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Query: UMLS:C0024530 (malaria)
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Over the past 30 years, the mountainous area of Kalinga Apayao Province on Luzon Island in the Philippines was extensively deforested due to slash and burn farming. The malaria risk is reduced, but malaria is still endemic. During 1990-1992, morbidity surveys identified 614 malaria cases. Researchers wanted to determine the accuracy, predictability, and reliability of clinical signs and symptoms for diagnosing malaria. Most individuals (89%) claimed to have had fever, yet just 35.4% had a body temperature greater than 37.6 degrees Celsius. Only 51.8% of fever cases had parasitemia, indicating that the World Health Organization's recommended case definition of malaria (i.e., presence or history of fever) did not adequately identify malaria. Further, prior to this study, about 50% of the area's children were usually infected, but just 11.3% of children younger than 6 in this study had fever. A good general predictor of malaria included a sequential occurrence of fever, chills and/or sweating, or a combination of all 3 symptoms. The positive predictive values were: at-home observation and diagnosis (74-76% vs. 69-72% at the rural health clinic), age younger than 9 years (80-84% vs. 65-69% for = or 10 year olds), and presentation during November-January (94-100% vs. 74% for February-October). November-January was the season when the prevalence of acute lower respiratory infections was highest. These results demonstrate that health workers can develop simple algorithms with good predictability of clinical signs and symptoms for high-risk groups to manage malaria in endemic areas of the Philippines.
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PMID:Symptomatic identification of malaria in the home and in the primary health care clinic. 806 95

Permethrin-impregnated bed nets were evaluated as a control measure for malaria in northern Guatemala. Twelve hundred forty participants were allocated to one of three experimental groups (impregnated bed nets [IBN], untreated bed nets [UBN], and controls) and followed up for a period of 13 months. The incidence density of malaria was significantly lower in both IBN (86 cases/1,000 person-years) and UBN groups (106/1,000) compared with that in controls (200/1,000). No difference in malaria incidence was noted between the IBN and UBN groups. Complaints of fever and chills were less frequent in the IBN group compared with controls. The participants were enthusiastic about the nets, which they saw as a means for avoiding nuisance insects more than for preventing malaria. Most (85%) wanted to wash their nets every 4-12 weeks, a practice known to shorten the duration of residual insecticide action. Larger studies are needed to determine whether or not impregnated bed nets offer an advantage over untreated nets in this setting.
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PMID:Permethrin-impregnated bed nets for malaria control in northern Guatemala: epidemiologic impact and community acceptance. 821 70

Increasing drug resistance in Plasmodium falciparum and a resurgence of malaria in tropical areas have effected a change in treatment of malaria in the last two decades. Symptoms of malaria are fever, chills, headache, and malaise. The prognosis worsens as the parasite counts, counts of mature parasites, and counts of neutrophils containing pigment increase. Treatment depends on severity, age of patient, degree of background immunity, likely pattern of susceptibility to antimalarial drugs, and the cost and availability of drugs. Chloroquine should be used for P. vivax, P. malariae, and P. ovale. P. vivax has shown high resistance to chloroquine in Oceania, however. Primaquine may be needed to treat P. vivax and P. ovale to rid the body of hypnozoites that survive in the liver. Chloroquine can treat P. falciparum infections acquired in North Africa, Central America north of the Panama Canal, Haiti, or the Middle East but not in most of Africa and some parts of Asia and South America. In areas of low grade resistance to chloroquine, amodiaquine can be used to effectively treat falciparum malaria. A combination of sulfadoxine-pyrimethamine is responsive to falciparum infections with high grade resistance to chloroquine. Mefloquine, halofantrine, or quinine with tetracycline can be used to treat multidrug-resistant P. falciparum. Derivatives of artemisinin obtained from qinghao or sweet wormwood developed as pharmaceuticals in China are the most rapidly acting of all antimalarial drugs. Children tend to tolerate antimalarial drugs well. Children who weigh less than 15 kg should not be given mefloquine. Health workers should not prescribe primaquine to pregnant women or newborns due to the risk of hemolysis. Chloroquine, sulfadoxine-pyrimethamine, quinine, and quinidine can be safely given in therapeutic doses throughout pregnancy. Clinical manifestations of severe malaria are hypoglycemia, convulsions, severe anemia, acute renal failure, jaundice, pulmonary edema, cerebral malaria, shock, and acidosis. Health workers should be prepared to treat these symptoms accordingly.
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PMID:The treatment of malaria. 904 53

