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

A serial study of coagulation activation and whole-blood viscosity was performed on 37 patients with local or systemic bacterial infection, malaria, or a viral infection. Thrombocytopenia, without consumption of coagulation factors, was the main feature of benign tertian malaria and viral infection, whereas in septicaemia and malignant tertian malaria it was associated with activation of coagulation and fibrinolysis. Patients with evidence of intravascular coagulation showed the highest levels of factor VIII related antigen which did not correlate with fibrinogen and probably reflected vascular endothelial cell damage rather than an acute-phase protein reaction. Hyperviscosity, which has been implicated in the pathogenesis of endotoxic shock and cerebral malaria, occurred in parallel with the acute-phase rise in plasma fibrinogen. There was, however, no evidence to implicate hyperviscosity as a major causative factor in the pathogenesis of septic shock or severe infective illness.
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PMID:Coagulation activation and hyperviscosity in infection. 47

Cerebral malaria is a severe complication of Plasmodium falciparum infection in children, with a mortality rate of 15-50% despite antimalarial therapy. In order to determine whether combining iron chelation with quinine therapy speeds recovery of consciousness, the authors conducted a randomized, double-blind, placebo-controlled trial of the iron chelator deferoxamine in 83 Zambian children with cerebral malaria. To be enrolled, patients had to be under age 6, have P. falciparum parasitemia, have normal cerebrospinal fluid without evidence of bacterial infection, and be in a coma from which they cannot be aroused. Deferoxamine (100 mg/kg of body weight/day, infused intravenously for 72 hours) or placebo was added to standard therapy with quinine and sulfadoxine-pryimethamine. The time to recovery of full consciousness, time to parasite clearance, and mortality were examined with Cox proportional-hazards regression analysis. The rate of recovery of full consciousness among the 42 patients given deferoxamine was 1.3 time that among the 41 who received the placebo (95% confidence interval [CI], 0.7-2.3; the median time to recovery was 20.2 hours in the deferoxamine group, and 43.1 hours in the placebo group (p=0.38). Among 50 patients in deep coma, the rate of recovery of full consciousness was increased 2.2-fold with deferoxamine (95% CI, 1.1-4-7), decreasing the median recovery time from 68.2 to 24.1 hours (p=0.03). Among 69 patients for whom data on parasite clearance were available, the rate of clearance with deferoxamine was 2.0 times that with placebo (95% CI, 1.2-3.6). Among all 83 patients, mortality was 17% in the deferoxamine group and 22% in the placebo group (p=0.52). It is concluded that iron chelation therapy may speed the clearance of parasitemia and enhance recovery from deep coma in cerebral malaria.
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PMID:Effect of iron chelation therapy on recovery from deep coma in children with cerebral malaria. 845 79

Ninety-nine consecutive patients who received cytotoxic therapy for acute leukemia were retrospectively studied to determine the pattern of infection at the Tata Memorial Hospital, Bombay, India. In all, 224 infective episodes occurred in these patients. Bacterial infection was the commonest type, accounting for 152 (67.9%) of 224 infective episodes, followed by fungal and viral infections (15.6% and 14.3%, respectively). Gram-negative organisms (Pseudomonas and Klebsiella) were the commonest bacterial organisms isolated, constituting 38 (76%) of 50 positive cultures; infection with Staphylococcus was rare (10%). Infective hepatitis, malaria, and systemic tuberculosis were responsible for fever with neutropenia in 20, 4, and 2 patients, respectively. Three hundred fifty-two patients with lymphoproliferative malignancies were also retrospectively studied to determine the pattern of infection. Only 53 infective episodes were recorded. In these patients, in contrast to those with acute leukemia, viral infection (33 [62.3%] of 53) and pulmonary tuberculosis (18 [34%] of 53) were frequently seen. It is interesting that 50% of our patients with hairy cell leukemia also had tuberculosis. Bacterial infection was conspicuous by its absence. Knowledge of the prevailing pattern of infection permits the development of investigative and therapeutic approaches of optimal efficacy.
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PMID:Pattern of infection in hematologic malignancies: an Indian experience. 260 80

