BackgroundMalaria is the commonest imported infection in the UK. Malaria requiring ICU admission has a reported mortality of up to 25%. The relationship between ethnicity, immunity, and risk of malaria is complex. The Malaria Score for Adults (MSA) and Coma Acidosis Malaria (CAM) score have recently been proposed to risk stratify patients with malaria.MethodsRetrospective study of patients with WHO severe falciparum malaria admitted to ICU at the Hospital for Tropical Diseases, London, UK. The relationship between clinical variables and risk of death or a prolonged ICU stay were examined with logistic regression. The predictive value of the MSA and CAM score were calculated.Results124 patients were included. Cerebral malaria and acute kidney injury occurred earlier (median day 1) than acute respiratory distress syndrome (median day 3). Six patients had community acquired bacterial co-infection. Eight patients were co-infected with HIV, five of whom were newly diagnosed. The positive predictive value of a CAM score ≥2 or an MSA ≥5 for death were 12% and 22% respectively. Five patients died. No variable was significantly associated with risk of death. There were no significant differences between individuals raised in endemic countries compared to non-endemic countries.ConclusionsMortality in patients managed in a specialist centre was low. Patients who died succumbed to complications associated with a prolonged stay on ICU rather than malaria per se. The clinical usefulness of the MSA and CAM score was limited. Co-infection with HIV was relatively common but compared to studies in children, bacteraemia was uncommon. The relationship between ethnicity and immunity to severe disease is complex.

Abstract. We report 79 cases of acute schistosomiasis. Most of these cases were young, male travelers who acquired their infection in Lake Malawi. Twelve had a normal eosinophil count at presentation and 11 had negative serology, although two had neither eosinophilia nor positive serology when first seen. Acute schistosomiasis should be considered in any febrile traveler with a history of fresh water exposure in an endemic area once malaria has been excluded. Acute schistosomiasis was first described in 1847 in the prefecture of Katayama, Hiroshima district, Japan.1 Women brought to the region to be married were found to become acutely unwell with a fever after they had been exposed to fresh water. Acute schistosomiasis, or Katayama fever, is classically seen among travelers to regions where the disease is endemic. It is thought to be an immune-complex phenomenon, precipitated by the onset of egg-laying by newly matured adult female schistosomes. This occurs between 2 and 12 weeks after exposure 2 ; the syndrome is seen almost exclusively among people who have no history of previous exposure to the infection. The symptoms of Katayama may include fever, cough, an urticarial rash, and diarrhea, with an elevated eosinophil count as a characteristic laboratory finding 2 ; not every individual will have all of these. We report the clinical and laboratory features of acute schistosomiasis among 79 travelers who presented to the Hospital for Tropical Diseases (HTD) in London between 1998 and 2012.Acute schistosomiasis is often a clinical diagnosis at the time of presentation and may only be confirmed later in the illness once a serological test has had time to become positive. We therefore defined cases according to the following five predefined criteria, with each case fulfilling all five.1. Presence of at least one: fever, cough, rash, diarrhea. 2. A recent history of fresh water exposure in an area where schistosomiasis is endemic. 3. Positive schistosomal serology, either at presentation or follow-up. 4. Raised eosinophil count at some point during the illness. 5. Symptoms not attributable to any other condition.Cases were identified from three sources: a database of schistosomiasis cases and two prospective databases of both inpatients and outpatients seen at HTD. Clinical notes and laboratory data were reviewed using a standard proforma.Time from exposure to symptoms was taken as the first date of potential exposure to the date of symptom onset. Laboratory results were obtained from the appropriate clinical laboratories in University College London Hospitals. The schistosomal serology is an "in-house" enzyme-linked immunosorbent assay (ELISA) detecting antibody to Schistosoma mansoni soluble egg antigen; once positive this test may remain so for years despite successful treatment. Positive results are reported as levels (bands of optical density from 1 to 9) with a result of one or more regarded as positive. 3 The serology test has a sensitivity of 96% for S. mansoni and 92% for Schistosoma haematobium, whereas t...

Toxocara infection occurs through ingestion of parasite eggs excreted by dogs and cats, and can cause severe morbidity. The burden of disease in England and Wales is not well described, and the impact of public health campaigns conducted in the mid-1990s is uncertain. This paper uses data from two extensive databases to explore the trends in this disease in England and Wales from the 1970s to 2009.