A subacute advanced severe sensorimotor polyneuropathy developed over 6 months in a 47-year-old patient in stage 5 of an HIV infection (Walter Reed Hospital classification). Clinical examination, cranial computed tomography and spinal nuclear magnetic imaging failed to demonstrate any central nervous system complication. Cerebrospinal fluid showed a lymphocytic pleocytosis of 57/3 cells and total protein raised to 132 mg/dl as sign of an abnormal blood-brain barrier. Circulating immune complex in blood was raised to 30%. Assuming an immune-complex mediated neuropathy treatment with oral steroids was started, initially 150 mg daily. The signs of polyneuropathy regressed almost completely, even after prednisolone was discontinued. The proportion of circulating immune complexes in blood fell within 7 weeks to 10% during this treatment. It is suggested that in HIV-infected patients severe polyneuropathies may develop as part of a humoral immune reaction in which immunosuppressive treatment can be effective. Even in advanced HIV infection high-dosage and prolonged steroid treatment can be undertaken, under strictest indications, and may have impressive results.

Three patients fell ill with diarrhoea 14 to 15 days after eating smoked ham. All had an increased white cell count (up to 16,200 microliters), eosinophilia (14 to 38%) and increased creatinkinase activity (357 up to 1905 U/l). Patient 1 (a 21-year-old woman) also had fever of around 40 degrees C; patient 2 (32-year-old woman) had a fever up to 39 degrees C, with muscle pains and swellings in the face. Patient 3 (38-year-old man) had no other symptoms. Because of eosinophilia and as five other family members in former Yugoslavia whence the ham had been imported, also had had fevers, trichinosis was soon considered as the cause. Serology in patients 1 and 2 was positive on admission, in patient 3 after one week. Mebendazole was administered, initially 50 mg/kg in three doses for 2 days. Drug blood levels were determined 1 and 4 hours after start of treatment and the dosage was then increased to 80-100 mg/kg daily. Duration of treatment ranged from 11 to 14 days. All patients were discharged symptom-free and there have been no sequelae. In Germany trichinosis typically occurs in small outbreaks. It is assuming increasing importance as an imported disease.

: A decreased chloroquine (Resochin) sensitivity of strains of Plasmodium falciparum in certain areas of East Africa has given rise to an inappropriate change of chemoprophylaxis to pyrimethamine-sulfadoxine (Fansidar). Falciparum malaria occurred in five tourists during or after Fansidar prophylaxis. A therapeutic chloroquine-R2-resistance was observed in one seriously ill patient. In some patients the course of disease was prolonged to such an extent that the diagnosis could be established only after as much as 4 months after the end of the journey. This was in part surely caused by intake of anti-plasmodial drugs such as sulfonamides, tetracyclines and co-trimoxazol. The high mortality of falciparum malaria of nearly 10% in this country does not depend on the choice of drug prophylaxis or on problems of resistance, but still on a missed or delayed diagnosis.

Intestinal parasites are Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica, hookworms, ascaris, tape worms and others. As to organ parasites, their life-threatening courses are pointed out: amebiasis in the intestine, liver, lung and brain, toxoplasmosis in the brain, lung and heart muscle, including the danger for the child of a pregnant woman with an acute infection, West African sleeping sickness with encephalitis, the East African form with polyserositis, South American Chagas' disease with intestinal and myocardial involvement, visceral leishmaniasis Kala Azar, the filariasis Onchocerca volvulus with threatening blindness, the dog tapeworm with cysts and Echinococcus multilocularis with carcinoma-like infiltration of the liver and other organs, cysticercosis of the brain, eye and muscle tissue; partly generalizing parasitoses in immuno-suppressed including AIDS patients, finally skin parasites as causes of disease (e. g. scabies), and as potential carriers of pathogens.

This retrospective study aims to determine whether there is a difference in the additional consumption of alcohol between addicts treated with methadone or dihydrocodeine (DHC) and untreated addicts injecting heroin.1,685 patients admitted for opioid withdrawal between 1991 and 1997 were reviewed. Cross-reference tables and multiple logistic regression analyses were carried out. 28% of patients take more than 40 g of alcohol daily (on average 176 g). We found that patients who are treated with methadone or DHC drink alcohol significantly more often daily than the heroin-dependent patients (p < 0.01). Using multiple regression analyses, the results were confirmed. Additionally, we found that co-abuse of alcohol was predicted by male gender, longer duration of drug use, additional daily consumption of tetrahydrocannabinol and daily consumption of benzodiazepines. Alcohol consumption by opioid-addicted patients treated with methadone or DHC presents a serious medical problem. Co-abuse of alcohol will receive more attention.

