CORRESPONDENCE
Pride or prejudice? To the editor: Re Doug's Digest (Can
Med Assoc 1 114: 817, 1976). Mr. Geekie doth protest too much, methinks. Roy LE RICHE, Ml) College of Physicians and Surgeons 9901 - 108 St. Edmonton, AB
Bithionol therapy in Clonorchis sinensis infestation in Canada To the editor: Clonorchis sinensis infestation is endemic in Indochina, Hong Kong, Taiwan and Japan1" and is acquired by humans from ingestion of uncooked fresh-water fish of the carp family. Many patients have no ill effects and the diagnosis is made accidentally when ova are found in the stool.34 In heavy infestation the patient may present with cholangitis, hepatitis, cholecystitis, pancreatitis, a malignant tumour of the liver, or a hepatobronchial or biliarobronchial fistula. A 42-year-old man, who was born in China and last visited Hong Kong in 1965, was referred to the University of British Columbia respiratory clinic at Vancouver General Hospital Aug. 22, 1975 with a severe asthmatic attack. Bronchial asthma had developed 3 years earlier and he had had three major attacks, one of which had necessitated hospitalization in 1974. At that time stool examination had revealed numerous C. sinensis ova. A course of chloroquine therapy had not eradicated the parasite. His asthma had been treated with prednisone, oxtriphylline (Choledyl) and theophylline-ephedrine-phenobarbital (Tedral) but his breathlessness and wheezing had persisted. Serum concentrations of electrolytes, liver enzymes and protein, protein electrophoresis, liver scan and electrocardiogram were normal. Chest radiography revealed overinflation of the lungs but no inflammatory changes. Blood count was Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
normal except for an absolute eosmophil count of 900 x 106/i. His respiratory symptoms were alleviated after 14 days of intensive therapy, and he was discharged taking aminophylline, prednisone and beclomethasone aerosol. Because of the persistence of C. sinensis ova in the stool it was decided to try giving the patient bithionol (2,2'-thiobis(4,6dichlorophenol]), the use of which, in this disease, was new and experimental. Initial treatment was started Sept. 8, 1975 with 1000 mg of bithionol (Bitin) bid on alternate days, as recommended by Tanabe Pharmaceutical Company, Osaka, Japan,6 for a total dose of 18 g. At the end of the first course liver function values were normal (serum glutamic oxaloacetic transaminase, 30 IU; lactic dehydrogenase, 183 IU; and alkaline phosphatase, 95 IU). Hemoglobin value was 14.7 g/dl; proportion of reticulocytes, 3.5%; hematocrit, 44.1%; platelet count, 182 x 10./l; leukocyte count, 11.0 x 10'/I (neutrophils, 72%; lymphocytes, 19%; monocytes, 3%; eosinophils, 6%; absolute eosinophil count, 720 x 106/I). Serum electrolyte values were normal during and after the first course of therapy. On Nov. 3, 1975 the second course was started, again at 1000 mg bid on alternate days, as recommended by Tanabe Pharmaceutical Company,6 ior a total dose of 20 g. The laboratory results were normal. In spite of the two courses of bithionol therapy the parasite was not eradicated from the patient's stools. His asthma is now easier to control, but this is likely due to the addition of beclomethasone aerosol to the therapeutic regimen. The treatment of C. sinensis infestation has been a problem for many years and no remedy has yet been found to be universally effective.4 Bithionol apparently eradicates the liver fluke in animals and is claimed to be effective in the treatment of paragonimiasis (infection with the lung fluke) in man.6 The drug's side effects are limited to abdominal cramps 3 to 4 hours after ingestion of the drug, accompanied by loose watery stools; there has been no evidence of hepatotoxicity or damage to the kidneys, bone marrow, erythrocytes or platelets. The recommended dosage for a man of average weight is
