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Biomedical subjects

H D Nothdurft

Publications and source records attributed to H D Nothdurft.

At least 55 records · Page 3Linked to original sources
PubMed1997

Exchange blood transfusion in severe falciparum malaria: retrospective evaluation of 61 patients treated with, compared to 63 patients treated without, exchange transfusion.

The rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presumptive 'toxic' factors, and improvement of the rheological quality of the blood. We evaluated the records of 61 patients treated with ET to describe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of 61 patients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exchange transfusion is applied according to the clinician's subjective impression rather than strict guidelines. Logistic regression analysis adjusting for the differences in clinical parameters between patients treated with or without ET did not identify treatment as a prognostic indicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4-4.9). Exchange transfusion did not significantly improve the unfavourable prognosis in cases of severe falciparum malaria. However, failure to reach statistical significance may be due to the retrospective design of the study and therefore non-systematic approach.

Adult↗
PubMed1997

Anti-malarial drug resistance, malnutrition and socio-economic status.

To investigate the relationship between nutritional status and resistance to chloroquine treatment, we designed a nested case-control study prospective with respective to the outcome of Plasmodium falciparum-infected school children aged 5-14 years from Honiara, Solomon Islands. 38 chloroquine-resistant cases were compared with treatment-susceptible controls with respect to current nutritional status, behavioural characteristics, medical and demographic data. The overall prevalence of moderate malnutrition was 28%. The incidence rate of chloroquine resistance was 23%. Malnourished children were generally at higher risk for treatment failure than well-nourished ones (OR: 3.6; 95% CI: 1.6-8.4; P = 0.001). This effect was modified by socio-economic status. Stratified analysis by logistic regression resulted in an eightfold risk of resistance for malnourished children in the higher socio-economic category (OR: 8.1; 95% CI: 2.4-27.9; P = -.0001). In children from the lower socio-economic group, the effect of malnutrition was not significant (OR: 1.5; 95% CI: 0.4-5.6). Socio-economic differences may affect the immune status. The treatment response in children of lower socio-economic status, which are more exposed to malaria, may therefore be less affected by malnutrition.

Adolescent↗
PubMed1997

Prevalence of infection with Cryptosporidium parvum and Cyclospora cayetanensis among international travellers.

BACKGROUND: Cryptosporidium parvum and Cyclospora cayetanensis are recognised as possible pathogens of traveller's diarrhoea. AIMS: To identify the prevalence of C parvum and Cyc cayetanensis in travellers returning from developing countries. PATIENTS: Nine hundred and seventy eight stool samples wer taken from 795 patients returning from developing countries. METHODS: Microscopy (iron-haematoxylin stain, SAF concentration, modified acid fast stain) and a commercially available enzyme linked immunosorbent assay (ELISA) kit for the detection of Cryptosporidium antigen in stool. RESULTS: Of the 795 patients in the study, 469 suffered from diarrhoea. Infection with Cyc cayetanensis could be detected in five subjects (1.1%) by acid fast stain, and 13 patients (2.8%) were infected with C parvum. On evaluation, the antigen capture ELISA turned out to be clearly less sensitive for detection of C parvum than microscopy. All patients with either C parvum or Cyc cayetanensis infection suffered from watery diarrhoea. CONCLUSIONS: C parvum and Cyc cayetanensis are not major causes of diarrhoea in international travellers. In cases of persistent watery diarrhoea, however, these pathogens should be taken into account in the differential diagnosis.

Animals↗
PubMed1997

Japanese encephalitis vaccine in travellers. Is wider use prudent?

