Klaus Göbels

Comparison of three antigen detection tests for diagnosis and follow-up of falciparum malaria in travellers returning to Berlin, Germany

Abstract. We determined the sensitivity and specificity of three rapid immunochromatographic malarial antigen detection test systems (RDTs) for the detection of Plasmodium falciparum and assessed the quality of follow-up results. ParaSight-F and ICT Malaria detect histidine-rich protein-2 (HRP-2), whereas OptiMal detects plasmodial lactate dehydrogenase (pLDH). ParaSight-F performed with 95.1% sensitivity and 97.1% specificity (554 patients tested of whom 144 had falciparum malaria). ICT Malaria performed with 95.7% sensitivity and 99.2% specificity (718 patients tested of whom 184 had falciparum malaria). OptiMal performed with 76.2% sensitivity and 99.7% specificity (539 patients tested of whom 130 had falciparum malaria). In follow-up investigations, HRP-2 did not appear to be a useful antigen due to its long half-life, whereas pLDH offers a reasonable correlation with the presence of viable parasites in those cases initially detected. We therefore conclude that a combination of both antigens might be the best option for creating a reliable RDT for the diagnosis of falciparum malaria.

Acute fascioliasis with multiple liver abscesses

Human fascioliasis is distributed worldwide with several foci of high endemicity. Being a rare disease in Europe, we describe here a case in the initial hepatic phase of the disease. Therapeutic and, with reference to the 2 distinct stages of disease, diagnostic standards are discussed.Human fascioliasis is distributed worldwide with several foci of high endemicity. Being a rare disease in Europe, we describe here a case in the initial hepatic phase of the disease. Therapeutic and, with reference to the 2 distinct stages of disease, diagnostic standards are discussed.

Sensitivity of P. vivax rapid antigen detection tests and possible implications for self-diagnostic use

In a prospective study amongst febrile travellers returning from malaria-endemic areas to Berlin, Germany, two rapid malarial antigen detection tests were compared for the diagnosis of vivax malaria with routine microscopy. With ICT Malaria P.f./P.v.((R)), 664 samples of 492 patients were examined. 17 patients had vivax malaria, out of which 11 infections were missed (35.3% sensitivity). With OptiMal((R)), 659 samples of 539 patients were examined. 22 patients had vivax malaria, and all infections were identified correctly (100% sensitivity). Specificity was 100% with both tests. The ICT Malaria P.f./P.v.((R)) is advertised for layman use during travel, and the literature was reviewed with respect to the question of suitability of these devices for self-testing. It is concluded that with the ICT Malaria P.f./P.v.((R)), the detection of non-falciparum (i.e. predominantly vivax) malaria is unreliable, and test interpretation for medically untrained individuals particularly in distress might be too complicated even after proper instruction.

Visceral Leishmaniasis Presenting as Subcutaneous Nodules in a HIV-Positive Patient

Visceral leishmaniasis (VL) is a vector-borne diseasecaused by obligate intracellular Leishmania species. It isendemic in the tropics, subtropics and southern Europe,where dogs are the most significant reservoir. Transmis-sion occurs through the bite of an infected sandfly [1], butneedle-sharing among intravenous drug users might be analternate route of infection and could play a major role insouthern Europe [2].Coinfection with human immunodeficiency virus(HIV) and VL has long been recognized in Mediterraneancountries, where Leishmania infantum is endemic and VLis considered an emerging and AIDS-defining disease; theprevalence of HIV/VL coinfection in this region rangesfrom 2% to 9%. [3]. Leishmaniasis in HIV-positivepatients shows a different and less specific clinical picturethan in other patient populations, with parasites beingisolated from such atypical sites as the pancreas, palate,pericardium, gastrointestinal tract and the lungs [4, 5, 6, 7,8].In northern European countries, VL is not endemic,and most cases are imported either from the tropics orfrom the Mediterranean basin. Consequently, VL is oftennot included in the differential diagnosis, which frequent-ly leads to a considerable delay in the administration ofappropriate therapy [3]. We report here an unusual case ofVL infection presenting as subcutaneous nodules in aHIV-positive patient in Germany.A 42-year-old German male who was known to beHIV-positive was referred to our department in December2001 because of malaise, arthralgia, remitting fever up to38C and discrete clustered erythematous skin lesions atthe elbows, hands and knees, which had been persistingsince 1996. Initially, we suspected the lesions to representan allergic reaction to cotrimoxazole-trimethroprim,which was being administered as primary prophylaxisagainst Pneumocystis carinii pneumonia. This treatmentwas consequently stopped, but cessation had no effect onthe skin lesions.In 1996, subcutaneous lumps had been removed fromthe patient’s neck and buttocks in a surgical practice, butno pathological examination was carried out. Since 1997,the patient had complained of severe weakness afterexertion, bouts of fever and poor concentration. InNovember 1999, he presented to his general practitioner,who performed an abdominal ultrasound and a computedtomography scan of the abdomen, which revealed asplenomegaly. In order to control the remitting fever,various antibiotics were administered, but they wereineffective.In addition to HIV infection, which was first diagnosedin 1986, the patient’s medical history revealed a bout ofpneumonia in 1988 and a parotidectomy performed after asevere episode of parotitis in 1991. His travel historyincluded trips to Spain and the Canary Islands but not tothe tropics. On physical examination, hepatosplenomeg-aly and multiple clustered erythematous skin lesions atthe elbows and hands were present. Subcutaneous lumpswere also palpable on the knees.Laboratory parameters on admission were as follows:C-reactive protein, 0.6 mg/dl (normal, <0.5 mg/dl);platelets, 7110

Clinical and Laboratory Features of Dengue Virus-infected Travellers Previously Vaccinated Against Yellow Fever

Dengue is a mosquito-borne viral infection endemic throughout the tropics and subtropics. The global prevalence of dengue has grown dramatically in recent years and it has become a major international public health concern. The close taxonomic relationships between yellow fever and dengue viruses gave rise to concerns that previous vaccination against yellow fever could modify the course of dengue infection and contribute to the development of dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). This study reports the clinical and laboratory features of dengue virus-infected travellers previously vaccinated against yellow fever.