Fever from the USA or Portugal?
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Bone Marrow↗
Biomedical subjects
D Overbosch
Publications and source records attributed to D Overbosch.
Low body mass index is associated with an increased risk of neuropsychiatric adverse events and concentration impairment in women on mefloquine.
AIMS: We performed a prospective cohort study to gain more insight into risk factors for neuropsychiatric effects of mefloquine among tourists travelling to tropical areas. METHODS: We enrolled all patients who consulted the Travel Clinic of the Havenziekenhuis & Institute for Tropical Diseases Rotterdam for mefloquine prophylaxis during the period between 1 May 1999 and 7 March 2000. Each patient was followed from baseline (prior to starting mefloquine) up to 3 weeks after starting weekly intake of 250 mg mefloquine. We compared the intraindividual change in scores between baseline and follow-up visit on the Dutch shortened Profile of Mood States, and on the Continuous Performance Test (CPT) which measures sustained attention. RESULTS: The final cohort consisted of 151 subjects with a mean age of 38 years. In this population, a significant impairment of mood state was observed in those with a body mass index (BMI) < or = 20 kg m(-2). Stratification for gender showed that the total mood disturbance in females in the lowest BMI category significantly increased by 8.42 points [95% confidence interval (CI) 3.33, 13.50], whereas BMI did not affect the risk in males. Stratification for history of use of mefloquine showed that the risks were highest in first-time users. Analyses of the CPT showed that reaction time in women with a BMI < or = 20 kg m(-2) increased significantly by 22.5 ms (95% CI 7.80, 37.20), whereas reaction time in men showed a slight and nonsignificant decrease. CONCLUSION: Risk factors for mefloquine-associated neuropsychiatric adverse events and concentration impairment are female gender, low BMI, and first-time use. The frequency of neuropsychiatric effects is highest in women with a BMI < or = 20 kg m(-2).
Adolescent↗
Neuropsychiatric events during prophylactic use of mefloquine before travelling.
INTRODUCTION: It has been suggested that neuropsychiatric events during use of mefloquine are more common in females than in males and are partly explained by the psychological stress of travelling. Therefore, we investigated neuropsychiatric events in females and males on mefloquine in the 3-week prophylactic period that precedes travelling. Furthermore, we investigated whether first-time users had a higher risk of neuropsychiatric adverse events than subjects with a history of mefloquine use. METHODS: We enrolled all patients who visited a Travel Clinic for mefloquine prophylaxis during the period 1 May 1999 to 7 March 2000. Each patient was followed from baseline (prior to starting mefloquine) up to 3 weeks after the start of mefloquine but before travelling. We asked patients to register any adverse event in a diary and measured the intra-individual change in scores on the Dutch Shortened Profile Of Mood States (POMS) at baseline and at the end of follow-up. RESULTS: The final cohort consisted of 179 subjects with a mean age of 3 years. Females reported adverse events more frequently than males ( P=0.005). Overall, we observed a small but significant increase in the score on the domain fatigue [0.74 points, 95% confidence interval (CI) 0.18, 1.30]. The effect was exclusively present in females and not in males. First-time users of mefloquine increased 2.81 points (95% CI 0.70, 4.92) on the total score of the POMS, and among those, women showed the largest increase of 4.58 points (95% CI 0.74, 8.43). CONCLUSION: The use of mefloquine was associated with neuropsychiatric adverse effects. Females encountered neuropsychiatric effects more frequently than males, which could be confirmed by validated psychological tests. Neuropsychiatric effects were more common in first-time users than in individuals who had used mefloquine before.
Adolescent↗
Atovaquone plus chloroguanide versus mefloquine for malaria prophylaxis: a focus on neuropsychiatric adverse events.
