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

Chloroquine is considered essentially nontoxic when used for the chemosuppression of malaria, but gastrointestinal upsets, headache, blurring of vision, pruritus, and uritcaria may occur during chloroquine therapy. Recently, Bhargava et al. and Eronini and Eronini have reported the extrapyramidal syndrome (EPS) following chloroquine therapy in adults. The clinical manifestations included upward rolling of the eyeballs, retraction of neck and back, trismus with marked difficulty in speech, and coarse tremors. Observations of 4 instances of EPS in children following chloroquine therapy for malaria are reported. A 2-1/2 year old girl was admitted to the All India Institute of Medical Sciences Hospital with a 4 day history of intermittent high grade pyrexia with chills and rigors. Following treatment with oral chloroquine in the recommended therapeutic dosage, the fever responded, but the child became drowsy and developed paroxysms of involuntary movements of the tongue, torticollis, torsion dystonia of the limbs, and parosysms of tonic muscular spasms. She completely recovered spontaneously within 48 hours. The 2nd case was that of a 12-year old female brought to the hospital with a 15-day history of intermittent high grade fever with chills and rigors. The patient was started on chloroquine sulfate in the recommended therapeutic dose. After an interval of 4 days she developed coarse tremors of the hands, upward rolling of the eyeballs, episodic deviation of the angle of the mouth towards the left, and trismus. These symptoms disappeared spontaneously within 8 hours. A 6-year old girl, the 3rd case, developed episodes of opisthotonous, upward rolling of the eyeballs, protrusions of the tongue, intermittent writhing movements of the upper limbs, and drowsiness following the ingestion of 6 tablets of chloroquine sulfate for suspected diagnosis of malaria. She spontaneously recovered from EPS over a period of about 48 hours. The 4th case, a 7-year old boy, gave a history of high grade fever with chills and rigors of 1 day's duration. He developed drowsiness, tonic spasms of the neck, upward rolling of the eyeballs, and writhing contortions of all limbs about 2 hours following intravenous administration of 100 mg of chloroquine. 8 hours later an additional 100 mg chloroquine was given intravenously for the mistaken diagnosis of cerebral malaria. On examination the child was drowsy, had generalized stiffness, torticollis, and trismus. He recovered gradually over a 48-hour period without any specific therapy. The exact mechanism of production of EPS remains uncertain.
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PMID:Extrapyramidal syndrome following chloroquine therapy. 45 22

Clinical data on 24 civilian patients hospitalized for malaria in The New York Hospital were analyzed. Of 16 patients infected with Plasmodium falciparum, 14 acquired the disease in West Africa. Only three of the 24 had taken recommended courses of prophylaxis. Diagnosis was invariably, and often dangerously, delayed because physicians often made diagnoses of viral syndromes or used antibiotics; only one patient had a blood smear taken by a personal physician. Although all patients had fever and chills, classic malarial fever was seen in only seven patients; nausea, vomiting and diarrhea were common. Hepatomegaly and splenomegaly occurred in about half the patients. Blood smears stained in routine fashion by Wright's stain were positive in 23 of 24 patients. A normal leukocyte count was present in 19 of the 24 patients and thrombocytopenia in 16 of 23. The most frequent complications were those of central nervous system involvement. Therapy consisted mainly of chloroquine phosphate but other drugs, including quinine, pyrimethamine, sulfonamides and primaquine, were used in special situations. Suggestions for prophylaxis, diagnosis and therapy were made.
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PMID:Malaria - the mime. Recent lessons from a group of civilian travellers. 78 38

An operational field trial on community-based malaria control efforts in West Timor, one district in Indonesia, had been implemented since 1987. The trial investigated the utilization of Posyandu cadres in case finding and treatment of malaria. From this trial it appears feasible to utilize these cadres for malaria control. Efficacy of cadres in case finding and treatment of chills and fevers surpassed all expectations.
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PMID:The role of community participation in the malaria control program in Indonesia. 134 39

