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

Diagnosis and management of malaria in returning travellers must be treated as an emergency. A thorough travel history and a blood examination are prerequisites for diagnosis of the infection. Plasmodium vivax, P. ovale and P. malariae infections cause febrile illnesses that are usually not dangerous, but P. falciparum often causes complications that can be fatal. Hospitalization should therefore be considered in the latter cases. The clinical features of the disease are often non-specific (fever, headache, myalgia, sweating). Furthermore, mitigated and delayed courses of the illness due to sub-therapeutic antimalarial drug levels are recorded in patients who have taken incomplete chemosuppression. Chloroquine is still the treatment of choice in most cases of P. vivax, P. ovale and P. malariae infections. In P. falciparum malaria, chemoresistance in many parts of the world requires treatment with other antimalarials. Treatment should be started when there is strong suspicion of malaria even before the diagnosis is parasitologically confirmed. Quinine is the drug of choice in severe P. falciparum malaria. An intravenous loading dose is administered if no previous treatment has been given.
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PMID:[Current malaria management in Switzerland]. 780 89

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

In early 1992 in Tanzania, trained research assistants interviewed 20 rural medical aides (RMAs), 20 drug sellers, 120 patients at 20 dispensaries, and 120 customers of drug stores, all in Dar es Salaam, to examine knowledge and practices of health workers, drug sellers, and patients concerning malaria. The RMAs had adequate knowledge of the signs and symptoms of malaria (e.g., 90% for fever, 85% for headache, and 80% for painful joints). The drug sellers also had adequate knowledge of signs and symptoms (e.g., 80% for fever, 45% for headache, and 50% for painful joints). Even though chloroquine-resistant strains of Plasmodium falciparum malaria exist in Tanzania, all RMAs and most drug sellers (85%) believed that chloroquine could cure malaria. Further, it is the only antimalarial that the Ministry of Health provides its dispensaries. Just 65% of RMAs knew the correct dosage of chloroquine for people 14 years old and older. An even lower percentage of drug sellers knew the correct dosage (50%). Just 33.7% of patients and 22.5% of customers knew the correct dosage of chloroquine. An inadequate supply of chloroquine was available at 15% of dispensaries and 30% of drug stores. RMAs sometimes gave patients too few chloroquine tablets for a full course of therapy. Other drugs mentioned by RMAs to treat malaria were quinine, amodiaquine, cotrimoxazole, halofantrine, pyrimethamine/sulphalene, and pyrimethamine/sulphadoxine. Those mentioned by drug sellers included aspirin plus chloroquine, cotrimoxazole, pyrimethamine/sulphadoxine, and traditional medicines. These findings suggest that irrational drug therapy of malaria promotes resistant strains and prolongs the duration of illness. Introduction of treatment charts and health education promotion to the public are needed to improve malaria management at dispensaries and drug stores.
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PMID:Knowledge and management of malaria in Dar es Salaam, Tanzania. 818 61

The current formulation of halofantrine hydrochloride has poor absorption and bioavailability. A newly developed micronized formulation was evaluated for efficacy, safety and tolerance in the treatment of acute Plasmodium falciparum malaria. The study was conducted at a plantation hospital in northern Tanzania, where chloroquine resistance is common. Sixty in-patients with mild or moderate malaria were treated with 375-750 mg micronized halofantrine hydrochloride given in 3 equal doses, 6 h apart. Patients were followed up for 28 d after therapy. Treatment was associated with rapid parasite clearance (mean clearance time = 34.8 h), fever clearance (mean time = 20 h), and clinical improvement (70% of patients were free of all presenting symptoms within 2 d). The formulation was well tolerated clinically, although 3 patients (5%) developed mild pruritus after treatment which may have been drug-related. Haematological and biochemical studies did not indicate any significant toxicity. One patient, whose immediate recovery was uneventful, was found to have a headache and low parasitaemia 3 weeks after treatment. He was readmitted to the study and treated as before. Parasitaemia, fever and headache cleared rapidly and he remained aparasitaemic for 28 d.
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PMID:A new micronized formulation of halofantrine hydrochloride in the treatment of acute Plasmodium falciparum malaria. 824 83

One hundred and five healthy nonimmunes in Colombia took part in a randomize, double-blind comparison of 250 mg of Lariam (L) (active ingredient: mefloquine) on alternate weeks or one tablet of Fansidar (F) (active ingredients: sulfadoxine and pyrimethamine) weekly for malaria prophylaxis during at least six months. Volunteers also gave blood for determination of drug concentrations after six months and/or 24-27 months of prophylaxis. Twenty-five volunteers withdrew involuntarily when they lost their jobs in the company. Two who took L withdrew due to moderate diarrhea and mild nausea or headache, weakness, drowsiness and anxiety. One volunteer stopped taking F due to severe unilateral hypostatic eczema and slight S-T depressions on the ECG. The rest completed at least six (range 6-36) months of prophylaxis. The mean half-life for L was 26 days. The AUCs in the time interval 0-14 days for L varied between 19.3-31.5 mumol x days/l. For the main metabolite, the corresponding range was 28.8-81.3 mumol x days/l. The range of trough concentrations at day 0 and 14 were 0.95-2.01 mumol/l for L and 1.69-5.62 mumol/l for the metabolite. No differences in tolerability and efficacy were noted between L and F. Our kinetic results do not indicate that enzymatic induction or inhibition would be important during long-term prophylaxis with mefloquine. This favors a continued use of the drug for very long periods of time (= years).
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PMID:Comparative tolerability and kinetics during long-term intake of Lariam and Fansidar for malaria prophylaxis in nonimmune volunteers. 825 6

