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Amoebic liver abscesses are by far the most common extra-intestinal manifestation of invasive amoebiasis. The classical clinical picture consists of fever, right upper quadrant pain and hepatomegaly. Ultrasound and serology make an early diagnosis possible. Amoebic liver abscesses usually appear singly and are normally situated in the right lobe of the liver. This case report refers to a white Belgian woman, living in an endemic area for amoebiasis, presenting with 25 amoebic liver abscesses, who did not improve clinically despite appropriate anti-amoebic therapy, is described. Only percutaneous drainage of the larger abscesses led to clinical recovery. Amoebic abscess aspiration and evacuation under ultrasonographic guidance is of limited risk, but in experienced hands may enhance clinical recovery, particularly in patients with large abscesses not responding to conservative medical treatment. Aspiration of large abscesses (> 5 cm) is rarely necessary but should be considered if there is no clinical improvement after 3 days of nitroimidazole treatment with amoebicides.

To document ownership and use of bednets with its determinants in the visceral leishmaniasis (VL)-endemic region where mainly non-insecticide impregnated nets are available through commercial channels, and bednets are being considered as a leishmaniasis vector control measure.In August-September 2006, semi-structured household (HH) questionnaires and observation guides were used in a random sample of 1330 HHs in VL-endemic districts of India and Nepal to collect data on VL knowledge, HH socio-economic status, bednet ownership and use patterns. An asset index was constructed to allow wealth ranking of the HH. A binary logistic response General Estimating Equations model was fitted to evaluate the determinants of bednet ownership and use.The proportion of HHs with at least one bednet purchased on the commercial market was 81.5% in India and 70.2% in Nepal. The bednets were used in all seasons by 50.6% and 54.1% of the Indian and Nepalese HH owning a bed net. There was striking inequity in bednet ownership: only 38.3% of the poorest quintile in Nepal owned at least one net, compared to 89.7% of the wealthiest quintile. In India, the same trend was observed though somewhat less pronounced (73.6%vs. 93.7%). Multivariate analysis showed that poverty was an important independent predictor for not having a bednet in the HH [OR 5.39 (2.90-10.03)].Given the inequity in commercial bednet ownership, free distribution of insecticide-treated bednets to the general population seems imperative to achieve a mass effect on vector density.

Amoebic liver abscesses are by far the most common extra-intestinal manifestation of invasive amoebiasis. The classical clinical picture consists of fever, right upper quadrant pain and hepatomegaly. Ultrasound and serology make an early diagnosis possible. Amoebic liver abscesses usually appear singly and are normally situated in the right lobe of the liver. This case report refers to a white Belgian woman, living in an endemic area for amoebiasis, presenting with 25 amoebic liver abscesses, who did not improve clinically despite appropriate anti-amoebic therapy, is described. Only percutaneous drainage of the larger abscesses led to clinical recovery. Amoebic abscess aspiration and evacuation under ultrasonographic guidance is of limited risk, but in experienced hands may enhance clinical recovery, particularly in patients with large abscesses not responding to conservative medical treatment. Aspiration of large abscesses (5 cm) is rarely necessary but should be considered if there is no clinical improvement after 3 days of nitroimidazole treatment with amoebicides.

We do not agree with the conclusion of Sanne and colleagues that didanosine and hydroxyurea is a safe effective and economically relevant alternative to existing antiretroviral regimens for poor-resource patient populations. So far randomized clinical trials have not been able to demonstrate a clear benefit from hydroxyurea-containing regimens. Hydroxyurea reduces the viral load but it is unclear whether this parameter is a good surrogate marker for evaluating the efficacy of this drug. Hydroxyurea may be harmful because it is cytostatic and reduces the CD4+ lymphocyte count. Moreover it increases the toxicity of didanosine leading to a higher incidence of peripheral neuropathy and pancreatitis. It certainly should not be used in pregnant women or women at risk of becoming pregnant. One randomized trial (the AIDS Clinical Trial Group [ACTG] 65025 study) was prematurely stopped because of high rates of drug toxicity in the hydroxyurea arm. Among 68 patients randomized to the hydroxyurea arm three deaths related to complications of pancreatitis were reported. For these reasons we believe it is premature to recommend the use of hydroxyurea in daily clinical practice even in countries with poor resources. However we agree that additional randomized trials using hydroxyurea are needed to define the potential role of this drug in the treatment of human immunodeficiency virus (HIV). Such trials should include a sufficiently large number of participants who are followed for long enough to detect a significant difference in clinical outcome. (excerpt)

A case of retroperitoneal abscess revealing a perforation of the rectum due to colonoscopic polypectomy is reported.