In a prospective hospital-based study, endotoxin was detected by amoebocyte limulus lysate test in the blood of 18 of 20 patients with complicated Plasmodium falciparum (16 with cerebral malaria, 2 with blackwater fever, one with acute malarial hepatitis and one with hepatorenal failure) and in all 5 patients with uncomplicated malaria tested, but in none of 5 healthy volunteers. There were 4 deaths among the 18 patients with complicated malaria and endotoxaemia. No correlation between endotoxaemia and presence of complications, clinical severity, or degree of parasitaemia was found. A concomitant bacterial infection could account for endotoxaemia in 11 of the 16 patients with cerebral malaria and endotoxaemia; in the other 5 patients with cerebral malaria, 4 with other complications, and 5 with uncomplicated malaria, endotoxin was detected in the blood without any evidence of bacterial infection.
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PMID:Endotoxaemia in complicated falciparum malaria. 307 5

Ninety-four per cent of 169 patients with cerebral malaria developed anaemia (haematocrit less than 35 per cent) and 30 per cent required blood transfusion to maintain the haematocrit at more than 21 per cent. Anaemia was at its worst on admission in 58 patients (34 per cent); in the rest the haematocrit fell further, reaching its nadir one to 17 days later (mean 2.3 days). The mean lowest haematocrit was 24.3 +/- 7.2 per cent (+/- 1 SD) and the mean maximum fall was 7.9 +/- 5.6 per cent. Anaemia was more severe in patients with bacterial infection, retinal haemorrhages, schizontaemia and in pregnancy. The lowest haematocrit correlated with admission parasitaemia (r = -0.33, p less than 0.001), total serum bilirubin (r = -0.25, p less than 0.01) and serum creatinine (r = -0.22, p less than 0.01). In 23 patients with uncomplicated falciparum malaria the mean serum iron on admission was 53 micrograms/dl (range 16-157) and the mean serum ferritin 1773 ng/ml (range 170-10 000). There was a significant (p less than 0.001) rise in serum iron 96 h after starting antimalarial treatment; the serum ferritin declined slowly over several weeks. Stainable iron was present in all marrows examined and in eight patients the characteristic pattern of the anaemia of chronic disorders was seen. Seventy-three per cent of patients had dyserythropoiesis which was moderate to gross in 36 per cent. Dyserythropoiesis and erythrophagocytosis were often present on admission but sometimes appeared after the parasitaemia had cleared and persisted for at least three weeks into convalescence. These disturbances in iron metabolism and haemopoiesis are not completely explicable by red blood cell parasitisation. They may contribute more to the anaemia than has previously been recognised.
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PMID:The importance of anaemia in cerebral and uncomplicated falciparum malaria: role of complications, dyserythropoiesis and iron sequestration. 352 85

Lack of technical facilities to support diagnostic and curative medicine discourages physicians from providing rural health care. In developing countries, therefore, the first decision on most health problems is often made by auxiliaries. Such staff, in conducting basic community medicine, collect specimens for appropriate investigations. Simple tests performed by the auxiliaries themselves can assist in routine surveillance, in establishing priorities of medical care and in systematizing referrals to health centres. The simplest screening tests--of weight, temperature and haemoglobin--are the most useful. Serial weighing in childhood can monitor malnutrition, acute or chronic infections and infestations; in young adults, it can point to ill-health requiring further investigation. The finding of fever and examination of a blood film may reveal acute bacterial infection, malnutrition, malaria, hookworm, bilharzia and sickling, and thus be followed up by a thin blood film, or tests for sickle-cell and stool hookworm ova, pus cells or amoeba. The repertoire of simple laboratory investigations is largely completed by examination of sputum for acid-fast bacilli, or diplococci; by urine microscopy, with haematuria; and tests for protein or sugar, in cases of oedema or polyuria. A limited range of more elaborate tests may be available in the laboratories of district or regional hospitals. Human and technological factors which bear on the modus operandi of rural laboratories are identified and discussed.
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PMID:Laboratory support for rural health care. 610 29

