Tungiasis in Northern Tanzania : a clinical report from Qameyu village, Babati District, Manyara Region

INTRODUCTION: Tungiasis is an infestation caused by the penetration in the skin of the gravid female of the flea Tunga penetrans (T. penetrans). The current epidemiological situation of tungiasis in Eastern Africa is poorly known. We present the results of a cross-sectional study on tungiasis which was carried out in Qameyu (Northern Tanzania). METHODOLOGY: Sixty-two schoolchildren with suspected cases of tungiasis were examined. Location, number, morphology and symptoms associated with T. penetrans infestation were recorded for each patient. RESULTS: A total of 62 schoolchildren (38 males and 24 females), with ages ranging from 6 to 14 years, were examined. Sixty children were infested by T. penetrans. A total of 865 lesions were observed: 170 lesions were vital and 695 were non-vital. The first and the fifth toes were especially involved. The highest number of lesions observed in a single patient was more than 55 lesions. Pain was reported by 42 children, itching by 39 and difficult walking by 28. One child presented with fever which was considered to be caused by superinfected tungiasis. Complications were nail dystrophy (48 patients), deformity of the fingers or toes (12 patients), scarring (4 patients) and nail loss (4 patients). Thirteen children needed oral antibiotic therapy because of bacterial superinfections. CONCLUSIONS: Tungiasis is a public health concern in this region of Tanzania and it is associated with high morbidity. Improvement in housing hygiene, confining domestic animals and increasing the knowledge of the disease via health education are measures that should be taken to control the disease

Two cases of imported tungiasis with severe Staphylococcus aureus superinfection

Tungiasis is an infestation caused by penetration in the skin of the gravid female of the flea Tunga penetrans (T. penetrans) Linnaeus 1758 (Insecta, Siphonaptera: Tungidae) (1). T. penetrans is endemic in Central and South America, Sub-Saharan Africa and Central Asia. It is uncommon in returning travellers (1): in a study on 269 patients presenting to a tropical disease unit in Paris, 6% were affected by tungiasis (2). We describe two cases of imported tungiasis with severe Staphylococcus aureus superinfection

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Intervista video a F.S. Fera realizzata in occasione di Mantova architettura 201

Treatment of refractory blistering autoimmune diseases with mycophenolic acid

Background: Immunosuppressive drugs are used as steroid-sparing agents in the management of blistering autoimmune diseases. Mycophenolic acid (MPA) is a relatively new adjuvant drug that selectively inhibits T and B lymphocyte proliferation by suppressing de novo purine synthesis. Objective: To evaluate the efficacy of MPA in refractory blistering autoimmune diseases and the safety profile of a recent formulation, enteric-coated mycophenolate sodium (EC-MPS), in comparison with mycophenolate mofetil (MMF). Patients and methods: Twelve patients with various bullous dermatoses (three pemphigus vulgaris, one pemphigus herpetiformis, three bullous pemphigoid (BP), two cicatricial pemphigoid (CP) and three epidermolysis bullosa acquisita (EBA)) were enrolled in the study. In 10 cases, MPA was administered in combination with systemic corticosteroids, while in two patients with severe diabetes mellitus MPA was employed as monotherapy. The total time on MPA varied from 2 to 8 months. Four patients were given MMF (2000 mg daily), seven received EC-MPS (1440 mg daily) and one received both sequentially. Results: Complete remission, lasting for a mean time of 6.1 months, was achieved in 10 patients. Partial remission was obtained in two patients with disseminated CP and EBA. Both MMF and EC-MPS were well tolerated, but the latter was better in terms of gastrointestinal adverse effects. Conclusions: MPA may be proposed as a first-line adjuvant agent for pemphigus as well as for refractory BP and CP. MPA monotherapy has to be considered in selected cases of BP and pemphigus. The highly promising results obtained in EBA suggest a future key role for MPA in the management of this disease