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

A 44-year-old man developed bouts of fever (up to 40 degrees C) seven days after returning from a holiday in Kenya. Malaria prophylaxis with chloroquine had been correctly undertaken. Concentrations of lactate dehydrogenase and total bilirubin were raised (493 U/l and 3.55 mg/dl, respectively). Blood smear revealed the ring forms of Plasmodium falciparum. Thereupon the patient was given mefloquine in decreasing doses (750/500/250 mg) at intervals of 8 hours. The following night he had a circulatory collapse and complained of pain on pressure, especially in the left upper abdomen. Abdominal sonography showed a slightly enlarged spherical spleen with an echo-poor band and fluid collection in the rectovesicular pouch, indicating rupture of the spleen. A splenectomy was performed. Subsequently the number of malaria organisms in the blood smear gradually fell and signs of haemolysis disappeared. Splenic rupture is a very rare complication of acute malaria. It is presumably caused by marked stasis in the splenic sinuses with deformed parasite-containing red blood cells.
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PMID:[Spontaneous splenic rupture in acute malaria tropica]. 159 9

The examination of early perinatal mortality (between 28 weeks gestation and 1 week after birth) was conducted in the Machakos District Hospital in Kenya over a 4-month period. The hospital provides full gynecological and obstetric services and family planning. Out of 2171 deliveries recorded that early perinatal mortality rate (EPMR) was 53/1000 (114 losses). The maternal mortality rate was 2.7/1000 due to 3 ruptured uteri, 1 postpartum hemorrhage, 1 case of cerebral malaria, and 1 care of anesthetic complications. In the analysis of factors associated with EPMR, the findings showed that there was a statistically significant difference between married and single/separated status with regard to EPMR. Although not statistically significant, EPMR was lowest at a parity of 2. Maternal educational level and socioeconomic status had a statistically significant impact on EPMR. 70% of the mothers were in the low socioeconomic group, which had the highest rates of mortality. 5% of the birthing mothers did not receive prenatal care and contributed 22% of the perinatal mortality. There was also an unexpected number of perinatal deaths for mothers who had received prenatal car at a sub-district hospital. There was a very low EPMR (34/1000) for mothers without any complications, which constituted 81.4% of pregnancies. The highest EPMR of 315/1000 was found among those mothers with "threatened abortion." Malpresentation accounted for an EPMR of 242/1000, and prepartum hemorrhage, for an EPMR of 210/1000. 1.1% of mothers had a urinary tract infection, .1% had cardiac disease, and .1% had diabetes, but these complications were not associated with EPMR. 17% were premature births; 10% were births after 42 weeks. Mortality was highest among babies of less tan 28 weeks gestation. Among the 82% with the uncomplicated labor the EPMR was 10/1000. The 6% with prolonged labor had an EPMR of 177/1000. The highest EPMR was found among women with a ruptured uterus an cord collapse. The birth weight groups of 3000 to 3494 had the lowest EPMR. The recommendations pertained to improvements in the health care system.
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PMID:Factors influencing early perinatal mortality in a rural district hospital. 164 26

Malaria is diagnosed in 50-70 patients each year in Norway. Severe malarial infection with cerebral involvement as well as hypoglycaemia, circulatory collapse and renal failure is often difficult to diagnose since the condition is only rarely seen in Scandinavia. This report describes a 49 year old seaman, who was admitted to hospital with a clinical picture of sepsis with multiorgan involvement including cerebral affection. Subsequently, it turned out that the patient had a severe infection with Plasmodium falciparum, involving more than 50 per cent of the red blood cells. Despite being comatose for one week with repeated attacks of grand mal type, and requiring 11 days mechanical ventilation plus dialysis for 4 weeks, he recovered uneventfully and was dismissed from hospital with only minor neurological sequelae. Even severe malaria with cerebral involvement can result in full restitution if the diagnosis is made early and exchange transfusion plus treatment with relevant drugs are instituted promptly.
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PMID:[Exchange transfusion in cases of falciparum malaria]. 194 97

