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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Medical advice for the traveller is of increasing importance since in the past decade in industrialized countries there is a steady increase in numbers of travellers and distance travelled. Self medication was evaluated in 193 travellers to malaria-endemic areas. Diarrhoea, fever and headache were the most frequent symptoms. Antidiarrhoeal agents, analgetics/antipyretics, antibiotics and oral contraceptives were the drugs most often used by travellers. One case of mefloquine-resistant and chloroquine-sensitive Plasmodium falciparum malaria acquired in West Africa was reported, another patient took pyrimethamine/sulfadoxine because of suspected malarial fever. The main reasons for drug consumption in travellers to tropical and subtropical areas are functionally divided into 4 groups: vaccination and prophylaxis, medication during the outward and return journey, illness occurring during stay abroad and long-term medication. This classification should be considered when medical advice is given for travellers and is the basis for choosing the contents of a pocket dispensary for travellers.
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PMID:[Self-medication of 193 travelers in the tropics. Recommendations for clinical counseling of tropical travelers and organization of a tropical travel pharmacy]. 158 72

A randomized double blind study in long term malaria chemoprophylaxis was performed to compare the tolerability of Fansimef (1 tablet containing 250 mg mefloquine + 500 mg sulfadoxine + 25 mg pyrimethamine per week) with chloroquine (300 mg per week). 211 Austrian industrial workers and their families in Warri, Nigeria, participated in this study; 101 received Fansimef and 110 chloroquine for 3-18 months (mean 41 weeks). Prophylaxis was discontinued because of adverse effects in 7 volunteers in the Fansimef group (mainly insomnia, palpitations, dizziness, nausea and headache) and in 2 volunteers of the chloroquine group (headache and loss of hair in one volunteer, nausea, dizziness and vomiting in the other). Most of the adverse effects could be due to the mefloquine component. A few minor complaints of burning eyes, nausea and gastric pain were reported in both groups. Laboratory checks performed at 3-monthly intervals showed a slight, transient and clinically irrelevant (but statistically significant) increase of serum glutamic-oxalacetic transaminase and gamma-glutamyl transpeptidase at month 3 in the Fansimef group. An attack of acute Plasmodium falciparum malaria occurred in one volunteer 6 weeks after discontinuation of prophylaxis with Fansimef. Antibodies against blood stage parasites could be demonstrated by the indirect immunofluorescence test at different stages of the study, indicating that these two antimalarials are not causal prophylactic agents.
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PMID:Tolerability of long-term malaria prophylaxis with the combination mefloquine + sulfadoxine + pyrimethamine (Fansimef): results of a double blind field trial versus chloroquine in Nigeria. 290 58

Forty cases of cerebral Plasmodium falciparum malaria seen at San Lazaro Hospital, Manila, Philippines from 1979-1981 were reviewed. These cases represented 7% of all Plasmodium falciparum cases seen during this period. All of the patients had fever and headache, 73% confusion, 70% chills, 68% jaundice or abdominal pain, 60% sweats. Findings more frequent in the fatal compared to the non-fatal cases were: the presence of schizonts in the peripheral smear, oliguria, coma, convulsions, urinary incontinence, jaundice, pulmonary symptoms and vomiting. Fatal cases were less likely to be clinically diagnosed as malaria and more likely to be diagnosed as hepatitis than malaria. The treatment and management of these cases is discussed.
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PMID:Cerebral malaria at San Lazaro Hospital, Manila, Philippines. 717 Jun 37

In early 1992 in Tanzania, trained research assistants interviewed 20 rural medical aides (RMAs), 20 drug sellers, 120 patients at 20 dispensaries, and 120 customers of drug stores, all in Dar es Salaam, to examine knowledge and practices of health workers, drug sellers, and patients concerning malaria. The RMAs had adequate knowledge of the signs and symptoms of malaria (e.g., 90% for fever, 85% for headache, and 80% for painful joints). The drug sellers also had adequate knowledge of signs and symptoms (e.g., 80% for fever, 45% for headache, and 50% for painful joints). Even though chloroquine-resistant strains of Plasmodium falciparum malaria exist in Tanzania, all RMAs and most drug sellers (85%) believed that chloroquine could cure malaria. Further, it is the only antimalarial that the Ministry of Health provides its dispensaries. Just 65% of RMAs knew the correct dosage of chloroquine for people 14 years old and older. An even lower percentage of drug sellers knew the correct dosage (50%). Just 33.7% of patients and 22.5% of customers knew the correct dosage of chloroquine. An inadequate supply of chloroquine was available at 15% of dispensaries and 30% of drug stores. RMAs sometimes gave patients too few chloroquine tablets for a full course of therapy. Other drugs mentioned by RMAs to treat malaria were quinine, amodiaquine, cotrimoxazole, halofantrine, pyrimethamine/sulphalene, and pyrimethamine/sulphadoxine. Those mentioned by drug sellers included aspirin plus chloroquine, cotrimoxazole, pyrimethamine/sulphadoxine, and traditional medicines. These findings suggest that irrational drug therapy of malaria promotes resistant strains and prolongs the duration of illness. Introduction of treatment charts and health education promotion to the public are needed to improve malaria management at dispensaries and drug stores.
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PMID:Knowledge and management of malaria in Dar es Salaam, Tanzania. 818 61

