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Malaria infections has been an important public health problem in Europe and Western countries in the last years. The international travels and moreover immigration from Africa and Asia countries has been rapidly increasing especially in Italy. The transmission and diffusion of malaria has increased, especially over last decade, due to vector resistance to insecticides and chemoresistance of these parasites to most antimalarial drugs. The authors presents a severe case of malaria infection that was caused by Plasmodium Falciparum in a one year-old female children, born in Italy, infected during a return in the parents' country of origin, Nigeria. She was admitted because of febrile gastroenteritis for five days. Since the child was in a good state of health, normal the medical examination, blood tests and radiography of the chest. The next day, persisting the fever, the child was somnolent, pale, and was present a haemoglobin concentration of 5.1 g/dl and a thrombocytopenia, a complicated falciparum malaria was diagnosed (8% parasitaemia). Treatment was started immediately with a single oral dose of Mefloquine (25 mg/Kg). Red blood cells were transfused once. The parasitaemia dropped to 4% and 0.8% in less than 48 hours. Weekly controls for the following four weeks remained negative.
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PMID:[A severe case of Plasmodium falciparum malaria]. 1138 69

The present population in South Africa, roughly 43 million inhabitants, is made up of Africans (77.2%), whites (10.5%), Coloureds (mixed race) (8.8%) and Indians (2.5%). In 1900 the infant mortality rate (IMR) among Africans was 330 per 1,000 live births; this has now fallen to 50-60. In Soweto, a primarily African city, IMR averages 20-25. Life expectancy in the past was only 25-30 years; by 1995, this reached 63 years. However, this could fall again due to the rapidly spreading HIV/AIDS epidemic. Life expectancy could fall to 40-45 years by 2010 with the AIDS epidemic being the cause of half of all deaths--a disastrous change from the previous relatively commendable public health situation. Formerly, the most common causes of deaths in young people were infections, diseases associated with malnutrition and gastroenteritis. Adults died almost solely from infections, including typhoid, dysentery, malaria and tuberculosis (TB). Even though diseases associated with malnutrition are less common today, many infections still remain a major problem, particularly TB, which is increasing. As late as 1970, Africans who reached 50 years had longer life expectancy than whites due to the low prevalences of the chronic diseases of lifestyle. This is no longer so, due to the recent rises in non-communicable disorders/diseases, principally obesity in women, hypertension, diabetes, stroke and the cancers of prosperity. In the not so distant future, the level of control of HIV/AIDS related diseases will be the major health/disease regulating factor among Africans. Among white, Coloured and Indian populations, there have been falls in the mortality rates of the young and, despite rises in lifestyle diseases, increases in life expectancy are continuing. For all populations other important public health regulatory factors include water supply, sanitation, clinic/hospital services and personal environmental factors, employment, dietary pattern and intake, smoking practices and alcohol consumption and physical activity, particularly in urban dwellers. Unfortunately, public health expenditure, also a highly regulating factor, has fallen from 8.2% of the gross domestic product in 1994 to 4.1% in 2000.
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PMID:Changes in public health in South Africa from 1876. 1146 13

We reviewed 232 consecutive patients admitted to a tertiary-care hospital under the care of an infectious diseases unit for management of febrile illness acquired overseas. A total of 53% presented to hospital within 1 week of return and 96% within 6 months. Malaria was the most common diagnosis (27% of patients), followed by respiratory tract infection (24%), gastroenteritis (14%), dengue fever (8%), and bacterial pneumonia (6%). Pretravel vaccination may have prevented a number of admissions, including influenza (n=11), typhoid fever (n=8) and hepatitis A (n=6). Compared to those who had not traveled to Africa, those who had were 6 times more likely to present with falciparum than nonfalciparum malaria. An itinerary that included Asia was associated with a 13-fold increased risk of dengue, but a lower risk of malaria. Palpable splenomegaly was associated with an 8-fold risk of malaria and hepatomegaly with a 4-fold risk of malaria. As a cause of fever, bacterial pneumonia was > or =5 times more likely in those who were aged >40 years.
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PMID:Fever in returned travelers: review of hospital admissions for a 3-year period. 1148 83

