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[Peripheral facial paralysis in Petropolis].

The author presents 83 cases of "a frigore" peripheral facial palsy, occurred in the mountain city of Petropolis which has characteristics such as a tropical climate without any traces of a dry season and an average temperature of 50 degrees F to 73.5 degrees F. The author relates them with virus infections which appear within a year period. Fifty six patients belong to his clinic and have a follow up, while other 25 patients proceed from another clinics and from them he only has reports on sex, age, side of palsy and the beginning of illness. He shows that the largest number of cases occurred along the months of May, August, September and October. Season distribution for southern hemisphere is analysed. He also considers etiology, incidence, prevalence, treatment and results on patients studied.

Adolescent↗

Determinant factors for malaria transmission on the coast of Oaxaca State, the main residual transmission focus in Mexico.

OBJECTIVE: The purpose of this study was to investigate the influence of demographic, socioeconomic and ecological factors in malaria transmission in the most important residual transmission focus in Mexico, located in the state of Oaxaca. MATERIAL AND METHODS: The extension of the focus was determined by a spatial and time analysis of the distribution of malaria cases in the state between 1998 and 1999 using a Geographical Information System. A malaria transmission intensity index (MTII) was constructed based on the total number of cases during the study period and the duration and frequency of transmission outbreaks within the villages. The relationship between local determinants and malaria transmission intensity was investigated using multinomial and ordered logistic models. RESULTS: The distribution of villages according to their MTII was: 325 high, 341 medium, 142 low and 717 with no transmission. Localities of high MTII were associated with areas having a tropical climate with summer rains and low water evaporation. Most high MTII villages were located in elevations between 200 and 500 m above sea level, in the area around Pochutla City. The amount of temporary streams in the neighborhood of localities had a highly significant positive association with the MTII. Distance to roads was only significant in the high malaria MTII stratum. CONCLUSIONS: The main factors determining malaria transmission in the focus are related to good conditions for the breeding of mosquito vectors. The existence of short-range population movements around Pochutla, the main economically active city in the area, indicates the necessity to implement a system of epidemiological surveillance to halt the dispersion of new outbreaks.

Humans↗

Evaluation of temporal, seasonal and geographic stability of the molluscicidal property of Euphorbia splendens latex.

Laboratory tests with aqueous solutions of Euphorbia splendens var. hislopii latex have demonstrated seasonal stability of the molluscacidal principle, with LD90 values of 1.14 ppm (spring), 1.02 ppm (fall), 1.09 ppm (winter), and 1.07 ppm (summer) that have been determined against Biomphalaria tenagophila in the field. Assays on latex collected in Belo Horizonte and Recife yielded LD90 values similar to those obtained with the reference substance collected in Rio de Janeiro (Ilha do Governador), demonstrating geographic stability of the molluscacidal effect. The molluscacidal action of aqueous dilutions of the latex in natura, centrifuged (precipitate) and lyophilized, was stable for up to 124 days at room temperature (in natura) and for up to 736 days in a common refrigerator at 10 to 12 degrees C (lyophilized product). A 5.0 ppm solution is 100% lethal for snails up to 13 days after preparation, the effect being gradually lost to almost total inactivity by the 30th day. This observation indicated that the active principle is instable. These properties together with the wide distribution of the plant, its resistance and adaptation to the tropical climate, its easy cultivation and the easy obtention of latex and preparation of the molluscicidal solution, make this a promising material for large-scale use in the control of schistosomiasis.

Animals↗

The epidemiology of rotavirus diarrhea in Latin America. Anticipating rotavirus vaccines.

