Cotrimoxazole for childhood febrile illness in malaria-endemic regions

The efficacy of co-trimaxozole for the treatment of Plasmodium falciparum parasitaemia in children younger than 5 years of age was evaluated in Malawi. 46 children with P falciparum parasitaemia; 37 percent of whom also met clinical criteria for acute respiratory tract infection; were treated with 20 mg/kg co-trimaxozole twice daily for five days. Parasitaemia (mean clearance time 2.7 days) and syptoms were rapidly abolished and improvement was maintained during the follow-up 14 days. Co-trimaxozole may be an effecitve single treatment for febrile illness in young children in areas where malaria is endemic; resources are few; and diagnosis must rely on clinical findings alone

Stevens-Johnson syndrome during anti-tuberculosis chemotherapy in HIV-seropositive patients: report on six cases

Hypersensitivity reactions may occur during antituberculous chemotherapy. Severe reactions are rare; and in the three years 1983-86 during which we have both worked in Africa managing large numbers of patients with tuberculosis we only saw one or two cases with severe and generalised cutaneous hypersensitivity. In the last 12 months; however; there have been a number of cases with severe Stevens-Johnson syndrome which developed during antituberculous chemotherapy and has invariably been associated with seropositivity to HIV (human immunodeficiency virus)

Efficacy of quinine for falciparum malaria according to previous chloroquine exposure. [short report]

Chloroquine has been reported to antagonize the anti-parasitic action of quinine against Plasmodium falciparum in vitro. The authors looked for evidence of any such antagonism in vivo. In 123 Malawian children with cerebral malaria treated with parenteral quinine; the likelihood of survival and the rate of recovery were much the same in patients who had taken chloroquine and those who had not. In these circumstances there was no evidence of chloroquine/quinine antagonism

Cerebral malaria in children II: causes and treatment of hypoglycaemia before and during treatment

Presenting hypoglycaemia must be looked for in all patients with cerebral malaria; since it carries a poor prognosis and can be corrected. Several possible mechanisms for its development are discussed. It is important to continue to consider hypoglycaemia during treatment; since it may recur. Regular glucose supplementation must be given during quinine treatment; to prevent starvation hypoglycaemia. Quinine-induced hypoglycaemia does not seem to be a major problem in these circumstances; although the possibility must not be neglected; especially if treatment is prolonged

Complications of diabetes mellitus in Malawian Adults

One hundred Malawian adults with diabetes mellitus were examined for complications of the disease and results were compared with those obtained in age and sex matched controls. Impotence; hypertension; postural hypotension; lower limb pulse deficit; lower limb reflex loss; cataract; retinopathy and urine proteinuria were significantly more common in diabetes compared with controls. Complications were related to duration of disease. Apart from cataract (treated surgically in severe cases) and proliferative retinopathy; none of the observed complications resulted in serious disability

Clinical features in the diagnosis of peptic ulcer in Malawian adults

The predictive value of clinical features in the diagnosis of peptic ulcer diseases was studied in 104 Malawian adults (mean age 36 years) with epigastric pain who were consecutively investigated by fiber-optic endoscopy. In 40 patients with peptic ulcer and 64 with a normal investigation; clinical features with a positive predictive value greater than 50 percent included: male subject; farming occupation; cigarette smoking; alcohol consumption; episodic pain; vomiting and hematemesis. The triad of smoking plus episodic pain plus nocturnal pain gave a predictive value of 90 percent. Attention in the history to these clinical features should allow a more accurate clinical diagnosis of peptic ulcer in patients presenting with epigastric pain

Review of lymph node biopsies: medical ward; Kamuzu Central Hospital; 1985-1988

A descriptive study of lymph node biopsies done on the medical ward of Kamuzu Central Hospital [KCH] in Lilongwe between 1985-1988 was undertaken to describe the histological diagnosis; the site of the lymph node biopsy; the sex; and age of the individual. There were 53 biopsies; 27 (51 percent) were tuberculosis [TB] adenitis; 10 (19 percent) were reactive nodes (? viral infection); 8 (15 percent) were Kaposi's Sarcoma; 7 (13 percent) were lymphoma or leukemia and one was normal. Kaposi's Sarcoma occured more significantly in males than females. TB adenitis was most frequently in the age group 21-40 years and it mostly occured in the cervical area. Further study may reveal a clinically useful relationship between lymph adenopathy; the various diagnosis and HIV status for the purposes of diagnosis and management