Plasmodium vivax malaria infections in non-immune individuals manifest as periodic clinical episodes of fever with chills and rigors known as paroxysms. We have demonstrated that in non-immune patients the period of paroxysm is associated with the transient presence of plasma factors which kill gametocytes, the intra-erythrocytic sexual stages of the malaria parasite which transmit the infection from humans to mosquito, rendering them non-infectious to mosquitoes. Gametocyte killing in paroxysm plasma is mediated by tumour necrosis factor (TNF) acting in conjunction with other essential serum factor(s). Plasma TNF levels were elevated during a paroxysm. In semi-immune individuals from a P. vivax-endemic area clinical symptoms of malaria are mild and the parasite killing factors are not induced during paroxysm. Serum TNF levels were correspondingly lower in endemic patients during a paroxysm. Human peripheral blood mononuclear cells (PBMC) can be stimulated in vitro by extracts of P. vivax blood stage parasites to produce TNF and associated parasite killing factor(s), thus simulating in vitro the events that occur during a paroxysm, this being the release of parasite exo-antigens by rupturing schizonts and the subsequent induction of PBMC to produce TNF and other parasite-killing factors. We were able to show that convalescent serum from P. vivax semi-immune individuals block the induction of TNF and parasite-killing factors by malaria antigens in vitro, presumably through antibodies that neutralize parasite exo-antigens. Thus, individuals living in malaria-endemic areas appear to acquire clinical immunity to malaria by avoiding their induction during infection; we have shown that one such mechanism is the neutralization of parasite exo-antigens that induce the production of parasite killing factors.
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PMID:Tumour necrosis factor-dependent parasite-killing effects during paroxysms in non-immune Plasmodium vivax malaria patients. 135 32

A hospital-based retrospective case study of admitted patients was undertaken in four major hospitals of Delhi during 1991, with a view to assessing (i) recording and reporting system of malaria cases, (ii) diagnostic criteria being followed, (iii) management of complicated and severe malaria cases, and (iv) availability of life-saving antimalarials. The study showed that none of the hospitals either followed the international coding system for recording or adopted the National Malaria Eradication Programme guidelines for diagnostic criteria malaria, i.e. by blood smear examination. Diagnosis of malaria in three out of four hospitals was not preceded by blood examination in all cases. Only 55% of the 283 clinically suspected malaria cases were screened for malaria parasite with overall positivity of 20.14 per cent and of 38.25 per cent in examined cases. Age and sex break-up indicated that males suffered more and 65 per cent of the patients belonged to 16-40 years' age groups as compared to 38.4 per cent population falling in this age group according to 1981 census. Out of 263 recovered study cases, 13 per cent came from adjoining states while this percentage went up to 35 per cent (7 out of 20 cases) in the case of malaria deaths. Over 80 per cent of the clinically suspected cases presented with signs and symptoms of fever or fever with rigour, chills or vomiting. In 38 per cent of the cases there was a definite time lag in reporting of the cases to hospitals but most of the cases (91 per cent) were administered antimalarials within 24 h of admission.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of admitted malaria cases in four major hospitals of Delhi: a case study. 145 11

To evaluate the effectiveness of the Volunteer Collaborator Network (VCN) of Latin America as a community-based malaria case detection and treatment system, we conducted a study of the VCN of Guatemala. Volunteer Collaborators took 72.6% of all blood smears and identified 81.3% of all malaria cases reported by the Guatemalan National Malaria Service. The average volunteer treated 5.8 patients per month (range 0-32.8). In contrast, passive case detection (PCD) posts in government hospitals and health centers treated an average of 12.5 patients per month (range 0.5-91.4). The slide positivity rate of blood smears taken by Volunteer Collaborators was 16.2% compared with 9.7% for PCD posts in health centers and 10.3% for malaria workers during active case detection. The average delay between the date a blood smear was taken and examined ranged from 18.1 days on the Pacific coastal plain to 26.3 days in the less accessible northern region of the country. An additional 14.5 to 47.6 days elapsed before the radical treatments were initiated in these two regions. Seventy percent of the patients completed their radical treatments. In a survey conducted on the Pacific coastal plain of Guatemala, of 1,021 patients with chills and/or fever who believed they had malaria, 20.0% had visited a Volunteer Collaborator and 4.9% were treated at a government health center. Thus, the PCD network detected only 25% of all patients with symptoms suggestive of malaria. Most of the remaining patients treated themselves with antimalarial medications purchased in stores and pharmacies, but less than 15% of these patients used adequate courses of therapy. Furthermore, the rate of detection of symptomatic patients with malaria varied considerably from one community to another. Thus, data from the VCN are probably most useful when groups of communities or geographic areas are stratified for malaria control activities because at this level, variations between individual Volunteer Collaborator posts will be minimized. In spite of these problems, the VCN remains an excellent source of epidemiologic data for malaria control programs and the most practical means available for providing timely, appropriate antimalarial therapy to febrile patients in rural areas.
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PMID:Community participation in malaria surveillance and treatment. II. Evaluation of the volunteer collaborator Network of Guatemala. 155 65

