Idiopathic thrombocytopenic purpura due to vivax malaria in the Brazilian Amazon.

We describe a rare case of idiopathic thrombocytopenic purpura (ITP) triggered by Plasmodium vivax infection. The patient developed thrombocytopenia and bleeding associated with three episodes of malaria, and became dependent on corticosteroid therapy. The mechanisms by which this parasite evokes thrombocytopenia remain obscure.

[Malaria treatment with artesunate (retocaps) in children of the Brazilian Amazon]. / Tratamento da malária com artesunate (retocaps) em crianças da Amazônia brasileira.

We evaluated the clinical and therapeutic response to artesunate retocaps in 32 children admitted to the Fundação de Medicina Tropical do Amazonas (Amazon Foundation of Tropical Medicine) with clinical characteristics of moderate and severe malaria. Of these, 29 were infected with P. falciparum and 3 with P. vivax. They improved clinically 24 hours after the beginning of therapy, with 33. 3% of patients without fever, and after 48 hours, 77.2% of the children had no fever. The monitoring of asexual forms of the parasites showed that on D2 (day 2 of treatment) 58.6% of children with P. falciparum infection had no more parasites in the blood stream, on D4 all children had negative slides both for P. falciparum and for P. vivax infection. In a long-term follow up, we found 66.6% recrudescence in P. falciparum patients. The results enabled the conclusion that artesunate retocaps are efficient in practice and their use rapidly reduces the parasitemia and improves the patients' clinical picture. However, in P. falciparum malaria the recrudescence rate was very high. We observed no side effects from this drug.

[Clinical study of falciparum malaria in children in Manaus, AM, Brazil]. / Estudo clínico da malária falciparum em crianças em Manaus, AM, Brasil.

The clinical characteristics of falciparum malaria were studied among 61 children, aged 0 to 14 treated at a reference center in Manaus, from October to December 1997. The symptoms observed were fever (98.4%), headache (80.3%), chills (68.9%), perspiration (65. 6%), myalgia (59.0%), nausea (54.1%), lumbar pain (49.2%), vomiting (49.2%), cough (45.9%), arthralgia (31.1%), diarrhea (34.4%), dyspnea (8.2%), convulsions (8.2%) and dizziness (4.9%). Pallor and anaemia were found more frequently in children under five years old. Anaemia was associated with high levels of parasitaemia. Fifty-eight (91.5%) patients had uncomplicated malaria, 3 (4.9%) had severe malaria and the lethality was 1.6%.

[RIII mefloquine resistance in children with falciparum malaria in Manaus, AM, Brazil]. / Resistência à mefloquina do tipo RIII em crianças com malária falciparum em Manaus, AM, Brasil.

We report the occurrence of resistance to mefloquine 20mg/day in 51 children with falciparum malaria treated, at reference center of Manaus, Brazil, from October to December 1997. All children were evaluated at day 3, 5, 7, 14, 21, 28 and 35 of treatment. Clinical and parasitological cure criteria were adopted. The incidence of RIII mefloquine resistance was 5.9% (IC 95% 1.5-17.2). The cure/resistance proportion was 20:1 and cure/severity was 62:1. These findings suggest the importance of mefloquine resistance within this group of children.

Plasmodium falciparum infection in the pregnant patient.

Malaria should be considered a risk factor in women who are pregnant, principally when the infection is Plasmodium falciparum. Moreover, the risk is greater if the woman is pregnant for the first time; if she has no immunity for malaria; if the diagnosis is made late; or if P. falciparum shows resistance to antimalarial drugs. This article presents the most significant aspects of P. falciparum malaria during pregnancy, including information about treatments and prophylaxis.

Tumor necrosis factor alpha interferon gamma and macrophage stimulating factor in relation to the Severity of Plasmodium falciparum malaria in the Brazilian Amazon.