OBJECTIVE: To assess the disease burden and characterize the epidemiology of rotavirus diarrhea in Latin America. METHODS: We conducted a literature review of studies of children < 5 years of age who were hospitalized or seen as outpatients for diarrhea and for whom rotavirus was sought as the etiologic agent of the diarrhea. This review included inpatient and outpatient studies published since 1998 that included at least 100 children and reported surveillance activities lasting at least 12 consecutive months. RESULTS: A total of 18 inpatient and 10 outpatient studies met the criteria for inclusion in this review. Rotavirus was detected in a median of 31% of inpatients (range, 16%-52%) and 30.5% of outpatients (range, 4%-42%). The median detection rate was higher in studies that used an enzyme-linked immunosorbent assay (ELISA) (inpatients 38%, outpatients 33%) versus less sensitive methods of detection. The age distribution of rotavirus disease varied among countries, with 65%-85% of children hospitalized in the first year of life. Most countries had rotavirus admissions year round, and rotavirus generally exhibited a winter seasonal peak in both temperate and tropical climates. CONCLUSIONS: The heavy burden of disease attributable to rotavirus in Latin America suggests that vaccines currently being tested could have considerable impact in preventing hospitalizations, clinic visits, and deaths. The findings of the young age distribution of patients highlight the importance of early immunization for the success of a vaccine program. The data suggest that future surveillance for rotavirus diarrhea in Latin America should use a standardized surveillance protocol with an ELISA for detection. Data from surveillance studies will be critical to monitor the impact of the future introduction of vaccines.

Age Distribution↗

Effects of aging and dilution on attraction and toxicity of GF-120 fruit fly bait spray for melon fly control in Hawaii.

Attractiveness and toxicity of GF-120 Fruit Fly Bait (Dow AgroScience Indianapolis, IN) to melon flies, Bactrocera cucurbitae Coquillett, were examined to assess the effects of concentration and aging. We tested dilutions of 20, 40, and 80 ppm (AI) (spinosad) against water controls. The 80 and 40 ppm treatments were significantly more attractive than the 20 ppm and control treatments. Attraction was compared between baits aged for 2 and 24 h, fresh bait and water controls. Age had significant effects on both attractiveness and toxicity of GF-120. Baits aged for 2 h were 11 times less attractive to female melon flies than fresh bait. Mortality rates were reduced by 50% when GF-120 was subjected to rain. Our results suggest the need for frequent applications of GF-120 to obtain maximum benefits, particularly in wet tropical climates.

Animals↗

Carbohydrate and fluid needs of the soccer player.

Soccer is a game that demands a combination of repeated maximal sprinting wit with 10 to 11km of moderate running, sometimes performed under extremely warm conditions. Over the course of a match, there is partial to near complete depletion of glycogen reserves in the leg muscles (depending on the extent of initial reserves and the level of competition), with a resultant decrease in physical performance. Blood glucose levels also fall, sometimes to values likely to cause a deterioration of both tactical thinking and cooperation between players (3.0 to 3.8 mmol/L), while in tropical climates, fluid losses can amount to 4 to 5kg of bodyweight. The effectiveness of glucose solutions in correcting these problems is limited for 2 main reasons: concentrations greater than 2.5% slow the rate of gastric emptying and thus fluid absorption, while provoking a secretion of insulin with a resultant hypoglycaemia. Fructose solutions are less liable to increase insulin secretion, but they have an equal propensity for slowing gastric emptying; moreover, the ingested fructose is largely metabolised in the liver, without boosting blood glucose. However, glucose polymer preparations have a low osmotic pressure per unit content of glucose equivalent, so that substantial amounts of carbohydrate can be administered in this fashion before gastric emptying is inhibited. If polymers are given before and during a soccer game, they sustain blood glucose, sparing muscle glycogen stores and increasing game performance. If the concentration of polymer is too high, one possible complication is a movement of water from the plasma into the gut; nevertheless, with an appropriate choice of concentration (for example, 7% polycose, 360 mOsm/L, plasma volume is increased rather than decreased relative to that seen with administration of water. Probably because the intergame interval for competitive soccer players is short, replenishment of glycogen reserves proceeds quite slowly. Moreover, this process does not seem to be helped by ingestion of either glucose polymers or a high carbohydrate diet.

