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

A 50-year-old Swiss male died from strongyloidiasis 8 weeks after renal allotransplantation. Past history revealed malaria at age 20 years, when the patient had stayed in tropical and subtropical areas, as well as pulmonary tuberculosis. Hypertension, erythrocyturia, proteinuria and unexplained episodes of blood eosinophilia were first noticed age 45, and 4 years later dialysis was started. A mild acute rejection crisis was successfully treated 4 weeks after transplantation. 2 weeks later, however, bilateral pneumonia developed. Despite vigorous antibiotic and tuberculostatic therapy the patient died in septic shock. Autopsy revealed strongyloidiasis with adult females, eggs and rhabditiform larvae of Strongloides stercoralis in the small intestine. Numerous filariform larvae were detected in the lungs, in the walls of bronchi and trachea, in the brain, in the walls of arteries, and in lymphnodes. Massive granulomatous inflammatory reaction and extensive pulmonary hemorrhage were the main pathological findings.
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PMID:[Strongyloidiasis following kidney transplantation]. 36 Mar 82

The causes of mortality and frequency of diseases were tabulated in 304 autopsies performed at Hopital Mama Yemo, Kinshasa, between July 1973 and December 1974. 78 of these autopsies were performed on subjects who died at Hopital Mama Yemo, 36 encompassed subjects from other hospitals, and 190 were of medicolegal cases in which the cause of death was not apparent from external examination. Men comprised 63.5% of autopsied cases. The mean age was 30.19 +or- 1.31 for men and 19.84 +or- 1.76 for women. 16.8% of deaths were due to homicide, 6.3% to suicide, and 8.9% to accidents, yielding an overall prevalence for trauma of 32%. Cancer accounted for only 3% of deaths, and cardiovascular diseases 8.2%. Bacterial infections (predominantly streptococcal disease, lobar pneumonia, and pulmonary tuberculosis) represented the largest single cause of death (17.4%). Parasitic infections comprised a further 6.3% of mortality and viral infections 7.2%, giving infectious diseases a combined frequency of 30.9%. Metabolic diseases were responsible for an additional 11.8% of deaths. Obstetric causes were identified in 3.9% of fatalities, and 95% of these cases represented hemorrhagic and septic complications of illegal abortion. Neonatal deaths (4.3%) were largely due to pneumonitis from aspirated amniotic fluid. A final 5.9% of deaths were unexplained. Also analyzed were cases of sudden death occurring outside the hospitals. 31.3% of these deaths were attributed to cardiovascular diseases and 46.3% to infection (including 2.5% due to septic abortion). Finally, the frequency of major diseases in this series was tabulated. Malaria was most frequently found (41.8%), followed by intravascular erythrocytic sickling (18.3%) and hypertension (16%). 12% of females in this series (20% of those dying traumatically) showed evidence of pelvic inflammatory disease. This series is considered to overestimate the frequency of trauma because of the large number of medicolegal cases that fall in this category. This selection for trauma further led to an oversampling of adult men. Nonetheless, it represents the 1st and best qualitative estimate of disease mortality and prevalence in Zaire. The trends in mortality and morbidity identified through this study provide a basis for planning health care and health education.
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PMID:Autopsy analysis of disease frequency in Kinshasa, Republic of Zaire. 96 86

The WHO has developed disease-specific clinical case definitions to guide the management of children with fever and cough, the cardinal signs of malaria and pneumonia. To assess the usefulness of these case definitions and to investigate their interaction, the authors studied children with fever or cough who were brought to Lilongwe, Malawi. For all children, a thick blood smear was examined for Plasmodium falciparum parasites. Chest radiography was done only for children with parasitemia and those who satisfied the clinical case definition for pneumonia; others were assumed to have normal chest radiographs. Of 1599 enrolled children, 566 (35%) had parasitemia; 43 had both parasitemia and pneumonia. Of the 471 children who met the clinical definition for pneumonia, 449 (95%) also met the clinical definition for malaria. Among children with radiographic evidence of pneumonia, the clinical definition for malaria was not predictive of parasitemia (sensitivity 93%, specificity 5%. Whether malaria parasitemia was present or not, the pneumonia clinical definition distinguished children with and without radiographic evidence of pneumonia (sensitivity and specificity 60%). Children who satisfied the pneumonia clinical definition were more likely to have radiographic evidence of pneumonia (odds ration 10.4, 95% confidence interval 5.2-20.7), parasitemia (1.6, 1.2-2.2), or both at the same time (4.2, 2.1-8.4) than were children who did not meet the definition. Children who satisfy both clinical definitions need treatment for both disorders. Scarce diagnostic methods, especially microscopy, are necessary for more specific treatment of children with fever and cough.
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PMID:Usefulness of clinical case-definitions in guiding therapy for African children with malaria or pneumonia. 809 36

