Fred E. Pittman

Neurologic disease in patients with treated Whipple's disease.

Four patients with Whipples disease which had responded to antibiotic therapy, later developed neurologic disease identical to that seen in patients with Whipples disease who died without treatment. Dementia, myoclonus, ataxia, and supranuclear ophthalmoplegia were the main neurologic features. Restarting antibiotics has been followed by stabilization of disease in all four. Two have improved. In three, the previously diagnosed and treated Whipples disease was not considered as a possible cause of the neurologic disease until the symptoms and signs were far advanced. It is advisable to periodically evaluate all patients with Whipples disease, even after successful treatment. Signs of neurologic disease should be considered a possible recurrence of Whipples disease and antibiotics restarted.

Studies of human amebiasis

Four patients with well-documented amebic colitis had colonic deformities suggestive of ameboma. When barium enema examinations were performed, each of the 4 had cecal “coning,” and 1 had an additional sigmoid lesion. Only 1 patient with a cecal lesion had a palpable, tender mass in the right lower quadrant. After treatment with metronidazole (multiple courses in 1 case), there was clinical and parasitologic cure in each case and radiologic improvement in the 3 who were available for followup. Since ameboma may be confused with carcinoma, a search for amebae in stool and an indirect hemagglutination test for amebiasis may prevent unnecessary and potentially disastrous surgery.

Relationship of Cytotoxins of Axenically Cultivated Entamoeba histolytica to Virulence

Clarified homogenates prepared from different strains of axenically reared Entamoeba histolytica were assayed for acid and neutral proteinase activity, cytotoxicity, and protein content. The homogenates of the more virulent strains contained more acid or neutral proteinase and more toxin units per 10(6) trophozoites. Toxicity and neutral proteinase activities had a similar pattern of distribution. The cytotoxicity of the gel-filtered proteins of the studied strains followed the same rank order as their reported virulence. The more virulent strains (HM-1 and Rahman) had significantly more neutral proteinase activity than less virulent strains (HK-9, Laredo and Huff). Purified extracts of HM-1 and Rahman strains contained more toxin per milligram of protein and exhibited a lower cytotoxicity end point than those of the less virulent strains. The most cytotoxic fraction of each strain had a molecular weight of approximately 24,000, and all cytotoxins were antigenically similar. A more virulent strain (HM-1) secreted more cytotoxic activity when incubated under tissue culture conditions than did a less virulent strain (HK-9). Cytotoxic material secreted by strain HM-1 during axenic growth had the same molecular weight as that isolated from trophozoites. The Entamoeba histolytica toxin studied may be a neutral proteinase that is present in greater quantities in more virulent strains, thus accounting for their greater cytotoxicity in vitro and invasiveness in vivo.

Cimetidine-induced exfoliative dermatitis.

SummaryA 68-year-old woman developed exfoliative dermatitis while taking cimetidine for gastritis. She had no history of previous drug reactions, allergies, or skin disorders and had taken no other medications for three months. Although cimetidine is a relatively safe drug, severe reactions such as exfoliative dermatitis can occur.

Tropical sprue in american servicemen following return from Vietnam

Moderately severe tropical sprue was diagnosed in two American servicemen, 15 and 19 months after return from Vietman. Intestinal parasites, were not demonstrated, and clinical, laboratory, and jejunal histological abnormalities returned to normal following treatment with tetracycline and folic acid in one patient and folic acid alone in the other. Neither patient was anemic, although one had hypersegmented polymorphonuclear leukocytes and both had macrocytosis and megaloblastic bone marrows. In each of these patients, diagnosis was delayed because of the failure to consider tropical sprue in the differential diagnosis of diarrhea and weight loss. The findings in these patients indicate that individuals from nonendemic areas who reside in Vietnam are at risk of developing overt tropical sprue.Moderately severe tropical sprue was diagnosed in two American servicemen, 15 and 19 months after return from Vietman. Intestinal parasites, were not demonstrated, and clinical, laboratory, and jejunal histological abnormalities returned to normal following treatment with tetracycline and folic acid in one patient and folic acid alone in the other. Neither patient was anemic, although one had hypersegmented polymorphonuclear leukocytes and both had macrocytosis and megaloblastic bone marrows. In each of these patients, diagnosis was delayed because of the failure to consider tropical sprue in the differential diagnosis of diarrhea and weight loss. The findings in these patients indicate that individuals from nonendemic areas who reside in Vietnam are at risk of developing overt tropical sprue.