Persistent haemorrhagic ascites in generalised haemolymphangiomatosis: a therapeutic dilemma.

s ofSurgery 1953;96:209-27. (In Surg Gynecol Obstet 1953; March) 2 Jack HT, Chang J, Newkirk G, Carlton JD, Miller JD, Orsoni E. Generalised lymphangiomatosis with chylous ascites-treatment by peritoneovenous shunting.I PediatrSurg 1980;15:748-50. 3 Leveen HH, Vujic 1, D'Ovidio NG, Hutto RB. Peritoneovenous shunt occlusion: aetiology, diagnosis, therapy. Ann Surg 1984;200:212-8. (Accepted 3 February 1987) George Eliot Hospital, Nuneaton CV1O 7DJ BERNARD J SMITS, FRcp, consultant physician E PULLICINO, mRcp, registrar in general medicine ANNE NICOLSON, MRCP, senior registrar in general medicine G A COURT, FRcs, consultant surgeon Strongyloides stercoralis infection in Burma Star veterans Infections with the nematode worm Strongyloides stercoralis may persist for many years after exposure, by autoinfection. The condition is well described among former second world war prisoners of the Japanese' and occurs in over a fifth ofthose who worked on the infamous Thai-Burma railway.2 Most infections cause a "creeping eruption" or "larva currens" eruption--in itchy, serpiginous urticarial rash which occurs intermittently, usually over the trunk. The real danger of strongyloidiasis, however, is the potentially fatal hyperinfection syndrome, -which may occur when infected subjects become immunosuppressed-particularly with corticosteroid drugs.3 Soldiers ofthe second world war Burma campaign fought in areas endemic for strongyloidiasis. They usually had reasonably adequate footwear, however, making them much less liable to infection (which is acquired by skin penetration of free living soil larvae). Nevertheless, we have recently described a case of strongyloides infection in a British Burma Star veteran,4 diagnosed 40 years after tropical exposure. We therefore attempted to determine the prevalence of strongyloidiasis among this group ofmen. Patients, methods, and results We circulated a questionnaire at two reunion meetings of the Burma Star Association in 1985 in Bridlington and London. These questionnaires asked whether members suffered a creeping eruption type of rash, which was described in detail (colour photographs of the rash were also distributed). Those who responded positively were contacted further by post, and if their rash was considered typical inIvestigations were arranged (three stool samples for microscopy and larval culture, blood eosinophil count, and an enzyme linked immunosorbent assay (ELISA) serum test for strongyloides). Of 566 who replied to the questionnaire, three men were finally found to have strongyloidiasis-a prevalence of 0 53%. These were all successfully treated with mebendazole.