ABSTRACT
Quinine, a bitter-tasting, short-acting alkaloid drug extracted from cinchona bark, was the first drug used widely for malaria chemoprophylaxis from the 19th century. Compliance was difficult to enforce even in organized groups such as the military, and its prophylaxis potential was often questioned. Severe adverse events such as blackwater fever occurred rarely, but its relationship to quinine remains uncertain. Quinine prophylaxis was often counterproductive from a public health viewpoint as it left large numbers of persons with suppressed infections producing gametocytes infective for mosquitoes. Quinine was supplied by the first global pharmaceutical cartel which discouraged competition resulting in a near monopoly of cinchona plantations on the island of Java which were closed to Allied use when the Japanese Imperial Army captured Indonesia in 1942. The problems with quinine as a chemoprophylactic drug illustrate the difficulties with medications used for prevention and the acute need for improved compounds.
Subject(s)
Antimalarials/therapeutic use , Blackwater Fever/prevention & control , Chemoprevention/adverse effects , Malaria, Falciparum/prevention & control , Quinine/therapeutic use , Africa , Antimalarials/chemical synthesis , Antimalarials/isolation & purification , Asia , Australia , Blackwater Fever/complications , Blackwater Fever/history , Blackwater Fever/transmission , Chemoprevention/economics , Chemoprevention/history , Chemoprevention/psychology , Cinchona/chemistry , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Malaria, Falciparum/complications , Malaria, Falciparum/history , Malaria, Falciparum/transmission , Plasmodium falciparum/drug effects , Plasmodium falciparum/physiology , Quinine/chemical synthesis , Quinine/isolation & purificationABSTRACT
La fiebre amarilla es una zoonosis, aguda, febril que se encuentra catalogada como una fiebre hemorrágica potencialmente mortal. Es causada por un antrópodo del cual se conocen dos modalidades epidemiológicas, con un área endémica que corresponde a la mayoría de América del Sur y parte del continente africano. En Costa Rica la última epidemia de fiebre amarilla ocurrió a principios de los años cincuenta. La fisiopatología de la fiebre amarilla no es bien conocida. La mayoría de las infecciones son sintomáticas, y tienen una alta mortalidad que varía según la epidemia. El diagnóstico se confirma de forma definitiva con la serología y aunque éste examen no se realiza en el país, las muestras de los casos sospechosos son enviadas a laboratorios panameños. Con base en su gran mortalidad y a la ausencia de un tratamiento específico, es obvio que el camino a seguir en el manejo de la fiebre amarilla es la prevención mediante las vacunaciones masivas en las áreas endémicas y grupos de riesgo, así como el control del vector. La fiebre amarilla sigue siendo una entidad que afecta considerablemente la salud pública en varios países del mundo; Costa Rica reúne un conjunto de condiciones que facilitarían su aparición y propagación, por lo que es una patología cuyas características convendría mantener en mente. Descriptores: Arbovirus, fiebre amarilla, Costa Rica, zoonosis, fiebre hemorrágica.
Subject(s)
Humans , Blackwater Fever/diagnosis , Blackwater Fever/etiology , Blackwater Fever/prevention & control , Public Health , Vaccination , Yellow Fever , Yellow fever virus , Costa Rica , Diagnosis, Differential , Hepatitis B , Leptospirosis , Malaria , Typhoid FeverABSTRACT
Five cases of blackwater fever (BWF) are described, all of whom had a history of recent quinine therapy. In two cases a second haemolytic crisis was induced by halofantrine, in one case also a third. Increasing frequency of this syndrome with its dramatic clinical presentation is to be expected as imported P. falciparum infection, parasite resistance to chloroquine and the use of quinine and other related antimalarials become more frequent.
