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Biomedical subjects

T Loscher

Publications and source records attributed to T Loscher.

6 recordsLinked to original sources

Detection of mycobacterial lipoarabinomannan with an antigen-capture ELISA in unprocessed urine of Tanzanian patients with suspected tuberculosis.

A direct antigen-capture ELISA based on the detection of mycobacterial lipoarabinomannan (LAM) in unprocessed urine was evaluated for its usefulness in clinical practice. In Tanzania, 231 patients with suspected pulmonary tuberculosis (TB) and 103 healthy volunteers were screened with standard TB tests and with the new LAM-ELISA. Of 132 patients with confirmed pulmonary mycobacterial disease (positive sputum culture), 106 were positive using the LAM-ELISA (sensitivity 80.3%). In comparison, the sensitivity of acid-fast bacilli (AFB) sputum microscopy was 62.1% (82 of 132 confirmed cases). Of the 231 patients, 17 were both culture- and AFB-negative, but had typical radiographic signs of pulmonary mycobacterial infection and did not respond to antibiotic treatment. Of these 17 patients, 13 (76.5%) had positive LAM-ELISA test results. To define the specificity of the assay, urine samples from 103 healthy volunteers were also screened using LAM-ELISA. All but one had an optical density below the cut-off (specificity 99%). Of interest was a significant correlation between level of microscopic density of mycobacteria in sputum and LAM antigen concentration in urine (chi2=8.44). The LAM-ELISA is a field-adapted tool that can improve screening standards in countries with a high incidence of TB.

AIDS-Related Opportunistic Infections↗

[Emporiatrics].

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Antibiotic Prophylaxis↗

Geographic differences in the sensitivity of a polymerase chain reaction for the detection of Plasmodium falciparum infection.

The amplification of target DNA by highly specific probes using the polymerase chain reaction (PCR) provides a highly sensitive and specific method for the detection of malaria infection. The use the of PCR in settings with varying endemicity within one survey area has not been investigated intensively. Therefore, a cross-sectional study was conducted in the districts of Kabarole and Bundibugyo in western Uganda using material from three villages with different epidemiologic situations regarding malaria and DNA primers for a PCR that had shown satisfactory sensitivity and specificity in previous trials. The sensitivity of the PCR varied significantly (P < 0.001) in the three survey villages (between 63.2% and 83.9% for the primer pair K1-14-1 and between 37.9% and 69.9% for the primer pair MSP-1) and was highly linked to geographic differences and social exchanges of the inhabitants with other areas of the district. According to the results of this investigation, it is advisable not to use a single primer pair in epidemiologic field studies for the detection of falciparum malaria. The use of combined primer pairs and the frequent confirmation of the results by microscopy are recommended.

Animals↗

Long-term efficacy of primaquine in the treatment of vivax malaria in nonimmune travelers.

Fifty-six travelers presenting with vivax malaria to a German travel clinic were followed regularly for at least 18 months between 1984 and 1992 to investigate the long-term efficacy of primaquine in nonimmune patients without reinfection. All received a standard treatment of 15 mg of primaquine a day for 14 days following an initial total dose of 1,500 mg of chloroquine (base) given over a 48-hr period. None of the patients visited countries endemic for malaria during the period of observation. In seven patients (12.5%), relapses were confirmed microscopically by detection of malaria parasites in blood films. The frequency of relapses varied between one and four per patient and these occurred between 60 and 252 days after treatment. Four of these seven patients had acquired infection in Papua New Guinea or eastern Indonesia, while only five (10.2%) of the remaining 49 patients without relapses had traveled to these areas prior to referral (P < 0.01).

Adolescent↗

Direct amplification and differentiation of pathogenic and nonpathogenic Entamoeba histolytica DNA from stool specimens.

Discrimination of pathogenic and nonpathogenic Entamoeba histolytica is of great clinical importance. A simple and rapid DNA extraction method that can be used directly with stool specimens was developed without the need for prior cultivation of the parasites. The entire protocol can be performed at room temperature in a 1.5-ml microcentrifuge tube format. There is no DNA precipitation step. The subsequent nested polymerase chain reaction consists of an initial E. histolytica-specific amplification, followed by two separate amplifications using two primer pairs specific for pathogenic and nonpathogenic E. histolytica, respectively. Amplification products can be verified by restriction endonuclease digests. There is no need for hybridizations or the use of radionucleotides. One trophozoite per milligram of stool sample could be detected and differentiated in a 0.1-g specimen.

Animals↗

The efficacy of halofantrine in the treatment of acute malaria in nonimmune travelers.

A multicenter prospective trial was performed to investigate the efficacy and the tolerability of halofantrine in nonimmune patients with malaria imported from areas with drug-resistant falciparum parasites (mainly Africa). Forty-five of the 74 subjects were treated with a one-day regimen (3 x 500 mg) of halofantrine, and the other 29 received the same regimen with an additional treatment on day 7. In the second group, a 100% efficacy rate was demonstrated, but in the group receiving the one-day regimen, four recrudescences were observed in patients with falciparum malaria. Only five mild adverse reactions were seen, which disappeared spontaneously after the end of the treatment. We conclude that halofantrine is highly effective in curing malaria in nonimmune subjects. The treatment scheme for such persons should include an additional treatment on day 7 for nonimmune individuals. This drug was well tolerated in our patients, indicating that halofantrine will be useful in the treatment of multidrug-resistant malaria in nonimmune persons.

Acute Disease↗