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A clinical AIDS case definition is needed for surveillance in countries where the CDC case definition is not practical. To derive such a definition, we compared 110 HIV-seropositive and 135 randomly selected HIV-seronegative adult medical-ward inpatients in Brazil. Multivariate analysis of clinical signs and symptoms and simple diagnoses resulted in a discriminant function with sensitivity of 89% and specificity of 96% in predicting for AIDS. These data were the empirical basis for a clinical definition of AIDS in adults drafted in a Caracas, Venezuela, workshop sponsored by the Pan American Health Organization. The revised "Caracas" definition presented here requires a positive HIV serology, the absence of cancer or other cause of immunosuppression, plus > or = 10 cumulative points, as follows: Kaposi's sarcoma (10 points); extrapulmonary/noncavitary pulmonary tuberculosis (10); oral candidiasis or hairy leukoplakia (5); cavitary pulmonary/unspecified tuberculosis (5); herpes zoster < 60 years of age (5); CNS dysfunction (5); diarrhea > or = 1 month (2); fever > or = 1 month (2); cachexia or > 10% weight loss (2); asthenia > or = 1 month (2); persistent dermatitis (2); anemia, lymphopenia, or thrombocytopenia (2); persistent cough or any pneumonia except TB (2); and lymphadenopathy > or = 1 cm at > or = 2 noninguinal sites for > or = 1 month (2). This definition has a sensitivity of 95% and a specificity of 100% (91% without HIV serology) when applied to the Brazilian patients in this study. The Caracas definition has been adopted by Brazil, Honduras, and Surinam, and is in validation elsewhere. The use of a reasonably sensitive and specific case definition commensurate with available diagnostic resources should facilitate AIDS surveillance in developing countries.
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PMID:A simplified surveillance case definition of AIDS derived from empirical clinical data. The Clinical AIDS Study Group, and the Working Group on AIDS case definition. 145 32

The Expanded Programme on Immunization (EPI) dramatically increased coverage. In 1990, approximately 80% of the world's children younger than 1 year received measles vaccine, and it was estimated that around 2 million deaths were prevented. Still in 1990 an estimated 45 million cases and around 1 million deaths occurred in developing countries. In one community study in Kenya in 1985 measles accounted for 35% of reported deaths in infants 1-12 months old and for 40% of deaths in children 1-4 years old. The Schwarz vaccine was introduced in the 1960s; under most field conditions its efficacy is about 85% for children receiving the vaccine at 9 months or older. The urban poor, who usually have less access to immunization services, are usually the most at risk. Other high-risk groups include specific age groups (school children who represent cohorts from previous years when coverage was lower and who may not have been exposed to measles infection), ethnic minorities (who may have been underserved or may have rejected immunization for cultural reasons), hospitalized children who are at high risk of nosocomial transmission, and children in refugee camps. Vitamin A administered to children acutely ill with measles reduces mortality. Results from a trial in South Africa showed children treated with vitamin A had reduced risk of dying, recovered more quickly from pneumonia and diarrhea, and had less croup. In addition, symptomatic treatment for cases requires antibiotics to combat bacterial complications, and oral rehydration salts for dehydration following diarrhea. Case fatality rates can be lowered if cases reach health care facilities where appropriate care is offered early. For uncomplicated cases, supportive fluids, antipyretics, and nutritional therapy may be required. Many children need increased food intake for 4-8 weeks to recover their premeasles nutritional status.
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PMID:The epidemiology of measles. 146 63

