Casos notificados de malária no Estado do Pará, Amazônia Brasileira, de 1998 a 2006 / Notified Cases of Malaria in the State of Pará, Brazilian Amazon, from 1998 to 2006

Este estudo realizou um levantamento dos casos notificados de malária no Estado do Pará entre 1998 e 2006, com intuito de quantificar o risco de transmissão da doença, discriminar o número de casos por espécies de Plasmodium e destacar as áreas de maior incidência. Das 5.454.700 amostras sanguíneas examinadas, a positividade foi de 27,58 por cento (22,38 por cento Plasmodium falciparum; 76,11 por cento Plasmodium vivax; 0,31 por cento Plasmodium malariae e 1,20 por cento infecções mistas P. falciparum e P. vivax), sendo observada redução gradativa de notificações a partir de 2001. Além disso, constatou-se que sete municípios apresentaram incidência parasitária anual (IPA) alta entre 1998 e 2006 e outros 31 tiveram média dos nove anos de IPA≥50, sendo constatado aumento do número de municípios com IPA média e baixa. Em suma, o Estado do Pará apresentou redução significativa de casos notificados de malária, com tendência de aumento do número de municípios com IPA baixa e média, provavelmente reflexo das ações governamentais de controle e prevenção à malária na região.

The aim of this study was to carry out a survey of malaria cases reported in the state of Pará from 1998 to 2006 inorder to quantify the risk of disease transmission, to discriminate the number of cases by Plasmodium species and todetermine the areas of greater incidence. Among 5,454.700 blood samples examined, 27.58 per cent tested positive (22.38 per cent Plasmodium falciparum; 76.11 percent Plasmodium vivax; 0.31 percent Plasmodium malariae and 1.20 percent mixed infections of P. falciparum and P. vivax). A gradual reduction in notifications was observed, beginning in 2001. In seven cities there was ahigh Annual Parasite Incidence (API) between 1998 and 2006 and another 31 had average API of ≥50 over nine years.There was an increase in the number of cities with average or low API values. In summary, the state of Pará witnessed a significant reduction in the notification of malaria cases, with an increased trend in cities with low and average API values. This is probably a result of government actions for malaria control and prevention in that region.

Chloroquine resistant malaria in neonates

To analyze the clinical presentation, treatment given, and outcome of patients suffering from congenital and acquired malaria in neonatal period. Analytical study. Paediatrics Ward-2, QAMC/BVH, Bahawalpur for 02 years from October 2001 to October 2003. The study included 45 cases of neonatal malaria. Thirty cases of malaria, admitted during first ten days of life, diagnosed as congenital malaria, were kept in group A, while 15 cases admitted in the ward from the age of 11 to 28 days, labeled as acquired malaria, were named group B. The clinical features at the time of presentation were noted in each group from the charts having positive malarial parasite [M.P.] on thick and thin slides. The diagnosed cases were treated with the standard dose of chloroquine sulphate. Those patients who improved clinically as well as revealed no parasite on follow-up were labeled as chloroquine sensitive. On the other hand, patients showing poor clinical response with persistence of the parasites in the blood or initially disappearing but later again having a clinical disease with positive M.P. on follow-up, were labeled as chloroquine resistant. They were treated with quinine sulphate. Outcome was compared in both the groups regarding the pattern of chloroquine resistance and death/ survival. Data was collected on which Fischer's exact test of significance was performed to know the level of significance. P-value of < 0.05 was taken as statistically significant. Low birth weight, severe hemolytic anemia with history of fever in the mother were main features in group A while in group B fever, anaemia and history of blood transfusion were marked features. In group A 76.66% were caused by Plasmodium [P.] falciparum. While in group B 60% were caused by Plasmodium vivax. In group A 26.66% were chloroquine resistant while 33.65% were chloroquine resistant in group B. The mortality was 16.66% in group A and 13.33% in group B. Intrauterine growth retardation, hemolytic jaundice and history of fever in the mother in the last trimester of pregnancy in the congenital while fever, history of blood transfusion in the neonates in acquired malaria but pallor in both the groups, were important clinical features. Pattern of chloroquine resistance and mortality in both the groups was not statistically different

Prognostic factors relating to outcome of severe malaria among children in Bangladesh.