Mefloquine therapy for Plasmodium falciparum malaria in children under 5 years of age in Malawi: in vivo/in vitro efficacy and correlation of drug concentration with parasitological outcome

The in vivo and in vitro response of Plasmodium falciparum to a single oral dose of mefloquine (25 mg/kg body weight (M25) or 15 mg/kg (M15] was studied in children under 5 years of age in Malawi. Of the children who received mefloquine, 35% vomited at least once, and 10% did not tolerate the drug because of vomiting. The therapy failure rates for the M25 group on day 7, 14, and 28 were 15%, 18%, and 42%, respectively, and these did not differ significantly from those for the M15 group (4%, 18%, and 59%). In contrast, 34 in vitro microtests (17 per group) showed schizont inhibition at less than or equal to 32 pmol mefloquine per test well. On day 7, the concentration of mefloquine in samples of blood was significantly lower in both the M25 and M15 groups for children who were parasitaemic on day 7 than in samples from those who were aparasitaemic. A positive blood smear on day 7 was strongly associated with a mefloquine concentration of less than 500 ng/ml blood on day 2 or day 7 (P less than 0.0003). Vomiting was associated with a low mefloquine concentration on day 2 but not day 7. These results suggest that mefloquine is effective against P. falciparum in Malawi but that for young children the therapy appears to be complicated by frequent vomiting

Medical admissions to Kamuzu Central Hospital; Lilongwe; Malawi in 1986: comparison with admissions to Queen Elizabeth Central Hospital; Blantyre in 1973

A retrospective survey was carried out on adult medical admissions to Kamuzu Central Hospital; Lilongwe; Malawi during the period January to December 1986; and results compared with those obtained in Queen Elizabeth Central Hospital; Blantyre in 1973. There were 4700 admissions which was more than twice the number seen in Blantyre. However; the age distribution; the pattern of disease and the overall hospital mortality were similar. Infections (malaria; pneumonia; tuberculosis; gastroenteritis/dysentery and meningitis) were the most common cause of admission; and the major causes of death were still tuberculosis; pneumonia and meningitis. Smoking related diseases were uncommon; and there was no documented case of ischaemic heart disease. The reasons for the importance of periodic surveys; such as the present study; are discussed

Upper gastrointestinal bleeding in Malawian adults and value of splenomegaly in predicting source of haemorrhage

Fibreoptic endoscopy was carried out on 100 Malawian adults consecutively admitted to the department of medicine; Kamuzu Central Hospital; Lilongwe; with acute upper gastrointestinal bleeding. The principal causes of haemorrhage were oesophageal varices (45 percent ); duodenal ulcer (16 percent ); gastritis/erosions (9 percent ) and gastric ulcer (7 percent ). 69 percent of 29 patients with oesophageal varices who were investigated had S. mansoni infection. A palpable spleen positively predicted oesophageal varices in 91 percent of cases; while no palpable spleen predicted a source of haemorrhage other than varices in 97 percent of cases. In Malawi oesophageal varices are the major cause of upper gastrointestinal bleeding in adults; and the presence or absence of splenomegaly is a useful clinical pointer respectively to the presence or absence of oesophageal varices

Clinical trials with halofantrine hydrochloride in Malawi

Two clinical trials of the phenanthrene treatment of Plasmodium falciparum were conducted in Malawi; in areas where the parasite was known to be chloroquine resistant. Of 49 children followed up for 14 days; 47 became aparasitaemic -ie; the cure rate was 96 percent. In both trials the drug was very well tolerated. Halofantrine hydrochloride seems to be effective against P. falciparum chloroquine sensitive and resistant strains in Africa

Massive splenomegaly in Malawi

An analysis of consecutive admissions with massive splenomegaly to KCH in Lilongwe with the aim of providing simple guidelines to diagnosis and treatment of it in Malawi

Pulmonary tuberculosis in Malawian adults: why delay in diagnosis?

A study undertaken to determine the factors which lead to long delays between the symptoms and the diagnosis of pulmonary tuberculosis which seems to occur in Malawi