Multicenter trials in Southeast Asia have shown better survival rates among patients with severe malaria, particularly those with high parasitemia levels, treated with intravenous (IV) artesunate than among those treated with quinine. In Europe, quinine is still the primary treatment for severe malaria. We conducted a retrospective analysis for 25 travelers with severe malaria who returned from malaria-endemic regions and were treated at 7 centers in Europe. All patients survived. Treatment with IV artesunate rapidly reduced parasitemia levels. In 6 patients at 5 treatment centers, a self-limiting episode of unexplained hemolysis occurred after reduction of parasitemia levels. Five patients required a blood transfusion. Patients with posttreatment hemolysis had received higher doses of IV artesunate than patients without hemolysis. IV artesunate was an effective alternative to quinine for treatment of malaria patients in Europe. Patients should be monitored for signs of hemolysis, especially after parasitologic cure.

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This study concerns the first urinary schistosomiasis case observed in Corsica (France, Europe) occurring in a 12-year-old German boy. The aim was to identify the relationship between this Schistosoma haematobium infection and other schistosomes of the Schistosoma group with terminal-spined ova. Morphological and molecular analyses were conducted on the ova. The results showed that the schistosome responsible for the emergence of schistosomiasis in Corsica was due to S. haematobium introgressed by genes from S. bovis.

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Schistosoma mansoni infection, associated morbidity and symptoms were studied in Piida fishing community at Butiaba, along Lake Albert, Uganda, from November 1996 to January 1997. The study revealed that S. mansoni is highly endemic with an overall prevalence of 72%, a mean intensity of 419.4 eggs per gram (epg) faeces (geometric mean for positives only), with 37.8% of males and 33.0% of females excreting over 1000 epg. Prevalence and intensity peaked in the 10-14 year old age group and decreased with increasing age. Females were less heavily infected than males. Differences were also shown between tribes. Diarrhoea and abdominal pain were commonly reported in Piida. However, no clear-cut correlation between intensity of S. mansoni infection and these conditions could be demonstrated, indicating that retrospective questionnaires concerning S. mansoni related-symptomatology are of limited value. Organomegaly, as assessed by ultrasonography, was frequent and hepatomegaly was associated with heavy S. mansoni infection. No correlation was demonstrated between splenomegaly and infection. This study emphasizes that schistosomiasis mansoni is a major public health problem in Piida fishing community and presumably also in many similar fishing communities. These observations call for immediate intervention and can help in planning long-term strategies for sustainable morbidity control.

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Abstract. The individual and public health impact of female genital schistosomiasis (FGS) has been studied and FGS as a risk factor for acquiring human immunodeficiency virus is discussed. In a community-based study in Tanzania, 40% of the women of child-bearing age (n ϭ 543) showed excretion of Schistosoma haematobium eggs in the urine (median ϭ 2.2 eggs/10 ml of urine) and 32% (n ϭ 263) had S. haematobium eggs in their cervical tissue. Urinary and genital schistosomiasis coexisted in 62% of the women, but S. haematobium eggs were found in the cervix without detectable egg excretion in the urine in 23%. Only 43% of the FGS cases had hematuria. Since FGS frequently exists in women with scanty or no egg excretion in the urine and because this disease manifestation is a considerable individual and public health hazard in S. haematobium-endemic areas, mass treatment targeted to women of child-bearing age should be considered.Genital manifestations of infection with Schistosoma haematobium, although long known, have not attracted much attention. Only recently have the individual and public health implications of female genital schistosomiasis (FGS) been reported. 1 An estimated 9-13 million women may be afflicted by this disease entity in Africa alone. 1 This caused the World Health Organization to include FGS into a group of gender-specific diseases that deserve high-priority research. 2 Besides debilitating or life-threatening consequences such as infertility and ectopic pregnancy, FGS seems to be a risk factor for the transmission of human immunodeficiency virus (HIV). 1,3 Recently, it was shown that bacterial vaginosis is likely to increase the susceptibility of women to HIV-1 infection in sub-Saharan Africa. 4 Since in FGS the physical barrier function of the epithelium is impaired, women with genital schistosomiasis may also be at a higher risk for HIV infection than women with a normal reproductive tract. 3 Moreover, there is circumstantial evidence that the immunologic microenvironment of the peri-oval granuloma facilitates the local propagation and systemic spread of HIV. 1 If this hypothesis is correct, the control of urinary schistosomiasis, similar to the control of bacterial vaginosis, could reduce transmission of HIV. 4 It has been assumed that genital lesions are always accompanied by active urinary schistosomiasis as indicated by the presence of viable eggs in the urine. However, the observation of genital pathology observed in female European travelers with only scanty or no egg output in urine indicates that FGS may also occur in absence of urinary schistosomiasis. 5 To test this hypothesis, we carried out a cross-sectional, community-based study in two villages in Tanzania. MATERIALS AND METHODSStudy site and population. Kileo and Kivulini are situated about 36 km southeast of Moshi near the main road from Arusha to Dar es Salaam, Tanzania. A traditional irrigation scheme has enabled the villagers to grow rice. Schistosomiasis is endemic in both villages. 6 Women included in the study are mainly W...