Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 30-year-old woman underwent laparotomy and was placed on a seven-day course of metronidazole and ampicillin postoperatively. Chloroquine therapy for malaria was instituted on the sixth day and the patient developed acute dystonic reactions after a single dose. Diphenhydramine therapy before chloroquine administration did not prevent the development of the dystonic reactions. The extrapyramidal symptoms subsided upon diazepam administration and chloroquine withdrawal even though metronidazole therapy was continued. The mechanism of this adverse drug reaction based on the pharmacodynamic interaction between chloroquine and metronidazole is discussed. It is suggested that the combination of pyrimethamine and sulfadoxine be used in place of chloroquine for malaria chemotherapy in patients on metronidazole therapy.
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PMID:Chloroquine-induced acute dystonic reactions in the presence of metronidazole. 337 Nov 93

Many proteins produced by blood stages of the malaria parasite Plasmodium falciparum are natural immunogens in man. As an approach to determining which of these are relevant to protective immunity we have constructed an expression library of P. falciparum cDNA sequences, cloned in Escherichia coli. The cDNA sequences were inserted into the beta-galactosidase gene of an ampicillin-resistant derivative of the temperature-sensitive lysogenic bacteriophage lambda gt11. About 5% of the resulting clones expressed P. falciparum sequences as polypeptides fused to beta-galactosidase. We have identified many clones that express P. falciparum antigens by immunological screening in situ with antibodies from immune human sera that inhibit P. falciparum growth in vitro. The antigen-positive clones contain P. falciparum cDNA sequences, as determined by hybridization. Some express polypeptides that are larger than beta-galactosidase and react both with antibodies to beta-galactosidase and with antibodies from humans immune to P. falciparum. The cloned P. falciparum antigens should facilitate new approaches to the identification of potential vaccine molecules.
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PMID:Expression of Plasmodium falciparum blood-stage antigens in Escherichia coli: detection with antibodies from immune humans. 630 37

The case is recounted of a child who was admitted to hospitals several times over a period of 8 years on account of fictitious illnesses invented by his mother. The first occurred when he was 3.5 years old in January 1984. His mother, a nurse, gave a history of intermittent fever for 3 months, loss of appetite and weight. He had been treated with ampicillin, chloramphenicol, and procaine penicillin. No abnormality was detected and his weight at 15.5 kg was appropriate for his age. No fever was recorded throughout 2 weeks in hospital, but he was given chloroquine for possible malaria and then discharged. At follow-up 6 months later, the mother complained of his wheezing. On examination he was normal and had gained 3.8 kg since discharge. The possibility of vernal conjunctivitis plus asthma was entertained and he was then placed on ketotiphen prophylaxis. There was an uneventful follow-up for 6 months. 5 years later in March 1990, his mother related that he had been treated from 22 January 1988 to 21 November 1989 for tuberculosis with streptomycin, isoniazid, rifampicin, and ethambutol. He was also treated with digoxin and Esidrex-K for suspected rheumatic carditis, after which at the University Teaching Hospital, Enugu, he was investigated from 11 April 1989 to 10 August 1989 and found to be normal. One year later in August 1991 she went to one of the authors complaining about polydypsia, polyphagia, and polyuria. Examination had revealed nothing of note. A clinical assessment for diabetes mellitus found the urine specific gravity persistently at 1.010. He was therefore put on carbamazepine (Tegretol) 100 mg t.i.d. After review by a pediatric nephrologist, the child was declared normal. During this visit, the mother and child were interviewed separately. He believed he was ill because his mother said so. A diagnosis of Munchausen syndrome by proxy was made. The mother was referred back to her doctor to arrange for psychiatric care. In Munchausen syndrome, patients fabricate a variety of symptoms and evidence of illness that have no organic basis. Munchausen syndrome by proxy is a form of child abuse, difficult to diagnose, that could result in death. It is more prevalent in affluent countries with sophisticated medical facilities. Its rarity in developing countries may contribute to the difficulty of detection.
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PMID:Munchausen syndrome by proxy: an experience from Nigeria. 750 55