1 g twice a day on alternate days for 20 to 30 days. The results of bithionol therapy in two cases of liver fluke infestation outside Japan have not been impressive.4 Although the drug may be effective in the treatment of paragonimiasis, it does not seem to eradicate C. sinensis in man. The drug is not available in Canada or the United States except under special permission. We thank Dr. R.C. Rhodes for referring the patient to the UBC respiratory clinic, and Col. R. Dupuis of the Canadian Armed Forces for releasing bithionol for the study. SAMUEL M. SEPUYA, MD University of British Columbia Respiratory clinic 745 west 10th Ave. Vancouver, BC
References i. PACHECO G, wYKOFF DE, JUNG RC: Triai of an indirect hemagglutination test for the diagnosis of infections with Clonorchis sin-
ensis. Am I Trop Med 9: 367, 1960 2. Hou PC, PANG L5C: Clonorchis sinensis infestation in man in Hong Kong. I Pathol Bacteriol 87: 245, 1964 3. GIBSON JB, SUN T: Chinese liver fluke Clonorchis sinensis. Its occurrence in Hong Kong. mt Pathol 6: 94, 1965 4. HARTLEY JPR, DOUGLAS AP: A case of donorchiasis in England. Br Med 1 3: 575, 1975
5. HoU PC: Hepatic cionorchiasis and carcinoma of the bile duct in a dog. I Pathol
Bacteriol 89: 365, 1965
6. Tanabe Pharmaceutical Company, Osaka, Japan: Commercial information sheet (unedited translation)
Fatal mucocutaneous lymph node syndrome - in Canada? To the editor: In the recent pediatric literature several reports by Japanese authors have described what may be a new disease in young children. Tentatively it has been called mucocutaneous lymph node syndrome (MLNS).1 The main symptoms are fever, conjunctival congestion, reddening of the soles and palms with later desquamation, cervical lymphadenopathy and a polymorphous exanthem of the trunk. There is often myocarditis, pericarditis, arthralgia, proteinuna, leukocytosis, increased erythrocyte sedimentation rate (ESR) and negative
CMA JOURNAL/AUGUST 21, 1976/VOL. 115
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Pride or prejudice? To the editor: Re Doug's Digest (Can
Med Assoc 1 114: 817, 1976). Mr. Geekie doth protest too much, methinks. Roy LE RICHE, Ml) College of Physicians and Surgeons 9901 - 108 St. Edmonton, AB
Bithionol therapy in Clonorchis sinensis infestation in Canada To the editor: Clonorchis sinensis infestation is endemic in Indochina, Hong Kong, Taiwan and Japan1" and is acquired by humans from ingestion of uncooked fresh-water fish of the carp family. Many patients have no ill effects and the diagnosis is made accidentally when ova are found in the stool.34 In heavy infestation the patient may present with cholangitis, hepatitis, cholecystitis, pancreatitis, a malignant tumour of the liver, or a hepatobronchial or biliarobronchial fistula. A 42-year-old man, who was born in China and last visited Hong Kong in 1965, was referred to the University of British Columbia respiratory clinic at Vancouver General Hospital Aug. 22, 1975 with a severe asthmatic attack. Bronchial asthma had developed 3 years earlier and he had had three major attacks, one of which had necessitated hospitalization in 1974. At that time stool examination had revealed numerous C. sinensis ova. A course of chloroquine therapy had not eradicated the parasite. His asthma had been treated with prednisone, oxtriphylline (Choledyl) and theophylline-ephedrine-phenobarbital (Tedral) but his breathlessness and wheezing had persisted. Serum concentrations of electrolytes, liver enzymes and protein, protein electrophoresis, liver scan and electrocardiogram were normal. Chest radiography revealed overinflation of the lungs but no inflammatory changes. Blood count was Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