OBJECTIVES: We performed a prospective, double-blind, randomized study to compare the occurrence of neuropsychiatric adverse events and concentration impairment during prophylactic use of either mefloquine or atovaquone plus chloroguanide (INN, proguanil). METHODS: Our potential study population consisted of all persons who were included in the MAL30010 trial at the Travel Clinic, Rotterdam, The Netherlands. All subjects were randomized to receive either active atovaquone (250 mg) plus chloroguanide (100 mg) daily plus a placebo for mefloquine weekly or active mefloquine (250 mg) weekly plus a placebo for atovaquone plus chloroguanide daily. Each subject was followed up from a baseline screening visit up to the index date, 7 days after he or she left the malaria-endemic area. We measured the interindividual and intraindividual changes in mood disturbance by means of the Dutch shortened Profile of Mood States and 3 domains of the Neurobehavioral Evaluation System, which included sustained attention, coding speed, and visuomotor accuracy between baseline and follow-up visit. RESULTS: The cohort consisted of 119 subjects with a mean age of 35 years. A significant deterioration in depression, anger, fatigue, vigor, and total mood disturbance domains occurred during use of mefloquine but not during use of atovaquone plus chloroguanide. Stratification for sex showed between-treatment differences in female patients but not in male patients. In both treatment groups, sustained attention deteriorated after travel, especially with increased duration of stay. CONCLUSIONS: Prophylactic use of mefloquine was associated with significantly higher scores on scales for depression, anger, and fatigue and lower scores for vigor than prophylactic use of atovaquone plus chloroguanide.
Adolescent↗
Atovaquone-proguanil versus mefloquine for malaria prophylaxis in nonimmune travelers: results from a randomized, double-blind study.
Concerns about the tolerability of mefloquine highlight the need for new drugs to prevent malaria. Atovaquone-proguanil (Malarone; GlaxoSmithKline) was safe and effective for prevention of falciparum malaria in lifelong residents of malaria-endemic countries, but experience in nonimmune people is limited. In a randomized, double-blind study, nonimmune travelers received malaria prophylaxis with atovaquone-proguanil (493 subjects) or mefloquine (483 subjects). Information about adverse events (AEs) and potential episodes of malaria was obtained 7, 28, and 60 days after travel. AEs were reported by an equivalent proportion of subjects who had received atovaquone-proguanil or mefloquine (71.4% versus 67.3%; difference, 4.1%; 95% confidence interval, -1.71 to 9.9). Subjects who received atovaquone-proguanil had fewer treatment-related neuropsychiatric AEs (14% versus 29%; P=.001), fewer AEs of moderate or severe intensity (10% versus 19%; P=.001), and fewer AEs that caused prophylaxis to be discontinued (1.2% versus 5.0%; P=.001), compared with subjects who received melfoquine. No confirmed diagnoses of malaria occurred in either group. Atovaquone-proguanil was better tolerated than was mefloquine, and it was similarly effective for malaria prophylaxis in nonimmune travelers.
Adolescent↗
Atovaquone-proguanil versus chloroquine-proguanil for malaria prophylaxis in non-immune travellers: a randomised, double-blind study. Malarone International Study Team.
BACKGROUND: Chloroquine plus proguanil is widely used for malaria chemoprophylaxis despite low effectiveness in areas where multidrug-resistant malaria occurs. Studies have shown that atovaquone and proguanil hydrochloride is safe and effective for prevention of falciparum malaria in lifelong residents of malaria-endemic countries, but little is known about non-immune travellers. METHODS: In a double-blind equivalence trial, 1083 participants travelling to a malaria-endemic area were randomly assigned to two treatment groups: atovaquone-proguanil plus placebos for chloroquine and proguanil, or chloroquine, proguanil, and placebo for atovaquone-proguanil. Follow-up was by telephone 7 and 60 days after travel and at a clinic at 28 days. Serum samples were tested for antibodies to a malaria circumsporozoite protein. Blood and serum samples of participants with a potential malaria diagnosis were tested in a reference laboratory. FINDINGS: 7 days after travel, at least one adverse event was reported by 311 (61%) of 511 participants who received atovaquone-proguanil and 329 (64%) of 511 who received chloroquine-proguanil. People receiving atovaquone-proguanil had a lower frequency of treatment-related gastrointestinal adverse events (59 [12%] vs 100 [20%], p=0.001), and of treatment-related adverse events of moderate or severe intensity (37 [7%] vs 56 [11%], p=0.05). There were fewer treatment-related adverse events that caused prophylaxis to be discontinued in the atovaquone-proguanil group than in the chloroquine-proguanil group (one [0.2%] vs ten [2%], p=0.015). INTERPRETATION: Overall the two preparations were similarly tolerated. However, significantly fewer adverse gastrointestinal events were observed in the atovaquone-proguanil group in than in the chloroquine-proguanil group.
Adolescent↗
[Increase of malaria in the Dominican Republic].