A total of 446 infants in the first 6 months of life who presented at an urban children's hospital with complaints of any illness whatsoever were recruited into a study with the aim of determining the contribution of malaria to infant morbidity in a malaria-endemic urban area in Nigeria. Sixty-eight of the infants were in their first month of life and 79, 77, 61, 97, and 64 were in their second, third, fourth, fifth and sixth month of life, respectively. Overall, 107 (24.0%) infants were clinically diagnosed as having malaria. This included 3 who were in the first month of life, 12 in the second, 15 in the third, 17 in the fourth, 33 in the fifth, and 27 in the sixth months of life (4.4, 15.2, 19.5, 27.9, 34.0, and 42.1%, respectively). Laboratory investigations confirmed 35 (32.7%) of those clinically diagnosed and 86 (25.4%) of those not clinically diagnosed (n = 339) as having malaria parasitemia, giving an overall malaria parasite rate of 27.1% among the infants. Acute respiratory infection was the major diagnosis (41.3%) among those that were not initially diagnosed as malaria but turned out to have malaria parasitemia followed by gastroenteritis (11.8%) and failure to growth (1.5%). Overall geometric mean parasite density was 202.5 parasites/microL of blood (range, 12-65,317 parasites/microL of blood). The mean hematocrit of infants with parasites (33.0%) was significantly lower (P < 0.005) than that of infants without parasites (35.1%). The mean hematocrit of infants with malaria parasites in each age group was lower than that of infants without malaria parasites in the corresponding age group. Among the infants with malaria parasites, those aged 2 to 2.9 months recorded the lowest mean hematocrit (30.1%), and those aged < 1 month recorded the highest mean hematocrit (42.7%). Axillary temperature increased and hematocrit decreased with increase in parasite density. The percentage of infants with anemia likewise increased as the parasite density increased. Plasmodium falciparum was present in all infected infants, but mixed infection with P. malariae was present in only 2.5% of infections. Analysis of our data suggests an urgent need for health education of caretakers and for training of clinicians for increased awareness of malaria as an important cause of illness and anemia in infants aged < 6 months so as to reduce children's wasting due to an easily preventable and treatable disease.
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PMID:Malaria in the first 6 months of life in urban African infants with anemia. 1179 80

In the first half of the 20th century, improved living conditions, preventive measures, vaccines and antibiotics led to a marked reduction in morbidity and mortality from infectious diseases. It was predicted that the conquest of all infectious diseases was imminent. However, 50 years later, in 1999, they were still the major cause of disease worldwide, and caused nearly one third of all deaths (a total of 55.9 million). The eradication of smallpox in the 1970s and the approaching eradication of poliomyelitis represent major achievements. The prevalence of measles, pertussis and tetanus neonatorum is also markedly reduced, but still 1.5 million children in developing countries die each year because of lack of vaccines. Malaria and tuberculosis are re-emerging. Tuberculosis and HIV/AIDS are the diseases with known aetiology that cause most deaths, altogether 5 million each year. Respiratory and gastrointestinal infections cause 6.5 million deaths annually. Infections in the immunocompromised host have become a "trade mark" of today's advanced medicine. Almost every year, new diseases related to new micro-organisms are described; over the last 30 years, approximately 40 new diseases/micro-organisms have been diagnosed. Among the best known are HIV/AIDS, peptic ulcer caused by Helicobacter pylori, Legionnaires' disease, borreliosis (Lyme disease), hepatitis C, gastroenteritis caused by rotavirus, and Ebola haemorrhagic fever. Antimicrobial resistance development of micro-organisms has become one of the major health problems worldwide; a number of preventive measures are being introduced.
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PMID:[Microorganisms strike back--infectious diseases during the last 50 years]. 1180 14

The ease of access to air travel and its increased popularity over the last 30 years have led to a significant incidence of imported infectious diseases and potential infectious hazards. The commonest type of illness found is acute gastroenteritis. Tuberculosis and malaria are not currently common conditions encountered in the UK, but medical vigilance is increasingly necessary as a result of these and other infectious diseases being carried by arriving air travellers. Risks of transmission to other passengers have been considered, and tuberculosis has been shown to have relatively low infectivity on commercial flights. Incidence of serious communicable disease occurring in arriving passengers is low, and should be referred to communicable disease specialists for advice on management. High standards of precautionary hygiene measures are mandatory to commercial aircraft to prevent spread of infectious agents. Disease vectors and products of animal origin pose additional potential threats to public health. Vigilance by environmental health specialists helps maintain national defences against this group of threats. Alertness to recent travel history and awareness of international public health concerns is essential for clinicians likely to encounter sick members of the travelling public. The largest commercial airports have health surveillance units, tasked with acting as a first line of defence against infectious disease. The majority of cases do not present in flight or at the airport, so they can present to any primary care clinician or emergency department. An integrated strategy for health protection will be developed in the UK with the setting up of a Health Protection Agency.
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PMID:Infectious diseases in air travellers arriving in the UK. 1213 73

A study of 256 annual reports from 17 rural tropical hospitals in 4 African countries over a period of 16 years showed an absolute increase in the number of patients admitted with infectious diseases. Admissions were highest for malaria, followed by pneumonia and gastroenteritis. Admissions for immunisable diseases are decreasing in all countries. Fever remains the most important indicator of infectious diseases. Analysis of fever patients in rural tropical hospitals relies on knowledge of the epidemiology of diseases, plus expertise in physical examination. In this study, a detailed analysis of 900 fever patients indicated that 4% showed no infection, 21% of infections could be diagnosed by physical examination, 35% were diagnosed with the help of additional laboratory tests and 40% of patients were diagnosed as FUO (fever of unknown origin). 17% of FUO patients had a short, self limiting fever, but the remaining 23% were severely ill, suggesting bacterial sepsis, as was indicated by earlier studies. Undiagnosed fevers with resulting over-treatment and high resistance are costly and dangerous. These effects stress the need for better and more laboratory facilities, including possibilities for bacterial cultures. At present, patients are generally over-treated with antimalarials and antibiotics, since further diagnostic facilities are not available. Resistance is high for antimalatials ( Malaria) and for Amoxycillin, Cotrimoxazole and Gentamicin (Gram-bacteria from urine and blood).
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PMID:Analysis of infectious diseases in rural tropical areas. 1215 52