A 2-year prospective audit on the profile and outcome of malaria cases admitted to a general hospital was performed. Fifty-six cases were seen from January 1991 to December 1992, 52 of which were due to monoinfections with Plasmodium vivax. The main presenting complaints were fever, chills, sweats, myalgia, dry cough and headache. A significant percentage had anaemia (64.3%), thrombocytopaenia (57.1%), hyponatraemia (42.9%), and liver dysfunction (44.7%). Diagnosis rests on the demonstration of parasites in stained peripheral blood smears. None of the patients developed major complications. A high index of suspicion of malaria must be maintained in the medical evaluation of all patients and in particular, of returning travellers.
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PMID:Malaria: an audit of 56 cases admitted to a hospital. 894 52

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

Qualitative methods were used to gather data on community perceptions of malaria in Morong, Bataan. People recognised an illness which they called "malarya' through a discrete set of symptoms: high fever and intense chills, with or without a severe headache. Self-medication was common. Enquiry into perceptions of cause and prevention of the disease revealed a complex mixture of beliefs involving environmental conditions, the mosquito vector and parasites, but included also various ideas about dirty water, diet, hunger and conditions of hygiene. The implications of these findings for disease control, and the relationship between knowledge and practices, are discussed.
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PMID:Perceptions of malaria in a low endemic area in the Philippines: transmission and prevention of disease. 908 36

Morbidity and mortality due to malaria remains an important health problem for travelers visiting endemic zones. In this population, typical episodes of chills and fever followed by diaphoresis are not always observed; inaugural signs may limited to low-grade fever accompanying digestive disorders. Early diagnosis is nevertheless essential to prevent progression to acute pernicious malaria. Blood smears, quantitative butty coat (QBC) test or the Parasight test can give rapid diagnosis. Chloroquine is the drug of choice for Plasmodium vivax, P. ovale or P. Malariae infection, but chloroquine-resistant P. falciparum is widespread in tropical zones and resistant P. vivax has been reported in Indonesia. Currently, halofantrine is the best treatment for P. falciparum infection, although cardiac toxicity may occur in patients with a long QT on the electrocardiogram. Mefloquine can be alternative. The sulfadoxine-pyrimethamine combination is also used in many tropical zones because of its low cost and availability, but many resistant strains of P. falciparum have been identified. Use of quinine is also widespread in tropical zones. This basic antimalarial is rapidly effective but is also rapidly eliminated, necessitating repeated oral doses. Intramuscular injection may provoke necrosis. The main indication for quinine is acute pernicious P. falciparum malaria, but the drug is also used for simple episodes of fever in many tropical zones. Symptomatic care including fluid replacement, oxygen, transfusion, diuretics, respiratory assistance and dialysis may also be required in some cases. Use of corticosteroids or exsanguinotransfusion remains a question of debate. When administered rapidly, fever should regress within a few days. Neurological sequellae are exceptional after acute pernicious malaria in adults but may occur approximately 5% of children, emphasizing the importance of associating chemoprophylaxis and protection against insect bites. There has been much publicity concerning a vaccine, but results to date have been disappointing.
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PMID:[Malaria: what treatment today?]. 909 64

