We describe a case of type II mixed cryoglobulinemia, with monoclonal IgM rheumatoid factor, associated with visceral leishmaniasis caused by Leishmania infantum. Involvement of Leishmania antigen(s) in the formation of cryoprecipitable immune complexes was suggested by the fact that cryoglobulinemic vasculitis subsided after antiparasite therapy and that anti-Leishmania antibodies, as well as rheumatoid factor, were enriched in the cryoprecipitate. We observed 2 additional patients with visceral leishmaniasis and cryoglobulinemic vasculitis. All 3 patients had seemingly contracted leishmaniasis in Italy, were hepatitis C virus negative, and were initially diagnosed as having autoimmune disorders. These findings indicate that Leishmania can be an etiologic agent of type II mixed cryoglobulinemia. This parasitosis should be taken into consideration in the differential diagnosis of vasculitides in endemic areas.

About 85% of the population of two Somali communities harboured soil-transmitted intestinal nematodes and/or protozoa. The commonest parasite (75% in the Lafoole institution and 59% in the Afgoye institution) was Trichuris trichiura. Mixed infections were common. The source of infection is contaminated fields around dwelling quarters, because of indiscriminate defaecation. One of the factors responsible for the higher incidence of hookworm in Lafoole (45%) compared with Afgoye (1.5%) may be the different soil character of the surrounding fields.

In Somali nomads the incidence of intestinal helminths is very low compared with that observed in Somalian closed institutions and practically no Entamoeba infection occurs. Schistosoma haematobium eggs are observed in urine of 50% of adults nomads. Immunological tests reveal that the relative prevalences of leishmaniasis (the lowest), malaria, and toxoplasmosis (the highest) in nomads are similar to those shown by the same techniques in settled communities.

Hepatitis B virus (HBV) circulation was surveyed in three Somalian villages (Buur-Fuul, Mooda-Moode and Bajuni Islands) in different districts and 52 children living in a closed community, aged under one year, were studied. Of the 331 village subjects aged one to 83 years, 12.08% were HBs positive, 29.9% anti-HBs positive, 43.8% anti-HBc positive and 21.4 anti-HBe positive. Among the HBs-positive subjects, 34.7% had HBeAg and 21.7% had anti-HBcAg-IgM. No statistically significant differences were found for HBs, anti-HBs, anti-HBc and anti-HBe among the three villages. HBeAg prevalence was higher in Buur-Fuul than in Mooda-Moode and in Bajuni Islands. HBsAg prevalence was about the same for each age group studied, whereas the prevalence of anti-HBc showed a continuous rise and reached its maximum level of 43.8% in those aged 39 years and older. The proportion of HBs-positive subjects who also carried HBeAg was high in the youngest children but fell with age. HBs-positive children aged under one year had a high anti-HBc-IgM prevalence. Our finding suggests that perinatal infection may play an important role among the Somalian population in determining the reservoir of virus carriers.

Neisseria gonorrhoeae was isolated from 53 young females (6-14 years old) in a Somali orphanage. A male guardian was found to be the effective transmitter having sexually abused the children. All the bacterial isolates were of the same serogroup WI and the same serovar Aedih. This presents an unusual example of a tight geographic cluster of infected people which is often characteristic of gonorrhoea epidemics.