Intestinale Parasiten sind u. a. Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica, Hakenwürmer, Spulwürmer und Bandwürmer. Bei den Gewebe- und Organparasiten kann es zu lebensbedrohlichen Verläufen kommen, die besonders betont werden: Amöbiasis in Darm, Leber, Lunge und Gehirn, Toxoplasmose in Gehirn, Lunge und Myokard samt der Gefährdung des Kindes bei frischer Erkrankung von Schwangeren, westafrikanische Schlafkrankheit (Enzephalitis) und die ostafrikanischen Form (Polyserositis), südamerikanische Chagas-Krankheit im Intestinum und Myokard, viszerale Leishmaniose Kala Azar, Filariose durch Onchocerca volvulus mit drohender Blindheit, Hundebandwurm mit Zysten und Fuchsbandwurm mit infiltrativem Wachstum in der Leber und anderen Organen, Zystizerkose in Gehirn, Auge und Muskulatur sowie teils generalisierte Verlaufsformen einiger Parasitosen bei Immunsuppression/AIDS. Die Darstellung der Hautparasiten als Erreger z. B. der Skabies und als potenzielle Überträger von Krankheitserregern schließt sich an.

Up to 1999 more opioid dependent patients in Germany were substituted with codeine or dihydrocodeine (summarised as codeine) than with methadone. The current retrospective study compares the differences in detoxification treatment outcome for codeine-substituted patients, methadone-substituted patients and patients injecting illicit heroin. The study is based on the medical records of 1070 patients admitted consecutively for opioid and polytox detoxification between 1991 and 1997. The main hypothesis was that injecting illicit-heroin users would complete detoxification treatment less often than codeine- or methadone- substituted patients, and that methadone-substituted patients who had received more structured treatment would complete more often than codeine-substituted patients who did not receive any structured treatment beyond the prescription of codeine. We analysed a number of demographic and drug related variables as possible predictors. Our bivariate analyses confirmed our main hypothesis: 50.4% (OR: 1.8) of the methadone-substituted patients, 45.5% (OR: 1.5) of the codeine-substituted patients and 35.9% (OR: 1 comparison group) of the injecting illicit-heroin users completed the detoxification program (P=0.006). This finding remained significant even after correcting for a number of confounders. Using stepwise multiple logistic regression analyses, we found age, education, history of imprisonment, regular contact with a counsellor, currently being on probation and reported plans for participating in an abstinence treatment program to be significant predictors of completing detoxification treatment. Although the current analysis did not rule out differences in pharmacological effects as a contributing factor, the results are consistent with an interpretation of a dose-response association between psychosocial/psychotherapeutic support and detoxification outcome. More psychosocial/psychotherapeutic support leads to better detoxification treatment response.

Chest pain and myocardial infarction occurring in young people with angiographically normal coronary arteries is well documented. Opiates have a cardioprotective effect and are used in acute heart attacks. We described a 22-year-old opioid addicted male patient who suffered a myocardial infarction following the consumption of methadone and dihydrocodeine.

Chronic hepatitis C is the most common infectious disease among injection drug users (IDUs). Because of the allegedly poor compliance of IDUs with treatment requirements and conditions, hepatologists recommend treatment only if former IDUs have spent 6 to 12 months drug free. The aim of this prospective study was to investigate whether opiate-dependent IDUs with chronic hepatitis C virus (HCV) infection can be treated successfully with interferon. Eligibility for the study meant IDUs had to be HCV-RNA positive by polymerase chain reaction. Subsequently 50 inpatients were enrolled during detoxification treatment. HCV treatment was started with interferon alfa-2a (through 1998) or a combined regimen consisting of interferon alfa-2a and ribavirin (begun in 1998). All patients were treated and supervised by specialized physicians in both hepatology and addiction medicine. The end point for this study was defined as a loss of detectable serum HCV RNA at week 24 after treatment. The rate of sustained virologic response was 36%. Sustained response rates were not significantly different for patients who relapsed and returned to treatment (53%), relapsed and did not return to treatment (24%), or did not relapse (40%; P > .05). During the 24 weeks after treatment, we were unable to detect any reinfection, even among patients who injected heroin during this period. This surprising result should be examined in further studies. In conclusion, HCV-infected drug addicts with chronic HCV infection can be treated successfully with interferon alfa-2a and ribavirin if they are closely supervised by physicians specialized in both hepatology and addiction medicine.