In the treatment of severe Plasmodium falciparum infection antimalarial drugs should, ideally, be given by controlled rate intravenous infusion until the patient is able to swallow tablets. In cases where infection has been acquired in a chloroquine resistant area, and where it has broken through chloroquine prophylaxis or where the geographical origin or species are uncertain, quinine is the treatment of choice. When access to parenteral quinine is likely to be delayed, parenteral quinidine is an effective alternative. A loading dose of quinine is recommended in order to achieve therapeutic plasma concentrations as quickly as possible. In the case of chloroquine sensitive P. falciparum infection, chloroquine, which can be given safely by slow intravenous infusion, may be more rapidly effective and has fewer toxic effects than quinine. There is limited experience with parenteral administration of pyrimethamine sulphonamide combinations such as Fansidar, and resistance to these drugs has developed in South East Asia and elsewhere. Mefloquine and halofantrine cannot be given parenterally. Qinghaosu derivatives are not readily available and have not been adequately tested outside China. Supportive treatment includes the prevention or early detection and treatment of complications, strict attention to fluid balance, provision of adequate nursing for unconscious patients and avoidance of harmful ancillary treatments. Anaemia is inevitable and out of proportion to detectable parasitaemia. Hypotension and shock ('algid malaria') are often attributable to secondary gram-negative septicaemia requiring appropriate antimicrobial therapy and haemodynamic resuscitation. Many patients with severe falciparum malaria are hypovolaemic on admission to hospital and require cautious fluid replacement. Failure to rehydrate these patients may lead to circulatory collapse, lactic acidosis, renal failure and severe hyponatraemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of severe malaria. 269 26

Pathophysiological significance of hypoxia in malarial infection was investigated in mice infected with Plasmodium berghei NK65. Intraperitoneal inoculation of mice with 1 X 10(7) parasitized red blood cells resulted in death of the hosts 6-7 days later. Anaemia of infected animals developed on day 4 after inoculation and oxygen affinity of whole blood, measured as P50 act pH, increased simultaneously. This change may be a physiological adaptive response to a reduction in oxygen delivery to the tissues to day 5. However, the blood oxygen supply on day 6 appeared to be deteriorating and this is thought to be an important factor contributing to the death of the host. The value of adenylate energy charge in red cells during malarial infection, however, was comparatively well-maintained. Allopurinol stimulated the multiplication of malaria parasites and seems to have induced collapse in host-parasite balance more rapidly. Decrease in blood pH and in blood oxygen transport may be important factors for the pathogenesis of the allopurinol-treated hosts.
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PMID:Pathophysiology of hypoxia in mice infected with Plasmodium berghei. 330 17

The health system in Cuba guarantees accessibility to the entire population, and it is free of charge. Cuba's health figures are on a par with developed countries that have 20 times the budget. Each year around 4000 students start their medical training at 23 different universities. Since 1980 there has been a training course for family doctors. By 1995 22,000 of them have been trained covering 90% of the population. Their main work is preventive: health promotion and offering basic curative care. The family doctors are backed up by 400 polyclinics, where specialists offer their services to about 30,000 people. Life expectancy is 77 years and infant mortality a mere 9 per 1000 live births. Malaria has been eradicated and dengue fever successfully reduced. Leading causes of mortality are cardiovascular diseases, neoplasms, accidents, and homicides. Up to now only 1089 people have been diagnosed as HIV positive. From a mere epidemiological point of view, strict isolation could contain the epidemic in a closed society. In practice, however, the island opened the doors to tourism, with a side effect of increasing prostitution. Condoms or any contraceptives are in short supply. Nevertheless, the number of abortions is low, less than 1 per 100 deliveries. The reason is that all women whose expected menstruation is late by two weeks are offered a microaspiration in the polyclinic. 700 regulations are performed for every 5000 fertile women. Pregnancy tests are not performed as they are not available. The country is experiencing a difficult period because of the collapse and loss of support from the Soviet Union; over 30 years' trade embargo by the United States and the gradual change from a centrally planned economy towards more of a free market system. Family planning and AIDS seem two topics that need further exploration. Even if their system is under strain, health indices do not show a deterioration in health yet.
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PMID:Cuba: plenty of care, few condoms, no corruption. 758 May 57

