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

Pulmonary edema is a serious complication of falciparum malaria that usually occurs in association with cerebral malaria, acute renal failure, high parasitemias, or delayed antimalarial treatment. From 1993 to 1996, 120 adult patients admitted to the intensive care unit of the Bangkok Hospital for Tropical Diseases were enrolled in a prospective study to assess the combination of artesunate and mefloquine for the treatment of cerebral malaria. Twenty-five patients (21%) presented with pulmonary edema and a majority developed complications in other organs as well, especially acute renal failure. In most patients (19 of 25), pulmonary edema was noted on the first day of admission and was associated with higher parasitemias and levels of acidemia, than in patients without pulmonary edema. Ten of the 25 patients diagnosed with pulmonary edema developed signs consistent with adult respiratory distress syndrome (ARDS). The mean central venous pressure when pulmonary edema was diagnosed was markedly lower in ARDS than in non-ARDS patients, supporting the argument that fluid imbalance is not essential for malaria-induced lung injury. Seven of 10 patients with ARDS died, 5 within 24 hours of admission, but there were no deaths in the 15 pulmonary edema patients without ARDS. Early diagnosis and prompt treatment remain important principles to reduce the morbidity and mortality associated with complicated falciparum malaria. This report emphasizes that ARDS, when concurrently occurs, is a poor prognostic clinical indicator in cerebral malaria.
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PMID:Pulmonary edema in cerebral malaria patients in Thailand. 1043 53

Chloroquine has been the standard treatment for Plasmodium vivax malaria for more than 40 years in most regions of the world. Recently, however, chloroquine-resistant P. vivax has been reported from Oceania, several parts of Asia, and South America. In order to assess the situation in Thailand, 886 patients with vivax malaria who were admitted to the Bangkok Hospital for Tropical Diseases from 1992 to 1997 were followed prospectively. Most of the patients had been infected on the western border of Thailand and were experiencing their first malarial infection when admitted. All received oral chloroquine (approximately 25 mg base/kg body weight, administered over 3 days) and then were randomized to receive primaquine (15 mg daily for 14 days) or no further treatment. All the patients were initially responsive to chloroquine, clearing their parasitaemias within 7 days, and there were no significant differences in the clinical or parasitological responses between those treated with primaquine and those given no further treatment. Plasmodium vivax parasitaemias re-appeared within 28 days of chloroquine treatment in just four patients. In each of these four cases, re-treatment with the same regimen of chloroquine resulted in eradication of the parasitaemia, with no further appearance of parasitaemia during the next, 28-day, follow-up period. These data indicate that virtually all acute (i.e. blood-stage) P. vivax infections acquired in Thailand can still be successfully treated with chloroquine.
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PMID:Chloroquine sensitivity of Plasmodium vivax in Thailand. 1056 23

An increasing proportion of malaria cases in Italy is observed in immigrants revisiting their country of origin, but little specific research work has been carried out in this field. All malaria cases occurring from 1990 to 1998 at the Reference Clinic for Infectious and Tropical Diseases in Brescia were prospectically evaluated to compare clinical outcome in migrant and non-immune cases. No difference was observed between parasitaemia at diagnosis and time to clearance of peripheral parasitaemia. Clinical presentation was milder in migrants than in non-immunes, with an OR for severe malaria of 0.27 (c.i. = 0.09-0.84) (p = 0.01). Fever clearance time was significantly shorter in migrants (3.0 days, SD = 1.2) than in non-immunes (4.3 days, SD = 1.7) (p < 0.001). Among immigrants, the proportion of severe cases was higher in residents since 2 years or less (12.5%) compared to residents since 2 to 5 years (3.3%) and residents since more than 5 years (0.9%) (p = 0.02). The proportion of malaria cases who had used chemoprophylaxis was significantly lower among immigrants (30/272, 11.0%) compared to non-immunes (41/74, 55.4%) (p < 0.001). In a population based malaria KAP analysis among 504 migrants from malaria endemic countries, correct knowledge of malaria risk was reported by 351 (69.5%). Of 170 subjects who reported at least one visit back to the home country, 30 (17.6%) had sought pre-travel advice, 24 (14.1%) had started chemoprophylaxis and 7 (4.1%) had completed it during the last visit. Of 140 migrants who failed to seek pre-travel advice, 73 (52%) were unaware of malaria risk, 56 (40%) did not know how to protect themselves, and 11 (8%) refused to use protective measures. Migrants account for a significant proportion of imported malaria cases in industrialised countries. Clinical presentation is milder compared to non-immune subjects. The proportion of migrants who adopt malaria protective measure while returning home is very low, due to both unawareness of risk and inappropriateness of medical advice.
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PMID:Malaria in migrants. 1069 66