Swaziland is a kingdom with 800,000 inhabitants bordering on Mozambique and South Africa with about 50% of the population under 15 years of age. The experience of a nurse in a small clinic in the course of several years is recounted. Swaziland ranks 3rd in the world in alcohol abuse which often leads to wounds requiring suturing. Penicillin is given prophylactically with a paracetamol preparation for analgesia. As a rule, every injured person will get a .5 ml tetanus injection for prophylaxis. The most serious conditions of polyclinic patients are hepatitis, bilharzia, diarrhea, pellagra, pneumonia, and malnutrition. A great number of patients have sexually transmitted diseases, and the rate of AIDS infection is not known. According to 1 study 60-80% of the population in reproductive age will die of AIDS in the course of a 5-year period. The majority of people are impervious to counseling about their sexual behavior in spite of educational programs on the radio, in schools, and in work places. Condoms are not popular, since they are not considered manly. Pregnant women receive iron and multivitamin tablets in the course of pregnancy. Many pregnant women are anemic, and 70% give birth at home, the rest in a hospital or clinic. During delivery they get no analgesia, and there are few complications. The average weight of the newborn is 3.5 kg, although none of the women are under 150 cm. A little after birth all children are vaccinated with bacillus Calmette-Guerin (BCG) and polio, later with diphtheria-pertussis-tetanus (DPT) and measles.
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PMID:[Nursing under a different sky. Swaziland]. 146 29

In Egypt, bovine virus diarrhoea-mucosal disease (BVD-MD) was initially detected as the result of a serological survey of cattle and sheep, using the serum neutralisation test. In 1970, the causal pestivirus was isolated from bovine calves and buffalo calves with pneumonia and enteritis. Mixed viral infections were also prevalent. Cases of immune tolerance were identified. The Egyptian industry had complained of unthrifty cattle and high death rates of bovine calves and buffalo calves. A rinderpest outbreak in 1982 involved some cattle and buffalo which had been vaccinated against the disease, and such animals were positive to the gel diffusion test for BVD-MD pestivirus. Extensive immunosuppression due to BVD MD virus was suspected, because the attenuated cell-culture vaccine against rinderpest, issued in Egypt since 1965, had not been tested for freedom from non-cytopathic BVD-MD virus. Experimental infection of susceptible sheep with BVD-MD virus resulted in symptoms of Border disease. Innocuity of the attenuated C24V bovine pestivirus vaccine for animal tissues and the immune system of calves was confirmed.
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PMID:Bovine virus diarrhoea-mucosal disease and border disease in Egypt. 147 33

Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
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PMID:HIV and breast-feeding. 147 85

The standard WHO cluster sampling technique was applied to 30 randomly selected villages covering a population of 89,470 and 2010 live births in Jasra Community Development Block with a population of 123,000 distributed in 123 villages and 27 subcenters. In each cluster, 67 mothers were interviewed who gave birth between March 1989 and April 1990. Immunization history of tetanus toxoid given during the antenatal period and the delivery was recorded by 2 teams. There were 49 neonatal deaths: 30 (61.2%) were caused by tetanus neonatorum, 10 (30.4%) died of high fever of undetermined etiology, 5 (10.2%) of pneumonia, 3 (6.1%) of diarrhea, and there was 1 case of death of undetermined cause. The tetanus neonatorum rate was 18.7/1000 live births. 93% of the births were assisted by family members and untrained dais, and 2.4% by trained traditional birth attendants. In 69 deliveries (3.4%), a doctor was called, while in 24 cases a multipurpose female worker assisted. 46.7% of neonates with tetanus were brought to the district hospital for treatment, the rest were either taken to private practitioners or to traditional healers. 1336 (66.5%) of 2010 mothers interviewed had not received tetanus toxoid, 359 (17.8%) had received only 1 dose of toxoid, and 315 (15.7%) had been immunized with 2 doses. The mothers of 27 (90.0%) of those 30 neonates who died of tetanus had not received a dose of toxoid during the antenatal period, whereas 3 mothers obtained only 1 dose. None of the newborn of mothers immunized with 2 doses during pregnancy contracted tetanus. 61% of the neonatal deaths were attributed to tetanus. The causes of neonatal tetanus include unhygienic cutting of the cord and lack of immunization of mothers with tetanus toxoid during pregnancy. The administration of 2 doses of antenatal tetanus toxoid and health education regarding the importance of conducting hygienic deliveries could eliminate this disease.
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PMID:Impact of universal immunization programme on the incidence of tetanus neonatorum. 150 Jan 43