The author's conclusion in this article is that the problem of population displacement appears to be increasing and that the geographic impact is spreading. There is a need to predict complex emergencies (civilians affected by war or civil strike and population displacement) earlier. Effective intervention methods will require information on the quantity and content of relief commodities and analysis of the impact of relief on the health and nutrition of the affected population. International relief efforts must be more than a symbol of help. The goal should be to prevent excess mortality among the affected populations. The public health challenge is to improve the health status of populations caught in the cycle of war, intimidation, hunger, migration, and death. The direct health consequences of civil strife are identified as death, injury, disability, sexual assault, and psychological stress. The indirect health consequences are identified as mass migration, food shortages, hunger, and the collapse of health services. The numbers of people affected as dependent refugees under the care of UNHCR increased from 5 million in 1980 to almost 23 million in 1994. The total population of refugees and displaced persons is reported to have increased between 1990 and 1994 from 30 million to 48 million. The death rate of newly arrived refugees in Thailand, Somalia, and Sudan is estimated to be 30 times the death rate in the country of origin. Crude death rates (deaths/1000/month) during 1990-93 are reported as ranging from 3.5 to 12 times the rates in Ethiopia, Kenya, Nepal, Malawi, and Zimbabwe. The death rates of children aged under 5 years are estimated to be higher than adult rates. Causes of death are generally preventable. Common causes of death include measles, diarrhea, malaria, cholera and dysentery, and acute respiratory infections. Public health programs must target basic needs for shelter, food, water, and sanitation.
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PMID:Mass population displacement. A global public health challenge. 767 72

In a retrospective study we analyzed the clinical and blood chemical data of 12 patients with severe tropical malaria in the intensive care units of the University Hospital Zurich and the Stadtspital Triemli, Zurich, between 1991 and 1994. None of the 12 patients had been exposed to malaria before or had taken drugs for chemoprophylaxis. 7 patients survived, 5 died from complications of malaria. According to the criteria of severe tropical malaria defined by the WHO, the following pathological clinical and blood chemical parameters were noted on admission: cerebral coma (2/12); blood hemoglobin < 5 g/dl (0/12), < 8 g/dl (2/12); serum creatinine > 265 mumol/l (3/12); blood glucose < 2.2 mmol/l (0.12); circulatory collapse/shock (0/12); bleeding/signs of disseminated intravascular coagulation in laboratory tests (4/12); acidosis with pH < 7.25 (1/12). Further signs of severe tropical malaria were: hyperparasitemia > 5% (9/12); qualitative and quantitative disturbances of consciousness (6/12); thrombocytopenia < 30 x 10(9)/l (9/12); hyponatremia 125-135 mmol/l (9/12), < 125 mmol/l (2/12); rhabdomyolysis with creatine kinase > 1000 U/l (4/12). The basic treatment consisted of parenteral quinine hydrochloride in all patients; doxycycline was added in 8 cases, clindamycin in 3. Adjuvant therapy with desferrioxamin was given in 3 cases. 6 patients had exchange transfusions. Parasitemia cleared in all patients within 5 to 6 days. Later in the course, 5 patients developed acute respiratory distress syndrome, 6 required hemofiltration due to oliguria, and one became comatose.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intensive care aspects in severe tropical malaria: clinical aspects, therapy and prognostic factors]. 777 Jul 59

Ultrastructural alterations of human erythrocytes infected with asexual forms of Plasmodium falciparum were studied in naturally infected Saudi patients. These included surface knobs and nodules as well as invaginations associated with cytoplasmic vesicles observed in erythrocytes infected with asexual forms of the parasites. Such nodules and surface invaginations have been previously described only in erythrocytes infected with P. ovale and P. vivax, respectively. Within the cytoplasm of infected erythrocytes were membrane-bound clefts, similar to those that appear to be a common characteristic in all red cells infected with malaria parasites. Vacuolations were often seen in the peripheral cytoplasm and may represent hemolyzed areas. Collapsed cells with an internal-lucent interior and surrounded by an irregularly folded membrane may represent completely hemolyzed erythrocytes.
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PMID:Falciparum malaria in naturally infected human patients: II. Ultrastructural alterations to erythrocytes infected with asexual forms. 845 52

Political and social conditions deteriorated in Somalia during the 1980s before the onset of civil war in 1990. A cohort study of mortality among children under age 5 years was conducted in Lama-Doonka and Buulalow villages during 1987-89, a period of economic and political collapse in the rural parts of the country. Mortality among the children increased from 211/1000 in 1987 to 323/1000 in 1988 and 414/1000 in 1989. Boys and infants were at greater risk of death relative to girls and children aged 1-4 years, respectively. Respiratory infections, diarrheal diseases, fever/malaria, and tetanus during the prenatal period were the major signs before death. Mortality rates for diarrheal diseases increased significantly over the period, while rates for respiratory infections and diseases preventable by immunization increased more slowly. The increasing trend in under-five mortality was more pronounced when the mother derived her major income from sources other than farming and in larger households.
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PMID:Child mortality in a collapsing African society. 900 35


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