Zum Thema Kopfschmerzen und Fieber sind Kardinalsymptome der eitrigen (bakteriellen) Meningitis, der Herpes-simplex-Virus-Enzephalitis und des Hirnabszesses. Diese 3 Krankheitsbilder gehören zu den wichtigsten behandelbaren Infektionskrankheiten des Zentralnervensystems. Der ärztliche Erstkontakt mit diesen Patienten betrifft sowohl den Neurologen als auch den Internisten. In allen 3 Fällen ist eine rasche Diagnostik und der sofortige Beginn einer adäquaten Behandlung (mit Antibiotika bzw. Aciclovir) erforderlich. Zu den wichtigsten diagnostischen Maßnahmen, die eine Differenzierung dieser Krankheitsbilder erlauben, gehören insbesondere die lumbale Liquoruntersuchung und bildgebende Verfahren wie CT oder MRT. Der vorliegende Beitrag beschreibt ausführlich die klinische Symptomatik, Diagnostik und Therapie dieser 3 wichtigen Krankheitsbilder.

Immunoassay drug screening tests are usually used as a control during methadone maintenance programmes, to check cleanliness of drugs during detoxification treatment and abstinence programmes. False-positive results can have catastrophic consequences for the patient, as shown in the case report. False-positive results were reported for opioids following ofloxacin or rifampicin and for LSD following mucolytic. Since inpatient and outpatient units usually employ an urine quick test (immunoassay), positive results should be checked with gas chromatography/mass spectroscopy (GC-MS) or high pressure liquid chromatography (HPLC) before conclusions from the positive urine screening results can be drawn.

Summary Background: The objective of this cross-sectional, non-randomized, prospective study was to generate data on the prevalence of GB virus C (GBV-C)/hepatitis G virus (HGV) in a cohort of HIV-infected homosexuals from Munich. Patients and Methods: A total of 71 HIV-infected homosexual men were analyzed for prevalence of GBV-C RNA and antibodies to the E2 envelope glycoprotein (E2Ab). 475 healthy volunteer blood donors in southern Bavaria served as a control group. Results: The prevalence of GBV-C RNA was 27% (control group: 2.3%) and the prevalence of E2Ab was 35% (control group: 6%). The total prevalence for present and past infection was 62%. The differences between the HIV-infected patients and the control group were significantly (p < 0.0001). GBV-C RNA and E2Ab were not detected simultaneously in any serum sample. The E2Ab positive patients were older than the GBV-C RNA positives (mean 46 years versus 39 years, p = 0.0350). The GBV-C RNA and E2Ab negative patients were older than the GBV-C RNA positives (mean 47 years versus 39 years, p = 0.0236). The E2Ab positive patients had suffered sexually transmittet diseases more frequently than the patients negative for markers of GBV-C infection (p = 0.0308). E2Ab positive patients also had higher mean levels of alanine aminotransferase compared to patients without evidence of GBV-C infection (p = 0.0164). 59.4% of all individuals were anti-HBc IgG positive. Conclusion: The data can be interpreted as indirect evidence for sexual transmission of GBV-C.

Suspected tropical malaria is an acute emergency. Immediate effective pharmacological treatment is of the essence. As in the case of prevention, various antimalarials are now available for treatment. Complicated tropical malaria requires treatment in hospital and intensive monitoring. The risk of infection and serious illness leading to a fatal outcome can be considerably reduced by suitable chemoprophylaxis or the use of stand-by medication for self-treatment, which, however, must be matched to resistance zones and the incidence of the four species of Plasmodium, in particular Plasmodium falciparum.

Year for year, some 2.1 million people die of malaria worldwide. In Germany, about 1,000 people go down with the disease after visiting malarious areas, and up to 3% will die--mostly of tropical malaria. Decisive factors for mortality are age over 60 and delays in effective pharmacological therapy. It is essential that, in the presence of an appropriate history, malaria be suspected early on. The diagnosis can still be established using the "thick drop", or a blood smear stained with Pappenheim's stain, or Diff-Quick. In the event of a strong suspicion, the two methods should be applied every 8 hours for three days.

Von der immensen Zahl verschiedener Bakterienarten sind nur wenige zu potentieller Invasivität und Pathogenität befähigt. Die Arten mit hoher, nahezu obligater Pathogenität sind meist Erreger typischer Infektionskrankheiten (z.B. Pertussis, Gonorrhö) und bei entsprechender Kontagiosität Ursache klassischer Seuchen (z.B. Cholera, Pest), die durch hygienische Maßnahmen, Chemotherapie und Immunprophylaxe heute nur noch eine begrenzte Rolle spielen und meist nur noch sporadisch oder als importierte Krankheiten auftreten.