Malaria remains a major public health problem in large areas of the world. One of the major factors responsible for the resurgence is the emergence of Plasmodium falciparum, resistant to available antimalarials. An antimalarial, mefloquine, has been considered since its introduction as a promising alternative antimalarial drug to overcome the situation of widespread multidrug resistant P falciparum. Pharmacokinetic studies of mefloquine have been investigated in several groups of subjects either as mefloquine alone or as combined regimens. The oral absorption of mefloquine is relatively rapid, reaching peak concentrations within 24 hours. Metabolism takes place in the liver, with carboxymefloquine as a major metabolite. Mefloquine has a large apparent volume of distribution of 200 L and is highly bound (98%) to plasma proteins. The elimination is slow; the terminal half-life is 13 10 to 14 days in Thai patients with falciparum malaria. Vomiting within 1 hour of drug administration has an influence on blood concentrations of mefloquine and this may result in treatment failure. The whole blood concentrations of mefloquine on the first two days of treatment are important determinants of parasitological response. There appear to be no pharmacokinetic interactions between mefloquine and the other two components of Fansimef in patients with uncomplicated falciparum malaria. The advantage of this combination over mefloquine alone in multidrug resistant P falciparum is still debatable. However, recent data seem to support the higher efficacy of Fansimef over mefloquine alone. Concurrent administration of antibiotics, ie ampicillin and tetracycline with mefloquine results in a significant increase in maximum concentration, reduction of the apparent volume of distribution and shortening of the terminal elimination half-life of mefloquine. An antiemetic drug metoclopramide accelerates the absorption of mefloquine and increases the maximum concentration. In contrast, mefloquine concentrations are decreased in the presence of an antimalarial, artesunate. Primaquine has no effect on the pharmacokinetics of mefloquine when given concurrently.
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PMID:Clinical application of mefloquine pharmacokinetics in the treatment of P falciparum malaria. 772 Dec 26

Vietnam has a population of 71 million people with a per capita income of $205 per year. In recent years the economy has become liberalized, and development has accelerated, as foreign investments have poured in. The changes have their drawback, as the gap between the rich and the poor has widened, health care is no longer free in practice, the number of admissions into hospitals has decreased, and hospitals and health posts are ill-maintained. There is an extensive network of basic health care with district hospitals and health posts in the villages. In most district hospitals, there are essential drugs available (penicillin, ampicillin, co-trimoxazole, and chloramphenicol), but no cephalosporin or chinolone, which are too expensive. There are X-ray facilities in 50% of hospitals, but there is no echo apparatus. Six medical schools graduate 2000 doctors per year, but the quality of education was mediocre for many years. Malaria, diarrhea, and respiratory infections are the greatest problems. In 1992, there were 20% more malaria cases than in 1991. There were 29,000 cases of serious malaria in 1992 and 3300 deaths, compared to 4561 serious cases and 1070 deaths in 1987. The increase is attributable to socioeconomic factors: the dwindling of aid from the Soviet Union and less DDT spraying, people who are not immune to malaria settle in new economic zones for rice cultivation, diminished effectiveness of the antimalarial network because of scant resources, the chloroquine- and sulfadoxine-pyrimethamine-resistant parasites since mefloquine and halofantrine are too expensive, and the resistance of certain mosquitos against insecticides. Severe malaria has a mortality rate of 20-30% in spite of treatment. Vietnam produces hundreds of kilos of artemisinine annually, and derivatives are experimented with that could be used parenterally. The country needs help because its resources are limited, and unless the US economic embargo is lifted, it is parcelled out only piecemeal.
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PMID:[Vietnam back in perspective; reforms also concern health care]. 828 60

Between October 1994 and January 1995 a field hospital saw nine cases of falciparum malaria associated with meningococcal meningitis among Rwandan patients residing in Kibumba refugee camp in Goma, Zaire. All except one presented with signs and symptoms suggestive of meningeal irritation; all but one responded to intravenous quinine and chloramphenicol or ampicillin. Two had recrudescence of malaria and responded to treatment with pyrimethamine-sulphadoxine (Fansidar). There were no sequelae seen. Meningococcal meningitis is uncommon but frequently fatal if it occurs in patients with falciparum malaria. Early diagnosis and treatment are urgent to decrease morbidity and mortality.
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PMID:Meningococcal meningitis in patients with falciparum malaria. 893 28

