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

Epidemiological vigilance in Navarre covers 34 transmissible diseases, whose notification is compulsory, and epidemic outbreaks of any aetiology. Notification is carried out on a weekly basis by the doctors from paediatrics, primary and specialised level who suspect or diagnose any of these diseases. In 2003, 75.0% of all the possible notification reports (a weekly report for each doctor) were received, a percentage that has improved in the last five year period. In 2003, Influenza reached a rate of 48.9 cases per 1,000 inhabitants (Epidemic Index, EI: 0.91), showing an epidemic peak in January and another in November. The rate of respiratory tuberculosis was 11.76 cases per 100,000 inhabitants, and the rate of non-respiratory tuberculosis was 1.90, with a continuous trend to decrease in both cases. Five cases of tuberculosis occurred in two small family outbreaks. Thirty percent of the cases were produced in immigrants. The cases coinfected with HIV have fallen from 21% in 1996 to 2.5% in 2003. Fifteen cases of meningococcal disease were reported, (2.6 cases per 100,000 inhabitants), appearing in a sporadic form. Neisseria meningitidis serogroup B was isolated in 10 cases, and serogroup C in 5 cases. Eighty percent appeared in the form of sepsis, and death occurred in one case (6.7%). All of the cases younger than six years of age were vaccinated and belonged to serogroup B. The incidence of Legionnaire's disease was 3.8 cases per 100,000 inhabitants (EI: 0.92), without any epidemiological relation between them. There were 7 cases of malaria, all imported. The incidence of food borne infections has fallen (EI: 0.71).
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PMID:[Compulsory Diseases Notification (CDN) in Navarre 2003]. 1514 9

A number of new antimicrobial agents have been licensed in the last years, most prominently a number of new antiviral and antimycotic agents. The development of new antibacterial agents has slowed down, new agents are mainly targeted at a small but rapidly growing number of patients infected with bacteria resistant to the current antibiotics. The rates of resistance against antibiotics are rapidly rising, especially for gram-positive cocci and, in addition, for gram-negative nosocomial agents. Rising rates of resistances are further present in chronic viral infections, e. g., HIV infection. Instruments to monitor and minimize the rates of resistances are necessary. Important changes are to be found in a number of infectious complications. For patients with sepsis a new therapeutic principle, drocretogrin, has been found to reduce mortality. Additionally, low-dose corticosteroids in selected patients, close control of blood sugar and other interventions have shown to be effective. Corticosteroids have proven to be effective as well in the reduction of complications in adults with bacterial meningitis, most pronounced in pneumococcal meningitis. With new drugs licensed for the treatment of malaria and changes in the epidemiology, the guidelines for therapy and prevention have been reformulated.
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PMID:[Infectious diseases-Part II: New agents, resistances, and treatment strategies]. 1514 88

Over the past decade there has been a growing recognition that the rationalization of severe malaria in children into the two major syndromes of cerebral malaria and severe malaria anaemia is much too simplistic. Indeed, it has become apparent that death from severe malaria may arise from a wider spectrum of pathophysiological disorders with many features in common with the derangements seen in sepsis syndromes. Amongst these derangements acidosis has emerged as a central feature of severe malaria and the major predictor of a fatal outcome. We review the improved understanding of the pathophysiology of severe malaria through a series of clinical scenarios that reflect more accurately the clinical diversity of severe malaria in African children. Current therapeutic challenges are discussed and research priorities are highlighted.
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PMID:Pathophysiology of severe malaria in children. 1517 39

The health burden and mortality caused by infections during childhood remain large in sub-Saharan Africa. We performed a review of the causes of hospitalization and death among children admitted to a pediatric teaching hospital in Bamako, Mali. Medical records of children admitted throughout 2000 were systematically sampled and abstracted for demographics, diagnosis, hospital course, and disposition. A sample of 1644 charts, from 5001 admitted children, were abstracted. The median age was 8 months. Half of the children had a febrile illness. All diagnoses were made clinically. The annual incidence per 100,000 and case fatality rates of the four most common serious infections, excluding malaria, were as follows: pneumonia, 165 (12 per cent); sepsis, 75 (37 per cent); meningitis, 71 (20 per cent); and enteric fever, 14 (12 per cent). An estimated 1300 children were admitted with thick-smear confirmed malaria; at least 64 per cent met World Health Organization criteria for severe malaria and 11 per cent died. Seventy-one per cent of admissions were due to infections. Overall 21 per cent of children admitted died in the hospital, most within the first 3 days of admission. Infectious diseases remain the primary cause of hospitalization among Malian children and frequently lead to death. A substantial proportion of this morbidity and mortality is probably attributable to vaccine-preventable diseases, such as Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis. Prospective surveillance using microbiological data is needed to delineate the organism-specific burdens.
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PMID:The causes of hospital admission and death among children in Bamako, Mali. 1523 92

