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During the past five years the incidence of imported malaria increased among patients seen in East Birmingham Hospital and in St Thomas's Hospital, London. Plasmodium vivax was the predominant species in Birmingham, and was almost always acquired by Asian immigrants visiting the Indian subcontinent. In St Thomas's P falciparum was most commonly imported, usually by African immigrants visiting Nigeria and Ghana. Two patients (one Irish, one Japanese) died of falciparum malaria after visiting tropical Africa. In both hospitals the immigrant patients had seldom taken prophylactic drugs, and the few who had, ceased to do so on arrival in the UK and sometimes before leaving the malarious country. Apparently immigrants who visit their homeland do not consult their general practitioners before travelling, are given inappropriate advice, or do not take appropriate advice when given. Since the incidence of imported falciparum malaria in the UK is rising, the following points should be considered: the infection may be lethal, particularly in patients lacking immunity; it can mimic other diseases, which may lead to delayed diagnosis; severe disease may be associated with few parasites on a blood film, and even if the result is negative further tests should be performed; clinicians and hospital pharmacists should be aware of the need to keep permanent stocks of parenteral chloroquine and quinine preparations.

A questionnaire concerning the laboratory management of endocarditis was sent to 120 UK microbiologists. The 86 replies received indicated that most microbiologists undertake in-vitro sensitivity tests on both streptococci and staphylococci and nearly all perform serum bactericidal titres. Neither the methods used for these investigations nor the interpretation of the results obtained are uniform. Considerable importance is attached to the serum bactericidal titres and many microbiologists alter the antibiotic regimen on the basis of unsatisfactory results. The serum bactericidal titre obtained in 114 patients with endocarditis seen at St. Thomas' Hospital between 1970 and 1985 were analysed according to the outcome of the infection; this was classified as (i) cure, (ii) bacteriological cure/clinical failure or (iii) failure. There were only six failures, four of which had peak titres less than 1:8. Trough titres were of no predictive value. Peak titres of greater than 1:8 were reasonably predictive of bacteriological cure but not of clinical outcome. Failure of medical treatment in endocarditis is seldom the result of inappropriate antibiotics, it usually results from late diagnosis or late referral to cardiologists and cardiac surgeons. Critical evaluation of serum bactericidal titres is long overdue.