Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In Kenya, health professionals compared prospective data on 193 suspected malaria patients at the Eldoret District Hospital during February-March, 1992, with retrospective data on 120 suspected malaria cases at the same hospital during November-December, 1991, to examine the protocol on the management of suspected malaria cases. Between these 2 periods, physicians introduced a simple algorithm to follow in suspected malaria cases. The use of quinine as the 1st choice drug fell considerably between the 2 periods (54.2-19%). There was an increase in the use of chloroquine as the 1st choice drug for uncomplicated malaria (38.4-63.9%). The proportion of blood smear positive patients increased (27.5-51.3%), probably because the department technician was more careful conducting repeat blood smears than were technicians at the busy hospital laboratory. Blood smear negative patients were less likely to automatically receive any antimalarial treatment or quinine in 1992 than in 1991 (14.6% vs. 47.5% and 4.1% vs. 30.9%, respectively). The proportion of patients whose final diagnosis was an illness other than malaria was higher in 1992 than in 1991 (19.7% vs. 15.8%). No clear diagnosis other than flu-like illness was the case for 28 (14.5%) of the prospective patients. The tendency for clinicians to accept a diagnosis of malaria without enough evidence to confirm it can have the damaging effect of masking other serious diagnoses (e.g., dysentery [8 cases], meningitis [6 cases], and HIV infection [2 case]). These findings show that hospital physicians should develop simple protocols for inpatient management of suspected malaria cases, a properly quantified blood smear should be done of all suspected malaria cases to confirm or refute the diagnosis, and chloroquine should be the 1st line of treatment in the Kenyan highlands, until considerable parasite resistance is confirmed.
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PMID:Management of malaria before and after introduction of a treatment protocol at the Eldoret District Hospital. 805 55

Monoclonal antibodies (mAb) have revolutionised many areas of medicine, particularly research and diagnostics. Murine, human and humanized mAb have all been developed. The most important clinical applications to date have been in the fields of transplantation and oncology. Experimental and limited clinical trials suggest mAb are emerging as a new therapeutic strategy in the critically ill. Antibodies against a variety of bacteria or their products are potentially useful in gram-positive and gram-negative shock. Anti-cytokine and anti-neutrophil adhesion molecule mAb may be effective not only in septic shock but also in other conditions associated with acute inflammation and cytokine release, e.g., acid aspiration, ischaemia/reperfusion injury (myocardial infarction, haemorrhagic shock, aortic aneurysm repair). Antibodies inhibiting neutrophil adhesion may also be efficacious in asthma, pulmonary fibrosis, meningitis and cerebral malaria. The use of these and other mAb in intensive care is an exciting prospect and future clinical studies will determine the extent of their role in the management of the critically ill.
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PMID:Monoclonal antibodies--immunotherapy for the critically ill. 812 30

Two thousand eight hundred ninety-eight children younger than 5 years old were investigated during a 2-year period in a rural area of The Gambia for possible pneumonia, meningitis or septicemia. After clinical examination and appropriate investigations, 1014 children were diagnosed as having pneumonia, 31 as having meningitis and 100 as having septicemia. Nine hundred seven children had a final diagnosis of malaria including 702 who satisfied the World Health Organization criteria for a diagnosis of pneumonia. A bacterial etiology was established in 115 (11%) patients with a final diagnosis of pneumonia, in 25 (81%) with meningitis and in 29 (29%) with suspected septicemia. Overall the pneumococcus was the leading pathogen identified among children with pneumonia and meningitis and ranked third among those with septicemia. However, during the wet season, when malaria transmission was highest, 50% of blood culture isolates obtained from children satisfying the World Health Organization criteria for a diagnosis of pneumonia were Salmonella or coliform species, and the pneumococcus and Haemophilus influenzae type b accounted for only 43% of isolates. Thus enteric bacteria may be as important as those bacteria more usually associated with respiratory disease among children presenting with a clinical picture of pneumonia during the wet season. This finding has important implications for case management and surveillance for antibiotic resistance.
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PMID:Importance of enteric bacteria as a cause of pneumonia, meningitis and septicemia among children in a rural community in The Gambia, West Africa. 819 May 37

Of 92 school-age children who had convulsions with fever (CWF) of acute onset, seen in a 1-year period in an emergency room in Benin City, Nigeria, 49 per cent had malaria parasitaemia, 15 per cent bacterial meningitis, 8 per cent focal extracranial infections, and 1 per cent bacteraemia while 27 per cent had acute fever of undetermined origin. The prevalence of meningitis increased with presence of temperature > or = 40 degrees C (P < 0.01), focal seizures (P < 0.05), and rousable coma (P < 0.05). Bacterial meningitis is an important illness in school-age children with CWF, although malaria parasitaemia is the commonest infection.
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PMID:Convulsions with fever of acute onset in school-age children in Benin City, Nigeria. 827 42

The author worked for almost two years in a remote little clinic in Chesta, West Kenya. It was common for a child to be brought to the clinic with high temperature and other symptoms and be treated for cerebral malaria, lung inflammation, or meningitis. These episodes occurred day and night, sometimes the children were saved and sometimes they died. The author arrived in Kenya on her fourth missionary assignment looking for work and acceptance as a registered nurse. Six weeks had to be spent at a polyclinic and 12 weeks at various children's wards with Kenyan hospitals. There was a lack of medicines and supplies and an enormous turnover of patients. The organization that she was associated with had problems in finding replacements in health work in West Kenya, where, in connection with the usual evangelical work, clinics had been in operation for 12 years. She was requested by NORAD to participate in the health care component of an integrated development program at the Chesta mission station in West Pokot. The work involved being on duty in the clinic as well as out in the field, driving around and even flying on the mission's helicopter to reach villages in the Cherangani Hills. There were mobile clinics at 6 sites in the mountains with 1 visit per month. At 2 of these sites there was an integrated development program comprising health, agriculture, school development, and evangelization. The World Health Organization's vaccination program was conducted at every site. The available services included a maternal-child health care clinic, family planning, teaching of local midwives, and treatment of the sick. The Christian principle of placing equal value on all people was the foundation of the work. This was especially important for women: to be considered not just as chattel of men but as work partners with their own identities and worth.
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PMID:[Nursing under a different sky: West Kenya]. 827 35