In a retrospective study, we registered 210 patients hospitalized in Strasbourg for malaria from 1984 to 1995. The diagnosis was always confirmed by presence of the parasite on blood smears. We analysed the epidemiological, clinical, biological and therapeutic data. The number of cases rose each year, with a maximum in 1995. The majority of cases occurred in January and from August to October, these periods corresponding with the return of travelers. In most cases, infection took place in Africa. In this region, Plasmodium falciparum is the most frequent species of the parasite. The mean age of the patients was 33 years. The clinical manifestations were polymorphic: fever, chills, sweating, and headache were very frequent. We noted 15 serious infections (with the WHO's definition) and two cases of cerebral malaria. All cases had a favorable outcome. Five cases occurred in pregnant women; two of them had a severe form of malaria. Among the biological abnormalities, we found thrombopenia, haemolysis, hypocholesterolaemia and hypertriglyceridaemia. The significance of disturbance of the lipid metabolism is not known. Hypocholesterolaemia is very frequent, and hypertriglyceridaemia seems to be associated with severe malaria. Most malaria attacks occurred in patients without adequate chemoprophylaxis. This confirms the importance of prophylactic information given to patients by their physicians. Resistance develops against each new medication that is available; among these quinine remains the drug of choice to cure severe malaria.
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PMID:[Malaria brought into Strasbourg: an epidemiological, clinical, biological and therapeutic study]. 941 May 45

A survey was conducted from October 1, 1993 to June 30, 1995 to determine the arboviral etiologies of febrile illnesses in the city of Iquitos in the Amazon River Basin of Peru. The study subjects were patients who were enrolled at medical care clinics or in their homes by Peruvian Ministry of Health (MOH) workers as part of the passive and active disease surveillance program of the MOH. The clinical criterion for enrollment was the diagnosis of a suspected viral-associated, acute, undifferentiated febrile illness of < or = 5 days duration. A total of 598 patients were enrolled in the study. Demographic information, medical history, clinical data, and blood samples were obtained from each patient. The more common clinical features were fever, headache, myalgia, arthralgia, retro-ocular pain, and chills. Sera were tested for virus by the newborn mouse and cell culture assays. Viral isolates were identified initially by immunofluorescence using polyclonal antibody. An ELISA using viral-specific monoclonal antibodies and nucleotide sequence analysis were used to determine the specific variety of the viruses. In addition, thin and thick blood smears were observed for malaria parasites. Venezuelan equine encephalitis (VEE) virus subtype I, variety ID virus was isolated from 10 cases, including three cases in October, November, and December 1993, five cases in January and February 1994, and two cases in June 1995. The ELISA for IgM and IgG antibody indicated that VEE virus was the cause of an additional four confirmed and four presumptive cases, including five from January through March 1994 and three in August 1994. Sixteen cases were positive for malaria. The 18 cases of VEE occurred among military recruits (n = 7), agriculture workers (n = 3), students (n = 3), and general laborers (n = 5). These data indicated that an enzootic strain of VEE virus was the cause of at least 3% (18 of 598) of the cases of febrile illnesses studied in the city of Iquitos in the Amazon Basin region of Peru.
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PMID:Venezuelan equine encephalitis febrile cases among humans in the Peruvian Amazon River region. 945 89

As a result of both the constant influx of travellers and foreign workers from endemic countries and the presence of Anopheles vectors, Singapore remains vulnerable to malaria. In May and June of 1996, a localized outbreak involving 19 cases of vivax malaria was reported in central Singapore's Dairy Farm area. Resident in this area at the time were 120 foreign workers employed by and living within two nurseries. Following the outbreak, both epidemiologic and entomologic surveillance studies were conducted. The 19 cases of Plasmodium vivax involved 2 local residents of Dairy Farm Estate condominium and 17 foreign nursery workers (1 Thai, 5 Bangladeshi, and 13 Indian). The origin of the outbreak was traced to 2 foreign workers infected with Plasmodium vivax who defaulted on chloroquine treatment and relapsed within 7 months of arrival in Singapore. Malaria symptoms included fever (100%), rigors (94.7%), chills (89.5%), headache (78.9%), and sweating (42.1%). Larvae of Anopheles maculatus were found in 7 habitats: 4 seepages, 1 ground puddle, 1 earth drain, and 1 antimalaria drainage well. Transmission was interrupted within a week after the outbreak was alerted through a comprehensive strategy of active case finding, isolation and treatment of infected persons, epidemic vector control measures, and improved drainage to prevent Anopheles maculatus breeding. Malaria should always be considered in the differential diagnosis of foreign workers who present with fever.
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PMID:Local transmission of Plasmodium vivax malaria in Singapore. 949 62


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