Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The importance of Malaria, especially in pregnancy, cannot be over-emphasised. A major determinant of compliance with treatment in this environment is the pruritus chloroquine induces when ingested. This cross-sectional study of 200 antenatal patients was aimed at obtaining the pattern of the pruritus in antenatal patients. The prevalence of chloroquine-induced pruritus was 64.5%; 76.3% of the patients experienced the itching within 24 hours of ingestion of the drug and 60% of the patients still use the drug in spite of the itching for various reasons. Among the indices of severity, the frequency of itching with chloroquine use was the only factor that correlated with continuation of use (P < 0.01).
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PMID:Pattern of chloroquine-induced pruritus in antenatal patients at the University College Hospital, Ibadan. 1296 4

Malaria, caused mostly by Plasmodium falciparum and P. vivax, remains one of the most important infectious diseases in the world. Antimalarial drug toxicity is one side of the risk-benefit equation and is viewed differently depending upon whether the clinical indication for drug administration is malaria treatment or prophylaxis. Drug toxicity must be acceptable to patients and cause less harm than the disease itself. Research that leads to drug registration tends to omit two important groups who are particularly vulnerable to malaria--very young children and pregnant women. Prescribing in pregnancy is a particular problem for clinicians because the risk-benefit ratio is often very unclear. The number of antimalarial drugs in use is very small. Despite its decreasing efficacy against P. falciparum, chloroquine continues to be used widely because of its low cost and good tolerability. It remains the drug of first choice for treating P. vivax malaria. Pruritus is a common adverse effect in African patients. As prophylaxis, chloroquine is usually combined with proguanil. This combination has good overall tolerability but mouth ulcers and gastrointestinal upset are more common than with other prophylactic regimens. Sulfadoxine/pyrimethamine is well tolerated as treatment and when used as intermittent preventive treatment in pregnant African women. Sulfadoxine/pyrimethamine is no longer used as prophylaxis because it may cause toxic epidermal necrolysis and Stevens Johnson syndrome. Mefloquine remains a valuable drug for prophylaxis and treatment. Tolerability is acceptable to most patients and travellers despite the impression given by the lay press. Dose-related serious neuropsychiatric toxicity can occur; mefloquine is contraindicated in individuals with a history of epilepsy or psychiatric disease. Quinine is the mainstay for treating severe malaria in many countries. Cardiovascular or CNS toxicity is rare, but hypoglycaemia may be problematic and blood glucose levels should be monitored. Halofantrine is unsuitable for widespread use because of its potential for cardiotoxicity. There is renewed interest in two old drugs, primaquine and amodiaquine. Primaquine is being developed as prophylaxis, and amodiaquine, which was withdrawn from prophylactic use because of neutropenia and hepatitis, is a potentially good partner drug for artesunate against falciparum malaria. Atovaquone/proguanil is a new antimalarial combination with good efficacy and tolerability as prophylaxis and treatment. The most important class of drugs that could have a major impact on malaria control is the artemisinin derivatives. They have remarkable efficacy and an excellent safety record. They have no identifiable dose-related adverse effects in humans and only very rarely produce allergic reactions. Combining an artemisinin derivative with another efficacious antimalarial drug is increasingly being viewed as the optimal therapeutic strategy for malaria.
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PMID:Antimalarial drug toxicity: a review. 1472 85

The hypothesis that chloroquine-induced pruritus (CIP) may be determined by certain genetic factors was tested by investigating the epidemiology of CIP with respect to certain genetic red cell markers namely, haemoglobin genotype, glucose-6-phosphate dehydrogenase (G6PD) deficiency and the ABO blood groups. Three hundred consecutive patients treated for malaria with chloroquine at the University College Hospital, Ibadan, Nigeria were recruited into the study. They were observed over 3 days for presence of CIP. ABO blood groups, G6PD and Hb genotypes were determined appropriately for each patient. One hundred and twenty four (41.3%) of the patients responded positively to CIP. There was a reduced frequency of the sickle cell trait (HbAS) among itchers relative to non-itchers. This suggests that the trait may be protective against CIP. G6PD deficiency was also found to be relatively more common among itchers than non-itchers. This indicates that G6PD deficiency may increase susceptibility to CIP. There was however no difference in the distribution of itchers among the different ABO blood groups. It was concluded that CIP may be associated with certain genetic red cell markers particularly Hb and G6PD types which are known malaria markers but not ABO blood groups.
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PMID:Certain red cell genetic factors and prevalence of chloroquine-induced pruritus. 1502 76

