ABSTRACT
The authors describe the main clinical findings relative to cardiac involvement, in patients with acute Chagas' disease (CD) in yet another familial micro-epidemic episode of CD in Amazon region. Thirteen patients were studied with acute Chagas' disease, resident in the city of Abaetetuba in Pará state; they were submitted to clinical and heart evaluation, with electrocardiograph and echocardiograph exams. Ventricular extrasystole occurred in 38.5% of the cases. Right bundle branch block and 1st and 2nd degree atrioventricular block were found in 30.8% of the patients. Attention is called to two findings in the Doppler echocardiography: pericardiac involvement and an image suggestive of aneurismatic formation in two patients. The findings reveal acute heart disease, with evidence of cardiomyopathy and alterations in the conduction system of the heart, bearing similarity with the description of the disease in endemic areas.
Subject(s)
Chagas Cardiomyopathy/complications , Heart Diseases/etiology , Adolescent , Adult , Aged , Brazil , Chagas Cardiomyopathy/epidemiology , Child , Family Health , Female , Heart Diseases/parasitology , Humans , Male , Middle Aged , Rural PopulationABSTRACT
Relapses may occur with long standard treatment of vivax malaria, and these are caused by incomplete patient's compliance. The use of reduced schedules may further better patient compliance, while maintaining the same efficacy, tolerance and minimal adverse reactions. The objective of this study was to test two schedules with reduced doses of chloroquine for vivax malaria and comparing these with the classical schedule. The authors studied 120 outpatients, with vivax malaria, aged over 12 years, submitted to three therapeutic schemes: scheme I: chloroquine phosphate (150 mg) in a dose of 25mg/kg/day for three days (10mg/kg/ day in the first day, 7.5mg/kg/day in the second and third day), plus primaquine (15 mg) in a dose of 0.25mg/kg/day for fourteen days; scheme II: chloroquine, in a single dose of 10mg/kg, plus primaquine in a dose of 0.5mg/kg/day for seven days; scheme III: chloroquine, 10mg/kg in a single dose plus primaquine in a dose 0.5mg/kg/ day for five days. The clinical response to all three therapeutic schemes was satisfactory. The disappearance of malarial symptoms occurred after a maximum 96 hours of treatment, while the asexual parasitaemia clearance occurred within 72 hours, in all therapeutic schemes.
Subject(s)
Antimalarials/administration & dosage , Chloroquine/administration & dosage , Malaria, Vivax/drug therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Relapses may occur with long standard treatment of vivax malaria, and these are caused by incomplete patient's compliance. The use of reduced schedules may further better patient compliance, while maintaining the same efficacy, tolerance and minimal adverse reactions. The objective of this study was to test two schedules with reduced doses of chloroquine for vivax malaria and comparing these with the classical schedule. The authors studied 120 outpatients, with vivax malaria, aged over 12 years, submitted to three therapeutic schemes: scheme I: chloroquine phosphate (150 mg) in a dose of 25mg/kg/day for three days (10mg/kg/ day in the first day, 7.5mg/kg/day in the second and third day), plus primaquine (15 mg) in a dose of 0.25mg/kg/day for fourteen days; scheme II: chloroquine, in a single dose of 10mg/kg, plus primaquine in a dose of 0.5mg/kg/day for seven days; scheme III: chloroquine, 10mg/kg in a single dose plus primaquine in a dose 0.5mg/kg/ day for five days. The clinical response to all three therapeutic schemes was satisfactory. The disappearance of malarial symptoms occurred after a maximum 96 hours of treatment, while the asexual parasitaemia clearance occurred within 72 hours, in all therapeutic schemes.