Fever is the cardinal symptom of many infections in travellers returning from the tropics and is second in place only to infectious diarrhea. Once the obvious causes of fever in an individual patient have been eliminated, it may be very difficult to find the cause of fever. Fevers can be distinguished by their length of duration and divided into acute fevers i.e. up to 3 weeks duration and chronic fevers i.e. more than 3 weeks duration. Whether fever goes along with leucopenia or a normal white blood cell count on the one hand or with leucocytosis on the other hand is of differential diagnostic value. A schedule based on these two parameters will be presented to simplify differential diagnostic considerations. Two rules of thumb will be stressed: (1) Each febrile illness, even febrile diarrhea, jaundice or meningitis, is to be considered a malaria until it is excluded. (2) Patients returning from tropical areas might suffer from banal infections such as pneumonia, urinary tract infections, cholangitis, etc. as well.
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PMID:[Differential diagnosis of fever after returning from the tropics]. 150 60

The international community has launched the Children's Vaccine Initiative, which has created the most ambitious grouping of public and private sector interests ever to tackle a global health issue. Developed by WHO, UNICEF, UNDP, the World Bank, and the Rockefeller Foundation, the initiative is the result of decisions taken at the World Summit for Children, held in New York in September 1990. During that meeting, world leaders requested greater resources for the development of new or better vaccines. The Children's Vaccine Initiative, says WHO Director-General Dr. Hiroshi Nakajima, will not only yield specific benefits in improving vaccines, it will also establish a process of collaboration between the public and private sectors, which will have far-reaching benefits in other areas. The new initiative comes on the heels of another international effort, the successful Expanded Program on Immunization, which in 1990 achieved its goal of immunizing 80% of the world's children against 6 major childhood diseases: poliomyelitis, measles, tuberculosis, diphtheria, pertussis, and tetanus. The new initiative will strive to develop vaccines against a wider spectrum of viral, bacterial, and parasitic diseases which cause mortality in children. These diseases include rotavirus infection, hepatitis A and E, dengue, Japanese encephalitis, acute respiratory diseases, meningococcal meningitis, diarrheal diseases, pneumococcal pneumonia, and malaria. The new initiative will also seek to improve existing vaccines, making them easier to administer and less painful and costly.
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PMID:New children's vaccine initiative launched. 160 Apr 43

Glucocorticosteroids are the most commonly used immunosuppressive agents. In the following review important mechanisms of action of glucocorticoids on the immunological network are summarized, the relationship between duration of therapy, daily dose and incidence of infections is analysed, and evidence is presented that in some infectious diseases glucocorticoids may even be beneficial. The association between corticosteroid therapy and subsequent infections was calculated by pooling the data from 73 controlled clinical trials (meta-analysis). The rate of infectious complications was not increased in patients given a daily dose of less than 10 mg or a cumulative dose of less than 700 mg prednisone. With increasing doses the occurrence rate of infectious complications increased in patients given corticosteroids as well as in patients given placebo, a finding which suggests that not only the corticosteroid but also the underlying disease state accounts for the steroid-associated infectious complications observed in clinical practice. To analyze the effect of glucocorticoids prescribed as adjuvants in patients with infectious diseases, an analysis of the controlled trials was performed. Some patients with pulmonary tuberculosis or constrictive pericarditis have a better outcome when they are given prednisone. On the other hand, there is no evidence that patients with septic shock or ARDS derive advantage from glucocorticoid therapy. At present there is controversy as to whether patients with bacterial meningitis should be treated with glucocorticosteroids. Patients with hepatitis B should not be treated with glucocorticoids, whereas elderly patients less frequently show postherpetic neuralgia when given glucocorticosteroids. Patients with cerebral malaria should not be given glucocorticosteroids. Aids patients with pneumocystis carinii pneumonia have a higher survival rate when treated with glucocorticosteroids than with placebo.
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PMID:[Glucocorticoids and infection]. 173 19