To investigate the impact of HIV infection on hospital admission and death we studied children admitted to paediatric medical and surgical wards in Blantyre, Malawi, in March 2000. Unselected children whose parents or guardians consented to HIV testing of the child were recruited and HIV infection was determined by serology, with confirmation in children aged 15 months or less by PCR. We assessed the prevalence of HIV infection by age, clinical diagnosis and outcome of admission. Of 1064 admissions, 991 were tested for HIV infection, and 187 (18.9%) were infected. HIV was most common in children aged less than six months, 53 of 166 (32%). Parents of HIV-infected children were better educated, and more likely to have died, than those of uninfected children. Clinical symptoms and signs were not adequately sensitive or specific to be used for diagnosis of HIV. HIV was common in children with malnutrition (prevalence 40%), lower respiratory tract infection (29%) and sepsis (28%), and less prevalent among children with malaria (11%) or surgical admissions (11%). Almost 30% of HIV-infected children died, compared with 8.9% of uninfected children, and HIV-infected children constituted over 40% of in-patient deaths.
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PMID:HIV infection among paediatric in-patients in Blantyre, Malawi. 1525 4

Between January 2000 and December 2001, renal involvement in 81 cases of malaria was studied. Their age ranged between 05 and 66 (mean 35.5) years. Distribution of malarial parasite was P falciparum (75), mixed infection (4) and P vivax (2). The evidence of clinical renal disease in the form of acute renal failure, electrolyte abnormality, abnormal urinary sediment and increased urinary protein excretion (>500 mg/24 hours) was found in 100%, 91.3%, 46.9% and 18.5% respectively. Probable aetiopathogenesis of acute renal failure (ARF) was multifactorial. Volume depletion (72.8%) was the dominant cause of ARF in these patients. In addition, hyperbilirubinaemia, intravascular haemolysis and sepsis were responsible for ARF in 64.2%, 70.3% and 25.9% cases respectively. All the patients were managed with anti-malarial drugs and dialysis support was needed in 35 patients (43.2%). Prognosis of malarial acute renal failure is favourable with mortality rate of 18.5%. Multi-organ failure was the commonest cause (33.3%) of death.
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PMID:Spectrum of renal disease in malaria. 1547 74

In developing countries such as Zambia, teenage pregnancy is common and dangerous. In this study, out of 677 teenage mothers 33 died. The causes of this alarming mortality are documented and show the influence of sepsis, obstructed labour and uterine rupture. Malaria was an important associated cause. Only a major education programme with discouragement of pregnancy in young girls is likely to influence this distressing problem.
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PMID:Maternal deaths in teenage mothers. 1551 79

Severe Plasmodium falciparum malaria encompasses a complex syndrome affecting many organs and causing physiological perturbations that have many features in common with children with sepsis. Among these, metabolic acidosis has emerged as a central feature of severe malaria and is the best independent predictor of a fatal outcome in both adults and children. There is now clear evidence that intravascular hypovolaemia (shock) is common in children with malarial acidosis. How it should be treated presents a therapeutic dilemma because acidosis often coexists with impaired consciousness (cerebral malaria). We summarize the results of recent clinical trials examining the safety and efficacy of volume expansion in children with 'cerebral malaria' complicated by acidosis.
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PMID:Acidosis of severe falciparum malaria: heading for a shock? 1563 35

High mobility group box 1 (HMGB1) protein, a DNA-binding protein that can also act as a pro-inflammatory cytokine if released from cells, is an important amplification signal in various forms of inflammation. The concentration of HMGB1 in serum taken at admission was increased in falciparum malaria in sixteen African children, more so in fatal cases than in those who subsequently recovered (P<0.001). Serum from both non-fatal (P=0.0048) and fatal (P<0.001) cases contained significantly more circulating HMGB1 than did serum from healthy Caucasian adults. These data provide an additional argument that malaria is fundamentally a systemic inflammatory state. In keeping with its developing role in sepsis, HMGB1 may enhance and prolong the inflammatory processes, and thus illness, in malaria.
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PMID:High mobility group box 1 (HMGB1) protein: possible amplification signal in the pathogenesis of falciparum malaria. 1565 18

The spleen is critical for host defense against pathogens, including Plasmodium falciparum. It has a dual role, not only removing aged or antigenically altered erythrocytes from the blood but also as the major lymphoid organ for blood-borne or systemic infections. The human malaria parasite P. falciparum replicates within erythrocytes during asexual blood stages and causes repeated infections that can be associated with severe disease. In spite of the crucial role of the spleen in the innate and acquired immune response to malaria, there is little information on the pathology of the spleen in human malaria. We performed a histological and quantitative immunohistochemical study of spleen sections from Vietnamese adults dying from severe falciparum malaria and compared the findings with the findings for spleen sections from control patients and patients dying from systemic bacterial sepsis. Here we report that the white pulp in the spleens of patients dying from malaria showed a marked architectural disorganization. We observed a marked dissolution of the marginal zones with relative loss of B cells. Furthermore, we found strong HLA-DR expression on sinusoidal lining cells but downregulation on cordal macrophages. P. falciparum infection results in alterations in splenic leukocytes, many of which are not seen in sepsis.
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PMID:Fatal Plasmodium falciparum malaria causes specific patterns of splenic architectural disorganization. 1578 39


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