Animals↗

Fatal strongyloidiasis latent over 42 years in the antineoplastic chemotherapy of a case with malignant lymphoma.

A 66-year-old man with non-Hodgkin lymphoma died of strongyloides hyperinfection following antineoplastic chemotherapy. The patient had a military service in Micronesia in World War II where he was supposed to acquire strongyloidiasis. Here we stress the utility of bronchoscopic examination and importance of patients' lives in tropical climates in immunocompromised patients.

Aged↗

A case of Plesiomonas shigelloides cellulitis and bacteraemia from northern Europe.

Bacteremia caused by Plesiomonas shigelloides is a rare event, often associated with consumption of seafood and fresh or estuarine water in temperate or tropical climates. Most patients have showed underlying health disorders. Here we present a case of P. shigelloides septicaemia and cellulitis of the left hand associated with fish handling in Northern Sweden (65 degrees latitude north). The patient, who suffered from multiple myeloma, recovered uneventfully after initial treatment with intravenous cefuroxime followed by a course of oral ciprofloxacin. P. shigelloides seems to be ubiquitous in freshwater world-wide and may cause invasive infections also in cold climate areas.

Aged↗

Mycology in the Philippines, revisited.

The warm tropical climate of the Philippines and its interaction with cultural practices, occupation and immune responsiveness contribute to the increased susceptibility of Filipinos to fungal infections. An investigation to determine the prevalence of fungal infections in dermatology training institutions over a 4-year period was conducted. The results showed that fungal infections rank as the second leading cause of consultation with a prevalence of 12.98%. Pityriasis versicolor (25.34%), tinea corporis (22.63%), tinea cruris (16.7%) and tinea pedis (16.38%) were the most frequently encountered cases. Fungal culture yield is low and Candida sp. is the most common isolate, obtained predominantly from specimens taken from the oral mucosa and nails. Candidiasis is still the most common opportunistic infection followed by coccidioidomycosis, cryptococcosis and aspergillosis. Imidazoles are the most commonly prescribed systemic and topical treatment by Filipino dermatologists. Initial data collected would serve as reference for future research and may be used to compare with epidemiologic data obtained from other Asian countries.

Candidiasis↗

A case of Chromobacterium infection after car accident in Korea.

Chromobacterium violaceum is a gram negative straight rod, 0.8-1.2 by 2.5 to 6.0 m, which is motile by one polar flagella and one to four lateral flagella. The organism inhabits soil and water and is often found in semitropical and tropical climates. Infections in humans are rare. We report a case of infection caused by strains of C. violaceum. A 38-year-old male patient was admitted to KyungHee University Hospital, Seoul, Korea on July 28th, 2003, after a car accident. The patient had multiple trauma and lacerations. He had an open wound in the left tibial area from which C. violaceum was isolated. The strain was resistant to ampicillin, tobramycin, ampicillin/sulbactam, ceftriaxone and cefepime, but was susceptible to amikacin, gentamicin, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole and piperacillin/tazobactam. The patient was treated successfully by debridement, cephapirin sodium and astromicine sulfate.

Accidents, Traffic↗

Ultrasonography as a diagnostic aid for a district hospital in the tropics.

To improve diagnostic capabilities, an ultrasound unit was installed at a major hospital in Wad Medani, Sudan. During the implementation period (October 1986 to March 1987) of ultrasound service, 863 patients were examined cooperatively by Sudanese and German physicians. The service covered internal medicine (47.5%), obstetrics and gynecology (31.6%), surgery (12.5%), and pediatrics (8.4%). Pathologic findings were seen in 75% of the patients. In obstetrics, the rate of pathologic findings was 40%. Five hundred eighty-three pathologic findings were detected in organ systems that constituted the primary indication for ultrasonography (of a total of 1,009 indications). The clinical benefit of ultrasonography was evaluated in 289 randomly selected patients in a standardized questionnaire completed by the attending physicians. The final clinical diagnosis was established or substantially revised in 21.5% of the patients, based on the ultrasonographic report. The previously reported diagnosis was supported in 69.5% of the patients. Medical management was directly influenced in 26% of the patients. We conclude that the clinical benefit of ultrasonography at a district hospital in the tropics is substantial, providing cost-effective, immediate therapeutic benefits in 25% of the patients examined. The technique thereby contributes to better and more rational patient management in institutions with limited resources.

