グアテマラにおけるブユの病原体または寄生虫の種類, その宿主特異性, 感染率およびオンコセルカ症媒介ブユ3種の幼虫自然集団に与える影響に関して, これまで報告された知見を整理し, 紹介した。

抄録全体を表示

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.

抄録全体を表示

フィラリア感染の実験室内好適宿主であるスナネズミ (Molgolian gerbil; Meriones unguiculatus) を, 犬フィラリア (Dirofilaria immitis) 虫体より抽出した粗抗原によって免疫し, 抗体産生について受身皮膚アナフィラキシー (PCA) 反応を用いて検索した。免疫したスナネズミの血清中には, ラットを被検動物とした72時間PCA反応で陽性を呈し, 56℃30分間の熱処理によって不活化される抗原特異的抗体, すなわちIgE様抗体が検出された。
正常スナネズミのIgE様抗体を検出するために, 抗ラットIgEヒツジ抗体に対する, 即時型皮内反応を行った。スナネズミの皮膚もラットと同様に, 1,600倍希釈抗体に対して明瞭な陽性反応を示したことから, 正常スナネズミにもIgE様物質の存在が示唆された。
正常スナネズミの皮膚に, トルイジン・ブルー染色でメタクロマジーを呈する肥満細胞の存在が確認され, 上記の抗原抗体反応の場であると考えられた。

抄録全体を表示

1983-1987年の4年間にわたる, ナイジェリア国ジョスにおける腸内病原菌を対象とした調査において, 臨床的に急性下痢症と診断された0-5歳児1,137症例から, 307株 (27.0%) の病原菌が分離された。同様な調査は, 8つの農村, および市内の小学校における健康通学児童 (7-16歳, 1,468名) についても行われた。申告により下痢病歴のある児童は25.6%で, 菌の検出率は12.7%, 下痢病歴のない者からの検出率は11.6%であった。
この様にナイジェリア児童の保菌者率は, 先進国に比較すると大変に高い。一方, 成人を含む39家族については, 家族内感染を想定して同じような調査が行われた。1家族14人中4人からO128 : K67 (EHECの可能性あり) が分離され, 他の家族では7人中3人がO28 : K73が分離され, うち2人は多重感染をしていた。最近 (1990年) の日本における出血性下痢性大腸菌EHEC, O157 : H7に因る幼稚園児の集団下痢発生は, 34人の入院患者と2人の死者を生じた。このことは, 我々のナイジェリアにおけるEPEC分離データの再考慮を促した。その結果, たとえH抗原は調べなかったにせよ, 分離されたEPEC130株中48株 (36.9%) のうち, いくつかはEHECの可能性がある。残念なことに, 当時我々はO157 : H7に対する抗血清を入手出来なかったので, 相当数のこの菌を取り逃がしたことが考えられる。当時, 小学校の教師から子供達の中には, 背中 (腎臓部領域) の痛みを訴え, 赤い小便をする者がいて, 健康状態も良くないと言われたことを思いだすと, 今になって了解できるものがある。即ちナイジェリアにおいては, 相当数の児童がEHEC (VTEC) に感染し, 健康が阻害されていると予想され, この新しい観点にたっての再調査が, 緊急に必要と考えられる。

抄録全体を表示

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.

抄録全体を表示

[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.

抄録全体を表示

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.

抄録全体を表示

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.

抄録全体を表示

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.

抄録全体を表示