In November 1999 nine European cases of malaria caused by Plasmodium falciparum reportedly were imported by tourists from the Dominican Republic. The incidence of malaria has increased since the hurricane George and since building activities for tourist centres have favoured growth of the mosquito population. Travellers to the Dominican Republic are advised to take precautions against mosquitoes and to take proguanil prophylaxis also malaria should be considered in patients with fever who have visited the area, if only as tourists.
Antimalarials↗
[Acute management of patients bitten by poisonous snakes].
The management of poisonous snake bites includes first aid and clinical medical treatment. First aid consists of reassurement of the patient, immobilisation of the bitten limb and rapid transport to the nearest hospital to monitor the vital functions. In no case suction, incision or tight bandages should be applied. The degree of envenomation can be classified in three categories depending on the spread of the symptoms: no symptoms, only local non-progressive symptoms, and systemic or local rapidly progressive symptoms (severe envenomation). Antivenin therapy is indicated in severe envenomation. Because of the risk of anaphylactic reactions or serum sickness, antivenin should be given with great caution. Antibiotic therapy and tetanus prophylaxis are advised in all cases. Immediate consultation with the National Intoxication Centre of the Rijksinstitut voor Volksgezondheid en Milieu (RIVM) is always warranted; telephone: 030-2748888. In a national protocol, which is available at the RIVM, the Harbour Hospital Rotterdam, the Academic Medical Centre and Artis Zoo Amsterdam, the correct management of snake bites is described. An overview of all antivenins available in the Netherlands is also given in this protocol.
Anaphylaxis↗
[Cholestatic hepatitis ascribed to the use of thiabendazole].
Two women, aged 27 and 42 years, both born in Surinam and both suffering from heterozygous thalassemia, developed cholestatic hepatitis three and two weeks respectively after the start of a two-day course of thiabendazol for Strongyloides stercoralis infection. Other causes of cholestasis were unlikely in view of the results of blood tests, echography and the endoscopic retrograde cholangiopancreaticography. The symptoms persisted for several months, and the liver function disorders for 7 years and one year, respectively. The incidence of thiabendazole-induced cholestatic hepatitis is unknown, but probably low.
Adult↗
[Neurocysticercosis].
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Bacterial Infections↗
[2 patients with neurocysticercosis].
Cysticercosis of the CNS, caused by the pork tapeworm Taenia solium, was diagnosed on the basis of serological and imaging examination in two patients, a woman aged 50 and a man aged 40 years. The former patient suffered from aphasia, headache and epileptic attacks, the latter mostly from epilepsy. Cysticercosis of the CNS occurs mainly in the tropics but is occasionally observed in the Netherlands in people who have been to the tropics, such as the patients reported. Both ultimately recovered after drug therapy which included praziquantel.
Adult↗
'The tropics in our bathroom': chronic diarrhoea after return from the tropics.
Interest in imported tropical diseases has increased with the rising number of travellers to the tropics. This is especially true in the case of tropical gastroenterologic disorders. The causative organisms of chronic diarrhoea are different from those causing acute diarrhoea. Bacteria are relatively unusual; parasites, e.g. Entamoeba histolytica or Giardia lamblia or an opportunistic parasitic infestation associated with an HIV infection are more likely. Furthermore, non-infectious causes, such as postinfective tropical malabsorption, lactase deficiency or coeliac disease have to be considered. Today, elderly people often undertake a journey to the tropics; in these cases the diarrhoea may be associated not only with an increased susceptibility to tropical bowel infections but also with causes previously present, such as diverticulosis, carcinoma or inflammatory bowel disease. The classification of chronic diarrhoea following a visit to the tropics is essentially the same as that for acute diarrhoea: diarrhoea with and without fever and with and without blood. In addition, malabsorption is an important feature of chronic diarrhoea.
Adult↗
Carcinoma of the colon presenting as Streptococcus sanguis bacteremia.
Bacteremia by streptococci that normally inhabit the gastrointestinal tract has been associated with colon carcinoma. Such association is best known for Streptococcus bovis, but has also been reported for other streptococci. In the present communication a patient is described who presented with Streptococcus sanguis bacteremia and was subsequently found to suffer from an adenocarcinoma of the sigmoid. A possible association between bacteremia by commensal streptococci of both the upper and lower gastrointestinal tract and colon carcinoma is discussed.