To determine whether hemoglobin E trait influences the antimalarial effect of artemisinin derivatives, we retrospectively compared 32 case patients with hemoglobin E trait to 32 control patients who did not have hemoglobin E, beta-thalassemia, glucose-6-phosphate dehydrogenase deficiency, or alpha-thalassemia trait on the basis of a mean corpuscular volume > or =78 femtoliters. All patients were admitted to the Hospital for Tropical Diseases in Bangkok, Thailand, with acute falciparum malaria. Control patients were matched to case patients with hemoglobin E trait by treatment with artemisinin derivatives versus other antimalarial drugs, by ethnic group, and by parasite count. Among 38 patients treated with artemisinin derivatives, the presence of hemoglobin E trait was associated with significantly faster parasite clearance (2.9-fold; 95% confidence interval [CI], 1.4-6.3; P=.006). Among 26 patients treated only with other antimalarial drugs, hemoglobin E trait did not significantly enhance parasite clearance (hazards ratio, 1.1; 95% CI, 0.5-2.5; P=. 8). Hemoglobin E trait may potentiate the antimalarial effect of artemisinin derivatives.
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PMID:Influence of hemoglobin E trait on the antimalarial effect of artemisinin derivatives. 1076 87

The first international meeting of the Research Initiative on Traditional Antimalarial Methods (RITAM) was held at the Regional Dermatology Training Centre (RDTC) of the Tumaini University of Health Sciences, Moshi, Tanzania, on December 8-11, 1999. This Inaugural Meeting of RITAM, jointly hosted by the Global Initiative for Traditional Systems of Health (GIFTS) at Oxford University and the World Health Organization (WHO), was designed to develop a strategy for more effective, evidence-based use of traditional medicines that can also inform malaria-control policy decisions. RITAM was established during 1999 as a network of researchers and other people who are active or interested in the study and use of traditional, plant-based antimalarials. RITAM is a partnership between GIFTS of Health, University of Oxford and the Tropical Disease Research (TDR) Programme of WHO. Malaria is one of the key health issues affecting developing countries, particularly in sub-Saharan Africa and Asia. With increasing drug resistance and the high cost of pharmaceutical drugs, the use of herbal antimalarials is popular. The conference was attended by biologic and social scientists, clinicians, traditional healers, and policy makers from Africa, Asia, Europe, and the Americas. The meeting was funded by the Rockefeller Foundation, the Nuffield Foundation's Commonwealth Programme, WHO's TDR Programme, and direct support to delegates was provided by other funders. The meeting addressed the need for research and policy on the prophylactic and therapeutic effects of medicinal plants as well as on vector control and repellence. There were five main outputs from the meeting: (1) targets for making a significant contribution to the control of malaria through the use of traditional antimalarial methods; (2) methods for achieving these targets, including ethical guidelines; (3) an implementation strategy for moving this field ahead quickly and soundly and for putting research findings into practice; (4) linkages established between researchers working on traditional antimalarial methods, based on agreed research priorities and designed to avoid unnecessary replication; and (5) strengthening the RITAM database of current knowledge on traditional herbal antimalarial methods. Four specialist groups were established to develop the above: (1) policy, advocacy, and funding; (2) preclinical studies; (3) clinical development; and (4) repellance and vector control. These will be coordinated by an executive committee managed by GIFTS. Two meetings are planned in 2000: a natural-products chemistry meeting at WHO in Geneva, Switzerland, in June; and a symposium at the World Congress on Tropical Medicine in Cartagena, Colombia, in August.
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PMID:The first international meeting of the Research Initiative on Traditional Antimalarial Methods (RITAM). 1078 78

In an attempt to see if the OptiMAL dipstick (Flow Inc., Portland, OR) can be used to monitor antimalarial treatment, a pilot study of 17 patients with Plasmodium falciparum malaria, admitted to the Hospital for Tropical Diseases in London, U.K., was conducted. Sequential, follow-up, blood specimens were obtained from day 1 to day 3, 4 or 5 post-admission. Thin and thick films prepared from these samples were examined for the presence of malarial parasites, and the intensities of parasitaemia were estimated. In addition, each specimen was tested with the OptiMAL dipstick, Rhodamine-123 fluorescence staining and, on specimens collected on day 1 and the last follow-up before discharge, by a PCR-based test. The results showed that OptiMAL has good sensitivity for the initial diagnosis of P. falciparum malaria and also mirrors the decline in viability of the parasites on treatment, giving the potential to follow the efficacy of drug treatment. The results of the PCR-based tests were still positive when the blood film and OptiMAL result were negative. The OptiMAL dipstick compared well with blood-film microscopy for monitoring antimalarial treatment and could be a useful replacement for microscopy to monitor treatment in places where facilities for microscopy are either lacking or inadequate. In developed countries it could be a useful adjunct to blood-film microscopy, and it might permit a reduction in the duration of hospitalization and give an early warning of treatment failure.
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PMID:Comparison of blood-film microscopy, the OptiMAL dipstick, Rhodamine-123 fluorescence staining and PCR, for monitoring antimalarial treatment. 1088 66

