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)

The objective of this study was to determine the safety and efficacy of atovaquone and proguanil hydrochloride combination therapy for the prophylaxis of Plasmodium falciparum malaria in at-risk nonimmune subjects in South Africa. This open-label trial was conducted at research sites in South Africa during the main malaria transmission season, February through July. The study volunteers were temporarily living in, or traveling to, a malaria-endemic area. They received I tablet of 250 mg atovaquone and 100 mg proguanil hydrochloride once daily for up to 10 weeks. Subjects were monitored using sequential clinical and laboratory assessments. Thick blood smears were stained and evaluated by a central laboratory. An immunochromatographic test for P. falciparum was also used for on-site patient management. Prophylactic success was summarized using a 95% confidence interval for the proportion of subjects who did not develop parasitemia or who withdrew due to a treatment-related adverse event. A total of 175 subjects (15% women) were enrolled in the trial. The mean duration of drug exposure was 8.9 weeks. The combination of atovaquone and proguanil hydrochloride was well tolerated. The most frequently reported adverse events considered possibly related to study treatment were headache (7%), abdominal pain (2%), increased cough (2%), and skin disorder (2%). No serious adverse events were reported, and no treatment-emergent effects were noted for any laboratory variables. One subject who was noncompliant with therapy developed parasitemia, and 3 subjects withdrew due to a treatment-related adverse event (2 subjects with headache and 1 with nausea and dizziness). The prophylaxis success rate was 97%. In this study, atovaquone and proguanil hydrochloride combination therapy had an excellent safety and efficacy profile for prophylaxis of P. falciparum malaria in nonimmune subjects.
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PMID:Safety and efficacy of atovaquone and proguanil hydrochloride for the prophylaxis of Plasmodium falciparum malaria in South Africa. 1036 39

Imported dengue is increasingly observed in non endemic countries. We report a retrospective study of 44 cases of dengue fever diagnosed in nine french university hospitals between 1994 and 1997. The patients were aged between 13 and 67 years. Most of them were tourists and had been traveling for a few weeks, in French West Indies and French Guyana (18), South-East Asia (10), India (7) or Polynesia (4). Only, two contracted the disease in Africa. The onset of symptoms preceded the return or followed it within 7 days. The most frequent clinical presentation was a febrile and painful syndrome. Cutaneous manifestations (rash or macular exanthem) were observed in 59% of cases, digestive symptoms in 50%, pharyngitis and/or cough in 25%, microadenopathy in 20%, moderate mucous haemorrhagic manifestations in 16% and neuropsychiatric manifestations in 14%. The common biological abnormalities were thrombocytopenia (84%), leukopenia (59%), and elevated transminases (57%). The diagnosis, orientated by negativity of malaria smears, the knowledge of an epidemic in the visited country, or occurrence of similar cases in the entourage, were argued by serological results: presence of anti-DEN IgM in 25 cases, serological conversion (anti- DEN IgG) in 7 cases or very high seropositivity (anti-DEN IgG > 1/1280) in 12 cases. No virus isolation was obtained.
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PMID:[Imported dengue: study of 44 cases observed from 1994 to 1997 in 9 university hospital centers. Infectio-Sud-France group]. 1041 36

In February 1998, an outbreak of acute febrile illness was reported from the Kapalata military camp in Kisangani, the Democratic Republic of Congo. The illness was characterized by an acute onset of fever associated with severe headache, arthralgia, backache, neurologic signs, abdominal pain, and coughing. In 1 individual, hemorrhagic manifestations were observed. The neurologic signs included an altered level of consciousness, convulsions, and coma. Malaria was initially suspected, but the patients showed negative blood films and failed to respond to antimicrobial drugs. A total of 35 sera collected from the military patients in the acute phase were tested for the presence of IgM against vector-borne agents. Serum IgM antibodies against West Nile fever virus were found in 23 patients (66%), against Chikungunya virus in 12 patients (34%), against dengue virus in 1 patient (3%), and against Rickettsia typhi in 1 patient (3%). All sera were negative for IgM antibody against Rift Valley fever virus, Crimean Congo hemorrhagic fever virus, and Sindbis virus. These data suggest that infections with West Nile fever virus have been the main cause of the outbreak.
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PMID:An outbreak of West Nile fever among migrants in Kisangani, Democratic Republic of Congo. 1067 64

