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)

A twelve-month longitudinal household health interview survey in Machakos District (now Makueni District), Kenya, during 1991 covered 390 households randomly selected from 12 village clusters. The survey focused on recent disease symptoms and signs, illness severity, temporary disability and care-seeking behaviour. The total number of reported disease episodes was 9,393, (4.4 per person) with more episodes reported by adult females than by adult males. The disease pattern was dominated by malaria (39.6% of all reported episodes) and respiratory tract diseases (23.1%), followed by gastrointestinal illness (10.7%), joint/muscle disorders (6.4%), injuries (5.4%) and skin conditions (4.8%). Self-medication took place in 39.9% of episodes, while care was sought at hospitals or clinics in 32.1%. This survey generated information useful for local health care planning and management, especially regarding local perception of illness episodes and health care utilization. Respondents developed signs of interview fatigue, however, and the completeness and accuracy of symptom descriptions by the lay interviewers are uncertain. Survey costs were about USD 24,700, one third of which was spent on field work, another third on computerized data processing. Utility in relation to costs is likely to be modest. Improvement of the health information system for local planning and management may be equally or better served by selective improvement of the existing routine reporting system combined with occasional cross-sectional household surveys.
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PMID:A longitudinal health interview survey in rural Kenya: potentials and limitations for local planning. 762 60

Some 9% of deaths in Ghana are attributed to malaria, which also accounts for 30% of outpatient visits and 9% of hospital admissions. A survey conducted in four areas of Ghana revealed that the factors perceived as causing malaria included malnutrition, mosquitos, excessive heat, excessive drinking, flies, fatigue, dirty surroundings, unsafe water, bad air, and poor personal hygiene. Most adolescents had no idea how the disease was spread from person to person. The symptoms most frequently considered to be linked to malaria were yellowing of the eyeballs, chills and shivering, headache, a bitter taste, body weakness, and yellowish urine. Malaria was considered to be the most important disease in the communities of Kojo Ashong, Barekese, Barekuma and Oyereko. There was a widespread understanding that malaria adversely impacted the ability of adults to work and of children to attend school. Herbal preparations for self-medication included liquids for drinking, liquids for use as enemas, and potions for hot fomentation. Most people used the leaves of the neem tree (Adzadi rachta indica) to make such preparations. Most interviewees were aware of chloroquine used in the treatment of malaria. A few people sprayed their rooms with insecticide before going to bed in order to kill mosquitos, while others used repellent coils. Bednets were rarely used. There was little knowledge of how the transmission cycle of the parasite could be broken. One social implication of the disease is that if the breadwinner dies, the children may have to cease attending school. For Africa as a whole the annual economic burden of malaria was $ 0.8 billion in 1987; by 1995 it is expected to be $ 1.7 billion. The first step in any control program should be to educate the people about the cause and treatment of the disease. District assemblies should enact bylaws on the cleanliness of households, which inspectors should enforce.
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PMID:Socioeconomic factors in malaria control. 794 58

The frequency of malaria attacks after surgery was determined during a 3-month period in the surgical ward of Bobo-Dioulasso hospital (Burkina Faso). The survey was carried out during the period of highest malarial morbidity. All adolescents and adults admitted to the ward were included, except women undergoing Cesarian section and patients who died in the perisurgical period. Patients were questioned as to the use of antimalarial drugs during the days prior to admission, their occupation and their place of residence. Malarial parasites were tested for routinely on D0, D2 and D5, and every day in case of suspected malaria. Malaria attacks were diagnosed on the basis of clinical signs (fever, headache and tiredness), and microscopic identification of parasites. Only 6% of the patients developed malaria attacks during the 5 days after surgery, and all were due to Plasmodium falciparum. Parasite density at the time of the attacks was between 1,000 and 10,000 PRBC/mm3. These patients did not differ from the overall population in social or medical characteristics. This low incidence of postsurgical malaria attacks relative to other African countries may be due to the routine use of antimalarial drugs in case of attacks. The frequency of such attacks appears to be overestimated by physicians, and microscopic analysis is thus recommended to establish the diagnosis after surgery.
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PMID:[Malaria following surgery in an endemic region]. 818 22

To determine the characteristics of clinical illness accompanying Plasmodium falciparum infection induced by controlled exposure to infected mosquitoes, records of 118 volunteers participating in studies conducted between 1985 and 1992 were reviewed. One hundred fourteen volunteers (97%) reported at least one symptom attributable to malaria, with fatigue, myalgias or arthralgias, headache, and chills most commonly reported. The median duration of symptoms was 3 days. Fever was recorded in 61% of volunteers; 4 volunteers had temperatures >40 degrees C. Neutropenia and thrombocytopenia were present in 9% and 12% of volunteers, respectively. Despite counts as low as 658/microL (neutrophils) or 73,000/microL (platelets), no secondary infectious or hemorrhagic complications occurred. In all cases, volunteers recovered completely and laboratory values returned to baseline after specific antimalarial therapy. Recrudescence did not occur in any volunteer. In this model, mosquito inoculation of P. falciparum is a reliable, safe, and well-tolerated method of experimental challenge.
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PMID:Clinical manifestations of Plasmodium falciparum malaria experimentally induced by mosquito challenge. 960 76