A retrospective analysis of all malaria cases admitted to the Nairobi Hospital was performed by reviewing patient records. Six hundred and three cases were recorded between the period of January 1987 and July 1990 (43 months). The mean age of the patients was 32.5 years and 57.5% were male. Although 81.4% were permanent residents of Kenya, only 18.2% could be said to have lived in a malarial zone. One-quarter of the patients (25.6%) admitted having had a previous episode of malaria, and 57.7% were taking regular chemoprophylaxis. The most common presenting symptoms were fever, headache, vomiting and myarthralgia; the most commonly recorded accompanying signs were jaundice and splenomegaly. Sixty patients met the criteria for severe malaria. During their hospital stay, six patients (1%) died; five of whom were severely ill from the time of for the USA and UK, especially as it represents a selected population of the more serious malarial cases admitted to the hospital. Therefore, it may indeed represent clear evidence to support the hypothesis that a high index of suspicion combined with early diagnosis and treatment will result in improved outcome. Comparative features illustrating these points are presented. As the malaria parasite, P. falciparum, has dynamic antimalarial sensitivity and as more travelers are under threat from this disease, it is vital that ignorance of this danger should not be allowed to put individuals at risk for death. Continuing education of both the traveling public and the medical profession is the only way that both parties will shoulder their respective responsibilities.
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PMID:Nairobi Hospital, Kenya: the management of nonimmune P. falciparum malaria abroad. 825 8

Plasmodium falciparum malaria is endemic in the northern KwaZulu areas of South Africa. The clinical morbidity produced by this parasite has not been studied since the institution of the present malaria control programme. Fifty-nine patients were prospectively studied at a peripheral clinic during the peak malaria season; symptoms and signs of the infection, parasite loads, haemoglobin values and leucocyte counts were recorded in all patients. Haemoglobin and leucocyte counts were also measured in 37 control subjects without malaria. The commonest symptoms were persistent headache (100%), rigors (98%) and myalgia (93%). None of the patients presented with coma, pulmonary oedema, hypoglycaemia or algid malaria. Splenomegaly was found in 49%, hepatomegaly in 20% and mental confusion in 5% of patients. Mean parasite load was 1.71% and 57% of patients had parasite loads of < 1%. Anaemia of < 10 g/dl was significantly more frequent (P < 0.0001) in the patient group than in the control group. Leucopenia (white cell count < 4.0 x 10(9)/l) was present in 12 of 50 patients in whom it was measured compared with 2 controls (P = 0.0175). The results show a wide range of morbidity, without severe complications as presenting manifestations. Symptomatic infection in the presence of low parasite loads suggests that there may be little or no immunity in this population.
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PMID:Morbidity from falciparum malaria in Natal/KwaZulu. 845 85

The combined effects of nutrition and illness on the physical activity of subsistence farmers were investigated in a sample of 226 adults (114 households) from Ethiopia's drought-prone Rift Valley. The mean energy expenditure was estimated at 2937 kcal for men and 1977 kcal for women. Sex, age, nutritional status, period prevalence, severity of diseases, and seasonality independently influenced energy expenditure. The highest energy expenditures occurred during the pre-harvest period for men and during the harvest for women. The mean body mass index was 19.7 for men and 20.0 for women. 31.4% of men and 28.5% of women were defined as malnourished on the basis of a body mass index less than 18.5. 18.8% of respondents (20.9% of men and 17.1% of women) reported an illness in the preceding 2 weeks. Fever, headache, muscle and joint pain, malaise, and diagnosed malaria were the illnesses most frequently described. Of the 57 adults who reported a recent illness, half had stayed in bed for a mean duration of 7.8 days. Suspected, in this rural population, is a cycle of malnutrition, disease, and activity restriction that begins in childhood. Needed are interventions that reduce the prevalence of childhood stunting and health services that provide adequate prevention and treatment of diseases such as malaria.
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PMID:Physical activity, illness and nutritional status among adults in a rural Ethiopian community. 855 56

A 30-year-old female entered the emergency room for medical advice because of progressive deterioration of general health with headache, arthralgias, myalgias and fever after a vacation of three weeks in Malaysia and Hong Kong. Because of persistent fever, lymphadenopathy, slight leuco- and thrombocytopenia and only insignificantly elevated humoral signs of an inflammatory process, the patient was treated symptomatically after exclusion of malaria. A viral disease was suspected. Two days later, an exanthema erupted suddenly on the trunk. Pinhead-sized livid, flat macules, increasing in size within hours and spreading to the extremities, were observed. Further investigations revealed a significantly elevated titer of IgG directed against rickettsia conorii, leading to the diagnosis of Mediterranean spotted fever. Under antibiotic treatment with tetracycline, the aforementioned findings regressed within few days, and the patient recovered completely.
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PMID:[Febrile status and exanthema following a trip to the jungle]. 869 32


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