Vaccination against Japanese encephalitis has been carried out extensively in many Asian countries for the past 20 years and is also increasingly recommended for travellers to endemic areas. Although the currently available vaccine, manufactured from mouse brain, is generally considered to be highly effective and of low reactogenicity, approximately 50% of vaccinees report experiencing usually mild adverse effects following vaccination. Concern has been raised regarding potential neurological adverse effects but the incidence of such effects appears to be very low (around 1 to 2.3 per 1000000 vaccinations). Routine vaccination of all travellers to endemic areas is clearly not beneficial at this moment and use of the vaccine should remain restricted to persons spending a month or longer in endemic areas, especially rural areas, during the transmission season. However, when counselling individual travellers, it has to be kept in mind that the possibility of Japanese encephalitis can never be ruled out completely when travelling to endemic areas, and that such an infection can prove disastrous for the individual concerned.

Animals↗
PubMed1997

[Cross reactions of patients with acute dengue fever to tick-borne encephalitis].

Sera from 20 patients with acute dengue fever were tested on their cross reactivities to other flaviviruses, especially against tick-borne encephalitis (TBE). One of the test systems used, indirect immunofluorescence (IIFT), was shown to exhibit strong cross reactivity. The reactivity pattern of sera from patients with pre-existing vaccine-induced antibodies against TBE or yellow fever was found similar to dengue secondary antibody response. In plaque reduction neutralization tests (PRNT) no cross reactions between different flaviviruses were found. The results show that PRNT is the most specific test system for differentiation of flavivirus antibodies.

Acute Disease↗
PubMed1997

[Determination of actual risk factors for malaria infection for travelers by means of measurement of circumsporozoite antibodies].

Measurement of antibodies to circumsporozoite (CS) antigen of Plasmodium falciparum can be used as reliable indicator of malaria transmission in endemic areas. Sensitivity and specificity of an ELISA testkit for the detection of CS antibodies were assessed. In a second step, in order to estimate the actual rate of malaria infection, the prevalence of CS antibodies in serum was investigated in a selected population of travellers returning from sub-Saharan Africa and presenting without any clinical sign of malaria by use of an ELISA. CS antibodies could be detected in 47 out of the 222 investigated patients (21.2%), while 175 (78.8%) tested negative. Both groups did not differ in sex, age, destination or duration of journey or symptoms after return. There was, however, a considerable difference in travel type noticeable: 134 out of the 175 CS-negative patients (76.6%) travelled on a package tour, while this was only true for 8 out of the 47 CS-positive patients (17%, p < 0.001). These data demonstrate the importance of adequate malaria chemoprophylaxis in non-immune travellers to highly endemic areas.

Animals↗
PubMed1996

Evaluation of an antigen-capture enzyme immunoassay for detection of Entamoeba histolytica in stool samples.

In order to identify the prevalence of Entamoeba histolytica in tourists with diarrhoea returning from countries of the developing world, sensitivity and specificity of a commercially available enzyme immunoassay (EIA) kit for the detection of Entamoeba histolytica coproantigen in stool were evaluated. Five hundred seventy-seven specimens from 469 patients were examined by microscopy and EIA. Sixty-two specimens from 49 patients were considered positive for Entamoeba histolytica. Compared with microscopic examination of stool samples, the EIA was found to be slightly more sensitive (90.3% vs. 87.1%) and was 97.7% specific for Entamoeba histolytica.

Animals↗
PubMed1996

Risk factors of chloroquine resistance in Plasmodium falciparum malaria.

OBJECTIVE: To identify patient-related risk factors of chloroquine resistance. DESIGN: A case control study. SUBJECTS: Plasmodium falciparum infected school children were followed prospectively for 7 days for the detection of chloroquine resistance. Cases were 38 individuals with chloroquine resistant infections. Controls were 125 individuals with chloroquine sensitive infections. Cases were compared with controls with respect to previous or current study factor levels. Subjects were recruited from randomly selected schools which were stratified for area. Study location was in North Guadalcanal, Solomon Islands. OUTCOME MEASURE: Treatment failure of chloroquine in standard dosage (25 mg/kg). Follow-up period was 7 days. RESULTS: Logistic regression resulted in 5 independent significant predictors of chloroquine resistance, obtained simultaneously with the diagnosis of malarial infection: (i) Young age (odds ratio (OR) for age < 7 years: 7.1; 95% confidence interval (CI): 2.5-25.0; OR per year increase after the age of 5 years: 0.8; 95% CI: 0.6-0.9). (ii) High parasite density (OR for > 1000/microliters: 5.0; 95% CI: 2.0-10.6; OR per 500 parasites/microliters increase: 1.3; 95% CI: 1.1-1.7). (iii) Normal spleen size (OR: 4.0, 95% CI; 1.5-10.8). (iv) Malnutrition (OR: 4.9; 95% CI: 1.8-13.2). (v) Presence of gametocytes in the thick smear (OR: 3.0; 95% CI: 1.1-8.0). CONCLUSION: The identified risk factors are easily measurable without special equipment. They may be useful for health workers in the Solomon Islands, even in remote areas, to identify Plasmodium falciparum infected individuals at high risk for chloroquine resistance before a treatment decision is made.

