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Biomedical subjects

E Van den Enden

Publications and source records attributed to E Van den Enden.

At least 19 recordsLinked to original sources
PubMed1999

Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients.

During the 1995 outbreak of Ebola hemorrhagic fever in the Democratic Republic of the Congo, a series of 103 cases (one-third of the total number of cases) had clinical symptoms and signs accurately recorded by medical workers, mainly in the setting of the urban hospital in Kikwit. Clinical diagnosis was confirmed retrospectively in cases for which serum samples were available (n = 63, 61% of the cases). The disease began unspecifically with fever, asthenia, diarrhea, headaches, myalgia, arthralgia, vomiting, and abdominal pain. Early inconsistent signs and symptoms included conjunctival injection, sore throat, and rash. Overall, bleeding signs were observed in <45% of the cases. Typically, terminally ill patients presented with obtundation, anuria, shock, tachypnea, and normothermia. Late manifestations, most frequently arthralgia and ocular diseases, occurred in convalescent patients. This series is the most extensive number of cases of Ebola hemorrhagic fever observed during an outbreak.

Adolescent↗
PubMed1999

Organization of patient care during the Ebola hemorrhagic fever epidemic in Kikwit, Democratic Republic of the Congo, 1995.

In contrast with procedures in previous Ebola outbreaks, patient care during the 1995 outbreak in Kikwit, Democratic Republic of the Congo, was centralized for a large number of patients. On 4 May, before the diagnosis of Ebola hemorrhagic fever (EHF) was confirmed by the Centers for Disease Control and Prevention, an isolation ward was created at Kikwit General Hospital. On 11 May, an international scientific and technical committee established as a priority the improvement of hygienic conditions in the hospital and the protection of health care workers and family members; to this end, protective equipment was distributed and barrier-nursing techniques were implemented. For patients living far from Kikwit, home care was organized. Initially, hospitalized patients were given only oral treatments; however, toward the end of the epidemic, infusions and better nutritional support were given, and 8 patients received blood from convalescent EHF patients. Only 1 of the transfusion patients died (12.5%). It is expected that with improved medical care, the case fatality rate of EHF could be reduced.

Algorithms↗
PubMed1998

Recurrence of blackwater fever: triggering of relapses by different antimalarials.

Five cases of blackwater fever (BWF) are described, all of whom had a history of recent quinine therapy. In two cases a second haemolytic crisis was induced by halofantrine, in one case also a third. Increasing frequency of this syndrome with its dramatic clinical presentation is to be expected as imported P. falciparum infection, parasite resistance to chloroquine and the use of quinine and other related antimalarials become more frequent.

Adult↗
PubMed1997

Kabisa: an interactive computer-assisted training program for tropical diseases.

In Europe, tropical pathology is usually taught in special short courses, intended for those planning to practise in developing countries. The theoretical knowledge to be assimilated during this short period is considerable, and turning such newly acquired knowledge into competence is difficult. Kabisa is a computer-based training program for tropical diseases. Instead of concentrating on strictly tropical diseases, students are trained in recognizing diseases in patients presenting randomly in an imaginary reference hospital in a developing country. Databases are compiled by experts from experiences in various parts of Africa, Asia and tropical America. Seven languages and three levels of competence can be chosen by the student. Updating of all databases is possible by teachers who want to describe a particular setting. A 'consistency checker' verifies the internal consistency of a new configuration. The logical engine is based upon both a 'cluster' and a Bayesian logic, with built-in corrections for related disease characteristics. This correction allows calculated probabilities to stay closer to real probabilities, and avoids the 'probability overshoot' that is inherent to 'idiot Bayes' calculations. The program provides training in diagnostic skills in an imaginary second-line setting in a tropical country. It puts tropical and cosmopolitan diseases in perspective and combines applied clinical epidemiology and pattern recognition within varying sets of presenting symptoms. Students are guided in searching for the most relevant disease characteristics, in ranking disease probability, and in deciding when to stop investigating.

Belgium↗
PubMed1996

[Sleeping sickness as an import pathology following a stay in Zaire].

A 32-year-old Italian man developed fever and general malaise 3 weeks after arrival in Zaïre. Malaria was diagnosed by a thick blood film, but consequent treatment with quinine was unsuccessful. After repatriation, the diagnosis of early stage sleeping sickness was established. Treatment with eflornithine (Ornidyl) resulted in complete recovery.

Adult↗
PubMed1995

Eosinophilic myositis resulting from sarcocystosis.

Muscle sarcocystosis is a parasitic infection acquired by ingestion of sporocysts of Sarcocystis species. A case is described where symptoms of fever, chronic myositis and eosinophilia were present. Diagnosis was made via muscle biopsy. Improvement and cure coincided with treatment with cotrimoxazole. A limited review of human muscle sarcocystosis and an outline of the gaps in the knowledge of this infection is presented.

Adult↗
PubMed1995

Clinical training for tropical doctors in the nineties.

Together with economic causes, the declining belief in the relevance of clinical skills, the omission of the hospital from the health system, and the erroneous generalisation of a complaint centred approach enhanced the decline in clinical medicine in several developing countries over the last decades. Despite a growing interest and important efforts in continuous education, basic training remains generally knowledge-directed. Clinical training should start from a realistic job description, and aim at acquiring skills instead of knowledge. Basics of clinical epidemiology can help refine clinical logic both at the health centre and the hospital level. the district hospital should be awarded a key role in pre-graduate and continuous clinical training. Awaiting a revival of the economy in most tropical countries, and especially in tropical Africa, an effective way for improving clinical practice is to invest in training, at all levels, with an emphasis on continuous medical training.

