Visceral larva migrans and the hypereosinophilia syndrome

This is a case of visceral larva migrans and hypereosinophilia syndrome with persistently elevated white blood cell count despite adequate medical therapy in a 4-year-old boy with leukocytosis and splenomegaly. Medical history included reactive airway disease and geophagia (pica). Serology for Toxocara canis revealed elevated IgG and IgM titers. Ophthalmologic evaluation ruled out ocular larva migrans. After 5 days of thiabendazole therapy, leukocytosis persisted, and a second course of anthelmintics was prescribed. Two weeks later, a decrease in leukocytosis was noted. Thiabendazole therapy was continued for 15 more days. Repeated serology for T canis revealed a decreased IgM titer and a further elevated IgG titer. Follow-up showed increased physical activity, improved respiratory status, and resolution of splenomegaly.     

Enteritis caused by atypical Yersinia (author's transl)

For the first time in the Federal Republic of Germany Yersinia species "frederiksenii", "kristensenii", "serovar 0 : 6" (each once) and "serovar 0 : 5" (twice) were found in the stool of 5 patients with gastroenteritic complaints. Serum agglutinins against these species could not be demonstrated. Other enteropathogenic microorganisms were excluded microscopically, by culture and serologically. These Yersinia isolates were resistant against penicillin G, ampicillin, carbenicillin, ticarcillin, and cefalotin.     

Pathogenesis of osteopathy caused by anticonvulsives (author's transl)

After a short survey of the recent suggestions of the pathogenesis of osteopathy caused by therapy with anticonvulsives it is demonstrated in the light of 3 case reports that 1. A vitamin D-sensible rickets, which is only due to abnormal living conditions, can develop in severely cerebral-damaged persons if there is no specific vitamin D administration. 2. An "antiepileptic rickets" is spontaneously reversible if the anticonvulsive therapy is stopped. 3. An enzymatic induction due to anticonvulsives is also detectable in the light of morphologic hepatic changes (biopsy, electron microscopy). Hence it follows that there are demands for a specific control of all patients treated with anticonvulsives. It is recommended to carry out a rickets prevention for a selected patient group.     

Persistent cutaneous larva migrans due to Ancylostoma species

Cutaneous larva migrans is considered to be a self-limited parasitic infection of about 2 to 8 weeks' duration, though it has been reported to persist for as long as 55 weeks. In this case, a healthy 47-year-old white man had multiple serpiginous lesions typical of cutaneous larva migrans for 18 months. A biopsy taken 2 months before presentation showed a parasite consistent with Ancylostoma species deep in a hair follicle. The patient initially responded to topical thiabendazole, but relapse occurred when therapy was discontinued. Oral thiabendazole cured the problem after 22 months of infestation. Cutaneous larva migrans may sometimes be long-standing, here almost 2 years, even in a healthy patient. Organisms may reside deep in the hair follicles. Topical thiabendazole may not penetrate to this depth, necessitating oral thiabendazole therapy.     

Male infertility and mycoplasma infections (author's transl)

The frequency and pathogenic role of mycoplasmas in cases of male infertility were studied in 2 groups: in 69 subjects in whom the reduced fertility (most often called asthenozoospermia) could not be explained, 35 (50%) carried mycoplasmas. 120 other subjects suffering from subacute or persisting urethritis presented sperm anomalies the degree of which seemed to be proportional to the duration of the urethritis. The presence of mycoplasmas was demonstrated in 2 cases of repeated abortion. The disappearance of this microorganism after treatment resulted in satisfactory pregnancies in these cases. This work confirms the probable role of mycoplasmas in male infertility and their certain role in certain cases of repeated abortion.     

Pleuro-pulmonary infections with anaerobic germs (author's transl)

The author presents his experience with the study of 42 patients with pleuro-pulmonary infection with anaerobic germs. He underlines the value of research tending to improve the conditions of sampling and culturing to ensure a bacteriological diagnosis and the setting of a suitable therapy.     

Problems of infections following renal transplantation (author's transl)

Infections arising as a complication of immunosuppressive therapy were analyzed in more than 40 renal transplant patients. Bacterial infections were observed in 78.0%, viral in 68.3% and mycotic infections in 56.3% of cases seen during a 3-year investigation. Infection was the cause of death in 5 out of 8 cases with fatal complications. Bacterial infections of the lungs were amongst the gravest post-transplant complications. Hepatitis B, herpes simplex and cytomegalovirus were the most common viral infections. Simultaneous bacterial, viral and Candida albicans infections--so-called "triple infections"--with a very poor prognosis were diagnosed in 25% of the investigated cases. The data show that after cadaveric kidney transplantation special emphasis should be laid on careful prophylaxis of infections and diagnostic measures for the early recognition of possible infections arising as a complication of immunosuppressive therapy.     

Hemorrhage caused by thrombocytopathies: new aspect of treatment (author's transl)

Hemorrhage due to thrombocytopathies can in most cases be stopped by application of the homologous coagulation-active phospholipide complex Fibraccel, as shown in a study in which 78 patients suffering from various thrombocytopathies were checked. This effect is especially important in patients with immunothrombocytopathies which do not permit any thrombocyte substitution. Recalcification time and thromboelastogram should be normalised during Fibraccel treatment. In existing extravascular coagulation Fibraccel treatment is contraindicated, especially in cases of inadequate protection by heparin.     

Treatment of urinary tract infections caused by unknown bacteria (author''s transl)

The occurrence of hepatic porphyrias--acute intermittent porphyria (AIP) and variegate porphyria (VP)--in Finland has been studied. During a period of 9 years 107 patients with AIP and 45 patients with VP were found. The prevalence of hereditary hepatic porphyrias was calculated to be 3.4 per 100 000 inhabitants. The patients belonged to 42 different families. Eighty-nine patients (59%) had had acute attacks, whereas 63 were symptomless latent cases. Precipitating factors, symptoms and excretion of porphyrins and their precursors did not significantly differ from what has been reported earlier from other parts of the world. A slight fragility of the skin on the back of the hands was noted in some 50% of VP patients. Abnormal sensitivity to sunlight could not be seen in a single case. However, about 50% of patients with VP showed an abnormal reaction when irradiated with artificial ultraviolet light. The difference in the skin symptoms in South African and Finnish VP patients is discussed.     

Bilateral fracture of the scapulae caused by a convulsive seizure (author's transl)

The authors report a case of bilateral communicated fractures of the scapulae caused by a seizure of unknown etiology. The differential diagnostic problems and the mechanism of inquiry are being discussed.