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Fasciola hepatica is a worldwide distributed zoonotic trematode incidentally infecting humans. Although often symptomatic, fascioliasis can cause a wide spectrum of disease. The diagnosis can be established by stool examination detecting ova of the parasite, although serological testing has a higher sensitivity and specificity in the acute phase of disease. This case presents a 24-year-old Somalian man admitted with jaundice and abdominal discomfort due to fascioliasis after chewing khat. The patient was treated successfully with a single dose of triclabendazole.

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A 34-year-old woman presented two weeks after a visit to Burma with fever peaking up to 39 degrees C, chills, non-productive cough, headache, muscle pain, shortness of breath and a painful swelling on the left lower leg. She was treated immediately with intravenous amoxycillin-clavulanic acid. The Gram negative causative agent of melioidosis, Burkholderia (previously Pseudomonas) pseudomallei, was cultured from samples taken beforehand. The patient then received ceftazidime. She recovered. In view of the risk of relapse she was treated with amoxycillin-clavulanic acid for a further six months. Melioidosis is endemic in Southeast Asia and Northern Australia. It is rarely seen outside these areas. The clinical spectrum of the disease is wide and varies from fulminating sepsis to a subclinical disease and may affect any organ system, usually the lungs. The mortality of the septicaemic form after adequate treatment is 40%. Surviving patients have a high relapse rate (4-20%). Melioidosis can become chronic with formation of abscesses or can remain subclinical for many years, probably because the microorganism can survive within phagocytic cells with a risk of reactivation at moments of immunosuppression. The optimal treatment consists of ceftazidime intravenously for at least two weeks followed by an eradication phase consisting of oral antibiotics for at least 3 months.

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A 28-year-old male refugee from Sierra Leone complained about a darker colour of his left leg with slight itching. A subcutaneous nodule on the left leg was an onchocercoma. After treatment with ivermectin the itch disappeared and the difference in skin colour slowly subsided.

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A 15-year-old boy presented with biochemical and histological hepatic abnormalities consistent with chronic aggressive hepatitis and concomitant hyperthyroidism. After treatment with antithyroid therapy not only the hyperthyroidism subsided but also the hepatic function normalized. Two years later, the hyperthyroidism and liver function disorders relapsed in combination with a striking vitiligo and once again the liver function normalized after treating the hyperthyroidism. The liver biopsy sample taken in remission showed a normal picture without signs of hepatitis, fibrosis or cirrhosis. The diagnosis of a polyglandular syndrome was made, of which three types have been described. At this moment the patient fits best in type 3, which is a rather heterogenic group. Recovery of chronic hepatitis by treatment of concomitant hyperthyroidism has never been described before.

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It is extremely important to look for tropical and other exotic diseases in travellers who return with illness or become ill after travelling. Especially tropical diseases and exotic infectious diseases have to be excluded because of their possible fatal outcome. On the other hand, many travellers return with 'common' not-exotic illnesses not related to their journey. When in such cases attention is only given to exotic causes of their illness, diagnosis can be delayed which may be harmful. This was the case in 5 patients: a woman aged 44 years who suffered for months from bloody diarrhoea since her return from Brasil, due to a rectal adenocarcinoma, a 61-year-old man with diarrhoea upon returning from Egypt, who had hairy-cell leukaemia, a 17-year-old boy who developed a ketoacidotic diabetic crisis whilst on a journey in Uganda, but in whose case the first thoughts went to malaria, a 50-year-old man who suffered from throat pain since a journey through East Africa, during which he contracted a flu-like disease, and in whom Kahler's disease was diagnosed, and 69-year-old man suffering from recurrent fever and cough, in whom a radiological lesion was observed in the thorax which proved to be part of Wegener's disease.

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A 38-year-old man was admitted with signs of meningoencephalitis. Tick-borne encephalitis was considered because the patient reported a tick bite during a vacation in South Germany and because of the biphasic course of the symptoms. Serology for tick-borne encephalitis was positive: this constituted the first reported positive serology outcome in the National Institute for Public Health and Environment in the Netherlands. Tick-borne encephalitis is an infection with a flavivirus transmitted by an infected tick, which is endemic in parts of Central and Eastern Europe. The neurological symptoms are meningitis, meningoencephalitis or meningoradiculomyelitis. In a small percentage of patients neurological symptoms persist. A reliable vaccine is available, but is not routinely recommended for tourists.

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OBJECTIVE: To analyse the efficacy of ELISA serology in patients with Strongyloides infection acquired during World War II and maintained through repeated autoinfection. DESIGN: Descriptive. SETTING: Laboratory of Parasitology, Faculty of Medicine, Leiden, the Netherlands. METHODS: Parasitological and clinical data on 193 ex-prisoners of war (South-east Asia) were presented previously (1990) by Verburg and De Geus. ELISA using L-3 S. ratti antigen was carried out with sera of these patients and the results were compared with those of repeated stool examinations using Baermann's method. RESULTS: All subjects harbouring larvae in repeated stool examinations (26) were positive in serology. In 21 out of 167 patients in whom no larvae could be demonstrated, specific antibodies were detected. Anamnestic information together with data on eosinophilia and IgE levels suggested that the majority of these subjects were actually infected. The serological prevalence of infection with Strongyloides stercoralis was 33% for those imprisoned in Burma and 4% for those who were prisoners of war in the former Netherlands East Indies. CONCLUSION: In the group of subjects studied, in whom Strongyloides infection was apparently maintained through a process of autoinfection for a period of over 40 years, serology appears a sensitive and specific diagnostic tool. Larvae could be detected in no more than 26 out of 47 serologically positive subjects.

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A survey was performed to estimate the prevalence of chronic strongyloidiasis among 145 Dutch ex-prisoners of war who had been working on the Burma-Thailand railway in 1943-1945, and 56 ex-internees in civil camps in the former Dutch East Indies. No infections were found in the latter group while in the Burma group 26 men (17.9%) had S. stercoralis larvae in their stools. Many of them suffered from larva currens, an urticarial skin disorder, cured by treatment. Examination of fresh stool specimens with the Baermann concentration technique gave better results than faecal cultures and microscopy of duodenal aspirate. Mean IgE level and eosinophil count were significantly higher in infected persons but the ranges are too wide to use these tests in diagnosing individual cases.

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Mondor's disease, a harmless superficial thrombophlebitis of mainly thoracic veins, was diagnosed in four patients. Two of them were initially suspected of carcinoma of the breast, while the two others were thought to have a helminthic infection. Symptoms, signs, pathology and aetiology of this disease are discussed.

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