The current formulation of halofantrine hydrochloride has poor absorption and bioavailability. A newly developed micronized formulation was evaluated for efficacy, safety and tolerance in the treatment of acute Plasmodium falciparum malaria. The study was conducted at a plantation hospital in northern Tanzania, where chloroquine resistance is common. Sixty in-patients with mild or moderate malaria were treated with 375-750 mg micronized halofantrine hydrochloride given in 3 equal doses, 6 h apart. Patients were followed up for 28 d after therapy. Treatment was associated with rapid parasite clearance (mean clearance time = 34.8 h), fever clearance (mean time = 20 h), and clinical improvement (70% of patients were free of all presenting symptoms within 2 d). The formulation was well tolerated clinically, although 3 patients (5%) developed mild pruritus after treatment which may have been drug-related. Haematological and biochemical studies did not indicate any significant toxicity. One patient, whose immediate recovery was uneventful, was found to have a headache and low parasitaemia 3 weeks after treatment. He was readmitted to the study and treated as before. Parasitaemia, fever and headache cleared rapidly and he remained aparasitaemic for 28 d.
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PMID:A new micronized formulation of halofantrine hydrochloride in the treatment of acute Plasmodium falciparum malaria. 824 83

Plasmodium falciparum malaria is endemic in the northern KwaZulu areas of South Africa. The clinical morbidity produced by this parasite has not been studied since the institution of the present malaria control programme. Fifty-nine patients were prospectively studied at a peripheral clinic during the peak malaria season; symptoms and signs of the infection, parasite loads, haemoglobin values and leucocyte counts were recorded in all patients. Haemoglobin and leucocyte counts were also measured in 37 control subjects without malaria. The commonest symptoms were persistent headache (100%), rigors (98%) and myalgia (93%). None of the patients presented with coma, pulmonary oedema, hypoglycaemia or algid malaria. Splenomegaly was found in 49%, hepatomegaly in 20% and mental confusion in 5% of patients. Mean parasite load was 1.71% and 57% of patients had parasite loads of < 1%. Anaemia of < 10 g/dl was significantly more frequent (P < 0.0001) in the patient group than in the control group. Leucopenia (white cell count < 4.0 x 10(9)/l) was present in 12 of 50 patients in whom it was measured compared with 2 controls (P = 0.0175). The results show a wide range of morbidity, without severe complications as presenting manifestations. Symptomatic infection in the presence of low parasite loads suggests that there may be little or no immunity in this population.
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PMID:Morbidity from falciparum malaria in Natal/KwaZulu. 845 85

The objective of this study was to report on a breakthrough of Plasmodium falciparum infection following a military exercise in central Kenya and the treatment regimens used. A series of case reports are presented from the three UK hospitals involved. Among 150 British soldiers who had been on exercises for five weeks in central Kenya, taking proguanil/chloroquine anti-malarial prophylaxis, seven developed symptomatic falciparum malaria. Initial symptoms, which started between 2 and 10 days before their return to England, included faintness, sweating, shivering, diarrhoea, headache and myalgia. Diagnosis was delayed from between 5 and 13 days after the first symptom. One patient was severely ill with 50% parasitaemia: he required intensive care, exchange blood transfusion and haemofiltration for acute renal failure. Compliance with chemoprophylaxis was not measured and anti-mosquito measures were not generally practised. However, British Army policy was amended in June 1993 so that mefloquine will be used in future rather than proguanil/chloroquine. It was concluded therefore that even in an educated and motivated population simple preventive measures are not observed. Chemoprophylactic compliance could be improved by changing to a simpler regime. Falciparum malaria is a medical emergency that requires urgent admission for confirmation of diagnosis, supportive and curative treatment. Its presence should be suspected in any ill traveller.
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PMID:Imported falciparum malaria in British troops returning from Kenya. 882 63