A new project supported by the Pathfinder Fund to serve migrant farm workers has been developed in Adana Province, a populous region in southern Turkey. The economy their is primarily agricultural, with some heavy industry. As estimated 100,000 migrant workers are needed to planting and harvesting in this region. They make between $55-$60 a month, which is about 1/3 of the minimum age. Most migrant workers travel long distances to Adana where they live in tents. Living conditions are poor, with no running water or toilets. Malaria, gastroenteritis and intestinal parasites are endemic. Unofficial figures show that over 75% of school children have intestinal parasites. UNICEF has helped with vaccinations, maternal and health care, and powdered milk distribution. Most Turkish workers are covered by social security laws that provide health care for them. Almost non of the migrant workers are covered by social security. Surveys show that 80% of migrant workers desire 4 or more children, usually due to economic conditions, (i.e. labor for increased family income). The rates of miscarriage, morbidity and mortality are very high in August and September because pregnant women try to work until the very last day of the term. The pilot program in Adana increased the number of health centers per workers, as well as offering extended evening hours. Health clinic trailers were rotated as needed within the region. The program provided general health care, vaccinations, pre natal and post natal maternity care and a sharp focus on family planning. The year long pilot program was considered wildly successful. This was attributed, in large part, to the extended evening hours of the clinics as well as mobility of the trailers. Also, finances provided by the Fund were also crucial for implementation.
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PMID:Family planning for seasonal migrant workers in Adana Province, Turkey. 1231 53

The Emergency Department, the showcase of the hospital, must be functional at all times with sufficient resources for looking after the patients without delay. In the Medical Emergency Department of the Yalgado Ouedraogo national hospital of Ouagadougou (Burkina Faso), problems such as delays and difficulties to obtain medicine, give rise to conflicts thus causing the hospital to be a target for public criticism. The aim of this study is to establish the profile of the patients and to assess how they are taken care of. A cross-sectional survey was carried out for 21 consecutive days spread out over three months, from April 25 to June 25, 1997 and concerned all of the 551 patients consulting on those days. The self referral rate was 50.8%. Patients came mainly from the Kadiogo province (90.7%), with their own transport means (85.1%), more often at the beginning of the week (31 patients per day on average) than during week ends (21 patients per day on average, p<0.001). The age group was 15 to 93 years with a mean of 35.4 ( 14,2) years. Infectious diseases, particularly gastroenteritis (21.3%), malaria (12.1%), and pneumonia (10.2%) were the main diagnoses. The median waiting time was 8 min (from 0 to 3 h 59 min), the median therapeutic time was 56 min (from 5 min to 16 h 19 min). Patients were supplied with medicine in 14.5% of cases. Thus median medicine acquisition time was significantly reduced from 35 min to 21 min (p<0.001) when medicines were bought. Medicine acquisition time significantly contributes to increase the therapeutic delay (rs=0.31; p<0.001). The median therapeutic time was 56 min (5 min to 16 h 19 min). The diagnostic accuracy rate was 77.4%, and the satisfaction index 3.5%. Patients expenditure was 9,002 CFA francs on average, including 7,963 CFA francs for medicine. Thus access to medicine constitutes a major point of malfunction, increasing the caretaking time span as well as patients' expenditure. In addition to quickly and systematically supplying medicines to all patients, organizing the reception and providing comfortable waiting conditions must be considered in order to offer better care delivery services.
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PMID:[Medical emergencies in the Yalgado Ouedraogo national hospital of Ouagadougou: patients' profile and assessment of care practices]. 1247 25

Ectopic pregnancies can be very difficult to diagnose at initial admission. This paper reviewed the morbidity and mortality associated with misdiagnosis of ectopic gestation over a 15-year period (1985-99) at Ile-Ife, Nigeria. There were 380 confirmed ectopic pregnancies of 35 857 live births, giving an incidence of 10.5 per 1000 live births. Of the 380 cases, 38 (10%) were misdiagnosed initially at presentation. Mistaken diagnoses include pelvic inflammatory diseases, cholera, acute appendicitis, typhoid enteritis, incomplete septic abortion, uterine fibroid with menorrhagia, malaria, gastroenteritis, peptic ulcer and intestinal obstruction. There were five maternal deaths among the 38 misdiagnosed cases compared to two maternal deaths among the 342 initially correctly diagnosed cases. Significant morbidity included prolonged hospital stay, increased hospital costs and an enterocutaneous fistula. To improve the chances of correct diagnosis at initial admission, accurate menstrual and sexual history should be obtained. Facilities for improved diagnosis such as serum beta HCG and transvaginal ultrasonography should be provided. Colleagues from other specialities should be educated to increase their suspicion of ectopic pregnancy in any woman of childbearing age and perform the appropriate investigations.
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PMID:Mortality and morbidity associated with misdiagnosis of ectopic pregnancy in a defined Nigerian population. 1252 28


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