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Biomedical subjects

H D Nothdurft

Publications and source records attributed to H D Nothdurft.

At least 73 records · Page 4Linked to original sources
PubMed1995

Evaluation of circumsporozoite antibody testing as a sero-epidemiological tool for the detection of Plasmodium falciparum infection in non-immune travelers.

The objective of this investigation was to collect data concerning CS-antibody levels and duration of the immunological response to exposure of non-immune persons to a single malaria infection. For this purpose 156 specimens from 98 patients with confirmed falciparum malaria, 76 specimen derived from 64 patients with vivax malaria and sera from 32 patients who had not been previously to malarious areas were investigated by use of a commercially available ELISA testkit. All specimens from patients with falciparum malaria were also tested for merozoite-antibodies by an indirect fluorescence antibody test (IFAT). Positive levels of merozoite-antibodies were detectable in 89.1% of the specimen in this panel during the period between days 8 and 90 after onset of symptoms and decreased steadily thereafter. The test results were positive for CS-antibodies in 36.4% of the specimens from patients with falciparum malaria during the first 7 days after onset of symptoms. This figure increased to 55.8% during days 8-90 after onset and decreased to 38.9% in specimens which were tested later (91-1898 days). 11 specimens reacted positively to CS-antibody testing but negative in the IFAT. Therefore, the percentage of specimen detected by either IFAT or CS-ELISA was at 51.9% during days 0 and 7 (p < 0.001), 95.3% during days 8 and 90 (p = 0.039) and 44.4% for testing performed later (p < 0.001). CS-antibodies could also be detected in 5.3% of specimen from patients with vivax malaria while none of the sera from the malaria-negative control-group tested positive for CS-antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Protozoan↗
PubMed1995

Stand-by treatment of suspected malaria in travellers.

Travellers to malarious areas are increasingly advised to carry an emergency medication for self-treatment of suspected malaria in absence of medical attention. However, no data are available so far how travellers cope with self-diagnosis and stand by treatment (SBT). We therefore investigated the frequency, circumstances and outcome of emergency self-treatment for suspected malaria in German travellers. 3434 travellers were recruited for an open prospective study by 28 different travel clinics in Germany. 2867 travellers (90.1%) who returned questionnaires after their journey were analyzed. 40 travellers (1.4%) reported about SBT during their journey. Significant Plasmodium falciparum antibody levels could be demonstrated in only 4 of 37 SBT users (10.4%). In another 127 travellers with febrile episodes but without SBT use, no malaria was indicated by follow-up and/or serology.

Adult↗
PubMed1994

[Sequelae of imported tropical diseases in Germany].

20-50% of all travellers to tropical and subtropical countries experience health problems during or after travel. Mainly respiratory tract infections or gastrointestinal disorders are predominant. As specific disorders imported from the tropics traveller's diarrhoea is prevailing, however amebic and helminthic infections, hepatitis A, malaria, sexually transmitted diseases as well skin disorders are rather common. Classical tropical diseases such as cholera, sleeping sickness or trachoma play only a very minor role as imported infections. The majority of health impairments during or after travel are uncomplicated or self limiting. However, falciparum malaria, viral hepatitides, typhoid fever, tropical viral infections and infections of the CNS can take a malicious course. Early diagnosis and treatment generally can provide complete cure without sequels. Sequels are most commonly seen following hepatitis B and C as well as HIV infection but also as a result of CNS infections (e.g. encephalitis) and of imported tuberculosis. For medical expert opinion it is essential that sequels were present already during the acute phase of illness. The socio-economical impact of infections imported from the tropics is considerable due to the high morbidity figures. Preventive measures before and after a stay in tropical countries could markedly reduce the health risks involved.

Cause of Death↗
PubMed1994

Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients.

The symptoms, medical history, and treatment of 98 patients with cutaneous larva migrans (creeping eruption) who attended a travel-related-disease clinic during a period of 4 years are reviewed. This condition is caused by skin-penetrating larvae of nematodes, mainly of the hookworm Ancylostoma braziliense and other nematodes of the family Ancylostomidae. Despite the ubiquitous distribution of these nematodes, in the investigated group only travelers to tropical and subtropical countries were affected; 28.9% of the patients had symptoms for > 1 month, and for 24.5% the probable incubation period was > 2 weeks. The efflorescences typically were on the lower extremities (73.4% of all locations). The buttocks and anogenital region were affected in 12.6% of all locations, and the trunk and upper extremities each were affected in 7.1%. Only a minority of patients presented with eosinophilia or an elevated serum level of IgE. No other laboratory data appeared to be related to the disease. Therapy with topical thiabendazole was successful for 98% of the patients. Systemic antihelmintic therapy was necessary in two cases because of disseminated, extensive infection.