Background: The objectives of this study were (1) to compare the efficacy of Lariam (mefloquine) with that of Fansimef (mefloquine, sulfadoxine, and pyrimethamine), Fansidar (sulfadoxine and pyrimethamine), chloroquine, and placebo in suppressing asexual parasitemia in semi-immune persons living in an area endemic for Plasmodium falciparum malaria; and (2) to compare the tolerance of these drugs when taken over a prolonged period of time. Method: A randomized double-blind comparative placebo-controlled study was undertaken in the village of Biasso, 60 km from Abidjan in the southern part of the Ivory Coast, a region where P. falciparum malaria is endemic. Four hundred and ninety nine male volunteers (five parallel groups), who were inhabitants of Biasso, were involved. The main outcome measures concerned the incidence of malaria breakthroughs (acute malaria attacks) and the incidence of parasitemia. Results: Within this strictly defined epidemiologic context, prophylaxis, taken once weekly, proved to be fully protective (parasitic index: 0) in the Lariam, Fansidar, and Fansimef groups throughout the whole study period. Prophylaxis with chloroquine proved incompletely protective (parasitic index: 2.5) The most frequent side effects were pruritus (5.6%), diarrhea (1.2%) and headache (0.06%). No significant differences in the incidence of side effects in each group (chi-square test) was observed. All side effects were transient and judged to be mild by the investigators. Conclusions: Excellent efficacy was observed in the prophylaxis of P. falciparum malaria with Lariam, Fansidar, and Fansimef as compared to the partial protection provided by chloroquine. Safety and tolerance were comparable in all groups during the whole period of observation (5 months).
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PMID:Mefloquine in the Prophylaxis of P. Falciparum Malaria. 981 95

Malaria poses a major health risk to people who are exposed to infection in malaria-endemic areas. A randomized, double-blind, placebo-controlled study was conducted to determine the efficacy and safety of Malarone (250 mg of atovaquone/100 mg of proguanil hydrochloride per tablet) for the chemoprophylaxis of Plasmodium falciparum malaria in Zambia. Adult volunteers received a three-day treatment course of Malarone to eliminate pre-existing parasitemia and were then immediately randomized to treatment with either one Malarone tablet daily (n = 136), or one placebo tablet daily (n = 138) for at least 10 weeks. Malaria blood smears were prepared on a weekly basis and a failure of chemoprophylaxis was defined as any subject who had a positive blood smear, or who withdrew from the study due to a treatment-related adverse event. The prophylaxis success rates in the Malarone and placebo groups were 98% and 63%, respectively (P < 0.001). The most commonly reported adverse events with at least a possible causal relationship to study medication were headache and abdominal pain, which occurred with a higher incidence in the placebo group. No subjects were withdrawn from the study due to a treatment-related adverse event. Thus, Malarone appears to have an excellent safety and efficacy profile for the chemoprophylaxis of P. falciparum infection.
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PMID:A randomized, double-blind, placebo-controlled field trial to determine the efficacy and safety of Malarone (atovaquone/proguanil) for the prophylaxis of malaria in Zambia. 1034 23

The objective of this study was to determine the safety and efficacy of atovaquone and proguanil hydrochloride combination therapy for the prophylaxis of Plasmodium falciparum malaria in at-risk nonimmune subjects in South Africa. This open-label trial was conducted at research sites in South Africa during the main malaria transmission season, February through July. The study volunteers were temporarily living in, or traveling to, a malaria-endemic area. They received I tablet of 250 mg atovaquone and 100 mg proguanil hydrochloride once daily for up to 10 weeks. Subjects were monitored using sequential clinical and laboratory assessments. Thick blood smears were stained and evaluated by a central laboratory. An immunochromatographic test for P. falciparum was also used for on-site patient management. Prophylactic success was summarized using a 95% confidence interval for the proportion of subjects who did not develop parasitemia or who withdrew due to a treatment-related adverse event. A total of 175 subjects (15% women) were enrolled in the trial. The mean duration of drug exposure was 8.9 weeks. The combination of atovaquone and proguanil hydrochloride was well tolerated. The most frequently reported adverse events considered possibly related to study treatment were headache (7%), abdominal pain (2%), increased cough (2%), and skin disorder (2%). No serious adverse events were reported, and no treatment-emergent effects were noted for any laboratory variables. One subject who was noncompliant with therapy developed parasitemia, and 3 subjects withdrew due to a treatment-related adverse event (2 subjects with headache and 1 with nausea and dizziness). The prophylaxis success rate was 97%. In this study, atovaquone and proguanil hydrochloride combination therapy had an excellent safety and efficacy profile for prophylaxis of P. falciparum malaria in nonimmune subjects.
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PMID:Safety and efficacy of atovaquone and proguanil hydrochloride for the prophylaxis of Plasmodium falciparum malaria in South Africa. 1036 39


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