Paroxysms are sharp episodes of high fever accompanied by chills and rigors that occur periodically, once in every 48 hr in Plasmodium vivax infections. We have measured the changing levels of serum tumor necrosis factor (TNF) during paroxysms in non-immune patients infected with P. vivax malaria. The changes in TNF levels closely paralleled the rise and fall in temperature during the paroxysms but tended to precede them by 30-60 min. These observations suggest that the rise and fall in temperature during P. vivax paroxysm may be directly related to the periodic changes in TNF levels induced during these infections. The peak TNF levels reached during P. vivax infections were much higher than even those which have been recorded during severe and fatal P. falciparum infections in which TNF has been postulated to contribute to the severe manifestations of this disease.
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PMID:Dynamics of fever and serum levels of tumor necrosis factor are closely associated during clinical paroxysms in Plasmodium vivax malaria. 156 11

The "eradication of malaria" in Taiwan was announced by WHO in 1965. From 1966 to 1989, 919 malaria cases were detected in Taiwan. Of these cases, 803 were classified as imported malaria. During 1977 to 1989, our hospital collected 11 cases of imported malaria, 6 of Plasmodium falciparum (PF), including 1 suspicious case, 2 of Plasmodium vivax (PV), 1 of mixed infection (PF plus PV), and 2 unclassified. Most of the patients presented clinically with fever and chills. Hepatosplenomegaly was the most common abnormal finding during the physical examination. Jaundice and anemia occurred in the more severe cases. No cases had lymphadenopathy which is helpful in making a differential diagnosis. Six cases had thrombocytopenia which may be considered as an indirect sign in the diagnosis. The MCV levels were within normal limits in all of the cases. This may indirectly imply a potential protective effect against malaria infection in cases of congenital hemoglobinopathy such as thalassemia or G6PD deficiency. Initially, 10 cases were given "standard treatment", which consisted of chloroquine 450 mg qd for 2 days then 300 mg qd for 2 days and primaquine 15 mg qd for 2 weeks. Four cases of chloroquine resistance were encountered, all in cases with PF infection. Two cases were grade I delayed type resistance and were successfully treated with Fansidar, tetracycline and quinine. Two cases were grade II resistance and presented clinically as cerebral malaria. Intravenous quinine was given plus Fansidar and tetracycline. The cases were resolved without sequele or recurrence. None of the cases, except for 2, received chemoprophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Imported case of malaria in Taiwan: analysis of 11 cases]. 167 9

Occurrence of fevers and chills, headaches and body and joint pains, and body temperature and malaria parasitaemias were recorded monthly for a year for 121 Liberian adults. There was no apparent correlation between any of the symptoms and the presence or density of blood parasites; it was therefore not possible to define a case of clinical malaria in the study population, which was probably highly immune to infection. Only a few people with patent blood infections had elevated blood temperatures and these were below 37.5 degrees C. Malaria prevalence and levels of parasitaemia declined with age and indicated that immunity continues to develop well into adult age. The data did not support the view that adults experience symptoms at lower parasitaemias than children. Pregnant and non-pregnant women had similar levels of symptoms, but high levels of parasitaemia were found more frequently in the pregnant group.
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PMID:Clinical and parasitological studies on malaria in Liberian adults living under intense malaria transmission. 181 34

The incidence of malaria in travelers returning to the United States has been increasing. Persons visiting areas where malaria is endemic should use insect repellent, wear clothing that covers the arms and legs, and remain in screened areas between dusk and dawn. Chemoprophylaxis for travelers consists of weekly doses of chloroquine; a new drug, mefloquine, should be used in the increasing number of countries where chloroquine-resistant malaria is found. Travelers to these areas should carry three tablets of pyrimethamine-sulfadoxine, which should be taken for presumptive treatment of malaria at the onset of chills and fever. It is essential that chemoprophylaxis be continued for four to five weeks after departure from endemic areas. In travelers who develop symptoms of malaria after returning from an endemic area, it is imperative that treatment be started even if blood smears are negative.
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PMID:Preventive therapy for malaria. 154 92


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