Adult↗
PubMed1993

[Halofantrine in the treatment of imported malaria in nonimmune travelers].

The efficacy (criteria: cure rate, time to resolution of fever or absence of parasites) and safety (criteria: clinical side effects, altered laboratory parameters) of halofantrin were investigated in a multi-centre study of 96 non-immune patients (71 men, 25 women, mean age 34.3 [21-62] years) with malaria imported from regions of high resistance into Germany or Switzerland. The initial 63 patients received one-day treatment (three doses of 500 mg halofantrin), while the last 33 patients received an additional course of treatment one week later. Treatment was curative in all patients in the second group, but relapses occurred in five of the 41 patients (12.2%) with falciparum malaria who received one-day therapy. Fever resolved after a mean of 45 hours and parasites were absent after a mean of 66 hours. There were small increases in transaminase values (most probably because of the infection) in five patients, but all became normal again within a few days. Halofantrin is a safe drug and is suitable for both therapy and stand-by therapy of resistant Plasmodium infections. Treatment should be repeated after 7 days.

Adolescent↗
PubMed1993

[Health and travel in the tropics].

BACKGROUND: Roughly one-half of all travellers to the tropics become ill, either during or after their journey. MAJOR POINTS DISCUSSED: For counseling in the doctor's office, both the particular risks of the individual (pregnancy, childhood, chronic illnesses) and the specific situation in the country to be visited, duration of stay there, and the form of travels envisaged (hotel, trekking, safari, etc.), must all be taken into account. The major infectious diseases, their prophylaxis and their treatment are described. In addition to gastrointestinal infections, malaria today heads the list of health risks encountered in tropical countries. Of the almost 1000 cases of malaria reported every year in the FRG, about one-half contracts the feared quotidian (falciparum) malaria. In patients with relevant exposure, any flue-like illness must be suspected to be malaria until proved otherwise. Present-day possibilities of prophylaxis and treatment are presented.

Diarrhea↗
PubMed1992

[Fasciola hepatic infection in a family: diagnosis and therapy].

A 39-year-old man was hospitalized because of a 5-week history of feeling very ill, with fever up to 39 degrees C and nonspecific upper abdominal pain. He looked very pale and his spleen was painful on palpation. There was a blood eosinophilia of over 50% and computed tomography demonstrated hypodense areas in the liver, suggesting a parasitic infection with liver involvement. An ELISA factor of over 100 and the finding of liver fluke eggs in bile confirmed the diagnosis of Fasciola hepatica infection, which was probably acquired by eating wild watercress when visiting in the Allgäu. A fasciola infection was also proven in his 37-year-old sister who for some time had complained of colicky right-sided upper abdominal pain, her 40-year-old husband with similar symptoms and their 10-year-old daughter. All four were successfully treated for two days with 10 mg/kg triclabendazole daily by mouth. Persons eating raw vegetables and salads of wild-growing plants are at risk of being infected with Fasciola hepatica.

Adult↗
PubMed1989

[Sleeping sickness in German travelers to the tropics].

A brother and sister (the latter having been resident in Ruanda for three years) fell ill with African trypanosomiasis (sleeping sickness) after a two-day safari in the Akagera National Park. Cardinal symptoms were fever, lymphadenopathy and the typical primary lesion (trypanosomal chancre). The diagnosis was confirmed by demonstrating trypanosomes in the peripheral blood. There was no CNS involvement in either case. Administration of suramin, 1 g weekly intravenously for six weeks, quickly brought about regression of the symptoms and the parasitaemia. According to the number of cases reported since 1970, the risk for German travellers to certain African areas of contracting trypanosomiasis is about 0.3 per 100,000. Since in Africa the incidence of the disease is increasing, in some parts considerably, one must reckon with an increasing risk for tourists.

Adult↗
PubMed1986

[Complicated malaria tropica: specific and supportive therapy in the imported diseases].