Adenocarcinoma↗
Neurocysticercosis. An introduction with special emphasis on new developments in pharmacotherapy.
Neurocysticercosis is the most important parasitic infection of the nervous system in countries of the third world. The disease is caused by the cystic larval stage of Taenia solium, the pork tape worm. The clinical picture of neurocysticercosis is due to the parasite itself and/or an inflammatory reaction around degenerating cysts in the central nervous system. It may cause epilepsy, chronic meningitis and hydrocephalus. The diagnosis is greatly facilitated by the use of computer tomography, magnetic resonance imaging and serological tests. Praziquantel and albendazole now offer a reasonable treatment for neurocysticercosis. However, the effect of praziquantel is largely dependent on its bioavailability, which is decreased by the use of antiepileptics and, possibly, dexamethasone. Albendazole is associated with side effects on bone marrow and liver, and it has teratogenic and mutagenic properties. Both drugs act poorly on intraventricular cysts. Coadministration of cimetidine with praziquantel leads to a significant two-and-a-half times' increase of the latter drug's bioavailability. This resulted in a good clinical response to treatment for 12 patients with various forms of neurocysticercosis. Although neurocysticercosis is no longer endemic in many Western European countries, its incidence is likely to increase due to increased travel to, and immigration from, endemic countries.
Albendazole↗
[Tropical malaria; does prophylaxis become simpler?].
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Animals↗
Complete and partial deficiencies of complement factor D in a Dutch family.
A young man suffering from recurrent Neisseria infections was shown to lack detectable serum complement factor D hemolytic activity. Addition to the patient's serum of purified factor D to a final concentration of 1 microgram/ml resulted in full restoration of the activity of the alternative pathway. Using an enzyme-linked immunosorbent assay, it was shown that the patient's serum did not contain measurable amounts of factor D antigen either. The sister, the father, as well as the parents of the mother had factor D levels within the normal range, and the factor D level of the mother was decreased. The capacity of the patient's serum, at concentrations up to 5%, to promote phagocytosis of Escherichia coli by normal human granulocytes was low when compared to normal serum. Substitution of the patient's serum with purified factor D resulted in a full restoration of opsonic activity. This study describes the first complete deficiency of factor D, and demonstrates its possible relation to recurrent Neisseria infections.
Adult↗
Inhibitory effects of cimetidine ketoconazole and miconazole on the metabolism of praziquantel.
In order to find ways to increase the usually very low bioavailability of praziquantel, the effect of cytochrome P-450 inhibitors on the metabolism of praziquantel was investigated in rats. Cimetidine, ketoconazole, and miconazole yielded a 90% inhibition of the metabolism of praziquantel in liver microsome preparations from phenobarbital-pretreated rats at concentrations of 2.0, 0.03, and 0.01 mM, respectively. In rats in vivo ketoconazole and miconazole increased the bioavailability of praziquantel by a factor of 2 and 4, respectively in doses of 25 mg/kg. In phenytoin-pretreated rats ketoconazole increased the bioavailability of praziquantel by a factor of 1.4, whereas miconazole yielded a 5-fold increase of the bioavailability. Cimetidine was an effective inhibitor at a dose of 200 mg/kg. These results suggest that the inhibitors tested may suppress the metabolism of praziquantel in humans and consequently increase the bioavailability and blood levels at doses common in human therapy.
Animals↗
Jaundice caused by hydatid disease of the liver.
Between 1980 and 1985, 40 patients were treated surgically for hydatid disease of the liver. In 4 cases (10%) jaundice was the first and most conspicuous sign of this disease. The patients originated from Spain, Morocco, Turkey and Lebanon. In 2 of these cases the initial diagnosis was hepatitis; one patient was operated on for suspected acute cholecystitis. All 4 patients had an eosinophilia and positive hydatid serology. Hydatid material was found in the biliary tract in two cases, while bile-stained hydatid fluid proved that there was a communication between cystic cavity and biliary tract in the other two patients. Obstruction of the common bile duct by hydatid elements causes jaundice and probably also cholangitis. Calcifications in the cyst are no guarantee against future complications. Surgery is the treatment of choice. When patients from an endemic area present with jaundice, hydatid disease of the liver should be suspected, particularly if eosinophilia also exists.
Adult↗