Clinical Competence↗
PubMed1995

Diagnosis of amoebic infection of the liver: report of 36 cases.

The classical clinical picture of amoebic infection of the liver consists of fever, right upper quadrant pain and hepatomegaly. In recent years, the widespread availability of ultrasound and serology made an early diagnosis possible, which could result in less prominent clinical pictures. Thirty six cases of liver amoebiasis diagnosed in Antwerp between 1985 and 1992, were reviewed. Three patients acquired their infection in Belgium. For the other patients, the average delay between arrival in Belgium and the first symptoms was 5.64 months. The classical triad of clinical signs (fever, right upper quadrant pain and hepatomegaly), was observed in only 13.9% of the patients, whereas it was much more frequent in earlier studies (68-75%). The right lobe was the most frequently affected (94%). The colour of the liquid, obtained by puncture, was brown in 61% of patients in whom it was reported. Amoebic cysts were found in the stools of only one patient. Amoebic serology was initially negative in only one patient, but became positive on second testing. Chest X-rays were abnormal in 34% of the patients. All patients who develop unexplained fever during the year after a stay in tropical countries should undergo an abdominal ultrasound examination and serological testing for Entamoeba histolytica.

Adult↗
PubMed1994

Atypical varicella zoster infection in persons with HIV infection.

Four patients with HIV infection and severe immunodeficiency are described who developed atypical varicella zoster lesions. Three of the patients presented with chronic varicella zoster lesions. In two of them such lesions were hyperkeratotic. All three patients had been treated initially with subtherapeutic doses of acyclovir. In one of the patients the lesions were clinically resistant to high dose acyclovir treatment and disappeared only when renal insufficiency developed during foscarnet-famcyclovir treatment. One patient developed a disseminated varicella zoster infection.

AIDS-Related Opportunistic Infections↗
PubMed1994

Twelve patients with severe malaria treated with partial exchange transfusion. Comparison between mathematically predicted and observed effect on parasitaemia.

Imported malaria is increasing in Western countries, which results in considerable morbidity and mortality, the latter mainly due to delayed diagnosis and treatment. Partial exchange transfusion has been proposed as a therapy for very severe falciparum malaria, but the utility of this procedure has not been proven. We report on 12 patients with severe Plasmodium falciparum malaria, treated with exchange transfusion in 5 Belgian hospitals between 1987 and 1991. The mean parasitaemia before exchange was 17.2% (range 6-35%). An average of 3.1 l was exchanged within 3 to 7 hours. Ten of the 12 patients survived. One patient recovered initially, but died as a consequence of a cascade of complications of dialysis. Three patients developed the adult respiratory distress syndrome (ARDS), two had less serious pulmonary involvement, and five had temporary renal failure; none of the survivors had sequelae. A formula is proposed to calculate the expected reduction in parasitized erythrocytes by exchange transfusion in function of the initial parasitaemia, the initial haemoglobin level and the volume of blood exchanged. Comparison between the mathematically predicted and the observed decline in parasitaemia shows on average a 25% excess of observed over predicted efficacy per unit of blood exchanged. After introducing this correction the formula enables the clinician to estimate roughly the volume of blood that has to be exchanged in order to bring the initial parasitaemia down to a desired level.

Adult↗
PubMed1994

Development of hyperreactive malarious splenomegaly in an 8 year-old Caucasian boy, 18 months after residence in Africa.

Hyperreactive malarial splenomegaly (the former tropical splenomegaly syndrome) refers to a combination of splenomegaly, high antimalarial antibodies and high serum IgM content, a condition resulting from an aberrant immunological response to malaria. It has rarely been described in expatriates. We report the case of an 8 year-old Dutch boy who developed this syndrome 18 months after returning from Zaire. Treatment with mefloquine resulted in gradual improvement of all laboratory abnormalities. The spleen did not decrease in size, but became normal for age as height increased.

Animals↗
PubMed1993

Evaluation of two staging systems for HIV infection for use in developing countries.

OBJECTIVE: To evaluate the clinical axis of the World Health Organization (WHO) clinical staging system and the modified WHO staging system proposed by Montaner et al. using the lymphocyte strata > 1500, 1500-1000 and < 1000 cells x 10(6)/l. DESIGN: Cross-sectional study. PATIENTS: Four hundred and fifteen consecutive patients with HIV infection attending three HIV reference centres in Belgium. METHODS: Absolute CD4 lymphocyte counts were compared between stages within the two staging systems. RESULTS: Median CD4 lymphocyte counts decreased with increasing stage of disease in both staging systems. Differences in median CD4 lymphocyte counts between stages of each staging system were statistically significant (Kruskal-Wallis one-way analysis of variance, P < 0.001). The WHO clinical stage 1 and the modified WHO stage I had positive predictive values of 56 and 58%, respectively, for identifying patients with CD4 lymphocyte levels > 500 cells x 10(6)/l. The WHO clinical stage 4 and the modified WHO stage IV had positive predictive values of 79 and 80%, respectively, for identifying patients with CD4 lymphocyte levels < 200 cells x 10(6)/l. CONCLUSIONS: The WHO clinical staging system or a modified version of this system using lymphocytes stratification may be a good alternative in developing countries to the CD4 lymphocyte count-based HIV staging system used in the developed world. Cohort studies in developing countries are needed to assess their prognostic value.

CD4-Positive T-Lymphocytes↗