R.S Goldsmith

Three- to 7-year follow-up after albendazole treatment of 68 patients with cystic echinococcosis (hydatid disease).

Sixty-eight cystic echinococcosis patients were each treated with 800 mg albendazole/day in four 28-day courses separated by 14-day drug-free intervals. Follow-up for 3-7 years showed that this treatment alone eradicated the cysts in many patients; in most of the remainder, disease progression stopped. Of the 59 patients with liver cyst(s), 41% were cured (all cysts disappeared), 17% showed marked improvement (> 25% contraction, complete consolidation), 24% limited improvement and 15% no change. Of the 12 patients with lung cyst(s), 72% were cured, 9% showed limited improvement and 18% showed no change (18%). No patient worsened but a recurrence occurred in two patients at about 56 months. The times taken to detect an initial cyst change and to detect cure were longer than is generally expected; initial cyst changes and cure could only be detected after 1 year in 12% and 69% of patients with liver cysts and 22% and 37% of those with lung cysts, respectively.

High prevalence of human hydatid disease (Echinococcosis) in communities in northern Israel : epidemiologic studies in the town of Yirka

The resurgence of hydatid disease in communities in northern Israel led to epidemiologic studies in 1988 in the town of Yirka, a semirural Druze community of 8200 persons. In domestic animal surveys, 8% of 63 dogs tested after an arecoline purge and 10% of 255 sheep at the abattoir were found to be infected. In a randomized serosurvey of 758 persons using the indirect hemagglutination test (positive titer greater than or equal to 1:512), 9% (68) had a titer greater than or equal to 1:64, 2.2% had a titer greater than or equal to 1:256 and 0.9% had a titer greater than or equal to 1:512. Of those with titers greater than or equal to 1:64, 59 were evaluated by abdominal sonography and chest x-ray: 6 of the 59 were found to be persons who previously had had a liver or a lung hydatid cyst surgically removed; 6 other persons (5 with negative indirect hemagglutination titers) were found to have a newly detected asymptomatic cyst. Of the latter group, hydatid confirmation was subsequently obtained by surgery for 2 persons and by arc 5 and/or immunoblot assay for 4 persons. Thus, the cumulative percentage of confirmed present or recent past hydatid infections was 12/758 (1.6%) leading to an extrapolated rate of 1583/100,000 persons. This ranks Yirka among the highly endemic areas for hydatidosis worldwide. The study also showed that imaging methods were more sensitive than the indirect hemagglutination serologic test for conducting a prevalence survey.

Use of the enzyme-linked immunosorbent assay (ELISA) for detection of Entamoeba histolytica antigen in faecal samples.

A promising new ELISA method developed by Root et al. to diagnose amoebiasis by the detection of Entamoeba histolytica coproantigen was tested in Mexico City and was reported to be more than twice as sensitive as microscopy. In this study the same procedure was compared to microscopy for paired specimens from 107 patients in San Francisco. Microscopy was more than twice as sensitive as ELISA: of 12 specimens positive by microscopy only 5 were also positive by ELISA. The ELISA did not detect a single specimen not detected by microscopy. Over-all, there was a 93% agreement between the two tests: 5% were positive and 89% negative by both tests. Possible reasons for the differences in the San Francisco and Mexican City findings are discussed.

Resurgence of hydatid disease (echinococcosis) in communities in northern Israel

Hydatid disease (echinococcosis), formerly endemic in the area of Israel, has occurred only sporadically in the past 40 years, mostly in immigrants. An unusual spatial and temporal cluster of surgically confirmed infections in northern Israel led to a review of echinococcosis hospital records. This revealed a resurgence of the disease in some rural and semirural Arab and Druze communities. Between 1960 and 1989, 224 cases of hydatid disease were surgically confirmed in residents of these communities. During this period, as the Arab-Druze population doubled, the mean annual surgical incidence of new cases per 100,000 rose 5-fold from 1.4 to 7.1. In Yirka, a Druze community of 7500 persons, from which no cases were known before 1970 and in which 52 cases were surgically confirmed thereafter, the mean annual surgical incidence for 1980-1989 rose to 53/100,000, to become one of the highly endemic areas of the world. The probable explanation of the outbreak is that, since 1967 with the opening of the border, importation of infected sheep has occurred from the hydatid-endemic West Bank region to individual homes in the communities in northern Israel. The sheep are raised to maturity in pens before home slaughtering; the offal, available to dogs, resulted in canine and then human infections.

Use of a nomogram to quantitate plasma dilutions for serological testing following blood collection in capillary tubes

A technique for the processing and quantitation of small volumes of plasma collected in heparinized capillary tubes is presented using a nomogram that determines the final amount of diluent needed for variable volumes of plasma.