The clinical characteristics of falciparum malaria were studied among 61 children, aged 0 to 14 treated at a reference center in Manaus, from October to December 1997. The symptoms observed were fever (98.4%), headache (80.3%), chills (68.9%), perspiration (65. 6%), myalgia (59.0%), nausea (54.1%), lumbar pain (49.2%), vomiting (49.2%), cough (45.9%), arthralgia (31.1%), diarrhea (34.4%), dyspnea (8.2%), convulsions (8.2%) and dizziness (4.9%). Pallor and anaemia were found more frequently in children under five years old. Anaemia was associated with high levels of parasitaemia. Fifty-eight (91.5%) patients had uncomplicated malaria, 3 (4.9%) had severe malaria and the lethality was 1.6%.
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PMID:[Clinical study of falciparum malaria in children in Manaus, AM, Brazil]. 1088 Nov 32

The aim of this study was to determine the prevalence of HIV-1 infection, the clinical spectrum of HIV-1-associated conditions and HIV-1-associated mortality among children hospitalized in the medical paediatric wards at Muhimbili Medical Centre (MMC), Dar es Salaam, Tanzania. All children admitted to the medical paediatric wards of MMC between August 1995 and January 1996 were eligible for the study. Testing for HIV antibodies was done using 2 consecutive enzyme linked immunosorbent assays (ELISAs). ELISA-reactive samples from children aged 18 months and below were further tested by a recently developed heat-denatured p24 antigen assay. The prevalence of HIV-1 infection among the 2015 children studied was 19.2%. When present for 14 days or more, fever, cough, diarrhoea, ear discharge, oral ulcers and skin rash were all significantly more common in HIV-1-infected than in HIV-uninfected children (p < 0.001). In the multivariate analysis cough, ear discharge, oropharyngeal ulcers and skin rash were found to be the most important symptoms. Clinical signs found to be significantly associated with HIV-1 infection in the univariate analysis were wasting, stunting, hair changes, oral thrush, oropharyngeal ulcers, lymphadenopathy, lung consolidation and lung crepitations (p < 0.001). In the multivariate analysis, oral thrush, lung crepitations, cervical lymphadenopathy, wasting and inguinal lymphadenopathy were found to be the most important signs. The 3 most common diagnoses in HIV-1-infected children were acute respiratory infection (ARI) (39.4%), malnutrition (38.1%) and tuberculosis (19.3%), while in HIV-uninfected children they were malaria (47.0%), ARI (25.0%) and malnutrition (16.1%). The mortality rate was 21.4% in HIV-1-infected children and 8.4% in HIV-uninfected children (p < 0.001). In conclusion, the prevalence of HIV-1 infection among hospitalized children at the main hospital in Dar es Salaam was high and associated with high mortality. Many symptoms and signs are indicative of HIV-1 infection, but appropriate laboratory testing is required for diagnosis.
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PMID:Prevalence of HIV type 1 infection, associated clinical features and mortality among hospitalized children in Dar es Salaam, Tanzania. 1095 42

In a prospective study spanning 12 1/2 years (July 1983 to December 1995), 272 children with nephrotic syndrome seen at the University of Nigeria Teaching Hospital Enugu, Nigeria, were followed up and reviewed at the end of the study period. The demographic, clinical and laboratory features, response to treatment and prognosis were documented. Nephrotic syndrome made up 1.34% of all paediatric admissions. There were 164 males and 108 females giving a male to female ratio of 1.5:1. The ages ranged from 2 to 16 years, with a mean of 7.9 +/- 3.4 years and peak age of 5-7 years. The major clinical features were generalized oedema (100%), hypertension (23%), fever (20%), oliguria (10%) and cough (7%). Haematuria was present in 26%, mean serum albumin was 16 +/- 5, 1 gm/L, serum cholesterol 9.53 +/- 1.6 mmol/L Malaria parasitaemia was present in 38.7% and 9 patients (3.3%) had sickle cell disease (SS). Treatment with diuretics, pooled plasma, prednisolone or cyclophosphamide in various combination achieved 63.9% remission. Mortality was 5.5% being mainly due to chronic renal failure, hypertension and infections. The study calls for more trials in the use of steroids and cyclophosphamide in the treatment of childhood nephrotic syndrome in the tropics.
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PMID:Childhood nephrotic syndrome in Enugu, Nigeria. 1107 Jul 50

