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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although the use of chloroquine (C) and hydroxychloroquine (HC) in the treatment of malaria prophylaxis during pregnancy is probably safe, the use of much higher doses for treatment of systemic lupus erythematosus (SLE) and rheumatoid arthritis during pregnancy has been controversial. We analyzed the cases of 24 pregnant women with a total of 27 pregnancies who had taken these drugs during their first trimester of pregnancy. C and HC were given in 11 patients with SLE, three with rheumatoid arthritis, and four for malaria prophylaxis. Most of these women had already been on antimalarial drugs for 1 to 172 months prior to pregnancy (mean, 32.2 months). Of the 27 pregnancies, 14 resulted in normal full-term deliveries, six were aborted due to severe disease activity or social conditions, three were stillbirths, and four pregnancies resulted in spontaneous abortions. No congenital abnormalities were detected in the 14 live births at ages between 9 months and 19 years (mean, 5.3 years). All these children are physically and developmentally normal with no clinical evidence of eye or hearing defects. The seven pregnancies that were associated with fetal loss occurred particularly in patients who had active SLE, although stillbirth and spontaneous abortion occurred also in patients with rheumatoid arthritis and in two of the three patients who had been treated prophylactically for malaria. Although of the 215 reported pregnancies with C and HC exposure, including our study, only seven (3.3%) had congenital abnormalities, the risk associated with antimalarials may be cumulative and further studies are needed to elucidate the safety of this drug later in pregnancy.
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PMID:Pregnancy outcome following first trimester exposure to chloroquine. 202 76

This paper reports on an in vitro culture system for the exoerythrocytic (EE) stage of Plasmodium berghei (P.b.) using embryonic lung cells. The system was first developed by our laboratory in China. The embryonic lung cells were isolated by trypsin digestion of a human embryonic lung obtained from a therapeutic abortion case and was designated as cell line Elu 8801. Anopheles stephensi mosquitoes were infected by biting P.b. ANKA strain infected Kunming mice and after 18-21 days were dissected under aseptic conditions for preparation of a sporozoite suspension. This suspension was used to inoculate the monolayer cultures of Elu 8801. Regular examination found that following a cultivation for 48 hours, up to 100 multinuclear EE schizonts of P.b. could be observed on 1 x 1 cm cover slide. Seventy-two hours later mature merozoites were seen among part of the schizonts. An intraperitoneal inoculation of the supernatant culture medium to mice could induce malaria infection which could be transferred to other mice by blood inoculation. When the mice infected with the second generation were allowed to feed A. stephensi, sporozoites developed in the mosquitoes. The results demonstrate that the human embryonic lung cell line Elu 8801 established in our laboratory is susceptible to P.b. ANKA sporozoites and can support the developmental maturation of EE stages, producing potentially infectious merozoites.
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PMID:[In vitro cultivation of the exoerythrocytic stage of Plasmodium berghei]. 206 49

Between October 1985 and September 1986, 488 children aged less than 15 years, 45 pregnant women, 21 other women and 18 men with tick-borne relapsing fever (TBRF) were seen at Mvumi Hospital, Central Tanzania. 88% of the children were less than 5 years old and 36% were less than 1 year. Twelve children were less than 1 month old and some of the 10 infants diagnosed at between 4 and 12 days of age were cases of congenital infection. The clinical features of TBRF in the children and pregnant women were compared with 129 children with a similar age distribution and 52 pregnant women, respectively, who had blood smears positive for malaria but negative for spirochaetes. The common presenting features in children with TBRF were a high fever, splenomegaly, convulsions, and meningism. The difficulty of differentiation from malaria is described. Severe disease in both children and adults was associated with high density of spirochaetes in blood smears. Of the 45 infected pregnant women, 22 (49%) went into labour. One of the deliveries was an abortion and 10 were preterm infants, 4 of whom died. There were no maternal deaths. The estimated overall mortality for children was 1.6%, and 2.3% for those aged less than 1 years; for the 95 children admitted it was 8.4%. Penicillin was a satisfactory treatment for all ages, with a relapse rate of 4.7%. Recommendations for patient management are given.
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PMID:Tick-borne relapsing fever in central Tanzania. 209 23