We report here the sensitivity and specificity of OptiMAL for the diagnosis of acute malaria in patients presenting to the Hospital for Tropical Diseases (HTD), a tertiary referral centre for Tropical and Infectious diseases. A sensitivity of 95.3% and a specificity of 100% for Plasmodium falciparum and a sensitivity of 96% and a specificity of 100% for Plasmodium vivax was obtained. The ability to follow the course of the parasitaemia using OptiMAL during treatment and its significance for use in areas where expert microscopy is not available is discussed.
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PMID:Performance of the OptiMAL malaria antigen capture dipstick for malaria diagnosis and treatment monitoring at the Hospital for Tropical Diseases, London. 1138 Apr 33

By the 1890's, some of the excitement had gone out of classic bacteriology. The germ theory of disease was widely accepted and the causative agents identified for many bacterial diseases. The nature of immunity preoccupied many scientists, but attention also shifted to the class of diseases which Patrick Manson called "tropical". 1898 has claim to be the year in which tropical medicine came of age. It saw the work of Ross and Grassi on mosquito transmission of malaria, the research on the sexual nature of Plasmodium reproduction by Simond and MacCallum, the planning of the schools of tropical medicine in London and Liverpool, the opening of the Laboratory in Senegal, the first issue of the Journal of Tropical Medicine and the publication of Manson's classic textbook, Tropical Diseases. My talk will examine the state of biomedical knowledge a century ago, in a time of confident imperialism.
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PMID:[Medicine and medical science in 1898: insects and disease transmission]. 1100 Sep 50

Chloroquine-induced itch in black-skinned African malaria patients is common and frequently leads to poor compliance or treatment defaulting.To assess the frequency and severity of chloroquine-induced pruritus in an Asian population, we reviewed case records of 1189 Plasmodium vivax malaria patients treated with chloroquine (25 mg/kg over 3 days) at the Bangkok Hospital for Tropical Diseases from 1992 through 1997. The majority of patients were Thais or ethnic Burmese (light brown skin), referred from the western border of Thailand. Overall, there were 23 patients (1.9%) with complaints of pruritus during chloroquine therapy. Of these, 12 (52%) had palm and sole involvement, eight (35%) had generalized pruritus including the palms and soles, and three (13%) had palm itching only. One patient developed pruritus on the palms and soles on two consecutive admissions. The pruritus did not interfere with daily activity, was reduced in intensity by anti-histamine therapy, and did not affect the patient's willingness to complete the chloroquine regimen. Therapeutic responses in the 23 patients with chloroquine itch was similar to those without itch. Among the itch patients, there was no association with gender or level of parasitaemias. Our findings indicate that the frequency of chloroquine-induced pruritus in Asian patients treated with chloroquine for P. vivax malaria is low in comparison with black-skinned Africans.This may be related to pharmacogenetic factors, the infective Plasmodium species, drug metabolism or drug-parasite interactions, or a lower affinity of chloroquine for less pigmented skin.
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PMID:Frequency of pruritus in Plasmodium vivax malaria patients treated with chloroquine in Thailand. 1107 53

121 malaria cases treated in the Ward of Tropical Diseases of the Clinic of the Institute of Maritime and Tropical Medicine in Gdynia in the years 1993-1999 were analysed. About 37% of the patients showed symptoms of parenchymal liver injury manifested by increased bilirubin concentration, elevated transaminase, alkaline phosphatase and GGTP levels. Histopathological examination of the liver revealed the activation of cells of mononuclear phagocyte system, Kupffer's cells in particular, with the presence of granules of browny-black ,,malarial" pigment and iron deposits. In one fatal tropical malaria case, symptoms of disseminated intravascular coagulation were found along with a few lymphocytic infiltrations in portal spaces, and focal necrosis of hepatocytes. In some patients with the so-called ,,untypical" secondary liver lesions present in the histopathological examination, the toxic effect of antimalarial drugs should be taken into account. A liver biopsy is justified in patients manifesting multiple courses of malaria. It is indispensable in cases of suspected polyetiological changes in the liver and in cases of recompensation payment claims.
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PMID:Liver injury in the course of malaria. 1121 8


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