Maternal mortality is examined from June 1980 to December 1986 at Mulago, Nsambyo, Old Kampala, Rubaga, and Mengo Hospitals in Kampala, Uganda. Clinical or immediate causes, direct and indirect, were recorded from case summary forms based on ICD9 definitions of obstetric complications. The nonabortion maternal mortality rate (NAMMR) was 2.65/1000 deliveries (580 deaths); the abortion-related maternal mortality rate (ARMMR) was 3.58/1000 abortions. The hospital maternal mortality rate was 2.0/1000 deliveries. 75% of maternal deaths of women of 28 weeks' gestation or more had delivered outside the hospital. NAMMR doubled between 1980-86, a statistically significant increase. ARMMR increases were almost significant. 75% were direct obstetric and 21% were indirect obstetric causes. 38% had clinical anemia, 29% had some sepsis, 18% had substantial bleeding, and 14% had obstructed labor. Other contributing conditions were pneumonia, ruptured uterus, laparotomy, evacuations and curettage, malaria, preeclampsia, sickle cell anemia, pulmonary embolism, malnutrition, tetanus, meningitis, prolonged labor, and hepatitis. At admission, 48% were in poor condition, 30% in good condition, and 22% in fair condition. 27% had sickle cell anemia, high blood pressure, multiple pregnancy, or malaria at admission. 64% were admitted within 24 hours after delivery, 67% 1-7 days after delivery, and 92% 7-42 days after delivery. Those in good condition were all admitted 7 days postdelivery. 41% of deaths were due to lack of drugs, 7% lack of fluids, 20% with theater problems, 14% with doctor-related factors, and 3% with midwife-related factors. Better information is needed on mortality before delivery, mortality in hospitals vs. outside, and mortality from abortion, and ectopic and hydatidiform molar pregnancies. An explanation given for the increase in maternal mortality is the decline in economic conditions. Abortion complications may be due to the concealment practiced. Causes are consistent with trends from the 1950s, 1960s, and 1970s in Uganda and developing countries in general. Availability and accessibility of gynecological and obstetric services needs great improvement. Training traditional birth attendants and obtaining rural ambulance services are also needed. Health workers lack creativity and imagination for developing country conditions; scarce resources are not the only problem.
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PMID:Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986. 176 15

Infections with parasitic protozoa have always been problems for the developing world and are becoming of greater importance to the developed world in this age of easy international travel. The major human protozoal diseases are summarised with an emphasis on their presentation in normal hosts and in immunocompromised individuals and current US drug treatment recommendations are discussed. Present antiprotozoal regimens are based either on a pharmacokinetic rationale or on clinical trial and error. Regimens based on trial and error include amphotericin B against leishmaniasis and arsenic against African trypanosomiasis. Regimens which are to some extent driven by pharmacokinetic or biochemical considerations include paromomycin and metronidazole against amoebiasis, sodium stibogluconate against leishmaniasis, halofantrine and mefloquine against malaria, dihydrofolate reductase (DHFR) inhibitors against Pneumocystis carinii and toxoplasmosis and aerosolised pentamidine against P. carinii pneumonia. The majority of pharmacokinetic studies have been performed only on agents which have some therapeutic activity against other diseases of the developed world. Despite the trend toward rational treatment regimens, no studies have been performed that permit optimisation of antiprotozoal treatment regimens on the basis of clinical conditions such as renal failure.
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PMID:Pharmacokinetic justification of antiprotozoal therapy. A US perspective. 178 41

According to the literature, socio-economic factors may contribute more to geographic variations in the aetiology and prognosis of childhood coma than has previously been recognised. This prospective study involving 118 children with strictly defined coma demonstrated that the commonest causes of coma in Ibadan were cerebral malaria (55%), meningitis (13%) and encephalitis (10%). The prognosis was poor. Forty-three (36%) of 118 cases died and 75 (64%) survived, including 23 who showed neurologic deficits. Noteworthy prognostic indices of coma were the aetiology of the condition, the presence of severe anaemia, hypoglycaemia and pneumonia. The findings are discussed in the context of the socio-economic background of children in the tropics.
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PMID:Childhood coma in Ibadan. Relationship to socio-economic factors. 181 64

Hydroxynaphthoquinone 566C80 was synthesised and initially developed as an antimalarial with potent activity against drug-resistant strains of the human malaria parasite, Plasmodium falciparum. Subsequent studies have revealed that in addition, this compound has experimental activity, both in vitro and in vivo, against Pneumocystis carinii and Toxoplasma gondii; the data obtained thus far for Cryptosporidium parvum are equivocal. Currently 566C80 is being assessed clinically not only against malaria, but also against P. carinii pneumonia, toxoplasmosis and cryptosporidiosis.
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PMID:566C80, an antimalarial hydroxynaphthoquinone with broad spectrum: experimental activity against opportunistic parasitic infections of AIDS patients. 181 43


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