Even with the Hurricane. . .
November 1, 1999 4 minutes read
Even with the Hurricane. . .
Special Coverage
It has been said in many ways, and by at least one famous poet,—of all sad words of tongue or pen the saddest are these, "It might have been." The 47th Annual Meetings of the American Society of Tropical Medicine and Hygiene were canceled this year, due to severe hurricane damage in Puerto Rico. Both I and the associate editors of Travel Medicine Advisor took a long look at the published abstract book that presaged a meeting potentially filled with interesting scientific material and exciting clinical advances. Rather than allow it to all sit on the shelf until next year or be lost in a library, we have planned, in both this issue of TMA Update and the next, to highlight several clinical abstracts that would have been presented at those meetings. For readers who wish to obtain copies of the abstract book, it is designated as the Program and Abstracts of the 47th Annual Meeting of the American Society of Tropical Medicine and Hygiene, a supplement to the American Journal of Tropical Medicine and Hygiene 1998;59. Additional copies of the abstract book can be obtained from the Society (telephone 847- 480-9592) or the program book can be searched by abstract word, title, subject and author on-line at http://www.astmh.org or http://abstract.med.virginia.edu/abstract/ We hope the material we have chosen illustrates how important the Clinical Sessions at the ASTMH have become for Clinical Tropical Medicine and Travel Medicine specialists. So, visit the web site or review the abstracts if you have not done so already. The hurricane damage and its aftermath have been sad enough already; it would be a shame to miss the program entirely. —fjb
Abstract 80: Bubonic Plague—An Imported Case.
There has not been a case of imported plague into the United States since 1926. However, Wolfe and associates reported a serious case of acute bubonic plague in a 47-year-old American woman who had been working in the La Paz district of Bolivia, collecting and studying mammals. Her exposure to infected fleas occurred while skinning rice rats as she crushed several fleas with her fingers. Acute illness was characterized by swelling in her right axilla with additional nonspecific signs and symptoms, such as headache, fever, chills, myalgias, and signs of possible respiratory infection, at least when seen by a physician in Bolivia.
On arrival in Washington, DC, an enlarged fluctuant right axillary lymph node with surrounding boggy edema was noted. To the credit of her examining physicians, she was immediately hospitalized with a presumptive diagnosis of plague. Aspiration and staining of lymph node material revealed rare bipolar staining gram-negative organisms and the aspirate was culture-positive for Yersinia pestis. She was successfully treated with a 10-day course of streptomycin.
Without using gloves as protection, working on small mammals in a plague-endemic area, then leaving for home—such a scenario could have spelled tragedy for this patient. Instead, clinical awareness of the potential for imported, occupation-related plague on the part of some astute clinicians is surely a story worth recounting again.
Abstract 402: Leishmaniasis Infection Among U.S. Owned Dogs Living in Catania Province, Sicily.
Orndorff and associates inform us that Leishmania infantum has been known to be endemic to Sicily since 1901. Catania Province, Sicily, is a known important focus of human visceral leishmaniasis and, within that Italian community, more than a dozen cases are diagnosed during hospital admissions each year, with nearly 40 cases reported in both 1996 and 1997 throughout Sicily. Orndorff et al report two cases in U.S. military personnel families: a 7-month-old infant and the teenage daughter of a Navy family.
Italian veterinarians have been aware of inapparent canine infections in all parts of Catania. The sand fly vector is also present. Orndorff et al investigated seropositivity rates among dogs living with U.S. personnel there; more than 60% of the animals tested had elevated specific IgG antibody levels with most animals in apparent good health. Besides the increased risk for inapparent infection by L. infantum in U.S. personnel, as well as their pet dogs during tours of duty in Sicily, there are other issues of which travel medicine specialists must be aware.
There is the real potential for inapparent subclinical leishmaniasis to progress to severe clinical visceral leishmaniasis in immunocompromised hosts. Southern Europe, particularly Spain, France, and Italy, are experiencing an epidemic of visceral disease associated with advanced HIV infection among intravenous drug users.1 Essentially, for HIV-infected patients, visceral leishmaniasis becomes an opportunistic infection that accelerates HIV progression. Parasites are readily demonstrated in blood but leishmania antibodies are often not detectable—making serological diagnosis even less reliable than it already is.2
References
1. World Health Organization: Leishmaniasis/HIV co-infection. Epidemiological analysis of 692 retrospective cases. Wkly Epidemiol Rec 1997;72:49.
2. Badaró R. When leishmania and HIV interact, a new broad spectrum of leishmaniasis occurs. Braz J Infect Dis 1997;1:145-148.
Abstract 403: Eosinophilia-Myositis Syndrome Associated with Sarcocystis: An Outbreak of Seven Cases in U.S. Military Personnel in Malaysia.
This interesting summary of seven U.S. Air Force personnel operating out of rural Malaysia describes a syndrome that was remarkably similar to acute trichinosis—an acute febrile illness with fever, myalgia, bronchospasm, pruritic skin rash, and eosinophilia associated with elevations of serum muscle enzymes. Fixed subcutaneous nodules were observed and persisted for more than one year in the index case. The clinical spectrum ranged from asymptomatic to severe. The coccidian parasite, a Sarcocystis sp., was identified in skeletal muscle biopsy on the index case, who also developed a dilated cardiomyopathy documented by echocardiogram 18 months after his initial presentation. Sarcocystis serology was positive in five of the seven affected men and one other team member with no other evidence of infection. Albendazole therapy appeared to be of benefit. Clinicians should be aware of this symptom complex associated with sarcocystosis, its potential for infecting cardiac muscle, and potential responsiveness to albendazole therapy.
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