Adolescent↗

Central nervous system infections in the rainforest zone of Nigeria.

OBJECTIVES: To ascertain incidence rates of central nervous system infections and provide information for health care planners. DESIGN: A two-stage screening through supervised case referrals and diagnostic evaluation at referral centre to establish a register of CNS infections. SETTING: A rural community in the rainforest zone of Nigeria with land area of 186500 m2, average daily temperature of 28 degrees C, annual rainfall of 2080 mm, adult population of 109851 and served by 26 primary, three secondary and twelve comprehensive care facilities. More than two per cent of the populations live in waterlogged areas. SUBJECTS: Adults aged sixteen years and above, constituting incident cases of CNS infections. MAIN OUTCOME MEASURES: Incident CNS infections per 100,000 populations averaged over a two year observational period. RESULTS: Incidence rates were 3.6, 4.1, 2.3, 09, 1.8, 0.9 for acute bacterial meningitis, aseptic meningitis, rabies encephalitis, non-rabies encephalitis, tuberculous meningitis and chronic non-tuberculous meningoencephalitis, respectively. Syphilitic neuroarthropathy had 0.46. CONCLUSIONS: Mortality from acute pyogenic meningitis and tuberculous meningitis remained distressingly high. Aseptic meningitis had the highest incidence rate, yet remained inadequately emphasised. Rabies encephalitis was the third commonest cause of CNS infection in the area.

Adolescent↗

[Haemorrhagic exanthema due to dengue virus induced by acetylsalicylic acid].

Dengue fever, a viral infectious disease characteristic of tropical climates, is considered to be a re-emergent pathology responsible for several serious outbreaks in the last decade. Some factors have been involved in the spread of the virus and its vectorial mosquito carrier: human alteration of the ecosystems, improvement and speed in the transit of goods and people and climate changes. As a reflection of this, an increase in imported cases is probable, especially in tourists coming from endemic areas, considering its short period of incubation (7-10 days). The recognition of personal antecedents of journeys, the main symptoms of the disease and the potential presence of complications (haemorrhagic dengue) should be included in the examination of fever of unknown origin or feverish exanthema. The case of a patient is presented whose clinical picture of classic dengue fever was worsened by self-treatment with acetylsalicylic acid.

Anti-Inflammatory Agents, Non-Steroidal↗

[Diagnostic and treatment of hypereosinophilia upon return from the tropics: 102 patients].

Management of blood eosinophilia in travelers returning from the tropics is controversial. In this prospective study, 102 asymptomatic tropical travelers underwent investigation and treatment for hypereosinophilia. In contrast with direct tests for parasitic infection which were positive in only 15% of cases, immunological tests were suggestive of helminthic infection is 77%. The most common diagnoses were toxocarosis (49%), strongyloidiasis (30%), and filariasis (19%). Anti-parasite treatment was undertaken based on laboratory findings (12 cases) or on presumptive diagnosis using two-agent therapy (ivermectin and praziquantel) in 13 cases or three-agent therapy (ivermectin, praziquantel, flubendazole) in 77 cases. As a result of treatment, eosinophil count returned to normal in 61% of cases and decreased in 30%. These findings suggest that presumptive treatment of blood eosinophilia can be undertaken in tropical travelers using three anti-parasitic drugs: ivermectin (1 x 0.4 mg/kg), flubendazole (2 x 100 mg per day for 3 days), and praziquantel (1 x 40 mg). As a precaution before using ivermectin, tests should be performed to detect loiasis which can lead to adverse reactions.

Adult↗