Chemotherapy of malaria fever with chloroquine is often associated with generalized pruritus of unknown pathogenesis. This adverse side effect leads to diminished compliance. We report that chloroquine (1.25-40 mg/kg, s.c.) elicits dose-related, compulsive, and vigorous scratching in mice. This frenzied behavior is essentially abolished when the mice are pretreated s.c. or orally with nalfurafine (TRK-820), a centrally penetrating kappa opioid agonist. Peripheral kappa receptors are involved because chloroquine-induced scratching is also antagonized by the peripherally restricted kappa agonist, ICI 204,448: R,S-N-[2-(N-methyl-3,4-dichlorophenylacetamido)-2-(3-carboxyphenyl) ethyl]pyrrolidine. We propose that combination therapy for malaria with chloroquine and a kappa agonist (probably one targeting peripheral receptors) will lead to better treatment compliance because of a reduced incidence of pruritus.
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PMID:Kappa opioid agonists suppress chloroquine-induced scratching in mice. 1547 49

The efficacy of chloroquine plus chlorpheniramine, a histamine H receptor antagonist, which reverses chloroquine 1 insensitivity in Plasmodium falciparum in vitro and in vivo , was evaluated in 30 pregnant women with recrudescent chloroquine-resistant Plasmodium falciparum malaria. All patients had at least one or more treatment failures with one or more courses of chloroquine or pyrimethamine-sulphadoxine. There was a prompt response to treatment with parasitaemia and fever clearing in all patients within 48 and 96 hours respectively of commencement of therapy with the combination. The cure rate on day 14 was 77%. Parasitaemia recurred in seven patients after day 14 and was successfully treated with oral mefloquine. The combination was well tolerated; pruritus and drowsiness were the only noticeable adverse effects. The progress of pregnancy and its outcome were not adversely affected by treatment with the combination. When fully developed, the combination of chloroquine plus chlorpheniramine may be an alternative in the treatment of chloroquine-resistant malaria during pregnancy in Nigerian women.
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PMID:Efficacy of chloroquine plus chlorpheniramine in chloroquine-resistant falciparum malaria during pregnancy in Nigerian women: a preliminary study. 1551 68

To assist the Peruvian Ministry of Health in modifying the malaria treatment policy for their north Pacific coastal region, we conducted an in vivo efficacy trial of sulfadoxine-pyrimethamine (SP) and SP plus artesunate (SP-AS) for the treatment for uncomplicated Plasmodium falciparum infections. A total of 197 patients were randomized to therapy with either SP (25 mg/kg of the sulfadoxine component in a single dose on day 0) or a combination of SP plus AS (4 mg/kg on days 0, 1, and 2) and were followed for 28 days for symptoms and recurrence of parasitemia. No statistically significant differences between the two groups were observed on enrollment with respect to age, sex, history of malaria, or geometric mean parasite density. A total of 185 subjects completed the 28-day follow-up. Of the 91 subjects treated with SP alone, two had recurrences of parasitemia on day 7 and one on day 21. Of the 94 subjects treated with SP-AS, one had a recurrence of parasitemia on day 21. Fever and asexual parasite density decreased significantly more rapidly and the proportion of patients with gametocytemia on days 3-28 was significantly lower in subjects treated with combination therapy than in those who received SP alone. No severe adverse drug reactions were observed; however, self-limited rash and pruritus were significantly more common and an exacerbation of nausea, vomiting, and abdominal pain were observed significantly more frequently among patients who had received SP-AS. These results have contributed to a National Malaria Control Program decision to change to SP-AS combination therapy as the first-line treatment for uncomplicated P. falciparum malaria in northern coastal Peru in November 2001, making Peru the first country in the Americas to recommend this combination therapy.
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PMID:Efficacy and tolerability of artesunate plus sulfadoxine-pyrimethamine and sulfadoxine-pyrimethamine alone for the treatment of uncomplicated Plasmodium falciparum malaria in Peru. 1589 Nov 31

Chloroquine (CQ) is a very useful drug with a broad spectrum of uses (as anti malarial, anti amoebiasis and for connective tissue diseases). A major side effect preventing or limiting its utilization in blacks is chloroquine induced pruritus (CP). A descriptive cross sectional questionnaire based epidemiological study of medical and nursing students, medical doctors and other workers with historic CP in a Nigerian tertiary (teaching) hospital was carried out to determine factors and features related to the development of CP. From the study the intensity of CP was not reduced by taking less CQ. About 92% of the subjects had close relations who suffered from CP. 84.5% of responders itched for 1-3 days. The longest duration for CP was 7 days. The sites of itching in descending order were generalized (49.2%) hands (46%), legs and feet (46%), perineum/genitalia (28.5%). Relieving factor/drug was identified in 66.6% of responders. Itching with oral CQ occurred in 100%. Intramuscular injection of CQ caused 49% of itching. 19% had pre-chloroquine itch. 28.5% had CP with other antimalarials notably Amodiaquine (23.8%). 50.7% took other antimalarials when down with malaria. There is a need for the identification of a cheap and readily available antidote for CP to enable CQ remain useful/relevant in Nigeria and in the West African sub-region.
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PMID:Chloroquine induced pruritus--questionnaire based epidemiological study. 1729 24

