Efficacy of micronized halofantrine in semi-immune patients with acute uncomplicated falciparum malaria in Cameroon.

Fifty subjects with acute uncomplicated falciparum malaria were treated orally with a new micronized formulation of halofantrine. The dose given corresponded to one-half the normal dose for the standard formulation. Parasitemia cleared in all subjects within 78 h. There was recrudescence of falciparum malaria in seven subjects after day 14. The mean +/- standard deviation clearance times of parasitemia and fever were 49.0 +/- 14.2 and 24.3 +/- 13.2 h, respectively. Other clinical symptoms related to malaria cleared within the first 3 days. Pruritus occurred in two subjects, back pain occurred in one subject, and diarrhea occurred in one subject; all of these symptoms were mild. Hematological and biochemical indices were not adversely affected by treatment except in five subjects in whom minor and transitory increases in aspartate aminotransferase and alanine aminotransferase were observed. Micronized halofantrine appears to be a safe, well-tolerated, and effective treatment for acute falciparum malaria in semiimmune patients.

Proposals for a new therapeutic strategy for simple Plasmodium falciparum malaria attacks in Cameroon.

From simplified in vivo tests, authors set up a cartography of the sensitivity of Plasmodium falciparum to amino-4-quinolines in Cameroon; they also evaluated the clinical and parasitological efficacy of different therapeutic protocols which make use of amino-4-quinolines, quinine, mefloquine and halofantrine. All these drugs are administered orally. They recommend maintaining home medication with chloroquine at the dose of 25 mg/kg over 3 days, conserving quinine for use in the case of a possible failure. The use of most recent antimalarials can be proposed only as a last resort.

[Drug sensitivity study of Plasmodium falciparum in the city of Yaounde (Cameroon)]. / Etude de la chimiosensibilité de Plasmodium falciparum aux antimalariques dans la ville de Yaoundé (Cameroun).

In July 1990, the in vitro chemosensitivity of 22 isolates of Plasmodium falciparum was assessed by an isotopic semi-microtest in Yaounde, Cameroon. Out of them, 54.5% were resistant to chloroquine, 28.6% to amodiaquine, 4.8% to quinine and 4.5% had a decrease of sensitivity to mefloquine. A strong positive correlation between the IC50 of the antimalarial drugs compared by pairs was detected.

Interet de l'amodiaquine dans le traitement des acces palustres simples a plasmodium falciparum en zone de chloroquinoresistance

La resistance aux amino-4-quinoleines a ete constatee pour la premiere fois en 1985 au Sud du Cameroun; a Limbe. En 1987-1988; une etude realisee a Yaounde mettait en evidence un taux de 37 pour cent d'echec de l'amodiaquine a la posologie de 25 mg/kg sur trois jours. A celle de 35 mg/kg; toujours sur trois jours; ce taux d'echec a chute a 6 pour cent en 1989 et a 2 pour cent en 1990. En consequence l'amodiaquine; a la posologie de 35 mg/kg repartis sur trois jours; est proposee en traitement de premiere intention dans les formations sanitaires du Cameroun

[Interpretation of the CATT (Card Agglutination Trypanosomiasis Test) in the screening for human trypanosomiasis due to Trypanosoma brucei gambiense]. / Le problème de l'interprétation du CATT dans le dépistage de la trypanosomiase humaine à Trypanosoma brucei gambiense.

Mass screening for Gambiense sleeping sickness is usually done with the Card Agglutination Trypanosomiasis Test (CATT) in series (total blood CATT followed by a serum CATT if the first test is positive) and the search for trypanosomes in cervical adenopathies. At present, the double positives (blood CATT and serum CATT) as well as the subjects in whom the trypanosome was found (in the blood or gland juice) are treated. The existence of patients whose gland punction was proved positive whereas the total blood CATT remained negative, has led the authors to make a survey with the CATT in parallel (on blood and serum CATT) on a 2,030 subjects sample in the Boko Songho site (Congo-Bouenza area). Whereas the prevalence of the positive cases to blood CATT and serum CATT (CATT in series) is 6.8%, the prevalence of the positive cases to at least one of both CATT's (CATT in parallel) is 19%. The 12.2% discordant results (blood+/serum- or blood-/serum+) have been reexamined a month later with the CATT and with the indirect Fluorescent Antibody Test (IFAT). Among these, 22.3% had become positive to blood and serum, whereas 30.6% had become negative. The latter group presents the problem of cross-reactions. The authors performed an IFAT with Trypanosoma congolense (T.c.) as antigen on an 18 subjects sample with a discordant CATT. All IFAT performed with T.c. were positive to a 1/50th threshold whereas some of the serum remained negative with IFAT when Trypanosoma brucei gambiense had been used as an antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolonged malaria prophylaxis with chloroquine and proguanil (chloroguanide) in a nonimmune resident population of an endemic area with a high prevalence of chloroquine resistance.

One hundred thirty nonimmune subjects living in Yaoundé, Cameroon, completed an 18-month prospective study on the efficacy and safety of weekly chloroquine and daily proguanil (chloroguanide) (Ch-P) in malaria prevention. A total of 9 of 78 Ch-P-treated subjects and 26 of 52 subjects who received no prophylaxis contracted Plasmodium falciparum infection during this period (P less than 0.00005). These two groups were comparable for demographic parameters and degree of exposure. Clinical manifestations were of similar severities in the two groups, but parasite counts were significantly higher in the subjects who received no prophylaxis (P less than 0.00005). Side effects of prophylaxis were frequent (31%), minor, and related to chloroquine, and they usually resolved within 4 to 6 weeks. Prolonged administration of Ch-P is safe and effectively prevents P. falciparum malaria in an endemic area with a high prevalence of chloroquine resistance.

[Malaria and surgery: which prophylaxis?]. / Paludisme et chirurgie. Quelle prophylaxie?

The authors report on a study carried out at the Centre Hospitalier universitaire (University Hospital) of Yaounde (Cameroon). Such a study aimed at to check interest of systematic malaria chemoprophylaxis during the peri-operative phase in general surgery. 61 patients were divided in two groups by random allocation with and without quinine chemoprophylaxis. All of them were monitored clinically and parasitologically during the peri-operative phase. Results show that in both groups, only patients already positive before surgical intervention presented clinical malaria signs, biologically confirmed; malaria attack was more frequent and more severe in the group without quinine. No malaria attack was observed in patients of both groups in which thick smear was negative in pre-operative phase. The authors suggest that any patient during the pre-operative phase, be tested to find out Plasmodium falciparum. If the test is positive, so chemoprophylaxis with quinine be prescribed. But such a medication is valuable only in urban endemic zone.

[Absence of epidemiologic interrelations between retroviral infection by HIV and human African trypanosomiasis (HAT)]. / Absence d'inter-relations épidémiologiques entre l'infection rétrovirale à VIH et la trypanosomiase humaine africaine (THA). Analyse de trois enquêtes cas-témoins réalisées en 1989 et 1990 en Afrique centrale.

Authors are reporting results from 3 control-case surveys carried out in sleeping sickness foci in Cameroon, Central African Republic and Congo. HIV seroprevalence rates are comparable among sleeping sickness patients and trypanonegative control persons. These results lead towards the absence of inter-relationships between sleeping sickness and retroviral infection.