The goal of our study was to determine the epidemiological and clinical features of imported malaria seen at our military hospital in Hawaii. We reviewed the records of malaria cases seen from January 1, 1979, to December 31, 1995, and compared our results with published reviews from civilian hospitals in North America. Seventy-nine patients were diagnosed with malaria by blood smears. All acquired malaria abroad, mostly in southeast Asia. Sixty-seven percent of cases were vivax malaria, 22% were falciparum malaria, and 11% were caused by undetermined species. Common symptoms were fever (100%), alternate day fever (41%), rigors (91%), headache (59%), nausea (41%), fatigue (39%), dark urine (32%), and vomiting (31%). Ninety-one percent had fever during hospitalization, but 39% were afebrile on admission. Splenomegaly was detected in 49% of cases. The white blood cell count was normal in 65%, low in 31%, and elevated in 4% of cases. Other laboratory findings were anemia (58%), thrombocytopenia (74%), and mild hyperbilirubinemia (64%). Military physicians initially considered the diagnosis of malaria in only 54% of patients. The epidemiological features of our patients differ from those described in the civilian hospitals. Most of our patients were nonimmune, U.S.-born, military personnel infected in southeast Asia, whereas patients described in reviews from U.S. civilian hospitals were usually foreign-born civilians who were infected in Africa or India. The clinical features of malaria, and the problems of initial misdiagnosis in our patients, were similar to those reported from civilian hospitals. Military physicians, like their civilian colleagues, need more training and experience in malaria.
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PMID:A review of 79 patients with malaria seen at a military hospital in Hawaii from 1979 to 1995. 950 98

A study was undertaken to determine the role of typhoid in febrile illness. It was found that in 1992, Salmonella typhi, the causative agent of typhoid, played a 2.3% role in 25404 diagnostic specimens sent to Mulago Hospital, Kampala, the largest hospital in Uganda. The rates of isolation fell gradually from 2.3% in 1992 to 0.3% by 1995. Instead malaria was found to play a major role in febrile illnesses. Out of 355 patients attending a private clinic in Kampala, whose blood was examined for both malaria and typhoid, 97% were positive for malaria parasites compared to 0.84% with significant O and H Salmonella typhi antibody titres of > 1:80. Also malaria parasites were found in 60% (out of 105) of patients who had had persistent fevers and in whom doctors had also requested for HIV antibodies. Those who had HIV antibodies alone were six per cent and the ones with both were 28%, a finding which showed relatively low association of malaria and HIV. Where multiple tests were requested on one patient having general malaise or body joint pains and/or constant headaches, malaria was found to play a major role (73%) compared to syphilis (4.3%) and brucellosis (13.3%). Malaria parasites were seen in normal sizes and in somehow young or stunted forms. The latter were found more often in patients who had experienced one or a combination of the following: intermittent fevers, backache, headache, tiredness, joint and/or neck pains, and who had already received treatment for malaria.
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PMID:Selected laboratory tests in febrile patients in Kampala, Uganda. 964 Aug 25

Malaria infections have become an increasing public health problem in Europe, especially those imported into nonendemic areas. The transmission and diffusion of malaria has increased, especially over the last decade, due to changes in agricultural practices, vector resistance to insecticides, and most relevantly, increasing international travel and the resistance of these parasites to chemophrophylaxis. This study investigates the epidemiologic factors if imported malaria in an area of Italy, as related to international travel and prophylaxis by Italian immigrants who have revisited their country of origin. All cases (175) of imported malaria detected at the Laboratory of Microbiology of Ospedali Riuniti in Bergamo, Italy, between 1984 and 1993 were studied epidemiologically for the following variables: age, sex, and nationality; travel destination, length of stay, and date of return; and pathogen(s) detected, chemoprophylaxis used, and clinical symptoms exhibited. A high prevalence of Plasmodium falciparum was detected in more than three quarters of the cases with 91.4% of these travelers having visited African countries. Only two subjects had received adequate, correct prophylaxis. Fever, headache, and fatigue were experienced most often; however, in a few cases, blood, exchange transfusion, or treatment for splenomegaly were required. The results indicate that there is an emerging public health problem with immigrants who have resided in Italy for some time, revisited their country of origin, and consequently become infected with malaria, with specific prophylaxis not having been provided. This study emphasizes the importance of local epidemiologic studies, effective prophylaxis, and the need for those involved in the travel industry to promote specialized pretravel advice on a routine basis.
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PMID:Ten-year Experience with Imported Malaria in Bergamo, Italy. 981 30