The fact that economic progress has a bearing on health can be seen in most developing countries where widespread poverty causes poor health and high mortality. Childhood mortality is highest in Africa and in Southern Asia. The rate of decline in mortality has decreased in these areas since the 1950s. In Sri Lanka, approximately 5% of the children 5 years old die, yet yearly 1/3 of the children 5 Afghanistan and a few West African countries die. In less developed countries, adult mortality is high: in places where the life expectancy of a 15-year-old is under 50 years, 30-40% will die before age 60. 80-90% of the deaths from water and food borne diseases are accounted for by diarrhea and dysentery, and 60-70% of the deaths from airborne diseases by pneumonia and bronchitis. Present estimates from 4 localities indicate that measles, malaria, tetanus, and acute respiratory infection account for more than 90% of all child mortality. Various estimates suggest that there are 100-300 million cases of malaria and 1-2 million malaria-related deaths annually. Estimates indicate a ratio of abortions varying between 9/1000 live births in East Africa to 325/1000 live births in Latin America. 1986 WHO data indicate that induced abortion is responsible for 7-50% of all maternal deaths in developing countries. More than 90 countries now that operational diarrheal disease control programs, 47 countries are producing oral rehydration solutions, 8450 health personnel have been trained in diarrhea program supervisory skills, and oral rehydration use rates are slowly rising.
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PMID:Identifying health problems and health research priorities in developing countries. 266 49

The cause of fetal loss in malaria is not known. We report that a small (1.5-5.0 micrograms) intravenous dose of recombinant human tumor necrosis factor (TNF) caused fetal death and abortion in 16 day pregnant mice that were carrying low densities of Plasmodium vinckei. In contrast, 50 micrograms human TNF did not cause fetal death or abortion in uninfected 16 day pregnant mice. Endogenous TNF, which was not detectable in plasma of low parasitemia animals, pregnant or not, was present (1.6 +/- 0.9 ng/ml) in samples from malarial pregnant mice when, on day 17, parasitemia was high and the first signs of impending abortion were evident. No TNF was detectable in the plasma of uninfected mice at day 17 of pregnancy. A small dose of TNF also caused fetal death in 16 day pregnant mice that had received an intravenous injection of Coxiella burneti extract 9-10 days earlier. Thus, TNF-induced abortion may occur in a range of infections in which systemic macrophage activation occurs and a trigger for TNF release is present.
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PMID:Tumor necrosis factor in malaria-induced abortion. 317 38

43 determinants of low birth weight were analyzed from 895 published papers in the English and French literature from 1970-1984. The assessment was limited to singleton births of women living at sea level with no chronic illness; rare factors and complications of pregnancy were excluded. The 43 factors were categorized as genetic and constitutional, demographic and psychosocial, obstetric, nutritional, maternal morbidity during pregnancy, toxic exposure and antenatal care. The existence and magnitude of a causal effect on birth weight, gestational age, prematurity and intrauterine growth retardation were determined by a set of methodological standards. In developed countries, the most important factor was cigarette smoking, followed by nutrition and pre-pregnancy weight. In developing countries the major determinants were racial origin, nutrition, low pre-pregnancy weight, short maternal stature, and malaria. Pre-pregnancy weight, prior premature birth or miscarriage, diethylstilbestrol exposure and smoking were major determinants of gestational duration, but the majority of prematurity was unexplained in both developed and developing countries. There is a need for future research on the effect of maternal work, prenatal care, and certain vitamin and mineral deficiencies on intrauterine growth, and the effect of genital tract infection, prenatal care, maternal employment, stress and anxiety on prematurity.
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PMID:Determinants of low birth weight: methodological assessment and meta-analysis. 332 2

