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Query: UMLS:C0024530 (malaria)
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In order to determine whether giving iron to iron-deficient children increases their susceptibility to malaria, 213 Gambian children aged between 6 months and 5 years with iron-deficiency anaemia were randomized to receive either oral iron or placebo during the rainy season when malaria transmission is maximal. Haematological and iron measurements improved significantly in the group given iron. Regular morbidity surveys showed that fever associated with parasitaemia occurred more frequently in the iron-treated group than in the placebo group. This difference was not significant for all parasitaemias grouped together, but became significant and progressively larger for parasitaemias of ten or more positive fields per 100 high power fields (P less than 0.025), and for parasitaemias of 50 or more positive fields per 100 high power fields (P less than 0.01). Three children in the iron-treated group but none in the placebo group had more than one episode of fever and parasitaemia. Splenomegaly rates rose appreciably during the study in both groups, but in children at age 2 years the splenomegaly rate at the end of the study was significantly greater in the iron-treated group. We concluded that there is a significantly increased risk of fever associated with severe malarial parasitaemia for children with iron-deficiency anaemia given iron during the season of maximal malaria transmission in this part of The Gambia.
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PMID:The effects on malaria of treatment of iron-deficiency anaemia with oral iron in Gambian children. 247 38

Sizes of spleen and liver were studied by measuring spleen index calculated by multiplying the maximal length by the maximal width of the spleen and liver length at right mid-clavicular line below the costal margin using ultrasonography in 26 Papua New Guineans and in 25 Japaneses living in Papua New Guinea. In Papua New Guinean, spleen index and liver length were 77.4 +/- 9.9 cm2 and 5.4 +/- 0.7 cm, respectively. Their spleen index correlated inversely (p < 0.05) with hemoglobin level. In Japanese, spleen index and liver length were 24.5 +/- 2.1 cm2 and 0.8 +/- 0.3 cm, respectively and spleen index correlated positively with the duration of stay in Papua New Guinea (p < 0.05). These results indicate that the clinical and subclinical infections acquired in P.N.G. may play some role on the development of splenomegaly. Malaria is the prime suspect for the high prevalence of observed splenomegaly in both studied groups.
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PMID:Splenomegaly in Papua New Guineans and in Japanese living in Papua New Guinea: report of research and exchange program of Osaka University with the South Pacific region. 248 96

The relationships between S. haematobium, hookworm, malaria, hemoglobin level, splenomegaly, and hepatomegaly before and 8 months after treatment with a single dose of metrifonate or praziquantel were studied in Kenyan primary schoolchildren in an area where anemia, S. haematobium, and hookworm are common and malaria is holoendemic. Children with light to moderate S. haematobium infection were examined (Exam 1), assigned at random to groups receiving placebo (PL, n = 104), metrifonate (MT, n = 103, dose 10 mg/kg body weight) or praziquantel (PR, n = 105, dose 40 mg/kg body weight), treated, and examined 8 months later (Exam 2). At Exam 2, 62% of the MT group still passed S. haematobium eggs vs. 13% in the PR group. Egg reduction rates were substantial in both groups, but greater in the PR group; geometric mean egg counts in both groups were very low. Prevalence and intensity in the PL group had not changed between exams. Hookworm egg counts were significantly reduced in the MT group (59% egg reduction rate); malarial infection had increased in all 3 groups, presumably due to the long rainy season between exams. Hookworm egg count was the most significant predictor of initial hemoglobin level, followed by S. haematobium egg count and presence of malarial infection. Treatment with a single dose of MT or PR can produce substantial decreases in S. haematobium infection 8 months later.
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PMID:Single dose metrifonate or praziquantel treatment in Kenyan children. I. Effects on Schistosoma haematobium, hookworm, hemoglobin levels, splenomegaly, and hepatomegaly. 250 1

The tropical splenomegaly syndrome (TSS) is characterized by massive splenomegaly with hypersplenism, moderate hepatomegaly, and lymphocytic infiltration of the hepatic sinusoids. In previous reports this syndrome has been shown to be a consequence of a disordered immunologic response of the host to malarial infection. Treatment with antimalarial drugs has resulted in a decrease in malarial antibody titers and a reduction in splenic size. We report a child who had TSS associated with cytomegalovirus infection rather than malaria. Our results suggest that TSS may be precipitated by a variety of infections producing chronic antigenic stimulation and perhaps by autoantigenic stimulation as well.
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PMID:Tropical splenomegaly syndrome associated with cytomegalovirus infection. 254 Apr 53

The role of splenic leukocyte oxidative activity and macrophage activation in the development of protective immunity was examined during acute Plasmodium chabaudi adami malaria. Splenic leukocyte oxidative activity was compared in infected BALB/c and P/J mice; the latter are known to suffer from defects in macrophage function. Phorbol myristate acetate-stimulated chemiluminescence and superoxide anion production by splenic leukocytes from infected BALB/c mice were found to be increased dramatically, while the response of splenic leukocytes from infected P/J mice was elevated only minimally. Hydrogen peroxide release was slightly increased in splenic leukocytes from infected BALB/c mice but remained essentially unchanged in those from infected P/J mice. Macrophage function was assessed on the basis of measurements of tumoricidal activity. Splenic macrophages from uninfected BALB/c mice displayed significant tumoricidal activity against L929 target cells. As a result of splenomegaly during infection, tumoricidal activity, when calculated on a per-spleen basis, was increased further in infected BALB/c mice. In contrast, the tumoricidal activity of splenic macrophages from P/J mice was minimal, regardless of infection. Despite these differences, both strains of mice developed malarial infections that resolved within 16 days. Thus, while the production of reactive oxygen radicals by splenic leukocytes and the phenomenon of macrophage activation have traditionally been associated with the resolution of malarial infection, this study failed to establish a correlation between these parameters and the development of protective immunity to blood-stage infection with P. chabaudi adami.
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PMID:Reassessment of the role of splenic leukocyte oxidative activity and macrophage activation in expression of immunity to malaria. 255 11