Age Factors↗
PubMed1996

Adverse reactions to Japanese encephalitis vaccine in travellers.

Vaccination against Japanese Encephalitis (JE) has been carried out extensively in many Asian countries for the past 20 years. The vaccine was generally considered to be effective and of low reactogenity. However, since 1989 an unusual number of systemic reactions characterized mainly by generalized urticaria and/or angioedema following JE vaccination were reported from Australia, Canada and Denmark, 860 travellers were recruited during a period of 16 months for a prospective study with the aim to investigate the type and incidence of side effects following JE vaccination (JEV) in German travellers. 826 received a primary immunization (2 injections at days 0 and 7-14) and 34 received a single booster injection. A detailed standardized questionnaire was distributed to all vaccinees after the first injection. A total of 509 questionnaires could be evaluated, which represents a return rate of 59.2%. 46% of the vaccinees reported about no adverse events at all. 54% reported about one or more adverse effects. Local reactions at the injection site were observed by 209 vaccinees, while 65 reported about systemic side effects like headache, fever, dizziness and generalized rash. There was no significant difference following first or second injection of the primary immunization or the booster injection, respectively, regarding incidence, severity or type of side effects. 2.2% of the vaccinees reporting reactions sought medical advice and 1.8% were judged unfit for work for an average of 2.2 days. The amount of systemic reactions might indicate a potential hazard of serious anaphylactic reactions. Unlike hepatitis A. Japanese encephalitis is an extremely rare disease in travellers. Therefore, the risk of acquiring the disease when travelling to affected areas without prior immunization should be considered against the risk of developing serious side effects after vaccination. We conclude that JEV should remain restricted to travellers with an increased risk of acquiring JE.

Adolescent↗
PubMed1996

High prevalence of antibodies against circumsporozoite antigen of Plasmodium falciparum without development of symptomatic malaria in travelers returning from sub-Saharan Africa.

Circumsporozoite (CS) antibodies, indicating that falciparum malaria infection has occurred, have been shown to be reliable indicators of transmission in malaria-endemic areas. In order to estimate the actual rate of malaria infection, the prevalence of CS antibodies in serum was investigated by ELISA in a selected population of travelers returning from sub-Saharan Africa without any clinical sign of malaria. Sera from 39 (48.8%) of 80 individual travelers were positive, while this was only true for 8 (5.6%) of 142 travelers who took package tours. The risk of malaria infection was therefore 8.7 times greater for individual tourists than for package-tour travelers. These data demonstrate the importance of adequate malaria chemoprophylaxis in nonimmune travelers to areas with highly endemic disease.

Adolescent↗
PubMed1996

Parasite-specific lactate dehydrogenase for the diagnosis of Plasmodium falciparum infection in an endemic area in west Uganda.

The measurement of parasite lactate dehydrogenase (pLDH) has been presented as an easy and rapid method for the diagnosis of malaria in humans. In order to evaluate the sensitivity and specificity of such a test we examined blood samples from 429 Ugandan patients. While pLDH activity was significantly linked to parasitaemia, sensitivity and specificity were found to be rather low at 58.8 and 62.2% respectively. The positive and negative predictive values failed to meet necessary standards. We conclude that the methods of measurement of pLDH activity in malaria infection, although potentially useful for the fast diagnosis of malaria, need to be improved to be of true value in endemic areas.