The in-vivo efficacies of the artesunate malartin, alone and in combination with amodiaquine, have been assessed against uncomplicated cases of Plasmodium falciparum malaria attending two treatment centres in Cameroon (the WHO/University of Buea malaria health post in Bolifamba and the University of Buea's health centre in Molyko). The 213 participants were treated for 3 days (malartin-amodiaquine) or 5 days (malartin alone) and then followed-up on days 3, 7 and 14. Only 86 of the patients given malartin alone and 80 of those given malartin-amodiaquine completed follow-up. Most patients given malartin alone showed an adequate clinical and parasitological response (91.9%), the rest showing late parasitological failure (7.0%) or early treatment failure (1.2%). The corresponding values for the malartin-amodiaquine combination were slightly better, at 93.8%, 5.0% and 1.2%, respectively. No late clinical failures were recorded in either treatment arm. In both treatment arms, the prevalence of anaemia in the treated adults (aged>15 years) and children decreased significantly during follow-up (P<0.05). Both regimens were well tolerated and neither gave rise to any serious adverse effects. The most common side-effects were dizziness and fatigue in those given malartin alone and fatigue, itching and nausea in those given malartin-amodiaquine. Three days of treatment with the malartin-amodiaquine combination appears to be slightly more effective and a slightly better choice than 5 days of treatment with malartin alone.
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PMID:The comparative efficacies of malartin, with and without amodiaquine, in the treatment of Plasmodium falciparum malaria in the Buea district of Cameroon. 1731 95

Studies were conducted on the efficacy of Olyset nets-a long-lasting insecticidal net (LLIN) factory treated with 2% (w/w) permethrin on malaria transmission in an area under the influence of pyrethroid susceptible vector species Anopheles culicifacies and A. fluviatilis in Sundargarh District, Orissa, India. The study area comprised 22 villages that were randomized into three clusters and designated as Olyset net, untreated net, and no net area. Malaria incidence in the study population was measured through longitudinal active surveillance at fortnightly intervals. There was a reduction of 65-70% in malaria incidence in Olyset net area as compared to the control areas. The attack rate of Plasmodium falciparum or number of episodes per person per year in different age groups also showed significant reduction in Olyset net area as compared to untreated net and no net areas. Cross-sectional point prevalence surveys showed 45.7% reduction of malaria prevalence in Olyset net users, whereas there was an increase of 33.3% and 51% in untreated net and no net villages respectively. The compliance rate of Olyset net usage in the study population was 80-98% during different months, whereas it was between 70% and 90% for untreated nets. There were minimal complains of skin irritation (4%), itching (8%) and eye irritation (1.2%). However, these effects were only transitory in nature lasting for few hours of the first usage. Olyset nets also provided collateral benefits in terms of relief not only from mosquitoes and malaria but also from other household pests such as head lice, bed bugs, cockroaches, ants and houseflies. The Olyset nets were found to be safe to humans as no adverse event was recorded in the net users that can be attributed to the use of net. The study showed that Olyset nets are effective personal protection tool that can be used in a community based intervention programme.
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PMID:Efficacy of permethrin treated long-lasting insecticidal nets on malaria transmission and observations on the perceived side effects, collateral benefits and human safety in a hyperendemic tribal area of Orissa, India. 1964 15

Racial and ethnic differences in the prevalence and clinical characteristics of itch have rarely been studied. The aim of this review is to highlight possible associations between ethnicity and different forms of chronic itch. We provide a current review of the prevalence of different types of itch in ethnic populations. Genetic variation may significantly affect receptors for itch as well as response to anti-pruritic therapies. Primary cutaneous amyloidosis, a type of pruritic dermatosis, is particularly common in Asians and rare in Caucasians and African Americans, and this may relate to a genetic polymorphism in the Interleukin-31 receptor. Pruritus secondary to the use of chloroquine for malaria is a common problem for African patients, but is not commonly reported in other ethnic groups. In patients with primary biliary cirrhosis, pruritus is more common and more severe in African Americans and Hispanics compared with Caucasians. Racial and ethnic differences in itch and its medical care are poorly understood. Research is needed to examine biological, psychosocial, and lifestyle factors that may contribute to these disparities.
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PMID:Itch in ethnic populations. 2052 37


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