There is evidence that pregnancy enhances the clinical severity of malaria, especially of P. falciparum infections. In pregnant women with little or no prior experience of the disease, P. falciparum causes severe clinical illness, substantial malaria mortality, increased rates of abortion and stillbirth and low birthweight of offspring; moreover, in such women, the clinical consequences seen unmodified by maternal parity. However, in pregnant women resident in highly endemic areas who have acquired considerable immunity through prolonged prior contact with malaria, parity appears to influence susceptibility to an important degree. Women who are pregnant for the first time are most affected, showing increased prevalence and density of parasitaemia, increased frequency of clinical illness (but not mortality) and significantly increased frequency of delivery of low birthweight children. In contrast, in multigravid women these clinical features are much less obvious and rarely attain statistical significance. The differences in susceptibility to malaria of pregnant women associated with parity and previous immunological experience require that protective strategies must be planned with full knowledge of the local epidemiology of malaria and be specifically targeted to the women who require them. Furthermore, the effectiveness of each strategy requires careful monitoring to permit such modifications as may be required by change in the immune status of the resident population.
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PMID:Thoughts on malaria in pregnancy with consideration of some factors which influence remedial strategies. 333 80

The case notes of all patients who died over the January 1980 to December 1985 period in Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia, as a result of conditions associated with pregnancy, labor, and puerperium were reviewed in an effort to identify the most common causes of maternal death. Postpartum autopsy seldom was possible; consequently, the cause of death was based on clinical findings only. 216 deaths occurred over the 6-year period; there were 22,404 live births in the same period, giving a maternal mortality rate (MMR) of 9.6/1000. This rate included deaths from complications following abortions. 197 of the deaths occurred in women who were not booked into Tikur Anbessa Hospital. In terms of direct causes of death, abortion, puerperal sepsis, and ruptured uterus together accounted for 75.9% of deaths. Of indirect causes, infectious hepatitis, relapsing fever, and malaria accounted for 56.8% of deaths. Of deaths due to abortion, 21/48 occurred in nulliparas, and 25 were below age 19. Of the deaths caused by ruptured uterus, 20/29 occurred in multipara, and all of those women were from rural areas. The majority of deaths from hepatitis occurred in the 30-34 years age group. In Ethiopia, the maternal mortality rate is high because of both poor or inadequate antenatal and postnatal care as well as because of poor transportation and communication systems.
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PMID:A six-year review of maternal mortality in a teaching hospital in Addis Ababa. 341 42

The pathological changes associated with malarial infection in pregnancy were studied in rats and mice infected with Plasmodium berghei at different stages of gestation. Histopathological and ultrastructural studies of infected placentae near term in both species revealed disruption of architecture with gross thickening and necrosis of cells in the labyrinthine zone and fibrosis of the trilaminar trophoblast separating the maternal and fetal circulations. In the mouse, the extent of histopathological alterations in infected placentae ranged from the presence of immature erythrocytes in the fetal circulation in low grade maternal infection, to the marked deposition of fibrinoid material on the trilaminar trophoblast and inflammatory masses in severely infected placentae. In the rat, histopathological aberrations in the placentae were marked by placental stroma edema, fibrosis, and cellular infiltration. Immunohistological studies of cryostat sections of placentae from infected animals showed more parasites and pigment in infected mouse placentae than in the corresponding rat organ, but in both species parasites and pigment were largely confined to the maternal blood spaces and were only occasionally found in necrotic areas of trophoblast. No clear differences were observed between infected and control placentae in terms of the amount of IgG, IgM, or IgA which were each present in various amounts. These observations and the rarity of congenital malaria in the animals indicate that the placenta constitutes a major barrier to infection of the fetus. However, the pathological aberrations in the infected placentae may impose a biochemical stress upon the fetus which may account for the low birthweight, the increased frequency of abortion, and the greatly increased maternal and fetal death rates observed in malaria.
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PMID:Plasmodium berghei: histology, immunocytochemistry, and ultrastructure of the placenta in rodent malaria. 352 38

A case of chronic falciparum malaria during pregnancy is reported. The only disturbance was an anaemia, without fever. With chloroquine, the patient was cured. About this case, the barreful results of malaria on pregnancy are discussed: abortion, premature birth, fetal death, low birth weight, congenital malaria, anaemia of mothers. Immune response of the pregnant living in tropical areas is discussed. So is emphasized the need for chemoprophylactic treatment of mothers without immune response, during pregnancy.
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PMID:[Malaria and pregnancy]. 353 29


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