Humans↗
PubMed1996

Giardiasis in travellers: evaluation of an antigen-capture ELISA for the detection of Giardia lamblia-antigen in stool.

Diagnosis of giardiasis relies largely on the microscopical detection of trophozoites or cysts in feces. However, this method is labour- and time-intensive and depends highly on the skill of an experienced microscopist. In order to identify the prevalence of Giardia lamblia in travellers returning from overseas, we evaluated sensitivity and specificity of a commercially available ELISA kit for the detection of Giardia-lamblia-antigen in stool. Nine hundred seventy-eight stool samples from 795 patients were examined by microscopy (iron-hematoxyilin-stain, SAF-concentration) and ELISA. Altogether, Giardia infection could be detected in 74 subjects. On evaluation of all samples, the ELISA turned out to be more sensitive than microscopy (95.5% vs. 81.8%) and 99.7% specific for Giardia lamblia. Especially with microscopy, the examination of more than one stool specimen did improve diagnostic sensitivity. It seems therefore advisable to retain the practise of examining at least three stool samples before considering a patient as not infected. The coproantigen-ELISA is especially advantageous in situations where only a single stool sample can be examined. It should not, however, replace microscopical examination of stool specimens for ova and parasites since other potential pathogens would otherwise escape detection.

Animals↗
PubMed1995

[Epidemiology of echinococcosis in Bavaria].

OBJECTIVE: There are few and incomplete data about the epidemiology of echinococcosis in Germany. The aim of this retrospective study was to collect informations about frequency and distribution of this parasitosis in one of the main endemic regions (Bavaria). PATIENTS AND METHODS: Standardized questionnaires were sent to all Bavarian hospitals, requesting (anonymous) information about all patients with echinococcosis seen between 1985 and 1989. In addition, hospital statistics and archives were searched for echinococcosis cases. A total of 216 cases were found; sufficient data were available for 181 (87 males, 94 females; mean age 41 [4-79] years). There were 123 patients with cystic echinococcosis (infection with the larval stage of Echinococcus granulosus), 58 with the alveolar form (larval stage of Echinococcus multilocularis). In the remaining 35 the available information was inadequate for reliable differentiation. RESULTS: The data indicate a prevalence of echinococcosis in Bavaria of 1.9 per 100,000 inhabitants, 1.1 for Echinococcus granulosus and 0.5 for Echinococcus multilocularis. The mean annual incidence was 0.22 (Echinococcus granulosus 0.15; Echinococcus multilocularis 0.03). Dividing the patients by country of origin, 86.2% of those with Echinococcus multilocularis were German, while 68.3% of those with Echinococcus granulosus originated from outside Germany, mostly the Mediterranean area. The prevalence of Echinococcus multilocularis infection was highest in the District of Swabia (2.4/100,000) and Upper Bavaria (0.6/100,000). These are regions in which there is a proven significantly higher infestation of echinococcosis in foxes. Farmers were most at risk of being infected with alveolar echinococcosis.

Adolescent↗
PubMed1995

[A small outbreak of trichinosis caused by imported smoked ham].

Three patients fell ill with diarrhoea 14 to 15 days after eating smoked ham. All had an increased white cell count (up to 16,200 microliters), eosinophilia (14 to 38%) and increased creatinkinase activity (357 up to 1905 U/l). Patient 1 (a 21-year-old woman) also had fever of around 40 degrees C; patient 2 (32-year-old woman) had a fever up to 39 degrees C, with muscle pains and swellings in the face. Patient 3 (38-year-old man) had no other symptoms. Because of eosinophilia and as five other family members in former Yugoslavia whence the ham had been imported, also had had fevers, trichinosis was soon considered as the cause. Serology in patients 1 and 2 was positive on admission, in patient 3 after one week. Mebendazole was administered, initially 50 mg/kg in three doses for 2 days. Drug blood levels were determined 1 and 4 hours after start of treatment and the dosage was then increased to 80-100 mg/kg daily. Duration of treatment ranged from 11 to 14 days. All patients were discharged symptom-free and there have been no sequelae. In Germany trichinosis typically occurs in small outbreaks. It is assuming increasing importance as an imported disease.