We compared the tumor necrosis factor (TNF-alpha), interferon gamma (IFN-gamma) and granulocyte-macrophage colony stimulating factor (GM-CSF) serum levels in 87 patients with malaria from the Brazilian Amazon. They included asymptomatic infected individuals and symptomatic patients with mild disease or severe malaria with or without cerebral involvement. As controls we examined individuals living in endemic areas without past history of malaria. The TNF-alpha serum levels were increased in patients with malaria and progressively decreased in those with severe disease 7 days after specific treatment. We found correlation between parasitaemia, TNF-alpha levels and severity of the disease. The correlation between high TNF-alpha levels and severe malaria was independent of cerebral involvement. The increase in both IFN-gamma and GM-CSF levels among malarious patients was not related to the degree of severity or mortality. IFN-gamma concentration, however, was associated with high parasitaemia at admission.

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

Esplenomegalia tropical no Rio Ituxi, Amazonas, Brasil. / Tropical splenomegaly in the Ituxi River, Amazonas, Brazil

Sao descritos 10 pacientes portadores de grande e persistente esplenomegalia, procedentes de area onde a malaria e hiperendemica. Deles, quatro apresentavam sindrome da esplenomegalia tropical, cinco cirrose hepatica pos-necrotica, e em um, a associacao de ambas. Dos casos de esplenomegalia tropical tres eram irmaos e, havia infiltrado linfocitario sinusoidal hepatico com reacao de imunofluorescencia positiva para IgM em todos. Nos de cirrose o figado era duro e nodular em tres, o coagulograma anormal em todos e o AgHbs encontrado em tres

Insuficiencia renal aguda, em malaria por Plasmodium falciparum. / Acute kidney failure in malaria due to Plasmodium falciparum

Entre janeiro de 1977 a abril de 1982 foram internados no Instituto de Medicina Tropical de Manaus (I.M.T.M.) 1.429 pacientes com malaria por Plasmadium falciparum. Destes, 37 (2,58%) desenvolveram insuficiencia renal aguda (IRA) com creatinina serica superior a 3 mg%, sendo que 30 (81,08%) eram primo-infectados.No grupo que desenvolveu IRA o periodo entre o inicio dos sintomas e a internacao hospitalar foi de 9,00 +/- 4,87 dias (2-30) e que foi maior quando comparado com um grupo controle (p < 0,01). A ureia serica de internacao foi de 155,24 +/- 67,36 mg% (29-266) e a creatinina de 5,89 +/- 3,88 mg% (0,9-22,5). A mortalidade foi de 11 (29,72%) pacientes, sendo mais frequente no grupo em que a creatinina serica foi superior a 7 mg% (P < 0,1). Dialise peritoneal (DP) foi realizada em 11 pacientes e destes 6 (54,54%) morreram. Dos 26 restantes, que nao fizeram DP, 5 (19, 23%) foram a obito (p < 0,05). Nao observamos tendencias a hiperpotassemia. Edema cerebral pulmonar agudo foi a principal causa de obito

Tratamento da malaria (P. falciparum) com clindamicina. / Treatment of malaria (P. falciparum) with clindamycin

Os autores descrevem o emprego de clindamicina em dois esquemas, no tratamento da infeccao malarica pelo P. falciparum. Foram tratados 19 pacientes com dosagem de 20 mg/kg/peso durante tres dias e 17 pacientes por sete dias. O esquema de tratamento em sete dias mostrou ser mais eficaz em tratar e curar os pacientes

Esquistossomose aguda adquirida na Lagoa Feia (Formosa-Goias). / Acute schistosomiasis acquired in the Lagoa Feia) Formosa, Goias, Brazil)

Os autores relatam quatro casos de esquistossomose aguda adquiridos simultaneamente na Lagoa Feia (Formosa-Goias), a 80 km do Plano Piloto, D.F. Tres pacientes residiam no Plano Piloto e outro, procedente de Porto Alegre, estava a passeio em Brasilia O trabalho realca a importancia epidemiologica desta Lagoa por se um ponto turistico proximo aos contingentes populacionais do Distrito Federal