[An efficacy and tolerance study of oral artesunate alone and in combination with mefloquine in the treatment of uncomplicated falciparum malaria in an endemic area of Pará, Brazil]. / Estudo da eficácia e tolerância do artesunato oral isolado e em associação com mefloquina, no tratamento da malária falciparum não complicada em área endêmica do Pará, Brasil.

With the objective to evaluate the efficacy and tolerance of artesunate in the treatment of noncomplicated falciparum malaria in endemic area of the State of Pará, 153 patients were randomized and studied in three groups, distributed by therapeutical scheme (I received mefloquine 1000 mg, II used artesunate 600 mg followed by mefloquine 500 mg). Evaluation was made by daily clinical and parasitological examination, in the first 7 days, and weekly until the 35th day of the follow-up. Biochemical and hematological analysts previously done and on the 7th day, targeting cure control and identification of possible effects related to drugs administration. As to sex, parasitemia and fever, studied groups were homogeneous. Time for parasitemia disappearance was shorter in the groups II and III respectively, whose therapeutical schemes had artesunate. Fever disappearance was quicker in the group treated with the combination of drugs. Clinical and biochemical alterations associated with drugs administration did not show significant differences among the studied groups. Early disappearance of fever and parasitemia, and absence of important side effects suggest that artesunate, isolated or administrated in combination with mefloquine, constitutes an able therapeutical procedure to constitutes and able therapeutical procedure to contribute for disease control in that region.

Falciparum malaria. Epidemiology in Latin America, biologic and clinical considerations, treatment, and prophylaxis.

Falciparum malaria has become a major problem to health planning in Latin America, particularly because widespread drug-resistant strains of P. falciparum have been observed. This article reviews some current considerations in the treatment and management of falciparum malaria in this region.

Leishmaniasis and malaria: new tools for epidemiologic analysis.

Parasitic diseases are still prevalent in many parts of the world, causing both human suffering and economic loss. Recent developments in biotechnology, such as the use of monoclonal antibodies and recombinant DNA, have the potential for providing both more extensive and detailed information on the parasite in the infected human and in insect vectors. New methods of detection, both in man and insect vectors, have been developed for two parasitic diseases, leishmaniasis and malaria. These new methodologies will be important in epidemiologic studies on the prevalence and transmission of these parasitic diseases.

Specific DNA probe for the diagnosis of Plasmodium falciparum malaria.

Malaria can be diagnosed either by direct microscopic examination of blood smears, which is time consuming and requires expertise, or by immunological techniques, which are effective but do not distinguish between past and present infections. In this study, a simple procedure was developed for spotting lysed blood from infected patients directly onto nitrocellulose paper and identifying the malaria species on the basis of hybridization of parasite DNA with a species-specific probe. A genomic DNA library of Plasmodium falciparum was screened to detect clones containing DNA sequences that are highly repeated within the parasite genome. Several such clones were further analyzed to identify those that hybridize specifically with P. falciparum DNA but not with DNA from humans, P. vivax, or P. cynomolgi. This technique appears to be sensitive enough to detect 10 picograms of purified P. falciparum DNA (equivalent to 100 parasites) and in field studies is able to detect approximately 40 parasites per microliter of blood.

Application of an in vitro semi-microtest to the study of drug sensitivity of 66 Plasmodium falciparum isolates from 15 countries.

The activity of four antimalarial drugs against 66 Plasmodium falciparum isolates from 15 countries was assessed by an in vitro semi-microtest. Median inhibitory concentrations (IC50) for chloroquine were less than 120 nM in 22 isolates from patients successfully treated with chloroquine, and more than 250 nM in six isolates from patients with chloroquine-resistant malaria. 10 of 15 isolates from Brazil (Amazonia), 7 of 12 isolates from Madagascar, two from Kenya and two from Thailand had IC50 for chloroquine of more than 250 nM. None of the 35 isolates from West and Central Africa had IC50 of more than 120 nM. Very different levels of sensitivity were observed in Brazil and Madagascar. 27 of 28 isolates (including two that were chloroquine-resistant in vivo) had IC50 of less than 50 nM for dichlorquinazine, a 4-aminoquinoline. The IC50 for mefloquine was less than 160 nM in 55 isolates including ten from patients who were successfully treated with mefloquine. IC50 for quinine were between 140 and 660 nM for 30 isolates. This test has proved useful in epidemiological studies, therapeutic monitoring of clinical cases and in the evaluation of new drugs.

Histopatologia da hepatite de Labrea. / Histopathology of Labrea hepatitis

Sete casos fatais de hepatite de Labrea, com diferentes periodos de sobrevida, possibilitaram um estudo sequenciado das alteracoes histopatologicas no figado.As lesoes fundamentais e mais precoces foram a degeneracao gordurosa aguda e a necrose litica ou de coagulacao, atingindo hepatocitos em todos os lobulos, sem distribuicao macica ou zonal. As alteracoes inflamatorias, colestaticas, de proliferacao ductular biliar e de regeneracao hepato-celular aparecem como consequencias mais tardias. A doenca e uma afeccao primaria do figado, as alteracoes nos outros orgaos sendo leves e secundarias

Tratamento de malaria (P. falciparum) com clindamicina. II - Esquema posologico em cinco dias. / Treatment of malaria (P. falciparum) with clindamycin. II - Posologic schedule in 5 days

Sao apresentados os resultados do emprego de clindamicina na dosagem de 20 mg/Kg/peso/dia, durante cinco dias. A droga foi administrada por via oral ou venosa, a 26 pacientes infectados com P. falciparum, observando-se negativacao da parasitemia a partir do 3o. dia, com o maximo entre o 4o. e 6o. dia, quando 21 (80,8%) pacientes deixaram de apresentar parasitos assexuados no sangue periferico. A cura clinica e parasitologica foi obtida em todos os pacientes

Resistencia do Plasmodium falciparum na Amazonia Brasileira a associacao sulfadoxina mais pirimetamina. / Resistance of Plasmadium falciparum in the Brazilian Amazonia to the association sufadoxine plus pyrimethamine

A associacao de sulfadoxina mais pirimetamina (FANSIDAR) foi administrada a 19 pacientes que adquiriram a infeccao malarica pelo P. falciparum, na Amazonia Brasileira A avaliacao da resistencia mostrou que 12 (63,1%) dos pacientes eram portadores de cepa (s) resistente (s) sendo 8 (66,6%) a nivel de RI, 2 (16,7%) a nivel de RII e 2 (16,7%) a nivel de RIII

Resistencia "in vitro" do Plasmodium falciparum a associacao sulfametoxazol mais trimetoprim na Amazonia Brasileira. / In vivo resistance of Plasmodium falciparum to the association of sulfamethoxazol plus trimethoprim in the Bazilian Amazonia

Sao descritos com infeccao pelo P. falciparum que receberam como terapeutica, a associacao de sulfametoxazol + trimetoprim De 45 tratados, 30 apresentaram resistencia a nivel de RI e RII.Todos os pacientes eram procedentes da Amazonia Brasileira

Resistencia "in vivo" do Plamodium falciparum a associacao sulfadoxina mais pirimetamina, a nivel de RIII, no Amazonas, Brasil. / In vivo resistence of Plasmodium falciparum to the association of sulfadoxine plus pyrimethamine at RIII level, in Amazonas, Brazil

Os autores descrevem um caso de infeccao pelo P. falciparum, que apresentou resistencia "in vivo" a nivel de RIII, para o tratamento com a associacao sulfadoxina + pirimetamina