Eleven of 43 nonimmune patients with falciparum malaria had one or several organ complications: cerebral malaria, acute respiratory failure, acute renal failure, secondary infection, autoimmune haemolysis, spontaneous spleen rupture, and acute pancreatitis. Parasitaemia was 0.1 to 60%. Initial antiparasitic therapy with quinine given parenterally resulted in rapid regression of parasitaemia. An additional schizonticide agent was given depending on parasitic resistance. Supportive therapy comprised intensive-care monitoring including fluid and electrolyte balance and, if necessary, early haemodialysis and (or) endotracheal intubation with PEEP breathing. In one patient with excessive parasitaemia exchange transfusion was performed. Heparin was given only in proven disseminated intravascular coagulation, corticosteroids only in persistent autoimmune haemolysis. All patients survived without suffering permanent defects. Retrospective analysis shows that, apart from rapid specific therapy, supportive treatment of the individual organ complications determines course and prognosis of complicated falciparum malaria.

Acute Kidney Injury↗
PubMed1981

Praziquantel in clonorchiasis and opisthorchiasis.

A single stool examination revealed pathogenic intestinal parasites in 462 (58%) of 796 vietnamese and cambodian refugees. 56 (7.0%) were infected with Clonorchis sinensis and/or Opisthorchis viverrini. These patients received Praziquantel in a dosage of 20 mg/kg bwt. p.day on 3 consecutive days. Parasitological controls were completed after 12 months. No further excretion of eggs could be detected in 88% of the patients. Concurrent infections with other trematodes and cestodes were also cured. Nematode infections remained uninfluenced. No change of haematological and biochemical parameters could be observed during therapy. Diarrhea and epigastric pain were common side effects, which are probably not effects of the drug itself. They rather seem to be due to the release of parasitic antigens. This is also indicated by a further increase of circulating Ig E after therapy.

Adolescent↗
PubMedDate not supplied

Epidemiology of alveolar echinococcosis in southern Germany (Bavaria).

Alveolar echinococcosis is considered to be the most dangerous endemic parasitic disease for man in Central Europe. In Germany, unlike the neighbouring countries of Switzerland, Austria and France, only limited data on the prevalence and incidence of echinococcosis are available. Therefore, a retrospective cross-sectional study was conducted in order to investigate the epidemiology of echinococcosis in Bavaria, one of the two southern states of Germany. A standardised questionnaire was sent to all hospitals in Bavaria requesting information about patients seen from 1985 to 1989. In a second step a team of reviewers was sent to all relevant hospitals for active case finding in hospital statistics and medical records. A total of 216 patients with echinococcosis were detected of whom 58 had alveolar echinococcosis. According to these data, the prevalence in Bavaria was calculated to be 0.5 per 100,000 inhabitants with peak values in the counties of Swabia (2.4) and Upper Bavaria (0.6). The annual mean incidence of newly diagnosed cases amounted to 0.03 per 100,000. The distribution of prevalence in man was closely correlated to the infection rates in foxes throughout Bavaria (p < 0.05). Farmers are the occupational group with the highest risk to acquire echinococcosis with a prevalence/odds ratio of 14.6 for Swabia and 8.8 for Upper Bavaria, when compared to the general rural population.

Adult↗
PubMedDate not supplied

Imported rickettsioses in German travelers.

Twenty-two cases of rickettsiosis imported to Germany (13 men, nine women, average age 42 years) in a 5-year period were analyzed retrospectively regarding the travel histories, symptoms and clinical findings, laboratory features and course of the disease. The two primary rickettsial diseases were boutonneuse fever (18 patients) and scrub typhus (three patients). One patient had murine typhus. The main symptom was fever in 91% followed by headache (64%), myalgia (40%), arthralgia (50%) and diarrhea (36%). The most frequent clinical finding was lymphadenopathy in 65%. Eschar was detectable in 55% of patients with Rickettsia conori infection and in one patient with Rickettsia tsutsugamushi infection. All patients with R. tsutsugamushi infection as well as 33% of the patients with R. conori infection had a macular exanthema. One patient with scrub typhus had pleural and pericardial effusions. Seventy-three percent had an increased ESR. Three patients had leucocytosis, three increased transaminases and two normochromic anemia. The incubation period for R. conori infection was 5 to 28 days (average 14 days), for R. tsutsugamushi infection 7 to 21 days (average 16 days). Twenty-one patients were treated with tetracycline or doxycycline, one with erythromycin. All patients were cured. One patient had a relapse. Due to the fact that the symptoms are often not characteristic and that the routine laboratory findings are of only marginal help, the diagnosis of rickettsial diseases is often not easy. A detailed travel history sometimes gives an important hint for diagnosis.

Adult↗