Loiasis in endemic and nonendemic populations: immunologically medicated differences in clinical presentation

Article Abstract:

Loa loa, also called the African eye worm, is a parasite that is found in Central and West Africa, especially along the Congo River. Infection with this parasite causes loiasis, which is characterized by swelling in the arms and legs, and the presence of the parasite in the blood (microfilaremia). In rare cases the parasite causes damage to the heart, eyes, kidneys and nerves. It is transmitted to man by the bite of an infected deer fly or mango fly. After a person has been bitten by an infected fly, it takes three years for the immature form of the parasite (larvae) to grow into an adult worm. The worms can remain in a person for as long as 17 years. Natives who live in regions of Africa where Loa loa is found have large numbers of the parasite in their blood, but do not have the characteristic symptom of swelling in their arms and legs. On the other hand, people who visit this region of Africa for long periods of time develop arm and leg swelling, but do not have detectable amounts of parasite in their blood. In an attempt to determine why this occurs, 51 West African natives with loiasis and 42 infected West African visitors were examined. Ninety percent of the natives had parasites in the blood, but only 16 percent had symptoms of swelling. Ten percent of the visitors had parasites in their blood while 95 percent had symptoms of swelling. The natives had lower levels of white blood cells, and lower levels of parasite-specific proteins known as antibodies. In addition, their white blood cells were less sensitive to the parasite. The authors conclude that the natives' immune systems (the body's natural defense system for fighting infection) react differently to the parasite, and this may explain why they have parasites in their blood but do not have symptoms of infection, while the opposite is true for the visitors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Demographic aspects, Africa, Immune response, Filariasis

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Asymptomatic blastomycosis of the central nervous system with progression in patients given ketoconazole therapy: a report of two cases

Article Abstract:

Blastomycosis is a disease that is caused by infection with a fungus known as Blastomyces dermatitides. This fungus has been found in soil in the United States, Canada, and Africa. It can cause lung and skin infections, and in severe cases it can infect the central nervous system (CNS) and result in lung failure (adult respiratory distress syndrome). Amphotericin B is used to treat patients who have more severe forms of the disease. Ketoconazole (KTZ) is an antifungal drug that is used to treat patients with mild to moderate blastomycosis. Treatment with high doses of KTZ can be toxic to the stomach and intestines. However, lower doses are associated with increased rates of relapse and drug failure. At the present time there is no way to identify the patients who will respond favorably to KTZ treatment. It has been reported that patients with genital and urinary tract involvement are more prone to relapse. This article describes the cases of two patients with blastomycosis who were treated with KTZ. When treatment was initiated, both patients had skin and lung infections, but did not have symptoms of CNS blastomycosis. KTZ treatment cured the lung and skin infections. However, in both cases infection spread to the CNS. Treatment with amphotericin B cured the CNS infections. It is suggested that all patients with disseminated blastomycosis be tested (by computed tomography or lumbar puncture) for CNS infection even if they do not have any CNS symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Infection, Complications and side effects, Drug therapy, Central nervous system, Amphotericin B, Ketoconazole, Blastomycosis

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