With the discovery of the New World, the Europeans flocked to America and with them spread infectious diseases. During long sea voyages the agents of these diseases increased their diffusion capacity in a suitable environment. Lack of hygiene, fatigue and privations, a diet without vitamins and many persons kept in confined spaces were the essential features of this environment. Sick persons, whose health conditions worsened during the journey to the New World, carried the germs of infectious diseases. The first disease to appear in the New World was smallpox described in 1518 in Hispaniola. From there the disease moved rapidly to Mexico in 1520, exterminating most of the Aztecs, Guatemala and to the territories of Incas from 1525-26, killing most of them and the King himself. The second disease, influenza, appeared in La Isabela, a few years later, causing a heavy epidemic between 1558 and 1559. Other diseases followed such as yellow fever and malaria. So Europeans and these invisible and mortal agents caused enormous destruction of American populations. In fact historians have estimated that beginning from early 1500, in only 50 years the population of Peru and Mexico fell from 60 to 10 million; in the latter country, in one century, the populations fell from an initial 10 million to only 2 million.
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PMID:The major epidemic infections: a gift from the Old World to the New? 1023 Feb 64

Mefloquine is an orally administered blood schizontocide for the chemoprophylaxis of malaria in nonimmune travelers. New pharmacokinetic data has shown that food increases the bioavailability of mefloquine. Steady-state pharmacokinetics of weekly prophylaxis in long term travelers have shown that toxic accumulation does not occur and that weekly dosing is associated with protective levels of the drug. The pharmacokinetics of mefloquine are highly stereospecific and all pharmacokinetic parameters, except tmax are significantly different for the (+) and (-) enantiomers. Mefloquine and its metabolite are not appreciably removed by hemodialysis. Steady-state levels of mefloquine can be attained in a reduced time frame of 4 days compared to 7-9 weeks using a loading dose strategy of 250 mg mefloquine daily for 3 days followed thereafter by weekly mefloquine dosage. This strategy, is however, associated with a higher incidence of an adverse event (AE). Cumulative evidence suggests a high protective efficacy of mefloquine (>91%) in nonimmune travelers to areas of chloroquine resistant Plasmodium falciparum (CRPF) except for clearly defined regions of multi-drug resistance. Reports from sub-Saharan Africa indicate a low but increasing level of resistance to this drug. Mefloquine resistance is associated with halofantrine and quinine resistance but not with chloroquine resistance. Penfluridol has been shown to reverse P. falciparum mefloquine resistance in vitro. There is some controversy regarding the tolerabilty of mefloquine for malaria chemoprophylaxis. A review of the studies conducted during 1992-1998 shows that in the reporting of any AE the incidence lies in the range (12-90%) and where there is a comparator, is equivalent to the incidence reported for almost all alternative regimens. When some measure of subjective severity is applied to the rating of AE, it appears that 11-17% of travelers are, to some extent, incapacitated by AE. Major studies and worldwide monitoring have shown that serious events are rare. A recent meta-analysis showed that rates of withdrawal and overall incidence of AE with mefloquine were not significantly higher than those observed with comparator regimens except that mefloquine was more likely to cause insomnia and fatigue. Withdrawals in mefloquine arms were higher than in placebo arms. No performance deficit or functional impairment was observed in five clinical toxicity studies of mefloquine prophylaxis, including a study of driving performance. There is limited data regarding use of mefloquine in pregnancy. Early animal studies have documented teratogenic and embryotoxic effects associated with the use of high dose mefloquine. Two studies have shown a relatively high incidence of spontaneous abortions in mefloquine users. Cumulative evidence, however, is reassuring and has led the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to sanction the use of mefloquine in pregnant women during the second and third trimesters. In conclusion, mefloquine prophylaxis is recommended for travelers to high risk areas of chloroquine resistant Plasmodium falciparum. The risk of malarial infection and the proven efficacy of mefloquine to prevent malaria should be weighed against the risk of drug associated adverse events.
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PMID:Mefloquine for malaria chemoprophylaxis 1992-1998: a review. 1038 65

The pattern of acute illness was determined in 102 adolescents and adults with sickle cell anaemia who presented to the emergency unit of a Lagos hospital. The patients had a mean age of 20.5 years (SD 13.1) and a male-female ratio of 1.5. The symptoms included fever (72%), fatigue and weakness (59%), anorexia (59%) and pain (57.5%) while major clinical signs were pallor (100%), jaundice (71%) and hepatomegaly (68%). Sixty-eight per cent of patients had sickle cell crises, including one with hemiplegic stroke, 10% with combined anaemia and pain crises, 33% with anaemia crises only and 23.5% with pain crises only. Sixty-three per cent had infection which was malaria in 24.5%, bacterial in 17% and viral in 6%. Of 16 patients with pyrexia of unknown origin, seven responded to treatment with chloroquine and eight to antibiotics. Infection was detected in 50% of the patients with sickle cell crises. The association between anaemia crises and malaria was significant (P < 0.05). Of the eight deaths, seven (88%) had anaemia crises. In contrast to studies conducted two decades ago in the same hospital, the prevalence of anaemia crises now exceeds that of pain crises and malaria now exceeds that of bacterial infection. Severe symptomatic anaemia (anaemia crisis) was more frequently associated with infection (mostly malaria) than was bone pain crisis. The Girdle pain crisis more frequently resulted in a fatal outcome than the uncomplicated bone pain crisis.
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PMID:Acute sickle cell syndromes in Nigerian adults. 1093 Nov 63


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