Pathogens and parasites of larval and adult blackflies so far found in Guatemala were reviewed in relation to their host ranges, infection rates, and significance as regulatory factors on natural populations of the three onchocerciasis vectors.

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Phylogenetic relationships among the genera of the filarioid worm of subfamily Dirofilariinae were analysed based on cladistic. Fourteen characters among Macacanema, Edesonfilaria, Dirofilaria, Loaina, Pelecitus, Foleyella, Loa and Bostrichodera were compared resulting in a consensus phylogenetic tree. The last six genera form a group with at least one synapomorphy, and Foleyella, Loaina and Pelecitus are the most derived among the subfamily. Edesonfilaria and Macacanema most probably belong to a subfamily other than Dirofilariinae.

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Antibody, production in Mongolian gerbils (Meriones unguiculatus) immunized with crude extract of Dirofilaria immitis adult worm was tested with passive cutaneous anaphylaxis reaction. Immunized gerbils produced a long-term binding, heat-labile antigen-specific antibody which sensitized the rat skin. Those profiles were like an IgE antibody. In an intact gerbil, IgE-like substance was detected in an immediate intracutaneous reaction with anti-rat IgE antibody. Mast cells representing metachromasia were confirmed in the skin tissue section of Mongolian gerbils stained with Toluidine blue and were thought to be target cells for those anaphylactic reactions.

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In a 4 year study from October 1983 to March 1987, in Jos, Nigeria, bacterial enteric pathogens were isolated from 27.0% of 1, 137 children aged 0-5 years who were clinically diagnosed for acute diarrhoea. A similar investigation was also carried out on apparently healthy children of primary school age (7-16 years), who were on regular school attendance. Eight different primary schools located in the urban and rural areas of Jos, were selected for this phase of the study. The 1, 468 children examined in the latter group had a total infection rate of 11.9%. Though the children were considered to be apparently healthy, 25.6% of them reported a history of diarrhoea, lasting between 1-21 days; 12.7% of these were bacterial positive as opposed to 11.6% for the non diarrhoeal group.
In yet a third phase of the study, a total of 39 different households, predominantly of adult population were investigated for the presence of common organisms among members of the same family. Enteropathogenic Escherichia coli (EPEC) serovar 0128 : K67 was isolated from 4 of 14 members of one family, while EPEC serovar 028 : K73 was isolated from 3 of 7 members of another family including 2 cases of multiple infections.
Some of the 48 strains of EPEC out of 130 isolates, although H antigen was not examined, could possibly belong to EHEC (VTEC : verocyto-toxin producing E. coli) which are thought to be one of the causative agents of haemorrhagic diarrhoeae as well as hemolytic uremic syndrome which are severe illnessess.

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Patients with traveler's diarrhoea who returned from traveling India and/or Nepal more than 10 days were subjected to stool examination for Giardia lamblia at Osaka International Air Port Quarantine Station in 1986 to 1991. Results obtained were summarized as follows :
1) G. lamblia was detected in 59 of 692 cases examined (positivity rate, 8.7%). The positivity rate in each year was : 13.6% in 1986, 9.3% in 1987, 2.7% in 1988, 7.5% in 1989, 5.8% in 1990 and 19.4% in 1991, respectively. The seasonal variation in the piositivity rate was recognized as it was higher in March (9.2%), April and May (13.6% each), September (11.3%), and October (14.8%) than other months. No positive case was found in July and December.
2) 89.8% of the positive cases were the travellers over 14 days. 3) Travellers who visited both India and Nepal showed high positivity rate (10.4%). Those who visited only India or Nepal showed lower rate (8.4% and 3.2%, respectively).
4) More than 68% of positive cases were male at the age of 20s.
5) In 28.8% of the positive cases, some species of pathogenic bacteria (e.g. Shigella spp.) were concomitantely detected.
6) Major complaints of the positive cases were watery diarrhoea, lastig and loose passage. It was pointed out from the results that stool examination for G. lamblia to returning travelers with dearrhoea from India and Nepal should be made at qurantine as they were at high risk of G. lamblia infection.

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[Case] The patient was a Pakistani male, 26 years of age, who came to Japan in May, 1989. The last malaria episode was in Pakistan about 5 years prior to this date. On admission to Horie Hospital on April 15, 1992, he had a body temperature of 40.3°C, which did not respond to antibiotics. Vivax malaria parasites were first detected from thin blood smears taken on the 24th at the density of 0.05%. Antibody titers against Plasmodium vivax and Plasmodium falciparum antigens were shown at 1 : 1, 024 and 1 : 256 respectively by the indirect fluorescent antibody test. Two tablets each of Halfan (halofantrine hydrochloride, 233 mg base/tablet, Smith Kline and French Laboratories Limited) were administered orally at 18 : 00 on 26th, 0 : 00 and 6 : 00 on 27th, followed by primaquine at 15 mg per day for 14 days. Body temperature fell to normal at 15 : 00 on the 27th (36.9°C) and parasites were reduced to below 0.01% parasitemia on the 28th. No adverse reactions were recognized except slight nausea and vomiting.
Halfan has been used for the treatment of human malaria since 1984, and reported to be a effective against all parasite species. The drug is a phenanthrene derivative which does not share chemical structure with any other antimalarials, and is therefore particularly effective in the treatment of drug resistant malaria. Our report is the first in Japan of successful treatment of malaria with Halfan. Clinical side effects of the drug on this patient seem to have been very mild. Parasite clearance was rapid and fever dropped dramatically. Fansidar is the only antimalarial drug available in Japan so far, and imported drug-resistant malaria not only against chloroquine but Fansidar has been on the increase. The general use of Halfan is thus expected.