This study was done in the Paediatric in-patient department of Chittagong Medical College Hospital (CMCH), Chittagong, Bangladesh to identify and quantify the prognostic factors associated with increased mortality in severe malaria (SM) cases. All the patients with parasitologically confirmed clinical syndromes of SM, admitted between June 1997 and May 1998, were included. A total of 53 consecutive cases were studied. Cerebral malaria (CM) was the commonest type of SM, observed in 36(68%) cases, second commonest type was severe anaemia 13(25%). More than one type of severe manifestations were present in 23(44%) cases. Overall case fatality rate (CFR) was 17% and it was 30% among those who had multi-organ manifestations. Important poor prognostic clinical variables were Blantrye coma score (BCS) score of 0 and 1 on day 1 (OR = 7.78) and day 2(OR = 40.0), multi-organ manifestations (OR = 6.8) and in-hospital complications (OR = 5.18). Important poor prognostic laboratory variables were day 2 parasite count > 50,000/cmm (OR = 5.5), blood glucose < 2.2 mmol/l (OR = 21.5) and raised CSF protein > 50 mg/dl (OR = 7.0). It can be concluded that certain clinical variables e.g. low BCS on day 1 & 2, multi-organ manifestations, in-hospital complications; and laboratory variables e.g. high parasite count, low blood glucose level, raised CSF protein levels are associated with increased mortality rate in SM cases.

Cerebral malaria: CT and MRI findings

Computed Tomography [CT] and Magnetic Resonance Imaging [MRI] in two cases of severe cerebral malaria are presented. The first case was a 28 years old female whose initial CT scan showed infarctions with associated oedema in the bilateral temporoparietal regions which resolved after successful treatment with antimalarials. Second CT scan and MRI performed after five weeks showed small residual haemorrhagic infarction in the right temporoparietal region. The second case was a 30 years old male in whom the initial CT scan showed infarction with mass effect in the left temporal region which decreased on treatment as evident by a CT scan performed after three weeks

Tratamento da malária por Plasmodium falciparum com cloroquina e quinina: estudo da cardiotoxidade e resposta terapêutica / Treatment of malaria by Plasmodium falciparum wuth chloroquine or quinine: study of yours cardiotoxicity

Em 109 pacientes com malária por Plasmodium falciparum, 63 tratados com cloroquina (50 a 90 mg/kg peso, em 3 a 6 dias) e 46 com quinina (1,5 g/dia, durante 7 dias), foram estudadas a cardiotoxicidade e resposta terapêutica dessas drogas. A avaliaçåo da cardiotoxicidade baseou-se em achados clínicos, evoluçåo eletrocardiográfica e determinaçåo dos níveis enzimáticos (transaminase glutâmico-oxalacética e creatinafosfotransferase) antes, durante e após o tratamento. Quanto à cloroquina, a cardiotoxicidade manifestou-se principalmente sobre os mecanismos da repolarizaçåo ventricular (42,8 pôr cento), embora tenha ocorrido, com muito menor freqüencia, depressåo da excitabilidade (4,7 pôr cento), retardo na conduçåo do estímulo elétrico (14,2 pôr cento), arritmia supraventricular (1,6 pôr cento) e queda da pressåo arterial (3,2 pôr cento. Em relaçåo à quinina a depressåo da excitabilidade (bradicardia) foi a manifestaçåo mais significativa (34,7 pôr cento); foram também detectadas alteraçöes da repolarizaçåo ventricular (15,2 pôr cento), retardo na conduçåo do estímulo elétrico (19,5 pôr cento) e queda da pressåo arterial (21,7 pôr cento). No tocante à resposta terapêutica, nåo houve resistência a nível de RII e RIII, segundo os padröes da Organizaçåo Mundial da Saúde, com quaisquer das drogas. A cloroquina apresentou 15,0 pôr cento de resistência (RI) e a quinina 2,4 pôr cento. Ambas as drogas mostraram-se eficazes para o tratamento da doença, sobretudo nas formas graves, nåo tendo havido diferença importante em relaçåo à resposta clínica, apesar da açåo esquizonticida da cloroquina ter se mostrado discretamente mais rápida que a da quinina