected area in the world.

Infection rates of Hepatitis B have soared in China during the past 20 years, especially in rural areas where trafficking of illegal syringes and IV tubing is profitable and the cost of sterile medical supplies is prohibitive. Although many people are believed to have been infected as children during routine vaccinations, adults are also at risk. Apparently many Chinese prefer medications to be administered parenterally—believing they are more potent. As a result, rural "doctors," many of whom are not truly physicians, will administer injections of nutritional supplements, vitamins, and antibiotics as a "cocktail" to ill patients. Needles are ostensibly sterilized before reuse but the process is not monitored. Illegal blood donations have also contributed to the problem. Chinese authorities recently promised hundreds of millions of dollars to attempt to rectify the problem, which now has reached crisis proportions.

Nipple Piercing Goes Straight to the Heart

Source: Ochsenfahrt C, et al. Ann Thorac Surg. 2001;71:1365-1366.

A 24-year-old man with a history of congenital bicuspid aortic valve and coarctation of the aorta that had been surgically repaired about 15 years earlier decided to do what many kids his age do—he got his nipple pierced. Unfortunately, he received no prophylactic antibiotics for the procedure. Within days of getting his new nipple ring, he developed mastitis at the site. And, within 2 months, he presented with Staphylococcus aureus endocarditis eventually requiring valve replacement (the nipple ring was first removed). This case serves as a reminder to alert patients at risk for endocarditis that even simple cosmetic procedures, such as piercing, require antibiotic prophylaxis.

Dr. Kemper, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, is Associate Editor of Infectious Disease Alert.