Infections are the leading cause of childhood morbidity and mortality in developing countries. Bronchopneumonia, meningitis and gastroenteritis are the commonest fatal infections encountered in Ibadan. Tuberculous lymphadenitis, bronchopneumonia and meningitis are other frequent causes of death. The predominant sequela of measles is respiratory tract infection. Another important cause of childhood mortality is cerebral malaria. In half of the cases of tetanus no obvious portal of entry can be found. It is advocated that the implementation of immunization schedules should be vigorously pursued to curtail childhood mortality resulting from infection.
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PMID:Childhood infections in Nigeria: an autopsy study. 834 43

From January through December 1988 the causative factor of each case of childhood seizure seen in the Children's Emergency Room of the University of Calabar Teaching Hospital, Calabar, Nigeria, was prospectively studied with a focus on the relative importance of malaria-related seizures. Of the 134 seizure cases seen, febrile convulsion (FC) formed the majority (55%) with cerebral malaria (CM) as the only major (33%) rival. Other conditions such as meningitis, epilepsy, hypoglycaemia and drug poisoning together (12%) played a minor role. Malaria was the dominant cause (73%) of FC; 81% of these cases did not respond to chloroquine. On comparing the number of cases of CM accumulated in the same unit from 1986, there was a significant increase (P < 0.001) in the proportion of yearly CM admissions from 1986 through 1988. The study confirms the premier position of malaria in the causation of childhood seizures and also suggests a possible upsurge in the prevalence of CM in the environment. This upsurge probably derives from the emergence of chloroquine-resistant Plasmodium falciparum (CRPF) reported in Nigeria which appeared to have been identified in the present study. While more studies are needed to confirm this hypothesis, clinicians in areas of CRPF are alerted about a possible upsurge in CM in their locality.
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PMID:Upsurge of malaria-related convulsions in a paediatric emergency room in Nigeria. Consequence of emergence of chloroquine-resistant Plasmodium falciparum. 836 50

Neurologic manifestations of severe infectious complications of drug abuse and chronic alcoholism are reviewed in this article. Portals of entry from cutaneous postinjection infections and multiple vascular injection sites may lead to pyomyositis, tetanus, infective endocarditis, meningitis, brain abscesses, and vertebral osteomyelitis. Chronic intranasal abuse of cocaine may be followed by frontal osteomyelitis, botulism, brain abscess, and visual loss. Problems of hepatitis, malaria, and syphilis in drug abusers are discussed also.
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PMID:Infections other than AIDS. 837 45

One hundred twenty-one Liberian children were admitted in coma to the ELWA Hospital, Monrovia, Liberia. Admitting diagnoses, before lumbar puncture, were compared with discharge diagnoses. Ninety-four children were discharged with a final diagnosis of cerebral malaria and 27 with a diagnosis of meningitis. The admitting diagnosis was correct in 76.6% (72 of 94) of patients with cerebral malaria and 59.3% (16 of 27) of patients with meningitis. The cerebrospinal fluid leukocyte count was the single most significant factor in determining the correct diagnosis. Without the cerebrospinal fluid analysis, the discriminant accuracy (77%), i.e. definitive separation of the two illnesses, was comparable to the physician's admission diagnosis (73%). Other data contributing to the differential diagnosis of cerebral malaria and meningitis included the number of days of fever before admission, the presence or absence of nuchal rigidity, fontanelle fullness and peripheral blood malaria smear. Mortality rates for cerebral malaria and meningitis were 14.9 and 29.6%, respectively. These data suggest that physicians cannot reliably discriminate between cerebral malaria and meningitis without cerebrospinal fluid analysis.
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PMID:Initial clinical assessment of the comatose patient: cerebral malaria vs. meningitis. 841 24

Five-hundred-and-twenty-two infants and children aged 1 month to 6 years presenting at the Children's Emergency Room of the University of Benin Teaching Hospital with convulsions associated with fever (CAF) of acute onset were prospectively evaluated to determine the pattern of infections. Twenty-six per cent had localized infections of which 38 per cent were intracranial (meningitis = 16 per cent, cerebral malaria = 19 per cent, and encephalitis = 3 per cent) and 62 per cent were extracranial with respiratory tract infections contributing 51 per cent. Although, the prevalence of meningitis was significantly higher in 1-6 months old infants when compared with older children (47 per cent v. 12 per cent; P < 0.005), it was, none-the-less, present in all the other age groups (with a prevalence of 8-17 per cent). Seventy-four per cent of the children had no localizing signs of infection. Of these 68 per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria with bacteraemia, while no infections were identified in 21 per cent. Among children with bacteraemia Staphylococcus aureus was the commonest single isolate (33 per cent) although, overall, enterobacteriaceae were the commonest. We conclude, first, that meningitis should be excluded in all children aged under 6 years who present with CAF of acute onset and, secondly, that although anticipatory treatment for malaria is justified in children with CAF of acute onset without localizing signs of infection, consideration should also be given to the problem of bacteraemia.
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PMID:Pattern of infections in children under-six years old presenting with convulsions associated with fever of acute onset in a children's emergency room in Benin City, Nigeria. 844 82


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