Essential tremor: differential diagnosis and current therapy.
The patients taking albendazole had diarrhoea on 29% fewer days than those taking placebo (P < 0.0001) in the two weeks after treatment. The benefit of albendazole was maintained over six months. In patients with a Karnofsky score of 50 to 70 (needing help with activities of daily living and unable to work, but not needing admission to hospital) diarrhoea was reduced by 50%. Remission was obtained in 26% of all patients who received albendazole (P = 0.004 against 9% receiving placebo), and this difference was maintained over six months (log rank test, P = 0.003). Albendazole had no effect on mortality. Minimal adverse effects were noted.
Alveolar echinococcosis is a rare parasitic disease, especially of liver, caused by larval stage of tapeworm Echinococcus multilocularis. At the end of the last century France, Germany, Austria and Switzerland were the most often regions with this disease, these days is this infection diagnosed also in our territory. We describe the case of the disease of the twenty-five years old male with nonspecific signs and hepatomegaly, who was diagnosed on the basis of imaging and laboratory sampling. Due to inoperability the patient is now in infectologist follow-up on a long-term treatment with albendazole. He is clinically stable, included in waiting list for liver transplantation.Key words: alveolar echinococcosis - benzimidazols - Echinococcus multilocularis - parasitic disease of liver.
Sixty-two cases of neurocysticercosis (NCC) were examined over a period of five years. Convulsive seizure was the commonest presentation (57%). The other modes of presentation included features of raised intracranial pressure (19%) meningoencephalitis (9%), "Stroke" like onset (4%) and progressive dementia (6%). Clinical signs were scanty. Six patients had papilloedema, five had hemiparesis while three had isolated cranial nerve palsies. Soft tissue calcification and mucocutaneous nodules were infrequent and was found in 13 (21%) and 5 cases (8%) respectively. Clinical suspicion supported by CT scan and Immunobiologic tests using ELISA were the mainstay in diagnosis. Praziquantel and Albendazole were found effective in the treatment of neurocysticercosis, but because of serious side effects encountered in some cases, the drugs should be used cautiously in selected cases only.
A 56-year-old Nicaraguan man was referred because of a generalised seizure. CT revealed neurocysticercosis.
Specimens were tested for microsporidia by using culture, immunofluorescent antibody, polymerase chain reaction,immunohistochemistry, and electron microscopy. Donor medical records were reviewed and a questionnaire was developed to assess for microsporidial infection.
The diagnosis and management of strongyloidiasis present a continuous challenge in developing countries including Taiwan. In this study, the clinical characteristics and microbiological findings of 27 patients with Strongyloides stercoralis infection were retrospectively analyzed. Intestinal infection was identified in 17 patients and hyperinfection syndrome or disseminated disease in 10 (including 2 autopsy cases). The most frequent clinical findings were diarrhea (74%), fever (70%), abdominal pain (59%), cough (37%), dyspnea (33%), and constipation (26%). The common initial laboratory abnormalities were leukocytosis (81%), anemia (67%), liver function impairment (52%), and eosinophilia (44%). Most of the 27 patients had comorbid conditions, including malnutrition in 20 (74%), corticosteroid dependence in 15 (55%), chronic obstructive pulmonary disease in 9 (33%), chronic liver disease or cirrhosis in 8 (30%), and peptic ulcer disease in 7 (26%). There was no difference in the time interval from symptom onset to diagnosis between the intestinal infection group and the hyperinfection/disseminated group (22 +/- 15 vs 17 +/- 9 days). Larvae of S. stercoralis were identified in the stool of 24 patients, in the sputum smear of 5, in the gastric biopsy of one, and on histology of autopsy specimens in 2. Twenty-six patients received antiparasitic drug therapy of variable duration (mebendazole in 24, albendazole in 2, combined therapy in one). The overall cure rate was 52% (14/27). Relapse occurred in 4 patients. The overall mortality was 26% (7/27). There was a high mortality (up to 50%) in the hyperinfection/disseminated disease group. In conclusion, diagnosis of strongyloidiasis is often delayed and overlooked because of nonspecific symptoms. Physicians in endemic regions should include strongyloidiasis in the differential diagnosis when patients present with gastrointestinal and/or pulmonary symptoms with peripheral eosinophilia.
Cysticerosis is the commonest parasitic disease to affect the central nervous system (CNS). Distribution is universal. It is endemic in many developing countries and in the Third World. CNS cysticercoses or neurocysticercosis may be classified according to its site in three main groups: parenchymatous, extra-parenchymatous and mixed. The clinical features vary from casual findings to fulminating encephalitis. The commonest presenting symptoms are intracranial hypertension (HIC) in the extra-parenchymatous forms and convulsions in the parenchymatous forms.