One hundred and sixty eight febrile adult outpatients were investigated at St Francis Designated District Hospital in fakara, a holoendemic area in Tanzania. We wanted to assess the potential anamnestic and clinical risk indicators for malaria and to establish a rational strategy for malaria management. Blood slide investigations showed that 14% of all patients were positive for P. falciparum. All the positive cases were found during the rainy season. No reliable criteria for malaria were found in the history taking and physical examinations. Signs and symptoms of respiratory tract infection such as difficulties during breathing, sore throat, chest pain, cough, pathological findings in lung auscultation and combinations of these were negatively associated with malaria parasitaemia. The same was true for lymph node swelling and a clinical diagnosis other than malaria. Quality control of blood slide results from the hospital revealed a sensitivity of 55%, a specificity of 72%, and positive and negative predictive values of 24% and 91%. The main recommendations for malaria management in adults were to improve the quality of blood slide examinations and to use a different diagnostic strategy during the dry and rainy seasons. During the dry season blood slides of febrile adult patients should only be performed if there is a suspicion of malaria and antimalarial drugs should only be administered if blood slide results are positive. During the rainy season all febrile adults without obvious cause of fever other than malaria should be treated with antimalarials without previous blood slide examination.
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PMID:Towards a rational malaria management at district hospital level: exploratory case series of febrile adult patients in a holoendemic area of Tanzania. 1107 50

It is extremely important to look for tropical and other exotic diseases in travellers who return with illness or become ill after travelling. Especially tropical diseases and exotic infectious diseases have to be excluded because of their possible fatal outcome. On the other hand, many travellers return with 'common' not-exotic illnesses not related to their journey. When in such cases attention is only given to exotic causes of their illness, diagnosis can be delayed which may be harmful. This was the case in 5 patients: a woman aged 44 years who suffered for months from bloody diarrhoea since her return from Brasil, due to a rectal adenocarcinoma, a 61-year-old man with diarrhoea upon returning from Egypt, who had hairy-cell leukaemia, a 17-year-old boy who developed a ketoacidotic diabetic crisis whilst on a journey in Uganda, but in whose case the first thoughts went to malaria, a 50-year-old man who suffered from throat pain since a journey through East Africa, during which he contracted a flu-like disease, and in whom Kahler's disease was diagnosed, and 69-year-old man suffering from recurrent fever and cough, in whom a radiological lesion was observed in the thorax which proved to be part of Wegener's disease.
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PMID:[Illness after travel not always due to exotic disease]. 1123 88

Malaria, a major killer of mankind, apart from classical ague presentation, may present with respiratory manifestations. This may be misdiagnosed and important time may be lost in instituting antimalarials leading to higher morbidity and mortality. Present work was undertaken to study the clinical presentations of malaria with special reference to respiratory system and to evaluate the effect of antimalarials to such atypical presentation. One hundred slide positive cases of malaria were taken and detailed for respiratory involvement. Response to antimalarials was seen in these cases and associated complications (if any) were looked for. Mean age of the cases was 29.3 years with a male predominance. Positivity of peripheral smear read as: P vivax(53%), P falciparum (36%) and mixed infection (11%). Twenty-six patients had presented with respiratory manifestations-bronchitis (15), pneumonia (4), asthmatic bronchitis (1), adult respiratory distress syndrome (ARDS) (4) and pulmonary tuberculosis (2). Of these 26 cases, presenting symptoms noticed were cough (77%), dyspnoea (32%), expectoration (29%) and chest pain (15%). Twenty-five (96%) of these 26 patients were positive for P falciparum. Response to antimalarials was not significantly different in these 26 patients as compared to the rest (74 cases). All patients developing ARDS expired. The present study concludes that malarial atypical respiratory presentations are far higher in incidence than reported in literature. Peripheral smear examination in all patients of high grade fever with chills and rigors and having respiratory manifestations may unmask malarial infection and warrant early antimalarial treatment resulting in decreased morbidity and mortality.
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PMID:Pulmonary manifestations in malaria. 1125 88

Four hundred adults aged 20-60 years, (200 females and 200 males) were studied. All the subjects were residing in the urban areas of Lagos, Nigeria. Thirteen percent claimed they were having "constant malaria" (> 8 times per year), 5% (20) claimed to have cough mostly during the cold period, 2.5% (10) produced mucoid sputum, 2.5% unproductive cough, 13% were AFB smear positive, 1.5% had positive chest X-ray for pulmonary Tuberculosis (PTB), 1.5% were HIV positive and 50% were mantoux positive (> 10 mm induration). All who complained of "constant malaria" were AFB positive. Malaria parasite density was lower in those who complained of "constant malaria" than those who did not complain (P = 0.003). The complaint of frequent malaria attack decreased after Antituberculosis therapy for 6 months. This study revealed that in a malaria and tuberculosis endemic region, early stage of tuberculosis can masquerade as "constant malaria". Therefore any such complaint should be fully investigated.
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PMID:Tuberculosis masquerading as 'constant malaria'. 1150 83


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