In Niger, the infectious risk is of real concern in the field of the pathology of the adult, mainly caused by the major endemic diseases: Parasitic diseases such as malaria, bilharziasis, cutaneous leishmaniasis and recently visceral leishmaniasis, Bacterial diseases such as enterobacterial diseases, amibiasis, meningococcal diseases, tuberculosis, leprosy and treponematosis, Virus diseases such as arbovirus diseases and probably viral hepatitis. On the whole, the rate of occurrence and prevalence are not more significant than those in the neighbouring countries. On the other hand, diseases prevailing all over the world do not save the indigenous. Some recent hospital statistics demonstrate that the disease of the liver and the digestive system (28.8 pc), the respiratory diseases (16.49 pc), and the cardiovascular diseases (14.63 pc) are prevalent.
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PMID:[The danger of infection and common medical pathology among adults in the Sahel. Niger as an example]. 648 27

Serious defects in the living conditions of the vast majority of people in the tropics, rather than racial factors, are the underlying reasons why anaemia is common, why malaria is rampant and why the complications of sickle cell disease are so serious. Mass illiteracy, poor environmental hygiene and widespread poverty with all their implications explain why malaria eradication programmes have so far failed in tropical Africa and why basic health-care schemes have been difficult to establish. Pregnant women are very vulnerable to the effects of anaemia, malaria and sickle cell disease. However, appropriate use of folic acid and iron supplements as well as malarial chemosuppression succeeds in maintaining haemoglobin concentrations at reasonable levels during pregnancy. If, for whatever reason, the haemoglobin level falls to under 4.4 g/dl or the haematocrit value is 0.14 or less, anaemia becomes an obstetric emergency. Both maternal and fetal mortality rise sharply, maternal death being due to anaemic heart failure, fulminating bacterial infection and shock from even small loss at delivery or abortion. With the haemoglobin concentration as low as 4.4 g/dl, blood transfusion greatly improves maternal but not necessarily fetal prognosis. Additional cause of morbidity in sickle cell disease is painful crises, the control of which remains largely unsatisfactory. Now that sickle cell disease can be diagnosed early in intrauterine life the idea of aborting the affected fetuses as a means of controlling or reducing sickle cell disease is well within the means of developed countries, but it is a line of approach which developing countries cannot afford at present.
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PMID:Anaemia, malaria and sickle cell disease. 675 46

By ensuring that the issues raised in this article are appropriately discussed with each traveller at the pre-travel consultation, the chance of staying healthy while travelling is considerably enhanced. If all else fails, the traveller should be well equipped with a first aid medical kit (Table 2) and instructions on how and when to take medications. They should know how to treat travellers diarrhoea, recognise signs and symptoms of malaria and the difference between a bacterial infection and viral infection. Bon voyage!
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PMID:Staying healthy while travelling. 786 79

In cases of diarrhea, the two chief difficulties which the clinician must deal with are ability to demonstrate the nature of the pathogenic agent and, secondly, to be able to incriminate an organism found by stool culture as being pathogenic. The periodic emission of the parasite in coccidial infestations and in giardia infections requires repeated stool examinations. However, the persistence of a negative stool culture should lead to a search for a systemic cause such as malaria, a bacterial infection or toxin. Once an organism is identified, the distinction between a merely saprophytic nature and actual pathogenicity in the case of many parasites or candida can be determined on the basis of the clinical context and the underlying status of the patient. The epidemic context must also be taken into account, a healthy carrier state representing a fecal threat to other high risk patients, in particular regarding ameba and blastocyst infestations.
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PMID:[Difficult-to-diagnose organisms responsible for diarrhea in the immunocompetent patient]. 844 51


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