Recaídas que podem ocorrer com o tratamento convencional de longa duração para malária por P. vivax, são em parte devido a parcial adesão do paciente ao tratamento. A utilização de esquemas terapêuticos de curta duração pode proporcionar melhor adesão ao tratamento, mantendo a eficácia e tolerância e minimizando efeitos adversos. Com o objetivo de testar 2 esquemas terapêuticos com doses reduzidas de cloroquina para malária por P.vivax , comparando-o ao esquema clássico, os autores estudaram 120 pacientes, diagnosticados pela gota espessa, com idade superior a 12 anos, submetidos a três esquemas de tratamento: esquema I: fosfato de cloroquina (150mg), 25mg/kg (dose total), durante três dias (10mg/kg de peso no primeiro dia; 7,5mg/kg no segundo e terceiro dias), associada a primaquina (15mg), 0,25mg/kg/dia, por quatorze dias; esquema II: cloroquina, 10mg/kg, em dose única, associada a primaquina, 0,5mg/kg/dia, por sete dias; esquema III: cloroquina, 10mg/kg em dose única, associada a primaquina, 0,5mg/kg/dia, por cinco dias. A resposta de cura clínica aos três esquemas foi satisfatória. O desaparecimento da tríade sintomática ocorreu no máximo em até 96 horas, e a negativação da parasitemia assexuada ocorreu em até 72 horas, para os três esquemas.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antimalarials/administration & dosage , Chloroquine/administration & dosage , Malaria, Vivax/drug therapy , Prospective StudiesABSTRACT
OBJECTIVE: To assess the IgG antibody response against P. vivax (IgG anti-PV), and cytophilic (IgG1 and IgG3) and noncytophilic (IgG2) IgG subclasses in 34 children aged 0 to 15 years old infected with P. vivax malaria. METHODS: IgG levels were determined by indirect fluorescent antibody technique during the acute and therapeutic control phase. Patients were distributed into 2 groups according to the presence or absence of a previous malaria episode. IgG anti-PV levels were measured on the first and last day of treatment, and compared by Studentacute;s t test. Antibody levels were correlated with asexual parasitemia (Spearmans correlation test). RESULTS AND CONCLUSIONS: Increased IgG levels were observed on the first and on the last day of treatment. The geometric means for IgG subclass titers found in patients with previous history of malaria were: IgG1 (806.35) > IgG3 (28.28) > IgG2 (20). In patients infected for the first time, the responses obtained were: IgG1 (709.21) > IgG3 (39.3) > IgG2 (10.7). There was no association between asexual parasitemia and antibody levels on the first day of treatment. Cytophilic antibodies (IgG1, IgG3) predominated over noncytophilic antibodies (IgG2).
ABSTRACT
OBJECTIVE: Evaluation of epidemiological, clinical and laboratory features of Plasmodium vivax malaria in children and adolescents. METHODS: This study was carried out in the Malaria Program of the Evandro Chagas Institute (Belém, Pará), from January 1995 to November 1996. 100 children and adolescents with the diagnosis of P. vivax malaria (thick blood film) were randomly enrolled. A protocol was created to assess epidemiological, clinical and laboratory parameters of this pathology. RESULTS: Malaria occurred in both sexes, and had a prevailing incidence among adolescents (37%). Most of the children and adolescents (92%) had been infected in the State of Pará. Autochthonous cases in the metropolitan area of Belém accounted for 34 % of the sample. Primary infection was seen in 80% of the patients. Fever was the major onset clinical symptom (88%). A history of typical febrile paroxysm was recorded in only 25% of the casuistic. In the first day of treatment (D0) fever (97%), chills (91%), pallor (85%), splenomegaly (46%) and hepatomegaly (29%) were some of the clinical features observed. Pallor (clinical signal) was found to be significantly (p=0.0004) associated with anemia (hemoglobin rate). There was a high significant negative correlation (p=0.0001) between delay of diagnosis (mean 12,5 days) and hemoglobin values. Regarding parasitological examination, just children and adolescents with positive results to hookworms were significantly (p=0.0133, p=0.0075) more anemic than those who had a positive parasitological examination to other helminths and/or protozoa species. CONCLUSIONS: Malaria affected children and adolescents from both sexes. An emphasis on epidemiological and clinical data is an important tool to the precocious diagnosis of the disease. Delay on diagnosis made anemia worse.
ABSTRACT
OBJECTIVES: In the treatment of vivax malaria, an important factor affecting the occurrence of relapse is the duration of treatment. In Belém, a number of patients with vivax malaria were found to be cured despite failure to complete the standard course of treatment. In Belém, a number of patients with vivax malaria were found to be cured despite failure to complete the standard course of treatment. This observation suggested the present study, investigating more practicable courses of treatment for children with vivax malaria.METHODS: A randomized prospective clinical trial was conducted in 200 outpatient children with vivax malaria. Parasite clearance time and response to four therapeutic schedules were investigated: a) chloroquine*, 10 mg/kg in a single dose (chloroquine SD) + primaquine, 0.50 mg/kg/dose for 7 days; b) chloroquine SD + primaquine, 0.25 mg/kg/dose for 7 days; c) chloroquine SD + primaquine, 0.50 mg/kg/dose for 5 days; d) chloroquine SD + primaquine, 0.25 mg/kg/dose for 5 days. Fisherss Exact test was used to compare the responses to the schedules.RESULTS: All 144 children who completed the study had clearance of asexual parasitemia by the fourth day of treatment. Significant differences were observed between schedules A/D (p= 0.022) and C/D (p= 0.005). A doubled dose of primaquine (schedules A and C) proved to be significantly more effective (p=0.0042) than the standard dose (B and D). However, duration of treatment had no significant effect (p = 0.6104).CONCLUSIONS: In this study, complete cure of vivax malaria was better achieved with a doubled dose of primaquine than with standard doses. Effectiveness of the doubled dose was independent of the duration of treatment. Treatment schedule D is not recommended.