Recent studies in West Africa and in Papua New Guinea have shown that the prevalence of malaria can vary widely between neighbouring villages and within different parts of the same village. Both genetic and environmental factors are likely to contribute to these variations. Clustering in households of genetically determined red cell abnormalities, and possibly of immune response genes, may contribute to differences in the prevalence of malaria within a village. Environmental factors probably play the major part in explaining differences between villages. The position of a village in relation to mosquito breeding sites, the design of houses and the level at which anti-mosquito measures are used will all influence the degree to which its inhabitants are exposed to infection. Attitudes to the treatment of a case of malaria may also contribute to local variations in the prevalence of malaria. Malaria parasitaemia and splenomegaly will be less frequent in a community where effective treatment is given immediately at home, or sought promptly from a primary health care worker, than in a neighbouring community where there is a much greater reliance on traditional medicines. Recognition of local variations in the prevalence of malaria is important because identification of the factors responsible for a low prevalence in one village but a high one in a neighbouring community may indicate a possible control measure. Local variations in the epidemiology of malaria must also be taken into account when any kind of malaria intervention trial is planned.
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PMID:The microepidemiology of malaria and its importance to malaria control. 257 61

Forty cases of imported malaria (1978 to 1988) are reviewed and management principles are discussed. All 15 cases of Plasmodium falciparum malaria were acquired in Africa, 5 of which were probably chloroquine-resistant. Most cases of Plasmodium vivax (80%) were acquired on the Indian subcontinent, including 2 cases of congenital malaria. Six children developed P. falciparum malaria despite chemoprophylaxis. All children had a history of fever, usually with other influenza-like symptoms. Two-thirds had splenomegaly, and one-third were afebrile on admission. Thrombocytopenia (70%) and anemia (70%) were often present. Forty-five percent received previous wrong diagnoses and treatments. Quinine or quinidine with either Fansidar or clindamycin were used to treat P. falciparum malaria. Clindamycin may be more effective if given for 7 instead of 3 days. There were no deaths or residual complications. As the prevalence and severity of drug-resistant P. falciparum spreads, prophylaxis and treatment choices become more difficult. Diagnosis requires a travel history and a high index of suspicion.
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PMID:Review of 40 children with imported malaria. 259 48

One hundred and eighteen patients with chronic leukaemias were seen at the Lagos University Teaching Hospital, Nigeria, between 1964 and 1982. There were 75 patients with chronic granulocytic leukaemia (CGL) and 43 patients with chronic lymphocytic leukaemia (CLL). Although most of them presented with the familiar features of chronic leukaemias, a few features were remarkably different from those reported in some of the Caucasian series. CLL is less common than CGL in contrast to their relative incidence in Caucasians. Our patients generally presented with more massive splenomegaly and more severe anaemia, which could be attributed to late presentation, endemic malaria and possibly increased hypersplenism. The peak-age incidence in our patients with CGL was found in a younger age group (20-40 yr) than in the Caucasian series. When compared with a Caucasian series, our CGL patients on presentation had a significantly higher proportion of immature cells (blasts and promyelocytes) (P less than 0.05), probably reflecting their more delayed presentation. Follow up was generally poor as a result of a high default rate. Survival duration of both leukaemias was generally lower than in Caucasian series and for CGL patients there was a significant negative correlation between survival and spleen size at presentation, while for CLL patients there was a significant association between poor survival duration and high white cell count at presentation.
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PMID:Chronic leukaemia: an African experience. 261 22

A malariometric survey carried out among the upper Bonda tribals of Koraput district showed that malaria is the major cause of morbidity followed by worm infestation and malnutrition. A total of individuals 1,409 (32.2% of the population) were sampled and 771 were found positive for malaria parasites. Plasmodium falciparum was the predominant parasite (73.7%) followed by P. vivax (10.6%) and P. malariae (5.2%) among the positive cases. Mixed infection was observed in 10.5 per cent of positive individuals. The infant parasite rate was 60.0 per cent and the average enlarged spleen among the children between 2-9 yr was 2.11. The age specific parasite rate indicated high degree transmission and high level of acquired resistance among the tribals.
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PMID:Malaria & other common ailments among upper Bonda tribals in Koraput district, Orissa. 262 97

56 patients carriers of Plasmodium falciparum were observed throughout 1987: 47 males and 9 females of a mean age of 32. The following clinical aspects were observed: Falciparum malaria: 35 cases, malaria with a low parasitaemia (less than 1,000 HPM): 5 cases, tropical splenomegaly syndrome: 3 cases, isolated bi- or tricytopenia: 10 cases, cerebral malaria: 1 case, asymptomatic carriers: 2 cases. Statistically speaking, no significant correlation was observed between parasitaemia and the following clinical and biological symptoms: fever, splenomegaly, Hb level, platelet count. However, we noted a level of parasitaemia higher in the acute forms of malaria (Falciparum malaria and cerebral malaria) than in the non typical forms (chronic visceral malaria, haematological disorders). All asymptomatic carriers, who represent "malaria infection", presented a low parasitaemia (less than 1,000 HPM).
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PMID:[Current clinical aspects and role of parasitic density in the manifestations of falciparum malaria]. 266 7


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