A.D.M. Bryceson

Dangerous reactions to treatment of onchocerciasis with diethylcarbamazine.

Nine Nigerians with severe onchocerciasis who were treated with diethylcarbamazine developed clinical changes, ranging in severity from mild itching to distress, cough, and syncope. Physiological changes (fever, tachypnoea, tachycardia, or hypotension) were seen in eight. In five patients the systolic blood pressure fell by more than 25 mm Hg, and one patient collapsed on attempting to sit up. Circulating eosinophils decreased profoundly in all cases, reaching their lowest levels just before or during the clinical and physiological changes. A fall in serum complement (c3) accompanied the reaction but there was no fall in antibody titre. Diethylcarbamazine probably acts on the parasites cuticle, thus exposing it to the bodys defence mechansims. The reaction coincides with the death of microfilariae, and the accompanying physiological changes may be so severe, even in generally healthy patients, the treatment should perferably be started in hospital.

Meningococcal antigen in diagnosis and treatment of group A meningococcal infections

Meningococcal antigen was measured by countercurrent immunoelectrophoresis in the blood and cerebrospinal fluid of 200 patients with group A meningococcal meningitis. Antigen was detected in the blood of 27 (13.5 per cent) patients. These patients had a worse prognosis and a higher incidence of allergic complications, such as arthritis and vasculitis, about 5 days after the start of antibiotic treatment. Antigen was found in the CSF of 129 (67.5 per cent) patients); antigen often persisted in the cerebrospinal fluid despite antibiotic treatment before admission. A combination of immunoelectrophoresis and routine bacteriologic study was used in the diagnosis of 162 (84.8 per cent) patients with meningococcal meningitis. High levels of antigen and a slow antigen disappearance were associated with neurologic damage. The antigen is stable and may be detected from specimens of cerebrospinal fluid dried on filter paper.

Trial of Chloramphenicol for Meningitis in Northern Savanna of Africa

In a controlled trial chloramphenicol proved as effective and much cheaper than penicillin for the treatment of group A meningococcal meningitis in Zaria, Nigeria. A short course of five days cured most patients. Adults and older children were soon able to take chloramphenicol by mouth, which reduced the cost and simplified treatment. It is suggested that chloramphenicol is a suitable alternative to sulphonamides for the treatment of meningococcal meningitis in those parts of Africa where the organism is sulphonamide-resistant.

Bleeding in louse-borne relapsing fever I. Clinical studies in 37 patients

Abstract 37 patients with louse-borne relapsing fever (LBRF) were investigated. In 21 there was evidence of bleeding. Thrombocytopenia, with platelelet counts below 150,000/c.mm., was found in 31 (84%). This was attributed to increased consumption due to intravascular clotting and to pooling in the enlarged spleen. There was a significant correlation between bleeding and duration of illness, platelet count and SGOT. 7 out of 10 patients with prolonged prothrombin (PT) and partial thromboplastin times (PTT) and evidence of severe hepato-cellular damage, had epistaxis and purpura. Plasma fibrinogen levels were raised in 29 patients. Death of 1 patient who had hypo-fibrinogenaemia was attributed to DIC.

Physiologic changes during the Jarisch-Herxheimer reaction in early syphilis: A comparison with louse-borne relapsing fever

Abstract In twelve of fifteen patients with early syphilis body temperature increased by more than 0.8 °C after treatment with penicillin. In all cases the blood leukocyte count increased; the lymphocyte count fell in seven of eight patients, but neutropenia was never observed. In four of the patients detailed cardiorespiratory measurements were made. During the Jarisch-Herxheimer rection (J-HR) metabolic rate increased, but pulmonary ventilation and cardiac output exceeded metabolic requirements. There was evidence of impaired pulmonary oxygen uptake, and systemic arterial blood pressure fell due to decreased vascular resistance. The role of leukocyte pyrogen in the Jarisch-Herxheimer reactions of secondary syphilis and louse-borne relapsing fever (LBRF) is discussed, and possible reasons are suggested for the differences in timing and intensity of the reactions in the two diseases and for the absence of an early neutropenia in syphilis.

Some effects of louse-borne relapsing fever on the function of the heart

Clinical, electrocardiographic and hemodynamic studies were made in thirty-one patients with louse-borne relapsing fever in Ethiopia; more detailed physiologic studies were made in a further nineteen patients. Evidence of an abnormal myocardium was obtained and transient acute cor pulmonale was found to occur after the reaction to treatment. No simple correlation could be established between clinical signs and electrocardiographic and hemodynamic evidence of myocardial damage. A statistically significant correlation was found between prolonged QT c and relative acidemia before treatment and between T wave abnormalities and hypocapnia during the chill phase of the febrile reaction following treatment.

Bleeding in louse-borne relapsing fever II. Fibrinolysis following treatment

Abstract Treatment of louse-borne relapsing fever was followed by a sudden increase in fibrin degradation productions (FDP) in 6 of 7 patients. The FDP were believed to be the result of fibrinolysis secondary to intravascular clotting in 2 patients who also had transient decreases in plasma fibrinogen concentration and platelet count. In the remaining cases, a mixed form of fibrinolysis with elevated circulating fibrinolytic activity and local lysis secondary to intravascular clotting was presumed to be responsible for the elevated FDP. A heparin infusion in 3 patients did not prevent the increase in FDP following treatment.