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As the number of individuals traveling to malaria endemic countries increases, many patients with malaria are increasingly being observed in Japan. Nevertheless malaria is liable to be misdiagnosed, incorrectly treated, and a severe course is thus not unusual. However there are hardly any reports describing severe malaria in a Japanese patient due to mixed P.f and P. v. infection. We report a case of severe malaria due to mixed P.f. and P.v.infection. The effectiveness of the new antimalarial drug, artemether, in the treatment of this case of severe malaria is also documented.
A Japanese 31-year-old male was admitted to Kitasato University Hospital because of fever, diarrhea, and circulatory collapse. The history of this patient is that one week after his return from a 9 day visit to Indonesia, during which he had weekly chloroquine prophyraxis, developed fever and chills. He visited a hospital where he was treated for a common cold. High fever was sustained and accompanied by watery diarrhea. On admission to our hospital, his temparature was 40°C. The patient was lethargic but fully oriented and responsive. He was dehydrated and perfusing poorly. Physical examination revealed jaundice, hepatomegaly, and diffuse tenderness from the right costal margin to the epigastrium. P.f. and P. v. were detected from a blood smear (12% and 0.7% parasitemia, respectively). Oral therapy with 600 mg quinine hydrochloride and 100 mg doxycycline was initiated. The next day, his fever was unalterd, diarrhea and severe oliguria were evident. P.f. parasitemia increased to 29%. Antimaralial therapy was changed to 250 mg quinine hydrochloride administered intravenously and fansimef, one tablet. Within 24 hr, he developed anuria and drowsiness. Cerebral malaria was suspected and hemodialysis was started. Treatment with quinine was replaced by artemether. Two hundred mg of artemether was administered as first dose intramusculary followed by 100 mg at interval of 12 hr, up to a total of 600 mg. Examination of blood smear indicated complete elimination of asexual stages of the parasite, within 38 hr after the onset of treatment with artemether. Thereafter, diuretic phase began and the patient made a complete recovery. Histopathology of a renal biopsy specimen showed tubular atrophy with interstitial lymphocytic infiltration, mild fibrosis and pigmented casts, all suggestive of tubular necrosis but no glomerular involvement. Thus acute tubular necrosis was considered as a cause of acute renal failure in this patient. To consolidate artemether therapy and eliminate possible recrudescence, treatment with mefloquine was initiated, at the dose of 500 mg a day orally for 2 days. On the day the patient was discharged, he was put on primaquine at the dose of 15 mg a day for 2 weeks. Forty-eight days later, despite the treatment given, he had fever and was diagnosed as a P. v. relapse case. Treatment with chloroquine and twice as much primaquine cleared parasitemia. Four months following this last treatment, the patient again had the symptom of fever and was treated this last treatment, the patient was again had the symptom of fever and was treated this time with halofantrine and primaquine. Treatment with primaquine for 2 weeks was followed by primaquine (45 mg) together with chloroquine (300 mg) once a week for 8 months. Serum anti-P.f. and P. v. IFAT titer profile of the patient over the entire course of his treatment confirmed the clinical course of the disease.
The goal of the initial therapy of malaria is lowering the level of parasitemia as rapidly as possible under strict intensive care with monitoring of vital organ functions. Artemether was effective in achieving this goal even in this case of severe and complicated malaria due to mixed P.f. and P. v. infection.

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It is time worn to state that health is wealth. Yet this assertion is no less true and significant today as it was yesterday. Indeed, a healthy nation is contigent on healthy citizenry (1st NDP). This perhaps explains why no nation had ever attempted to go to sleep while its 'health house' is on fire. In fact, the health of a nation defines its potentials and actual deeds. The continual featuring of health in all the national development plans so far made, underscores the importance of the health of this nation's citizens to our social planners. Be that as it may available evidence shows a vaccum between rhetorics and action. While no two analysts agree on the modalities of making health care delivery services accessible to all (Steiner, 1966; Navarro, 1976; Titmus, 1966; Field, 1960). This paper is an attempt to contribute to this debate. Essentially, it warns that unless we re-order our priorities and achieve social justice in the health sector first, we may never be in a comfortable position to discuss the issue of integration less alone meaningful progress in the third republic; come 1992, when the present military government hands over power to a democratically elected government. Here lies the thrust.

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This paper is essentially theoretical and attempts to re-appraise the issues involved in the call for the integration of traditional healers by the WHO. In order to discuss in perspective, it focusses on the Nigerian situation and demonstrates why integration represents a more viable avenue to the realization of 'Health for all by the year 2000 AD'. The paper winds up suggesting a modality for achieving this.

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