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Rhinosporidiosis: three domestic cases
Journal of the American Academy of Dermatology Volume 35, Number 2, Part 1
Pearls of wisdom
245
Abstracts from the literature Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas Weiss M, Lopfinzi CL, Creagan ET, et al. J A M A 1995 ;274:1703-5. The effectiveness of follow-up tests for signaling recurrences in patients with intermediate and high-risk malignant melanomas was studied in 261 patients with rejected local (->1.69 ram) and regional nodal melanomas. Patients in a randomized single adjuvant trial were examined at frequent intervals with a history, physical examination, blood chemistry panels and complete blood cell counts, and roentgenograms of the chest during a 5~-year period. Minimum follow-up was 4 years. Of the 145 patients with recurrent melanoma, 99 (68%) had symptoms that signaled recurrent disease. Most of the recurrences in patients without symptoms were detected by history and physical examination in 37 patients (26%). Chest x-ray films showed abnormalities in nine patients (6%). Routine blood analyses and chest roentgenography were of limited value in the postoperative follow-up of these patients and were never the sole marker of recurrent disease. Most recurrences occurred by the end of the first (69%) or second (88%) year. Patients with longer diseasefree intervals tended to have an improved prognosis.
Elizabeth A. Abel, MD
Duration of tick bites in a Lyme diseaseendemic area Falco RC, Fish D, Piesman J. A m J Epidemiol 1996; 143:187-92. This study describes a method of estimating the duration of attachment of both nymphal and adult female Ixodes scapularis ticks from the scutal index, which is defreed as the body length/scutal width. The method was used to estimate the feeding times of more than 700 ticks removed from persons during the late 1980s in Westchester County in New York State, an area of high incidence of Lyme disease. Nymphs were attached for a mean of 35 hours (27% more than 48 hours), and female ticks for 29 hours (23% more than 48 hours). Children younger than 10 years of age had the lowest proportion of nymphs removed more than 48 hours after attachment, presumably because of careful inspection; however, they were also the age group with the highest number of nymphs attached
more than 48 hours because they are frequently bitten. These children also had the highest proportion of adult female ticks extracted more than 48 hours after attachment. The adult female ticks are active in the autumn. COMMEbrr: The critical time for Borrelia burgdorferi transmission is approximately 48 hours. These observations may explain the fact that children younger than 10 years of age account for the most number of Lyme disease cases in Westchester County. Increased awareness of the importance of inspection for and timely removal of ticks in the entire population and particularly in children may lead to reduction in the incidence of Lyme disease in endemic areas.
Martin A. Weinstock, MD, PhD
Rhinosporidiosis: three domestic cases Gaines JJ, Clay JR, Chandler FW, et al. South M e d J 1996;89:65-7. Although rhinosporidiosis is common in India, Sri Lanka, and Southeast Asia, it is a rare cause of conjuncrival and nasal polyps in this country. The causative agent is Rhinosporidium seeberi, a fungus aecasionally found in rural and aquatic environments. The authors report the occurrence of this infection in three boys whose ages ranged from 9 to 14 years. All were from rural Georgia and none had traveled out of the United States. Two of the patients had nasal polyps protruding from the nares. The third had a conjunctival mass. The diagnosis was confirmed by the recognition of the characteristic trophocytes and sporangia in the tissue specimens. The fungus cannot be cultured on routine synthetic media. Domestic animals may be the reservoir of Rhinosporidium in this
country. Alvin Solomon, MD
HIV infection and leprosy: a four-year survey in Ethiopia Frommel D, Telde-Haimanot R, Verdict M, et al. Lancet 1994;344:165-6. Epidemiologic data showed that the prevalence of HIV antibodies in 644 Ethiopians with leprosy rose from 5.2% to 6.5% in three separate surveys between 1988 and 1992,
Pearls of wisdom
245
Abstracts from the literature Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas Weiss M, Lopfinzi CL, Creagan ET, et al. J A M A 1995 ;274:1703-5. The effectiveness of follow-up tests for signaling recurrences in patients with intermediate and high-risk malignant melanomas was studied in 261 patients with rejected local (->1.69 ram) and regional nodal melanomas. Patients in a randomized single adjuvant trial were examined at frequent intervals with a history, physical examination, blood chemistry panels and complete blood cell counts, and roentgenograms of the chest during a 5~-year period. Minimum follow-up was 4 years. Of the 145 patients with recurrent melanoma, 99 (68%) had symptoms that signaled recurrent disease. Most of the recurrences in patients without symptoms were detected by history and physical examination in 37 patients (26%). Chest x-ray films showed abnormalities in nine patients (6%). Routine blood analyses and chest roentgenography were of limited value in the postoperative follow-up of these patients and were never the sole marker of recurrent disease. Most recurrences occurred by the end of the first (69%) or second (88%) year. Patients with longer diseasefree intervals tended to have an improved prognosis.
Elizabeth A. Abel, MD
Duration of tick bites in a Lyme diseaseendemic area Falco RC, Fish D, Piesman J. A m J Epidemiol 1996; 143:187-92. This study describes a method of estimating the duration of attachment of both nymphal and adult female Ixodes scapularis ticks from the scutal index, which is defreed as the body length/scutal width. The method was used to estimate the feeding times of more than 700 ticks removed from persons during the late 1980s in Westchester County in New York State, an area of high incidence of Lyme disease. Nymphs were attached for a mean of 35 hours (27% more than 48 hours), and female ticks for 29 hours (23% more than 48 hours). Children younger than 10 years of age had the lowest proportion of nymphs removed more than 48 hours after attachment, presumably because of careful inspection; however, they were also the age group with the highest number of nymphs attached
more than 48 hours because they are frequently bitten. These children also had the highest proportion of adult female ticks extracted more than 48 hours after attachment. The adult female ticks are active in the autumn. COMMEbrr: The critical time for Borrelia burgdorferi transmission is approximately 48 hours. These observations may explain the fact that children younger than 10 years of age account for the most number of Lyme disease cases in Westchester County. Increased awareness of the importance of inspection for and timely removal of ticks in the entire population and particularly in children may lead to reduction in the incidence of Lyme disease in endemic areas.
Martin A. Weinstock, MD, PhD
Rhinosporidiosis: three domestic cases Gaines JJ, Clay JR, Chandler FW, et al. South M e d J 1996;89:65-7. Although rhinosporidiosis is common in India, Sri Lanka, and Southeast Asia, it is a rare cause of conjuncrival and nasal polyps in this country. The causative agent is Rhinosporidium seeberi, a fungus aecasionally found in rural and aquatic environments. The authors report the occurrence of this infection in three boys whose ages ranged from 9 to 14 years. All were from rural Georgia and none had traveled out of the United States. Two of the patients had nasal polyps protruding from the nares. The third had a conjunctival mass. The diagnosis was confirmed by the recognition of the characteristic trophocytes and sporangia in the tissue specimens. The fungus cannot be cultured on routine synthetic media. Domestic animals may be the reservoir of Rhinosporidium in this
country. Alvin Solomon, MD
HIV infection and leprosy: a four-year survey in Ethiopia Frommel D, Telde-Haimanot R, Verdict M, et al. Lancet 1994;344:165-6. Epidemiologic data showed that the prevalence of HIV antibodies in 644 Ethiopians with leprosy rose from 5.2% to 6.5% in three separate surveys between 1988 and 1992,