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Query: UMLS:C0024530 (malaria)
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Between 1 September and 24 October 1976, 318 cases of acute viral haemorrhagic fever occurred in northern Zaire. The outbreak was centred in the Bumba Zone of the Equateur Region and most of the cases were recorded within a radius of 70 km of Yambuku, although a few patients sought medical attention in Bumba, Abumombazi, and the capital city of Kinshasa, where individual secondary and tertiary cases occurred. There were 280 deaths, and only 38 serologically confirmed survivors.The index case in this outbreak had onset of symptoms on 1 September 1976, five days after receiving an injection of chloroquine for presumptive malaria at the outpatient clinic at Yambuku Mission Hospital (YMH). He had a clinical remission of his malaria symptoms. Within one week several other persons who had received injections at YMH also suffered from Ebola haemorrhagic fever, and almost all subsequent cases had either received injections at the hospital or had had close contact with another case. Most of these occurred during the first four weeks of the epidemic, after which time the hospital was closed, 11 of the 17 staff members having died of the disease. All ages and both sexes were affected, but women 15-29 years of age had the highest incidence of disease, a phenomenon strongly related to attendance at prenatal and outpatient clinics at the hospital where they received injections. The overall secondary attack rate was about 5%, although it ranged to 20% among close relatives such as spouses, parent or child, and brother or sister.Active surveillance disclosed that cases occurred in 55 of some 550 villages which were examined house-by-house. The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of north-eastern Zaire between the Bumba Zone and the Sudan frontier near Nzara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless it was established that people can and do make the trip between Nzara and Bumba in not more than four days: thus it was regarded as quite possible that an infected person had travelled from Sudan to Yambuku and transferred the virus to a needle of the hospital while receiving an injection at the outpatient clinic.Both the incubation period, and the duration of the clinical disease averaged about one week. After 3-4 days of non-specific symptoms and signs, patients typically experienced progressively severe sore throat, developed a maculopapular rash, had intractable abdominal pain, and began to bleed from multiple sites, principally the gastrointestinal tract. Although laboratory determinations were limited and not conclusive, it was concluded that pathogenesis of the disease included non-icteric hepatitis and possibly acute pancreatitis as well as disseminated intravascular coagulation.This syndrome was caused by a virus morphologically similar to Marburg virus, but immunologically distinct. It was named Ebola virus. The agent was isolated from the blood of 8 of 10 suspected cases using Vero cell cultures. Titrations of serial specimens obtained from one patient disclosed persistent viraemia of 10(6.5)-10(4.5) infectious units from the third day of illness until death on the eighth day. Ebola virus particles were found in formalin-
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PMID:Ebola haemorrhagic fever in Zaire, 1976. 30 56

The American population developed, during thousands of years, free of epidemics that had been attacking Europe, Asia and Africa. The European and African migrations, after Columbus's first trip, produced an epidemic invasion of influenza, smallpox, measles, yellow fever, malaria, diphtheria, typhus, and other diseases that attacked the immunologically virgin populations and produced a very high mortality, with a diminution of the indigenous population of more than 90% in many places. According to historical evidence, the first epidemic was influenza, produced by swine strain of virus, immediately followed by smallpox. The Spaniards mated freely with the Indians producing a mixed race called the Mestizo, who were immunologically more capable of defending themselves against various viruses, bacteria, and parasites brought over from the Old World. Marriage between the races also was sanctioned by Queen Isabella (1503) and Fernando I (1515). With these new genetic immunologic defenses against infections, the Mestizo eventually made up the majority of the population of Indians in the New World.
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PMID:Epidemic hecatomb in the New World. 148 72

Malaria is largely preventable, so travelers should be taught general protective measures and given appropriate chemoprophylaxis before they leave on their trip. Chloroquine phosphate (Aralen) is still the drug of choice in locations where malaria remains chloroquine-sensitive. However, chloroquine-resistant areas infested with Plasmodium falciparum are becoming more numerous. In such areas, mefloquine hydrochloride (Lariam), doxycycline, or proguanil (Paludrine) (obtainable outside the United States) may be used. A single dose of pyrimethamine-sulfadoxine (Fansidar) may be used to treat presumptive malarial infection if medical care is not immediately available. For prevention of relapse of Plasmodium vivax and Plasmodium ovale infection, primaquine phosphate is recommended for the final 2 weeks of chemoprophylaxis on return from a malarious area.
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PMID:Prophylaxis for malaria. Helping world travelers come home healthy. 151 52

Traveler's diarrhea, malaria, acquired immunodeficiency syndrome and jet lag are among the issues for the traveler preparing for a trip to or returning from developing countries. With appropriate measures, most travel-related diseases can be prevented. Diarrheal diseases, schistosomiasis, sexually transmitted diseases and AIDS can be prevented with proper avoidance behavior. Diseases such as hepatitis, rabies, yellow fever and meningitis can be prevented with immunization. Chemoprophylaxis can prevent malaria, altitude sickness and sinus barotrauma. Diagnosing an illness in a returning traveler requires a high index of suspicion regarding diseases that might have been acquired during travel. Resources for accessing up-to-date information concerning prophylaxis, diagnosis and treatment of travel-related illnesses are available.
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PMID:Prevention and treatment of travel-related illness. 141 74