Fever is the cardinal symptom of many infections in travellers returning from the tropics and is second in place only to infectious diarrhea. Once the obvious causes of fever in an individual patient have been eliminated, it may be very difficult to find the cause of fever. Fevers can be distinguished by their length of duration and divided into acute fevers i.e. up to 3 weeks duration and chronic fevers i.e. more than 3 weeks duration. Whether fever goes along with leucopenia or a normal white blood cell count on the one hand or with leucocytosis on the other hand is of differential diagnostic value. A schedule based on these two parameters will be presented to simplify differential diagnostic considerations. Two rules of thumb will be stressed: (1) Each febrile illness, even febrile diarrhea, jaundice or meningitis, is to be considered a malaria until it is excluded. (2) Patients returning from tropical areas might suffer from banal infections such as pneumonia, urinary tract infections, cholangitis, etc. as well.
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PMID:[Differential diagnosis of fever after returning from the tropics]. 150 60

A clinical study on a new carbapenem antibiotic, meropenem (MEPM), was carried out in acute pediatric infections. MEPM was administered to 8 patients including 3 patients with acute pneumonia, 2 with cervical lymphadenitis, 1 with acute tonsillitis, and 1 with cellulitis and 1 with sepsis. The overall efficacy rate was 100%. As an adverse reaction, diarrhea was observed in 1 patient. In clinical laboratory tests 1 patient was found to have S-GPT elevation which normalized after discontinuation of MEPM. MEPM appears to be effective and safe drug for pediatric acute infections.
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PMID:[Clinical evaluation of meropenem in the pediatric field]. 152 73

The use of cefaclor advanced formulation (cefaclor AF) in the treatment of pneumonia caused by susceptible organisms was investigated in a multi-center trial conducted in the United Kingdom and the United States. A total of 266 patients were enrolled in this double-blind, double-dummy, randomized, parallel study; 132 patients were treated with cefaclor AF and 134 patients received the reference drug cefaclor. Inclusion criteria were a diagnosis of lobar pneumonia or bronchopneumonia, with a positive sputum culture and an infiltrate on chest roentgenogram. Patients received either cefaclor AF (750 mg twice daily) or cefaclor (500 mg three times daily) for 10 to 14 days. Forty patients in the cefaclor AF group and 45 in the cefaclor group were evaluable for efficacy, with 37 (92.5%) and 43 (95.6%), respectively, showing a favorable posttherapy clinical response. Proven or presumed pathogen elimination was achieved in 87.5% and 86.7% of cases, respectively. Both study drugs demonstrated high levels of activity against Streptococcus pneumoniae, Haemophilus influenzae (including beta-lactamase-producing strains), and Moraxella catarrhalis (including beta-lactamase-producing strains). There were no statistically significant differences between drugs in efficacy results. One or more side effects were reported by 42.4% of the patients treated with cefaclor AF and by 44.0% of those treated with cefaclor; diarrhea, nausea, headache, and respiratory disorders were the most common adverse events. No drug-related side effects were seen with a frequency or severity that would be unexpected with the use of oral cephalosporins. Cefaclor AF and cefaclor performed equally well with respect to clinical and bacteriologic response rates in the treatment of pneumonia.
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PMID:Cefaclor advanced formulation versus cefaclor in the treatment of pneumonia. 152 91

A 41-year-old woman with a myelodysplastic syndrome complained of diarrhea with malabsorption and protein-losing enteropathy after splenectomy. No cause was found and various therapeutic regimens were not effective. Pathological examination of biopsies from stomach, small intestine, and large bowel showed infiltrations interpreted as inflammatory on routine technics. Blast cell infiltration was found on electron microscopy. Treatment by citarabine induced normalization of leukocytosis, and diarrhea disappeared. Six months after the onset of illness, she developed acute myeloblastic leukemia and died of infectious pneumonia. Blastic infiltration of the lamina propria could be responsible for the determinism of symptoms, because of the lack of another etiology, the intensity of the blastic infiltration and the effect of cytotoxic therapy, even in the absence of new biopsies.
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PMID:[Diarrhea with malabsorption and exudative enteropathy caused by intestinal myeloid involvement in a patient with myeloproliferative syndrome]. 152


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