This study demonstrates the usefulness of oral fluid samples for the investigation of Ebola outbreaks, but further development in antibodies and antigen detection in oral fluid specimens is needed before these samples are used for filovirus surveillance activities in Africa.

A needlestick injury occurred during an animal experiment in the biosafety level 4 laboratory in Hamburg, Germany, in March 2009. The syringe contained Zaire ebolavirus (ZEBOV) mixed with Freund's adjuvant. Neither an approved treatment nor a postexposure prophylaxis (PEP) exists for Ebola hemorrhagic fever. Following a risk-benefit assessment, it was recommended the exposed person take an experimental vaccine that had shown PEP efficacy in ZEBOV-infected nonhuman primates (NHPs) [12]. The vaccine, which had not been used previously in humans, was a live-attenuated recombinant vesicular stomatitis virus (recVSV) expressing the glycoprotein of ZEBOV. A single dose of 5 × 10(7) plaque-forming units was injected 48 hours after the accident. The vaccinee developed fever 12 hours later and recVSV viremia was detectable by polymerase chain reaction (PCR) for 2 days. Otherwise, the person remained healthy, and ZEBOV RNA, except for the glycoprotein gene expressed in the vaccine, was never detected in serum and peripheral blood mononuclear cells during the 3-week observation period.

BACKGROUNDHighly active antiretroviral therapy (HAART) has improved the survival of patients with acquired immunodeficiency syndrome‐related lymphoma (ARL). The German ARL Study Group investigated whether HAART administered concomitantly with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy compromised the course of immune parameters during and after chemotherapy and exerted a positive effect on remission and survival.METHODSFrom 1997 to 2001, 72 patients with ARL were stratified prospectively into a standard‐risk group (n = 48 patients) and a high‐risk group (n = 24 patients) with either 0‐1 or 2‐3 of the following risk factors: CD4 < 50/μL, prior opportunistic infection, and/or a World Health Organization performance status ≥ 3. Patients in the high‐risk group received ≥75% of the CHOP regimen.RESULTSIn the standard‐risk group (CD4 = 223/μL; age‐adjusted International Prognostic Index [aaIPI], 38% ≥ 2), the complete remission (CR) rate was 79%, and median survival was not reached after a median 47 months of follow‐up. CD4 counts did not change from baseline to 4 weeks after the end of chemotherapy (206/μL). In the high‐risk group (CD4 = 34/μL; aaIPI, 88% ≥ 2), the CR rate was 29%, and the median survival was 7.2 months (3 patients survived for > 3 yrs). Toxicity was moderate: Leukopenia Grade 3 or 4 occurred in 100 of 249 chemotherapy cycles (40%) in the standard‐risk group and in 70 of 102 cycles (69%) in the high‐risk group.CONCLUSIONSBased on the aaIPI, the survival of patients in the standard‐risk group was very similar to that achieved by nonhuman immunodeficiency virus‐infected patients who had aggressive lymphomas. Concurrent CHOP plus HAART can be administered in an outpatient setting. Thus, the authors recommend using this modality as first‐line therapy for patients with ARL. Cancer 2006. © 2006 American Cancer Society.

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A 45-year-old woman presented at the outpatient department of a center for tropical diseases with fever, diarrhea, headache, myalgia, malaise, and an itchy papular rash. She had been on holiday with her family for 11 days in a mountain village in northern Cyprus. The place was infested with a lot of small, stinging flies or mosquitoes. She and her family became sick after they returned home. The physical examination was normal apart from the rash on the inside of the extremities. Significantly elevated transaminases and a slightly increased C‑reactive protein level were found in the blood examination. Considering the country of travel, the report of the "stinging flies" and the clinical presentation, sandfly fever was also taken into account as a differential diagnosis for the hepatitis. Antibodies to the sandfly fever Sicilian virus (SFSV) were detected. They showed the typical dynamics during the course of the illness and thus "pappataci fever" was diagnosed. The case report and a short review of up-to-date literature is meant encourage consideration of phlebovirus infection as a possible differential diagnosis in travelers or refugees suffering from severe febrile hepatitis and rash or aseptic viral meningitis after their stay in the Mediterranean area.

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Most tropical diseases imported by travelers can be treated quite effectively. Human endoparasites belong to the protozoa and worms. Protozoa can be seen as microparasites, characterized by short generation periods and high rates of reproduction within a host--consequently the diseases mainly are of short duration. Effective drugs are available for malaria, amebiasis and other intestinal protozoa as well as for leishmaniasis. Resistance, however, sometimes is a problem. Worms are macroparasites that generally do not reproduce within a host--teleologically speaking because otherwise they would rapidly damage their own basis of living. Accordingly, severe worm disease is rarely found in travelers. Levels of anthelminthic resistances so far are low. The most important worm disease in travelers is schistosomiasis, a disease that also can be treated effectively if diagnosed early.

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