Myron G. Schultz

Pneumocystis carinii Pneumonia in the United States: Epidemiologic, Diagnostic, and Clinical Features

Analysis of 194 patients with confirmed Pneumocystis carinii pneumonia in the United States over a 3-year period revealed that P. carinii pneumonia occurred almost exclusively in the immunosuppressed host who had a serious underlying disease. The epidemiologic features of pneumocystis pneumonia primarily reflected those of the underlying disease. P. carinii was identified antermortem in 81% of the cases usually by biopsy or needle aspiration of the lung, procedures associated with considerable morbidity and morbidity and mortality. Laboratory identification of P. carinii was usually accurate, but errors resulting from fault staining tecnique occurred. Most patients had been ill less than 2 weeks with bilateral diffuse interstitial pneumonia. Leukopenia (white blood cell count less than or equal to 3,00/mm3) and probably severe hypoxia were negative prognostic factors. Although treatment with pentamidine was effective, the drug frequently cased adverse reactions, particularly impaired renal function, when given with other nephrotoxic agents.

Pentamidine Isethionate in the Treatment of Pneumocystis carinii Pneumonia

Abstract In an 18-month period 164 patients with suspected or proved interstitial pneumonia due toPneumocystis cariniiwere treated with pentamidine isethionate. Side effects were noted in 69 patien...

Babesiosis in a Massachusetts resident.

THE babesia or piroplasmas are intracellular red-cell parasites transmitted by ticks that have been identified in a variety of wild and domestic mammals. Although many animal infections are subclin...

Taeniasis and Cysticercosis (Taenia saginata)

Publisher Summary This chapter summarizes all significant matters concerning Taenia saginata (T. saginata) taeniasis and cysticercosis—that is, nomenclature, host relationships, structure and biology, clinical and therapeutic features, epidemiology and epizootiology, and prevention of infection. It considers some taxonomic problems and the hosts of T. saginata. The structure and biology of the adult worm, egg, onchosphere, and cysticercus is discussed. The clinical aspects of taeniasis are dealt in terms of symptomatology, clinical pathology, diagnosis, and treatment. Yomesan is the drug of choice for T. saginata infection in Man at present, and some suggestions are made for treatment with this and other drugs. The chapter discusses epidemiology, epizootiological, and losses due to taeniasis and cysticercosis. Losses are difficult to estimate, because infection is rarely fatal, but some figures are available for European, African, and American areas. Meat inspection is dealt with as a means of prevention, likewise serological diagnosis and the immunization of cattle. Sanitation is a matter discussed, its improvement, expensive but connected with higher standards of living.

A Communitywide Outbreak of Giardiasis with Evidence of Transmission by a Municipal Water Supply

Three hundred fifty residents of Rome, New York, had laboratory-confirmed cases of giardiasis between 1 November 1974 and 7 June 1975. A random household survey showed an overall attack rate for giardiasis (defined as a diarrheal illness of 5 days or more) of 10.6%. A significant association was discovered between having giardiasis and using city water and between having illness and drinking 1 or more glasses of water a day. The presence of human settlements in the Rome watershed area suggested that the water supply could have been contaminated by untreated human waste. The infectivity of municipal water was confirmed by producing giardiasis in specific pathogen-free dogs fed sediment samples of raw water obtained from an inlet of a city reservoir. A microscopic examination of the water sediments uncovered a Giardia lamblia cyst in one sample. This was the first time that a G. lamblia cyst has been found in municipal water in an epidemic and the first time that such water has been shown to infect laboratory animals.

Transfusion malaria in the United States, 1972-1981.

Twenty-six cases of transfusion-induced malaria were reported in the United States from 1972 through 1981. In nine patients malaria was due to Plasmodium malariae; eight, P. falciparum; eight, P. vivax; and one, P. ovale. Four patients died. The estimated rate of transfusion malaria for this period was 0.25 cases per million donor units collected. Of the 18 cases in which a specific infective blood donor could be identified, at least nine of the donors should have been rejected for blood donation because of recent residence or travel to a malarious area. Among 17 patients for whom the national origin of the implicated blood donor was reported, 12 were born in malarious countries. We propose minor changes in donor procedures and standards, including stricter criteria for donors born in malarious countries. Potential donors should be deferred for 3 years after an unexplained febrile illness occurring 1 year after exposure to malaria.

Pneumocystis carinii pneumonia and primary immune deficiency diseases of infancy and childhood

Twenty-nine of 194 cases of Pneumocystis carinii pneumonia in the United States reported to the Parasitic Disease Drug Service over a 3 year period were in children less than one year of age; this attack rate is five times higher than that for any other age group in the general population. Twenty-four of the 29 children had primary immune deficiency disorders. By contrast, acute lymphatic leukemia was the most common disease associated with P. carinii pneumonia in children 1 to 4 years of age (18 to 22 cases). Only one child over one year of age had an immunologic deficiency disease. Severe combined immunodeficiency was the most commonly encountered type of immune deficiency disease (15 of 25 cases). Six (24 per cent) of the patients with immunodeficiencies had at least one sibling with an immunologic deficiency disease who developed proved P. carinii pneumonia in infancy. Although defects in both humoral and cellular immunity appear to be present in these patients, the mode of transmission of P. carinii and its association with immune deficiency states are poorly understood.

Imported African Trypanosomiasis in the United States

Since 1967, six cases of African trypanosomiasis have been diagnosed and treated in the United States. Five patients were Americans infected with Trypanosoma rhodesiense, and the other was an African student with T. gambiense. Presenting signs and symptoms for all cases were typical of the disease, but often the diagnosis was delayed. The five Americans had spent only brief periods in endemic areas. All cases responded to therapy although one relapsed. Cases of imported sleeping sickness are few, and the risk of Americans acquiring the disease while traveling to endemic areas is low. However, the early diagnosis of sleeping sickness requires that physicians be cognizant of the possibility of imported tropical diseases.

Malaria in migrants and travellers

Imported malaria is a growing problem in the world. In part this is a result of greatly increased and more rapid travel and in part a result of a resurgence of malaria in areas partially or completely cleared. Migrants, either refugees or those looking for better opportunities in life, have contributed to the movement of malaria to previously free areas. Failure of travellers to take appropriate action to prevent infection has contributed to the increased incidence of imported malaria. Vectors of malaria may also become travellers and thus contribute to the spread of infection.

Ascariasis: Nutritional Implications

Ascaris lumbricoides, the roundworm, is one of the largest parasites of man and probably infects one in four persons in the world. Despite its prevalence, ascariasis is a largely neglected public health problem that has attracted relatively little scientific inquiry. Frequently, a number of biases contribute to the uncritical conclusion that infection with A. lumbricoides adversely affects the nutritional status of the host. This situation is exacerbated by number of studies that have confirmed these biases but have employed questionable methods, such as the use of small samples and indistinct categories, the neglect of the double-blind safeguard, the selection of inadequate controls, and the performance of experiments that are not reproducible in a variety of circumstances. It is interesting to note that studies claiming positive correlation between ascariasis and protein energy malnutrition have not found a significant difference in weight between infected and uninfected children before intervention. Furthermore, several recent studies have shown no significant improvement in nutritional status after intervention. Thus, the causal relationship between ascariasis and protein energy malnutrition is not clearly proved, and it is premature to advocate mass treatment of children in ascariasis-endemic areas as a method to enhance their growth and development.