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Erythema infectiosum (EI) or fifth disease is a mild, acute exanthematous disease, occurring mainly among children, for which a causative virus has long been sought. In May 1983 an outbreak of exanthematous illness was reported in a primary school in North London. Children attending the school were investigated by questionnaire and 162 (43.9%) reported an illness with the features of EI. In each of 36 cases investigated virologically the illness was associated with parvovirus infection. Moreover, pre-existing antibody to parvovirus was correlated with protection from EI in 16 of 17 close family contacts of cases. We propose therefore that EI is the common manifestation of infection with the human parvovirus.

The prevalence of infectious diseases at our hospital (Centre hospitalier universitaire vaudois, Lausanne [CHUV], 900 beds) was studied retrospectively over a two years period (1980-1981). The medical diagnosis of 30203 patients recorded in the computerized medical archives, representing 93% of the patients admitted during the period of observation, was reviewed. To assess the reliability of the computerized data, quality control was carried out through detailed analysis of all the histologically proven appendicitis recorded during 1981. 88% of the histologically proven appendicitis were registered in the computer and the diagnosis was specific in 87% of cases. An infectious disease was the primary reason for admission in 12.8% of the patients (3873) during the study period. Altogether, 20.2% of patients presented with an infection during their hospital stay. Because of the retrospective nature of the study it was not possible to determine whether these additional infections were nosocomially acquired. The organ systems most frequently infected were the respiratory tract (28.5% of all infections), the digestive tract (20.5%), the skin and osteoarticular system (16%) and the urogenital tract (11.6%). An infection was the primary reason for admission of 40.2% of the patients hospitalized in the dermatology service, of 19.7% of patients admitted in internal medicine, of 15-17% of the patients admitted in pediatrics, ENT and general surgery, and of 1-2% of the patients admitted in neurosurgery and radiotherapy. These observations highlight the continuing importance of infectious diseases in a modern hospital, in spite of high socio-economic levels, stringent hygiene and epidemiologic measures, and modern antibiotic availability.

In what we believe to be the first case of cutaneous protothecosis identified in Taiwan, a 5-year-old Chinese girl presented with a pruritic erythematous plaque on her right upper eyelid. A clinical diagnosis of eczematous dermatitis was made initially, and sporotrichosis was diagnosed subsequently. Later, histopathologic and cultural studies of the lesion finally led to the diagnosis of protothecosis. The recognition of the characteristic sporangia containing symmetrically arranged endospores is the most important initial diagnostic clue of protothecosis. Biochemical assimilation tests and direct immunofluorescence study using species-specific antibodies identified the organism as Prototheca wickerhamii. Systemic ketoconazole treatment proved to be effective for our patient. The in vitro minimal inhibitory concentrations of tetracycline hydrochloride, amphotericin B, and ketoconazole were also determined.

Diphtheritic skin lesions are known to be relatively common in tropical as opposed to temperate climates, but the possible presence of Corynebacterium diphtheriae in skin lesions has not been investigated in East Africa, where classical diphtheria cases are rare. The authors therefore studied septic skin lesions and skin ulcers in 139 preschool children and schoolchildren in Uganda. A high percentage (up to 60%) of C. diphtheriae lesions was found, a majority of the isolations being of the mitis type. At the same time, low respiratory carrier rates for C. diphtheriae were found. The practical importance of the skin reservoir of C. diphtheriae for the development of specific diphtheria immunity in the tropics is stressed.

A comparison has been made between two vasoformative lesions, Kaposi's sarcoma and granuloma pyogenicum, as they are encountered in Uganda. Both are predominantly skin lesions arising in the distal extremities, may resemble each other clinically, and are widespread in their distribution in Ugandan communities. They bear a reciprocal relationship to each other as regards age and sex incidence, Kaposi's sarcoma being mainly a disease of adult males and granuloma pyogenicum a disease of immature males and females. Histologically there are many similarities between them, the essential difference being the presence of a spindle-cell sarcomatous element in Kaposi's sarcoma. The clinical behaviour reflects this difference in that granuloma pyogenicum develops quickly and appears to be self-limiting, while Kaposi's sarcoma is slowly progressive and shows much less tendency to regress. On the basis of these findings it is concluded that, although these two lesions may be completely unrelated, it is possible that both represent a response of the vasoformative elements in the skin to a similar form of initiating stimulus and that hormonal or sex-linked genetic factors determine which lesion will develop in response to this stimulus. The presence of intracytoplasmic inclusion in the tumour cells of Kaposi's sarcoma might be of significance in the histogenesis of this tumour, and of value in its histological differentiation from granuloma pyogenicum.

In three years, Corynebacterium diphtheriae was isolated from 1238 people, consisting of 820 North American Indians or Metis, 318 people of Caucasian origin, 97 Eskimos and 3 Asiatic Indians. Diphtheria infection of the throat, nose, ears and skin was common in the North American Indian and Metis people, but rarely caused severe symptoms. The infection occurred less often in white people but was more serious; of 27 cases of toxic respiratory diphtheria, 25 were white people. The public health significance of the endemic infection of the North American Indian and Metis people is discussed.