Biomedical subjects
Publications and source records attributed to T Kuberski.
A critically ill patient with septicemic plague and peripheral gangrene was treated successfully with ciprofloxacin. There are no previous reports of plague being successfully treated with ciprofloxacin. Peripheral gangrene of this patient's feet was managed with use of sympathetic blockade; the patient's toes appear to have been saved by this approach.
Haemophilus ducreyi was isolated from a patient who presented with a genital ulcer at the Port Moresby Clinic for Sexually Transmitted Diseases. This provides documentation for the occurrence of chancroid in Papua New Guinea. The differentiation of this disease from donovanosis is discussed.
The study of different ethnic groups living in the same physical environment provides the opportunity to examine interaction of genetic and environmental factors in the aetiology of diabetes mellitus. In rural New Caledonia, the prevalence of diabetes was higher in part-Polynesians than in Melanesians: males - 6.6 versus 0.5%; females - 6.3 versus 3.5% respectively. The prevalence of abnormal glucose tolerance (impaired glucose tolerance and diabetes) was 11.5 and 15.7% in part-Polynesian males and females, respectively, and 4.7 and 9.2% in Melanesian males and females. Mean age and degree of obesity in these ethnic groups were sufficiently similar to suggest that these factors played no significant role in the difference in diabetes prevalence. Furthermore, adjustment of relative risk of impaired glucose tolerance and diabetes for age and obesity indicated that the modest differences between groups were not responsible for the observed variation in diabetes prevalence. The differences in prevalence of impaired glucose tolerance and diabetes between Melanesians and part-Polynesians may be genetically determined, although the role of certain environmental factors other than obesity, e.g. differences in physical activity or qualitative aspects of diet, cannot be excluded.
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Serum and fecal samples collected from children with gastroenteritis and healthy children and adults living in Efate, Vanuatu (formerly the New Hebrides), were tested for the presence of human rotavirus antigen or antibody by electron microscopy and enzyme-linked immunosorbent assay. Virtually every subject was found to have detectable levels of antibody and age-specific studies showed that primary infections occur early in life. Human rotavirus was demonstrated to be the cause of an outbreak of gastroenteritis among children which occurred between August and September 1980, although it had not been detected in the population in the preceding 13 months. Epidemics of human rotavirus-associated gastroenteritis appear to occur every 2nd year in this population.
Between June 1979 and July 1980, faecal specimens were collected from 100 children in Efate, Vanuatu, and examined for the presence of virus-like particles by direct negative staining electron microscopy. Of the children, 40 were hospital patients 22 of whom had gastroenteritis and 18 had other illnesses. The remaining 60 children were apparently healthy controls. Coronavirus-like particles were the most common agents encountered and were detected in approximately 20% of all three groups of children. Particles with the morphological features of calicivirus, astrovirus, adenovirus and parvovirus were also detected.
Familial spastic paraplegia is described in four Cook Island children. Prior to the onset of the disease at age six or seven years, the children were apparently normal. Disease was characterised principally by progressive spastic paraplegia of the lower extremities, in addition to tremor and slow articulation. The disease in these children was probably due to the expression of an autosomal recessive gene. The disorder is of interest because the findings in these children appear to overlap the pure spastic and ataxic heredofamilial syndromes.
Hepatitis B virus infections were examined in two ethnically different Pacific Island groups, 532 Melanesians and 401 Polynesians, living under similar environmental circumstances on the island of Ouvea, New Caledonia. High hepatitis B virus infection rates (Melanesians, 89.3%, and Polynesians, 86.3%) and hepatitis B surface antigen (HBsAg) carrier rates (Melanesians, 11.7%, and Polynesians, 8.0%) were observed in both groups. The carrier rate for HBsAg was generally higher in men, particularly Melanesian men. Comparing the Ouvea Melanesians and Polynesians to 170 Melanesians living on the main island of New Caledonia, significantly lower rates for hepatitis B virus infection (47.1%) and HBsAg carrier state (0.6%) were found. The findings suggest that environmental factors may be more important than genetic factors in hepatitis B infections in these populations. Tattooing did not appear to influence the presence of hepatitis B virus infection.
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Retrospective and prospective studies were done on children with wheezing bronchitis on the small Pacific island of Niue. Wheezing bronchitis was found to be a common cause of morbidity, but not mortality in these children. Episodes of the disease were most common in children under the age of 4 years and tended to disappear as they became older. A case-control study indicated smoking by the mother (P less than 0.0001), positive stool examination for parasites (P less than 0.001), mother with a history of wheezing bronchitis (P less than 0.01) and father smoking (P less than 0.05) were all correlated with wheezing bronchitis. Skin testing and serologic results indicated that hypersensitivity to house dust mite (Dermatophagoides pteronyssinus) and plantain (Plantago lanceolata) antigens were also associated with having wheezing bronchitis. This study demonstrates the multifactorial etiology of wheezing bronchitis on a Pacific island.
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An outbreak of Vibrio cholerae, serotype Ogawa, biotype El Tor, was experienced on the coral atoll of Nauru in the central Pacific. Primary water-borne transmission was unlikely because the population was supplied with water from individual rainwater catchment tanks and surveillance of the tanks of patients and persons with asymptomatic infection showed no evidence of contamination with V. cholerae. A matched pair, case-control study suggested a food-borne point source for transmission also was unlikely. The principal mode of transmission was not established, but spread of cholera appeared to be by a route other than common source contamination of water or food.
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Biopsy specimens from the lesions of 14 patients with granuloma inguinale were examined by electron microscopy. Calymmatobacterium granulomatis, the presumed causative agent, was observed within the phagosomes of many macrophages, but only rarely in polymorphonuclear leukocytes. The morphology of the organisms was that of a gram-negative bacteria having a large capsule and no flagella. These morphologic observations are consistent with published findings suggesting that this organism is related antigenically to organisms of the genus Klebsiella.
A sudden outbreak of skin ulcers occurred in the Cook Islands beginning in early 1976. Information from the outbreak indicated that ulcers were most consistent with the clinical entity of tropical ulcer. A retrospective analysis was undertaken to determine the clinical and epidemiological features of the outbreak. The ulcers occurred most commonly in males in the 10--14 and 15--19 age groups. Antecedent trauma appeared to initiate the ulcer. Most ulcers were solitary, occurred on the lower limbs, and healed leaving a pigmented scar. The ulcers responded well to penicillin. The cause of the ulcers was not established, but gram-negative, pleomorphic bacilli were consistently observed in ulcer biopsies.
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The recent epidemic of cholera on the Pacific Ocean atoll of Tarawa, Gilbert Islands renewed interest in the use of coconut water as a rehydration fluid. Fifty-one samples of coconut water from Tarawa were analysed for a variety of constituents to assess its potential usefulness in the oral and parenteral rehydration of patients with cholera and other severe forms of gastroenteritis. Compared to oral rehydration fluids known to be effective in cholera, coconut water was found to have adequate potassium and glucose content, however was relatively deficient in sodium, chloride and bicarbonate. The addition of table salt to the coconut water is suggested to compensate for the sodium and chloride deficiency. In areas of the world where coconuts are plentiful, the advantages of sterility, availability and acceptability make coconut water theoretically feasible for the oral rehydration of patients with severe gastroenteritis when conventional fluids are unavailable.
Viable Angiostrongylus cantonensis was recovered from the cerebrospinal fluid of a 17-month-old boy with eosinophilic meningitis. Neurological findings were minimal, and the child had an uneventful recovery.