Absence of malaria mortality in villagers with chloroquine-resistant Plasmodium falciparum treated with chloroquine.

We carried out a series of malaria studies in Robek , Flores, Indonesia, a coastal village of 900 farmers and fishermen where malaria is hyperendemic by parasite rate and holoendemic by spleen rate. The studies showed that: (i) 28 of 31 isolates (90%) of Plasmodium falciparum were resistant to chloroquine in vitro, (ii) 3 of 12 isolates (25%) were resistant at the R-11 level in vivo, (iii) 376 P. falciparum infections occurred in 301 individuals during one year, (iv) no villagers who were treated with chloroquine for P. falciparum infections during the year died, and (v) increasing the dosage of chloroquine base from 15 to 25 to 37.5 mg/kg led to improved clearing of parasitaemia. We conclude that chloroquine can still be used as the primary antimalarial in Robek , but the dosage may have to be increased to clear parasitaemia.

Low dosage diethylcarbamazine administered by villagers for the control of timorian filariasis.

The results of mass treatment using low dosage diethylcarbamazine (DEC) in three small villages in West Flores, Indonesia, endemic for Brugia timori are described. DEC was distributed on a weekly basis by motivated persons in the community to nearly all villagers for 18 months. An educational programme was developed which focused on describing the relationship between microfilaraemia, vector and disease manifestations, the danger of repeated attacks of adenolymphangitis, and the efficiency of DEC in eliminating the parasites and attacks. During the consolidation phase motivated persons were assigned to treat promptly all cases with acute filariasis and to distribute DEC to all new residents. With this programme the microfilaria rates decreased to very low levels, even as detected by the use of membrane filtration techniques. The adenolymphangitis rates also decreased. An unexpected bonus was the cure of "elephantiasis" in many people. Mild side effects attributed to DEC were encountered only during the first few weeks of treatment.

The long term effects of repeated diethylcarbamazine administration with special reference to microfilaraemia and elephantiasis.

The result of mass treatment with 50 mg diethylcarbamazine (DEC) per kg body weight followed by two annual selective retreatments in an area highly endemic for Brugia timori infections are described. The criteria for selective re-treatment are simple and practical for use in rural areas. An education programme was developed which focused on describing the relationship between adenolymphangitis and filarial infections, the danger of repeated attacks and the efficiency of DEC in eliminating these attacks. Motivated persons in the community were charged with the responsibility of promptly treating all cases with acute clinical manifestations. With this programme the microfilaria rate by finger prick decreased from 24% to 0%, and by Nuclepore filtration from 30% to 5%. The adenolymphangitis rate decreased from 46% to 11% and the "elephantiasis' rate from 17% to 4%.

Human intestinal parasites in Karakuak, West Flores, Indonesia and the effect of treatment with mebendazole and pyrantel pamoate.

A survey for intestinal parasites and mass-treatment with a combination of mebendazole and pyrantel pamoate were conducted in Karakuak, West Flores in 1977. A total of 198 stool specimens from 104 males and 94 females ranging in age from less than 1 to 70 years were examined and 72% harbored one or more intestinal parasites. Ascaris lumbricoides (43%) and Entamoeba histolytica (21%) were the most common, followed by Entamoeba coli (19%), hookworm (18%), Iodamoeba bütschlii (8%), Giardia lamblia (5%) and Trichuris trichiura (4%). Other intestinal parasites infrequently found were: Entamoeba hartmanni (2%), Chilomastix mesnili (2%), Endolimax nana (1%), Enterobius vermicularis (1%) and a heterophyid sp. (1%). A combination of mebendazole base at 200 mg/day and pyrantel pamoate salt at 60 mg/day for three consecutive days was 100% effective.

A simple method to control Brugia timori by diethylcarbamazine administration.

The results of mass treatment using 50 mg diethylcarbamazine per kg body-weight followed one year later by short term selective re-treatment in a highly endemic area of Brugia timori are described. The criteria for selection of re-treatment are simple and practical for use in rural areas. The microfilaria rate by finger prick decreased from 24% to 0 and by Nuclepore filtration from 30% to 2.5%. The disease rates were also affected favourably. 88% of persons receiving the drug reacted to treatment, this percentage slightly exceeding the total filarial infection rate (71%). The prevalence, onset, duration and nature of side reactions are briefly discussed and related to the presence of microfilaraemia and disease manifestations among the study population.

Epidemiological and clinical features of Brugia timori in a newly established village. Karakuak, West Flores, Indonesia.

The epidemiological and clinical features of Brugia timori filariasis in a newly established village, Karakuak, West Flores, is described. The microfilarial rate by finger stick and Nuclepore filtration was 24% and 30%, respectively, and the disease rate 64%. Infected persons were found in every family and household with no predominant age or sex preference. Development of elephantiasis in the population was associated with residence in the new village of Karakuak, where extensive rice field cultivation was initiated soon after arrival. The irrigated fields provided excellent breeding sites for the vector, Anopheles barbirostris. People with no previous exposure to the parasite developed elephantiasis earlier and more frequently than those originating from other endemic areas.