• Adherence to a Combination of Artemether and Lumefantrine (Coartem) in Kajo Keji, Southern Sudan.

      Depoortere, E; Salvador, E T C; Stivanello, E; Bisoffi, Z; Guthmann, J P; Epicentre, 42 bis boulevard Richard Lenoir, 75011 Paris, France. evelyn.depoortere@brussels.msf.org (Published by: Maney Publishing, 2004-09)
    • Clinical Presentation of Louse-Borne Relapsing Fever Among Ethiopian Refugees in Northern Somalia.

      Brown, V; Larouze, B; Desve, G; Rousset, J J; Thibon, M; Fourrier, A; Schwoebel, V; Médecins Sans Frontières, Paris, France. (Published by: Maney Publishing, 1988-10)
      Louse-borne relapsing fever (LBRF) is still endemic among Ethiopian populations. In order to assess the clinical presentation of LBRF in an Ethiopian refugee camp in northern Somalia, a referral system was organized for all pyrexias of unknown origin. Among the 134 patients referred, 37 showed Borrelia in fresh and stained blood smears. Common clinical features were: high fever (above 39 degrees C in 73% of the cases), headache and general body pain (88%), liver tenderness (62%), petechia (54%), nausea and vomiting (46%), chills and rigors (30%) and epistaxis (11%). Jaundice was absent. No fatalities were observed. The clinical picture was less severe than in previous studies on LBRF. This difference might be due to the fact that the present study was community-based as opposed to the previous studies which were hospital-based.
    • Successful Miltefosine Treatment of Post-Kala-Azar Dermal Leishmaniasis Occurring During Antiretroviral Therapy.

      Belay, A D; Asafa, Y; Mesure, J; Davidson, R N N; Médecins Sans Frontières - Netherlands, Plantage Middenlaan 14, P.O. Box 10014, 1001 EA Amsterdam, The Netherlands. (Published by: Maney Publishing, 2006-04)
      The first two patients to be treated with miltefosine for post-kala-azar dermal leishmaniasis (PKDL) are reported. One was a 26-year-old Ethiopian man who had been treated with sodium stibogluconate, for relapsing visceral leishmaniasis (VL), four times between August 2002 and March 2004. In January 2004 this patient was found to be seropositive for HIV and began antiretroviral treatment with stavudine, lamivudine and nevirapine. Five months later he developed clinical PKDL, with extensive cutaneous, conjunctival and oral mucosal involvement. The second patient was a 42-year-old Ethiopian man who was treated for relapsing VL in November 2003. He too was subsequently found to be seropositive for HIV and was treated with stavudine, lamivudine and nevirapine from May 2004. He developed a nodular rash of PKDL over his face and upper body 2 weeks after starting the antiretroviral therapy. Treatment of both patients with oral miltefosine, at 100 mg/day for 28 days, led to the complete regression of their PKDL lesions. When checked 3-6 months after the end of the miltesofine treatment, neither patient showed any signs of VL, PKDL or other HIV-associated disease.
    • The Efficacy of Chloroquine for the Treatment of Acute, Uncomplicated, Plasmodium Falciparum Malaria in Laos.

      Guthmann, J P; Kasparian, S; Phetsouvanh, R; Nathan, N; Garcia, M; Phompida, S; Brockman, A; Gastellu-Etchegorry, M; Legros, D; Epicentre, 8 rue Saint Sabin, 75011 Paris, France. jguthmann@epicentre.msf.org (Published by: Maney Publishing, 2002-09)
      To assess the local efficacy of chloroquine for the treatment of acute, uncomplicated, Plasmodium falciparum malaria, children and adults from Sekong province (an area of Laos with a low intensity of transmission) were tested in a 28-day, in-vivo study. Complete data were collected from 88 of the 102 subjects enrolled between October 1999 and September 2000. After genotypic analysis to distinguish recrudescing infections from re-infections, 35 (39.7%, with a 95% confidence interval of 29.5%-50.7%) of these 88 patients were considered treatment failures. These results seriously question the use of chloroquine as the first-line treatment for P. falciparum malaria in the study area.
    • Visceral Leishmaniasis in Southern Sudan: Status of Healthy Villagers in Epidemic Conditions.

      Seaman, J; Ashford, R W; Schorscher, J; Dereure, J; MSF Holland (Artsen Zonder Grenzen), Nairobi, Kenya. (Published by: Maney Publishing, 1992-10)
      A combination of interview, serology and skin testing was used to investigate the status of apparently healthy villagers during a visceral leishmaniasis epidemic in southern Sudan. The number of people who had died equalled the number who were alive at the time of the survey. The direct agglutination test (DAT) identified 10% of the people as being serologically positive. Most young children (36/39) and 34% (22/64) of adults had neither positive serology nor skin test. About 64% (42/66) of adults had positive skin tests. In two villages, 54% and 76% of those over four years of age showed evidence of having been infected. The mortality associated with infection was estimated as at least 69%; 25% of those infected appeared to have cured spontaneously. The outcome for the remaining 6% was still doubtful. Even in this devastating epidemic there is, therefore, evidence of a considerable amount of infection without severe disease. Serological tests, while useful clinically, are apparently not useful for detecting early cases. Combined skin testing and serology produces a comprehensive though partially hypothetical picture.