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Malaria continues to be an increasing health concern in many endemic areas where it remains a major contributor to childhood morbidity and mortality. Chemoprophylaxis and treatment are increasingly compromised by drug resistance. Vaccination for malaria is not yet available outside clinical trials. In clinical trials bed nets have been shown to be effective in reducing malarial morbidity and mortality. Their efficacy outside of the clinical trial setting has been less well documented. We describe our experience with the introduction of bed nets in a remote rural Zambian village and document the effect on malarial parasitaemia, spleen rates and haemoglobin. Children were evaluated at the end of the rainy seasons in April 1998 and April 1999. Insecticide impregnated nets were made available for purchase to the village in July 1998. Rates of parasitaemia and anaemia were significantly reduced.

The report details a case of diffuse unilateral subacute neuroretinitis (DUSN) wherein a subretinal parasite was visualized and subsequently destroyed with laser photocoagulation.

Necrotizing fasciitis due to Streptococcus pneumoniae is a rare and grave condition, and only a few cases have been reported. Suggested risk factors include minor trauma, systemic lupus erythematosus, immunosuppression secondary to medication, use of intramuscular anti-inflammatories and alcoholism. A fatal case of pneumococcal necrotizing fasciitis that occurred in a 51-year-old woman with a history of alcohol abuse and oral anti-inflammatory use is presented. Her condition was caused by a multi-etiology outbreak of community-acquired pneumonia, from which S pneumoniae serotype 5 was also isolated. The case description outlines the subtle presentation and rapid clinical progression of this condition. Because serotype 5 antigen is included in the polysaccharide 23-valent pneumococcal vaccine, the present case highlights the importance of pneumococcal immunization programs in Canada.

A 36-year-old man with advanced AIDS presented with skin lesions, fever and weight loss. Physical examination revealed skin lesions suggestive of bacillary angiomatosis. Diagnostic imaging identified bone lesions, soft tissue masses and a single hepatic lesion. His clinical presentation was most consistent with Bartonella quintana; however, his risk for infection with B quintana was limited to a remote, brief period of homelessness. In contrast, his frequent contact with cats presented substantial potential exposure to Bartonella henselae. Diagnosing a Bartonella infection presents challenges. The detection of bacteremia is hindered by slow growth in BACTEC media (BD Diagnostic Systems, Canada). In the present case, recovery of the organism required blind subcultures after at least eight days of incubation. Speciation by 16s ribosomal RNA analysis confirmed B quintana as the pathogen. Because the patient presented with skin lesions, the diagnosis was straightforward; however, skin lesions are nondiagnostic in some cases. Microbiological confirmation of the diagnosis rests on sufficient clinical suspicion to apply labour-intensive laboratory protocols.

Several recent reports have described an association between human immunodeficiency virus (HIV) infection and porphyria cutanea tarda (PCT). We describe two HIV-infected patients who developed PCT and review 29 other reported cases of coexistent PCT and infection due to HIV. Recognized porphyrinogenic factors were identified in our patients and in 27 of the 29 cases described in the literature. Even in the two cases that lacked obvious precipitant factors for PCT, the possibility of hepatitis C was not excluded. This fact suggests that the cooccurrence of PCT and infection due to HIV may reflect the coexistence of risk factors for the two diseases rather than a causal association. Despite concern that exposure to sulfonamides might exacerbate porphyria, one of our patients and three patients described in the literature were safely treated with sulfonamides.

A 58-year-old woman presented with progressive midforehead swelling and erythema with frontal headache. Investigations revealed erosion of the anterior wall of the frontal sinus with subgaleal abscess formation, establishing a diagnosis of Pott’s puffy tumour. Pasteurella multocida was isolated in pure growth from an aspirate of the abscess. P multocida is a rare cause of sinusitis. It is isolated from the respiratory tract of asymptomatic individuals and, more commonly, patients with chronic respiratory conditions. Although a cause of osteomyelitis associated with animal bites or scratches, P multocida has not previously been implicated as a cause of frontal osteomyelitis or Pott’s puffy tumour. A review of reported cases of Pott’s puffy tumour, including clinical presentation, microbiology, treatment and outcome, is provided.

Fluoroquinolones are active against Plasmodium falciparum in vitro. In a prospective, randomized, comparative trial, norftoxacin, 400 mg twice a day for 3 days, was compared with a standard course of chloroquine in semiimmune adults with symptomatic falciparum malaria in northwestem Zambia, where chloroquine resistance is uncommon. Patients were followed for 28 days. The trial was terminated after 38 patients were studied because chloroquine was markedly more effective, curing all 18 patients (100%) compared with only 8 (40%) of 20 who received norftoxacin (P < .001). Of the 12 norftoxacin failures, 6 had clearing of trophozoites but recurrence during the study period (RI), 4 had incomplete clearance of trophozoites with later recurrence (RII), and 2 had no improvement (RIII). The mean parasite clearance time was significantly shorter with chloroquine (30.4 vs. 52.7 h; P = .02). The mean defervescence time was also shorter with chloroquine (16.9 vs. 24.5 h; not significant). In contrast to its inferior efficacy, norftoxacin caused fewer adverse effects than did chloroquine (33% vs. 0; P < .001).

Three cases of plague, all with pneumonic involvement, occurred in a small village in northwestern Zambia. Initial recognition of the diagnosis was delayed, but the outbreak was terminated by rapid intervention with insecticides and with the use of chemoprophylaxis for individuals with high-risk exposures to case-patients.