38 children with kwashiorkor and 41 with marasmus participated in a study of vitamin E supplementation in a nutritional rehabilitation center in the Dakar suburb of Pikine. Kwashiorkor, or edematous malnutrition, is a major factor in infant mortality in Senegal. Vitamin E supplementation was undertaken to test the hypothesis that kwashiorkor results from aggressive oxidation linked to excess free radicals, vitamin E being a major antioxidant in humans. The children attended the center daily, accompanied by their mothers, until they were cured, defined as disappearance of edema and achievement of 80% of the international standard of weight for height. All children were treated for parasites and malaria prevention. Children with kwashiorkor were given ampicillin, metronidazole and supplements of particular minerals. Between October 1993 and July 1994, 17 children with kwashiorkor and 19 with marasmus were given the vitamin E supplements, the other 43 children serving as controls. The cure rate was slightly higher for the groups receiving supplements, but the difference was not statistically significant. The highest cure rate, 89.5%, was in children with marasmus receiving the supplement, and the lowest cure rate, 68.2%, was in control children with marasmus, but the difference was not statistically significant. Among children with kwashiorkor, weight gain after disappearance of edema was 15.2 +or- 4.9 g/kg/d in the vitamin E group and 16.4 +or- 3.6 g/kg/d in the control group. Several factors may explain the absence of a favorable effect of vitamin E. The hypothesized relationship between aggressive oxidation and kwashiorkor may not exist, or the low plasma levels of vitamin E may not truly reflect deficiencies at the tissue level. The treatment dose of 10 mg/d of vitamin E may have been too low, or the existence of multiple deficiencies may have masked the possible beneficial effect of vitamin E.
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PMID:[Vitamin e supplementation in Senegalese children with kwashiorkor]. 902 18

The objective of this study was to evaluate the medication pattern of febrile patients and determine what proportion of these drugs were included in the Mexican Essential Drugs List. A cross-sectional study was conducted in 32 rural communities located in malarial endemic areas near the Mexico-Guatemala border. Of 817 febrile patients interviewed, 55% self-medicated, while 16% consulted a physician. The most frequently used drugs were antipyretics (68%), antibiotics (25%), and antimalarial drugs (37%), despite the fact that only 2% of all febrile patients were diagnosed with malaria. Antipyrine, acetylsalicylic acid, and acetaminophen represented 84% of antipyretics, and ampicillin, penicillin, and sulfadiazine-trimethoprim represented 51% of total antibiotics. Public health service and self-medicating patients used essential drugs (antipyretics and antibiotics) significantly more than those consulting private physicians. These findings demonstrate the need to foster access to primary health care (PHC) facilities, rational drug prescription by private physicians, and to review guidelines for prescription of antimalarial drugs for febrile patients.
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PMID:Medical drug utilization patterns for febrile patients in rural areas of Mexico. 912 May 33

From June to October 1995, the U.S. Army's 86th Combat Support Hospital was deployed in Haiti in support of the United Nations peacekeeping mission. The hospital's mission was to provide comprehensive health care to United Nations military and civilian personnel in Haiti. The hospital's laboratory, with microbiological and parasitological capability, was a critical asset in light of the infectious disease threats in Haiti. A total of 356 microbiological (5.4%) and 887 parasitological (13.4%) tests were performed, out of a total of 6628 laboratory tests. One finding was the discovery of antibiotic-resistant urinary isolates of Escherichia coli. These were from community-acquired infections and included strains resistant to ampicillin (6/15), trimethoprim+sulfamethoxazole (6/15), and ciprofloxacin (2/15). Ampicillin (8/15) and trimethoprim+sulfamethoxazole (3/15) resistance was also noted in Shigella spp. However, no chloroquine-resistant strains of malaria were encountered. Dengue virus, also mosquito borne, was a major pathogen. Antimicrobial-resistant nosocomial pathogens were also encountered. Deployed laboratories should be able to determine antimicrobial susceptibility and perform microbial identification to guide clinical management, conduct medical surveillance, and detect emerging resistance.
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PMID:Microbiological laboratory results from Haiti: June-October 1995. 918 62

In a prospective study to investigate mortality and antibiotic resistance in meningitis patients, thirty two meningitis cases were seen over a three month period. Mean age was 11.3 years (range one month-60 years). Cerebrospinal fluid cultures were positive in 26 patients (81.3%). S.pneumoniae was responsible for 15 cases (46.9%), followed by H.influenzae in seven (21.9%). Salmonella infection was seen in two patients, and E.coli and N.meningitidis in one each. Twelve patients (37.5%) died during hospitalisation with most of the deaths occurring within 48 hours after admission. No patients presented with atypical signs of meningitis. No significant differences were found between delay and outcome. Malaria parasites were found in blood of thirteen patients (41%), but did not contribute to higher mortality. Three of H.influenzae isolates (42.9%) were resistant to ampicillin and penicillin. Reduced sensitivity to penicillin was found in two (13.3%) of S.pneumoniae isolates.
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PMID:Bacterial meningitis in a rural Kenyan hospital. 980 30


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