normal except for an absolute eosmophil count of 900 x 106/i. His respiratory symptoms were alleviated after 14 days of intensive therapy, and he was discharged taking aminophylline, prednisone and beclomethasone aerosol. Because of the persistence of C. sinensis ova in the stool it was decided to try giving the patient bithionol (2,2'-thiobis(4,6dichlorophenol]), the use of which, in this disease, was new and experimental. Initial treatment was started Sept. 8, 1975 with 1000 mg of bithionol (Bitin) bid on alternate days, as recommended by Tanabe Pharmaceutical Company, Osaka, Japan,6 for a total dose of 18 g. At the end of the first course liver function values were normal (serum glutamic oxaloacetic transaminase, 30 IU; lactic dehydrogenase, 183 IU; and alkaline phosphatase, 95 IU). Hemoglobin value was 14.7 g/dl; proportion of reticulocytes, 3.5%; hematocrit, 44.1%; platelet count, 182 x 10./l; leukocyte count, 11.0 x 10'/I (neutrophils, 72%; lymphocytes, 19%; monocytes, 3%; eosinophils, 6%; absolute eosinophil count, 720 x 106/I). Serum electrolyte values were normal during and after the first course of therapy. On Nov. 3, 1975 the second course was started, again at 1000 mg bid on alternate days, as recommended by Tanabe Pharmaceutical Company,6 ior a total dose of 20 g. The laboratory results were normal. In spite of the two courses of bithionol therapy the parasite was not eradicated from the patient's stools. His asthma is now easier to control, but this is likely due to the addition of beclomethasone aerosol to the therapeutic regimen. The treatment of C. sinensis infestation has been a problem for many years and no remedy has yet been found to be universally effective.4 Bithionol apparently eradicates the liver fluke in animals and is claimed to be effective in the treatment of paragonimiasis (infection with the lung fluke) in man.6 The drug's side effects are limited to abdominal cramps 3 to 4 hours after ingestion of the drug, accompanied by loose watery stools; there has been no evidence of hepatotoxicity or damage to the kidneys, bone marrow, erythrocytes or platelets. The recommended dosage for a man of average weight is
1 g twice a day on alternate days for 20 to 30 days. The results of bithionol therapy in two cases of liver fluke infestation outside Japan have not been impressive.4 Although the drug may be effective in the treatment of paragonimiasis, it does not seem to eradicate C. sinensis in man. The drug is not available in Canada or the United States except under special permission. We thank Dr. R.C. Rhodes for referring the patient to the UBC respiratory clinic, and Col. R. Dupuis of the Canadian Armed Forces for releasing bithionol for the study. SAMUEL M. SEPUYA, MD University of British Columbia Respiratory clinic 745 west 10th Ave. Vancouver, BC
References i. PACHECO G, wYKOFF DE, JUNG RC: Triai of an indirect hemagglutination test for the diagnosis of infections with Clonorchis sin-
ensis. Am I Trop Med 9: 367, 1960 2. Hou PC, PANG L5C: Clonorchis sinensis infestation in man in Hong Kong. I Pathol Bacteriol 87: 245, 1964 3. GIBSON JB, SUN T: Chinese liver fluke Clonorchis sinensis. Its occurrence in Hong Kong. mt Pathol 6: 94, 1965 4. HARTLEY JPR, DOUGLAS AP: A case of donorchiasis in England. Br Med 1 3: 575, 1975
5. HoU PC: Hepatic cionorchiasis and carcinoma of the bile duct in a dog. I Pathol
Bacteriol 89: 365, 1965
6. Tanabe Pharmaceutical Company, Osaka, Japan: Commercial information sheet (unedited translation)
Fatal mucocutaneous lymph node syndrome - in Canada? To the editor: In the recent pediatric literature several reports by Japanese authors have described what may be a new disease in young children. Tentatively it has been called mucocutaneous lymph node syndrome (MLNS).1 The main symptoms are fever, conjunctival congestion, reddening of the soles and palms with later desquamation, cervical lymphadenopathy and a polymorphous exanthem of the trunk. There is often myocarditis, pericarditis, arthralgia, proteinuna, leukocytosis, increased erythrocyte sedimentation rate (ESR) and negative
CMA JOURNAL/AUGUST 21, 1976/VOL. 115
299
