Fever as the presenting complaint of travellers returning from the tropics

We investigated prospectively the cause of fever in patientsrequiring hospitalization after returning from the tropics.All consecutive admissions (n=195) with oral temperature >37.0°Cat the time of admission were enrolled. Final diagnosis as recordedon the discharge summary by the attending physician and resultsof any relevant laboratory or radiological investigations wererecorded on standard proforma. Malaria accounted for 42% ofadmissions; two patients had returned to Britain more than 6months before presentation. The second largest group was assumedto have a non-specific viral infection (25%). Cosmopolitan infections(urinary tract infection, community-acquired pneumonia, streptococcalsore throat, etc.) accounted for 9%. Coincidental infections(schistosomiasis, filariasis, intestinal helminths) were foundin 16%. Serology was positive for HIV infection in 3%. The mostuseful investigation was a malaria film, which was positivein 45% of cases in which it was performed. The combination ofthrombocytopaenia (platelet count <100 x 10⁹) and hyperbilirubinaemia(bilirubin > 18 IU/ml) were useful predictive markers ofmalaria: all 23 patients with both abnormalities had positivemalaria films. Malaria must be excluded in any febrile patientreturning from the tropics. In the absence of a positive malariafilm, the combination of a low platelet count and raised bilirubinmay suggest the need for an empirical course of therapy.     

Giardia muris infection in mice with concurrent graft-versus-host reaction

The effects of concurrent graft-versus-host reaction (GvHR) on the course of Giardia infection in CBA x BALB/c F1 mice have been examined, to test the hypothesis that T-cell-mediated immunity, in the form of a local DTH reaction, alters the host-parasite relationship in favour of the host by changing the physical environment of the parasite. GvHR did not enhance immunity, indeed mice infected with Giardia at a late stage of GvHR had significantly higher faecal cyst excretion and prolongation of the plateau phase of infection, indicating a degree of immunodeficiency.     

An open-label efficacy pilot study with pimecrolimus cream 1% in adults with facial seborrhoeic dermatitis infected with HIV

BACKGROUND: Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. OBJECTIVE: A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. METHODS: In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. MAIN OUTCOME MEASURES: Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. CONCLUSION: Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.     

Laryngotracheal stenosis: a serious complication of percutaneous tracheostomy

Tracheostomy in patients requiring prolonged artificial ventilation in intensive care is increasingly being performed by a percutaneous dilatational technique, in preference to the standard surgical method. Since its introduction numerous series have reported favourably on its general safety in the short-term, but there have been few reports of longer term follow-up of patients. We present four cases of laryngotracheal stenosis, a previously unreported complication associated with the technique, and discuss the relevance of these to the future practice of percutaneous tracheostomy.