A comparative clinical study of mefloquine and chloroquine in the treatment of vivax malaria.

Forty-six patients with Plasmodium vivax malaria were evaluated for their clinical and parasitological response to the two single doses of mefloquine in comparison with the standard 3-day treatment with chloroquine. The patients were randomly distributed into 3 groups. Group 1 with 13 patients were treated with a single dose 250 mg mefloquine, Group 2 with 15 patients were treated with a single dose 500 mg mefloquine and Group 3 with 18 cases were treated with the standard 3-day treatment course of 1,500 mg chloroquine. All patients in the three treatment group showed similar parasite, clearance time, fever clearance time and clearance time of signs and symptoms. There were no statistically significant differences between any of the groups. The age and weight, as well as the initial parasite count of the three groups were comparable. This study shows that mefloquine at the dosages used were as effective as the 3-day standard treatment with 1,500 mg chloroquine.

An obstinate case of intestinal capillariasis.

A patient who experienced episodes of intestinal capillariasis caused by Capillaria philippinensis 16 times is presented. The patient was first seen in July 1967 with the parasitosis and was treated with thiabendazole. He experienced a relapse in October 1967. He was readmitted to the hospital again in 1969, twice in 1971, twice in 1972, twice in 1973, once each in 1975, 1976, three times in 1978 and twice in 1979. During this period he was treated with various dosages of thiabendazole, mebendazole and flubendazole. At the final admission he was treated with mebendazole, 600 mg per day for 49 days, 200 mg per day for 30 days and 100 mg daily for 6 months. The patient was cured and had no further relapses in 5 years. The recommended dosage of mebendazole is 200 per day for 20 days for new cases and 30 days for relapses. It is advised to over-treat the infection rather than under-treat because of the problem of relapses. Internal autoinfection occurs and it is believed that the drug acts selectively on the adults and not the larval forms of the parasite.

Cerebral malaria at San Lazaro Hospital, Manila, Philippines.

Forty cases of cerebral Plasmodium falciparum malaria seen at San Lazaro Hospital, Manila, Philippines from 1979-1981 were reviewed. These cases represented 7% of all Plasmodium falciparum cases seen during this period. All of the patients had fever and headache, 73% confusion, 70% chills, 68% jaundice or abdominal pain, 60% sweats. Findings more frequent in the fatal compared to the non-fatal cases were: the presence of schizonts in the peripheral smear, oliguria, coma, convulsions, urinary incontinence, jaundice, pulmonary symptoms and vomiting. Fatal cases were less likely to be clinically diagnosed as malaria and more likely to be diagnosed as hepatitis than malaria. The treatment and management of these cases is discussed.