Myelopathy in a patient dually infected with HIV-1 and HTLV-I.
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Biomedical subjects
Publications and source records attributed to P J Fripp.
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It is generally accepted that schistosomiasis, if not causative, is at least associated with malignancy. In this review, the epidemiology of schistosomiasis and bladder carcinoma, as well as the role of chronic bladder infection, are discussed together with known carcinogenic factors, possible abnormal vitamin metabolism and/or deficiencies and factors that influence conjugated carcinogens. Experimental evidence is briefly examined and recent work from the Far East on schistosomiasis and colon carcinoma reviewed.
Stool material from seventy-eight children below the age of three years was examined for the presence of various enteropathogens. The patients had been admitted to the Ga-Rankuwa hospital for rehydration therapy. A causative agent was identified in 76.9% of the cases studied. The most prevalent organisms identified were 38.5% entero-toxigenic Escherichia coli (ETEC), 25.6% Cryptosporidium parvum, 15.4% Campylobacter sp., 14.1% enteric adenoviruses and 12.8% rotavirus. In 38.5% of cases, a mixed infection was observed with up to four different organisms being identified from a single patient. ETEC elaborating heat-labile toxin (LT) found together with C. parvum was the most common combination seen in mixed infections.
Three children with hydatid disease of the central nervous system (CNS) were seen. In two patients the lateral ventricles were involved, whilst one case involved the cerebellar hemisphere. In addition, one child presented with a deposit in the maxillary antrum, and deposits were also found in the liver. Operative removal of the deposits was performed, followed by post-operative treatment with praziquantel and albendazole. Investigation of other sites outside the CNS was undertaken for occult lesions. All hydatid cysts were clearly demonstrated on CT, but two cases posed the pre-operative problem of differential diagnosis from arachnoid cysts.
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Cryptosporidiosis was first recognised at GaRankuwa Hospital, a reference teaching hospital for mainly black patients near Pretoria, South Africa, in October 1985. Since then 289/6870 specimens (4.21%) submitted to the routine stool laboratory have been found to contain Cryptosporidium parvum oocysts. Seasonal peaks were seen in late summer (January, February, March) and minimum case numbers were recorded during late winter (August, September). The disease was predominantly one of early childhood, with the majority of patients being under 3 years of age. Only six positive stools came from patients older than 12 years. Cryptosporidiosis has replaced giardiasis as the most commonly detected gastrointestinal parasitic infection of patients in this hospital. Oocysts were also found in the sputum of an 84-year-old male patient with a persistent productive cough.
Schistosomiasis is endemic in many areas of South Africa, particularly the northern and eastern Transvaal. At Ga-Rankuwa Hospital in the northern Transvaal, 30 km north-west of Pretoria, spinal cord disease is common. In a substantial proportion of these cases no obvious cause for the condition can be found. In an attempt to draw attention to schistosomiasis as a possibly underdiagnosed cause of spinal cord disease, 3 cases of schistosomiasis of the spinal cord seen over a period of 3 years are reported. These 3 patients had histological evidence of spinal schistosomiasis. Because myelography of the spinal cord is often non-contributory in schistosomal involvement, it is suggested that patients with 'myelopathy of unknown origin' who come from an endemic area be given a therapeutic trial of praziquantel, especially if the serological findings are positive for schistosomiasis and the lower cord is involved.
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A prospective 3-year study for enteric pathogens associated with diarrhoea in children was undertaken at Ga-Rankuwa Hospital, South Africa. Rotavirus was the most commonly isolated pathogen (24%), showing a marked seasonal distribution, with an autumn peak in activity. Enterotoxigenic and enteropathogenic Escherichia coli were frequently identified, and Salmonella, Shigella and Campylobacter were also isolated. Cryptosporidium and Giardia lamblia were the most frequently seen parasites. Rotavirus, E. coli, Salmonella and Campylobacter occurred predominantly in children less than 1 year old, whilst Shigella and the parasites were prevalent at all ages.
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Extracts of adult schistosomes collected from Hippopotamus amphibius in the Kruger National Park gave alpha naphthyl acetate isoenzyme patterns after polyacrylamide gel electrophoresis that did not correspond with those of either Schistosoma mansoni or S. rodhaini.
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The rodent species used at the South African Institute for Medical Research for the culture of mammalian species of schistosomes are listed. Emphasis is given to the advantages of wild South African species which have been adapted to laboratory conditions, and infection techniques are discussed.
The movements of S. mansoni miracidia immersed in various solutions of organic chemicals were recorded by dark ground photography. Reduction of miracidial speed was recorded for miracidia in solutions of fatty acids and ammonia. The speed reduction was concentration dependant and pH dependant, indicating in both cases that the un-ionized molecule was responsible. Ammonia at concentrations between 0.4 mM and 0.8 mM elicited an increased "rate of change of direction" by miracidia. No changes in miracidial movements were recorded for miracidia immersed in aqueous solutions of amino acids, sugars or of molluscan nitrogenous excretion products other than ammonia. A possible role for chemo-klinokinetic behaviour patterns in miracidial host location was formulated.
In addition to the classical manifestations, bilharziasis may present with features which are atypical and which may simulate other conditions. In such cases the value of the previous history cannot be overemphasized, immunodiagnostic procedures are useful pointers in diagnosis but in general treatment should be undertaken only after ova of the parasites have been found.