Adult↗
PubMed1995

Plasmodium falciparum and Plasmodium berghei: effect of magnesium on the development of parasitemia.

The in vitro growth of Plasmodium falciparum was reduced by 35 and 43% through high concentrations (5 mmole/liter) of magnesium in RPMI medium and magnesium-free medium, respectively, after 48 hr, whereas no significant inhibition could be observed under these conditions after 24 hr cultivation in the respective medium. Levels of magnesium between 0.5 and 3 mmole/liter showed no inhibitory effect on the in vitro growth of P. falciparum even after long-term exposure for 7 days. The 50 and 90% chloroquine inhibitory concentrations of the chloroquine-resistant strain K1 after 24 hr were reduced to some extent in the presence of magnesium at 5 mmole/liter, but less than in the presence of verapamil at 10 mumole/liter, which showed intrinsic activities at this concentration and which completely reversed resistance. However, high physiologic magnesium plasma levels were associated with a significantly longer survival time of NMRI mice infected with P. berghei strain ANKA, compared to normal physiological plasma magnesium levels. It is concluded that in the case of clinically symptomatic magnesium deficiency, supplementation of magnesium will not aggravate concomitant plasmodial infections and therefore should not be withheld.

Analysis of Variance↗
PubMed1995

Cutaneous myiasis: review of 13 cases in travelers returning from tropical countries.

BACKGROUND: Cutaneous myiasis is frequently reported in patients from tropical countries. Most commonly infestation is due to Cordylobia anthropophaga and Dermatobia hominis, whereas Hypoderma lineatum is less likely to affect humans. METHODS: The clinical and parasitologic aspects in a series of 13 patients with cutaneous myiasis seen in a German travel clinic are reviewed. RESULTS: Six patients were infected with larvae of the tumbu fly, Cordylobia anthropophaga, six with larvae of the botfly, Dermatobia hominis, and one patient presented with an infection with Hypoderma lineatum. Dermatobia hominis was exclusively acquired in the American tropics and Cordylobia anthropophaga exclusively in Africa, whereas infection with Hypoderma lineatum was acquired in Nepal. The number of larvae removed from the skin was markedly higher in patients infected with the tumbu fly (average of five larvae) compared to the botfly (average of 1.7 larvae), whereas pain was more frequently reported from patients with botfly infestation. Treatment consisted in the removal of the larvae by forceps or surgical incision in tumbu or botfly infection and oral application of ivermectin in infection with Hypoderma lineatum. This led to complete recovery in all patients. CONCLUSIONS: In patients presenting with cutaneous lesions after return from tropical countries, myiasis has to be considered as a differential diagnosis. Simple and effective therapy is available through removal of the maggots.

Adult↗
PubMed1995

Long-term efficacy of primaquine in the treatment of vivax malaria in nonimmune travelers.

Fifty-six travelers presenting with vivax malaria to a German travel clinic were followed regularly for at least 18 months between 1984 and 1992 to investigate the long-term efficacy of primaquine in nonimmune patients without reinfection. All received a standard treatment of 15 mg of primaquine a day for 14 days following an initial total dose of 1,500 mg of chloroquine (base) given over a 48-hr period. None of the patients visited countries endemic for malaria during the period of observation. In seven patients (12.5%), relapses were confirmed microscopically by detection of malaria parasites in blood films. The frequency of relapses varied between one and four per patient and these occurred between 60 and 252 days after treatment. Four of these seven patients had acquired infection in Papua New Guinea or eastern Indonesia, while only five (10.2%) of the remaining 49 patients without relapses had traveled to these areas prior to referral (P < 0.01).

Adolescent↗