Preparing adult travelers for journeys abroad can be challenging and rewarding. Prevention is the cornerstone of a safe, enjoyable trip. Patient education and commonsense precautions may well prevent infection or disease. Prophylaxis for diarrhea and malaria could save one day of illness or inconvenience on an expensive trip or may save a traveler's life. And the Loa loa worm? The nurse fortunately waited until it crawled from under her cornea. Then it was gently teased from under the bulbar conjunctiva.
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PMID:Health risks of foreign travel. Preparing adults for jaunts abroad. 190 86

A 38-year-old patient with cerebral P. falciparum malaria was admitted 12 days after a short trip to Kenya. The serum level of tumor necrosis factor (TNF-alpha) was elevated (251 pg/ml). In contrast, Protein C (plasma activity 36.1%; antigen concentration 31.7%) and protein C inhibitor 1 (activity 0.55 U/ml) levels were decreased. This suggested a state of functional activation of the clotting system which was confirmed by elevated levels (4.8 ng/ml) of circulating thrombin-antithrombin-III-complexes (TAT). Protein S (total and free) and coagulation factor IX levels were within normal range. Under successful antiparasitic therapy, TNF-alpha as well as protein C and protein C inhibitor 1 levels returned to baseline within one week. In the context of other studies that demonstrate procoagulant effects of TNF-alpha, it is remarkable that in the case of complicated P. falciparum malaria, an elevated concentration of TNF-alpha can be paralleled by a decreased plasma level of protein C and an increase in TAT suggesting a procoagulant state.
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PMID:[Malaria tropica with activation of blood coagulation and detection of tumor necrosis factor (NF-alpha) in serum]. 215 19

Malaria should be considered in a patient with unexplained fever and a history of travel to an endemic area. Aggressive therapy must be started if Plasmodium falciparum infection is a possibility. Travelers must be educated about mosquito bite protection and appropriate chemoprophylaxis. Travelers can, however, acquire malaria despite chemoprophylaxis, and symptoms may appear up to one year after the trip.
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PMID:Malaria: chemoprophylaxis and therapy. 304 49

A 42-year-old man was admitted to hospital with, previously wrongly diagnosed, fulminant falciparum malaria, 14 days after a two-week trip to Kenya. He had a high fever and was jaundiced, with severe anaemia and thrombocytopenia. He was given quinine intravenously and pyrimethamine/sulfadoxine (Fansidar) by mouth. He developed acute renal failure and increasingly severe cerebral symptoms, at times coma. An exchange transfusion and several plasmaphereses were, therefore, performed. The cerebral symptoms quickly abated during the exchange transfusion, but renal function failed to improve. Because of continuing fever, mefloquin (Lariam) and doxy-cycline (Vibramycin) were also administered. After several dialysis periods the patient improved gradually and was discharged after three weeks in generally good condition with normal renal function.
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PMID:[Exchange transfusion and (or) plasmapheresis: effective measures in severe tropical malaria?]. 328 61

General practitioners are in a key position to provide advice to those travelling to malaria endemic areas. A study of at-risk travellers revealed that 54% visited their general practitioner before their intended trip overseas and of these 79% were given advice about antimalarial precautions. Of those advised 98% carried antimalarial tablets with them on their trip but only 46% had any knowledge of other methods of personal protection against malaria. Fewer non-white than white British residents received information from their general practitioners.It is suggested that general practitioners should be better informed about current malaria transmission and currently recommended chemoprophylactic drugs and dosages. It is also suggested that the major public health priority should be to stimulate a greater involvement of non-health service agencies in order to make the public aware of the risk of malaria and seek medical advice before travel.
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PMID:Imported malaria in the UK: advice given by general practitioners to British residents travelling to malaria endemic areas. 366 36

Before undertaking a trip to a tropical country, parents frequently ask their pediatrician or general practitioner about the necessary precautions for their child. Although there is no call for excessive concern, it is important to draw the parents' attention to the specific hazards of the trip. To achieve this, one can suggest: 1) before leaving, to ask specialized organizations for information on the specific risks in the areas to be visited according to the conditions of the stay, as well as on health formalities (advisory or compulsory vaccinations); 2) during the stay, to take the necessary precautions (chemoprophylaxy for malaria, precautions concerning food and bathing, treatment of diarrhea); 3) after the return home, to check the child's state of health, to continue giving antimalarials regularly, and to perform the necessary investigations if any symptom persists.
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PMID:[Pediatric advice before departure to tropical countries]. 630 5


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