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12 Exercises

  1. You are in the Congo. A colleague who has already worked in the area for 4 years tells you that, following the numerous blood analyses that he has done, there is no filariasis in the region with the exception of M. perstans. Pruritus -which is often thought to result from scabies- appears to be a common problem in your area. This condition responds little to the usual medication. Your advice?

  2. A group of tourists leaves the USA for the first time and takes a 2-week trip through the Angola-Zambia border region. They always cook their food and water. During their trip, however, they have to wade through water. Two weeks later two people develop a painful swelling of the lower legs. A few days later a mobile white spot appears. Can this be an acute guinea worm infection? Give three arguments. What do you think?

  3. You are working in Cambodia. There is a lot of blindness as a result of trauma, measles (keratitis) and cataract. Should you also consider performing skin scarification when examining a blind person?

  4. You are working in Mozambique. There is a lot of blindness as a result of trauma, measles (keratitis) and cataract. The staple diet is maize with little or no variety. What other causes of blindness might you detect?

  5. Cameroon. There are several patients who complain of "filariae" moving subcutaneously. What do you think of this conclusion? Do you do a stool examination?

  6. India. An Indian patient presents with a chronically swollen scrotum. A thick smear shows no microfilariae. What now?

  7. In a rural dispensary in Pakistan you are shown a patient who has microfilariae in the blood. These are sheathed so that it is said: "This can only be W. bancrofti." What do you think? Should M. perstans be considered?

  8. In Niger a well has been protected with a concrete wall so that water can now only be drawn with a bucket. It is thought that this will reduce the incidence of dracunculiasis, oxyuriasis, ancylostomiasis and bilharziasis. Do you agree?

  9. A patient in Gabon tells you that he has passed milky urine for many years. The day before yesterday he suddenly developed pain in the right side of the back, radiating to the genitalia. There was no trauma, there is no fever. What might have happened?

  10. A Malinese girl has had pain in the right knee for 2 weeks. The joint is swollen and warm. There is marked fever. You notice a moist wound on the lower leg. There has been no obvious trauma. On the following day she develops convulsions. She can only drink with difficulty. What is happening?

  11. Draw an Onchocerca microfilaria on your sheet (scale 1/1, i.e. without enlargement).

  12. How can you prove that someone living in an endemic region is not infected with microfilariae?

  13. Borneo. A 15-year-old boy is brought to you with pitting oedema of the lower legs. Protein determination in the blood shows severe hypo-albuminaemia. There is no malnutrition. Can chyluria be a cause? How do you test for this in your hospital? If the test is positive, what do you propose to do?

  14. Papua New Guinea. A patient with severe asthma responds less than usual to her aerosol with beta-2-mimetics. Acute bronchitis is diagnosed and ampicillin started. The dyspnoea increases and steroids are added. Over the course of time the patient improves, only to relapse during the following weeks. The attacks become more severe. You advise her once again to stop smoking. Tuberculosis examination is negative. She develops numerous black and red stripes on the skin and is confused. There is no improvement with an oxygen mask. The sputum contains many Charcot-Leydig crystals, but no Paragonimus eggs. What else might you look for in the sputum? Other possibilities?

  15. Onchocerciasis control:

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