Acute infectious erythemas in children.
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Biomedical subjects
Publications and source records attributed to S H Gillespie.
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Toxocara canis is an ascarid parasite of the dog. Human infection is acquired when ova of T. canis are ingested. Parks and play areas contaminated with dog faeces are recognised as potential sources of infection. Five hundred and twenty one soil samples were examined from fifteen parks and gardens in the greater London area to establish the prevalence of soil contamination in those facilities. Samples were examined using a magnesium sulphate floatation method. T. canis ova were found in 6.3% of the samples. Positive samples were commonly found in lawns, playing fields and children's play areas. The authors believe that this may constitute a significant health risk, particularly to children.
Cerebral toxoplasmosis is a life-threatening condition associated with the acquired immune deficiency syndrome (AIDS). Current diagnostic and therapeutic methods have serious limitations. The diagnosis of cerebral toxoplasma infection in a patient with AIDS was assisted by the detection of specific IgM in a highly sensitive immunosorbent agglutination assay and by the demonstration of Toxoplasma gondii nucleic acid in a brain biopsy specimen by means of the polymerase chain reaction. Following initial failure of the patient to respond to treatment with sulphadiazine and pyrimethamine, clinical improvement was observed during treatment with clindamycin followed by dapsone. Further assessment of novel methods in the management of cerebral toxoplasmosis is required.
A method for hatching second-stage larvae of Toxocara canis is described. Whole adult worms are processed by centrifugation in the presence of hypochlorite which allows the grinding step to be eliminated. The technique is more rapid and a high yield is obtained.
Seventeen adult patients with acute Plasmodium falciparum malaria, admitted to the Hospital for Tropical Diseases, were studied. Serial measurements of the serum concentration of C-reactive protein, serum amyloid A protein, and percentage parasitaemia were determined, together with initial measurement of serum electrolytes, liver function, haemoglobin, white cell and platelet counts. Initial C-reactive protein and serum amyloid A concentrations were increased (C-reactive protein mean 49.0 mg/l serum amyloid A 28 mg/l) falling towards the normal range by the seventh day of treatment. There was a significant correlation between the pretreatment parasite count and clinical and laboratory markers of inflammation. C-reactive protein and serum amyloid A concentrations correlated inversely with the serum sodium. These results indicate that measurement of acute phase reactants such as C-reactive protein and serum amyloid A may prove valuable in assessing the severity of P falciparum malaria, and in following the response to antimalarial treatment.
A faecal parasite concentration method which utilizes a formalin-detergent solution has recently been described. This technique was evaluated under field conditions in the Out-Patient Department of a hospital in Northern Tanzania. Fifty faecal samples were examined by saline wet preparation and following formol-detergent concentration. Forty-one different parasite identifications were made by both techniques. Ten parasites were found only on saline wet preparation, and 20 were found only in the formol-detergent concentrate. The method necessitates a 24-h delay in sending a report, which is not justified by the small improvement in diagnostic yield. The authors believe that a modification of the technique may yet achieve acceptable results.
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Bred as hunter, companion and pet, the dog has a long and honourable association with man. Yet the domestic dog can host a wide range of parasites - many of which can also infect humans. One of these, the ascarid nematode Toxocara canis (Fig. 1), is of particular interest because of retinal damage that may result from larvae becoming trapped in the eye. At the Hospital for Tropical Diseases in London, about 20-30 patients with toxocariasis are treated annually. Widespread fouling of public parks, playgrounds and pedestrian areas with dog faeces - especially in large cities - is well -recognized as one of the main sources of Toxocara infection. Yet as Stephen Gillespie discusses here, epidemiological indicators vary widely and the risk of infection is often treated too lightly.
The diagnosis of ocular toxocariasis is difficult to make with certainty. New methods of antigen detection are helpful. Surgical intervention may play a role in improving the prognosis, but the place of specific chemotherapy remains undefined. We discuss three case histories to illustrate these points. We suggest that the visual prognosis need not be so poor as commonly believed, and outline a suggested plan of management.
Pseudomonas pseudomallei is resistant to many antimicrobial agents. We determined the susceptibility to twelve beta-lactams and six aminoglycosides of twelve isolates of P. pseudomallei. Imipenem (MIC range 0.5-1.0 mg/l; MIC90 1.0 mg/l), ceftazidime (MIC range 1-8 mg/l; MIC90 8.0 mg/l), amoxycillin/clavulanate (MIC range 4-8 mg/l; MIC90 8.0 mg/l), piperacillin (MIC range 4-16 mg/l; MIC90 8.0 mg/l), and carumonam (MIC range 4-16 mg/l; MIC90 8.0 mg/l) were the most active. Aminoglycosides were relatively inactive, for example, gentamicin (MIC range 16-64 mg/l; MIC90 64 mg/l), netilmicin (MIC range 16-128 mg/l; MIC90 128 mg/l) and amikacin (MIC range 32-64 mg/l; MIC90 64 mg/l).
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A counterimmunoelectrophoresis (CIE) method for antigen detection using monoclonal antibody was assessed for its ability to aid in the rapid diagnosis of Bordetella pertussis in 59 patients. A positive diagnosis from a combination of results from tests of serum and urine was obtained in 51 (87%) of cases. For sera, CIE had a sensitivity of 85% and a specificity of 94%; for urine samples the sensitivity was 81% and a specificity of 100%. Antigen detection by CIE is simple to perform and yields results on the same day, thus allowing treatment to begin at an early stage.