[Congenital malaria: report of a case and considerations about the subject]. / Malária congênita: descrição de um caso e considerações sobre o assunto.

We report a case of Plasmodium falciparum malaria in a 21 day old child that was born from a mother that developed clinical signs of falciparum malaria just after giving birth and died. Transmission could have occurred either by the transplacental route or by maternal blood reaching the child during the childbirth. Literature review shows that malaria should be considered as a cause of a febrile disease in the newborn, particularly if there is a low birthweight and the newborn is a child of a woman coming from an endemic malaria region.

[Outbreak of malaria induced among users of injectable drugs]. / Surto de malária induzida entre usuários de drogas injetáveis.

Five cases of malaria were detected among cocaine users by the local health service in Bauru, a city with a population of 260,000, located 324 km from S. Paulo, Brazil, during the first three weeks of July 1990. Autochthonous malaria had not occurred in Bauru since 1978, and all the five cases denied having recently traveled to endemic areas. An extensive epidemiologic survey conducted from July 19 to September 13 revealed that the 5 cases were in fact part of a malaria outbreak among endovenous drug users. Moreover, at least 114 other people, who had in the last three months shared syringes and needles with one or more proved cases, were also involved in the outbreak. One hundred and two people were identified and interviewed orally. The examination of thick smears made from samples collected from 99 of them confirmed 21 cases of vivax malaria. Three people with negative blood smears had an indirect immunofluorescent assay positive to P. vivax antigen. Although the index case could not be discovered, the investigation suggested that one or more people who had recently traveled to the Amazon region might have introduced the disease. The control of the outbreak was achieved after offering treatment with chloroquine (10 tablets) to confirmed cases and contacts, followed by weekly suppressive chloroquine (2 tablets) until the last contact was detected. Malaria examination of 91 blood samples also revealed a high prevalence of hepatitis B virus infection (40%) and HIV infection (58%) among those involved in the outbreak. The strategy used to identify the cases and the contacts and the difficulties overcome in carrying it through are described.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transfusional Chagas infection detected in the program for the control of Chagas disease in the state of São Paulo (Brazil)]. / Infecção chagásica transfusional detectada no programa de controle da doença de Chagas no Estado de São Paulo (Brasil).

A system of surveillance for Chagas' disease aiming at a systematic investigation of the occurrence of triatominae in human dwellings in S. Paulo, Brazil was proposed. It included a serological survey of residents in house considered to be potential breeding places for blood-sucking triatomines. Serologically positive cases were observed to be distributed in age groups from 19 years of age upwards. Case-investigation revealed that the infection had been acquired either in S. Paulo in the past or recently in other States. A serologically positive (titre = 128 - IgG) case of an 8-year-old male child, was detected by the In direct Fluorescent Antibody Technique (IFAT). In S. Paulo State natural transmission is now of low probability. An epidemiological investigation disclosed the fact that this was a case of blood transfusion infection. The donor was found to be serologically positive (IFAT, titre = 1024 - IgG). His case-history was typical of vector transmitted infection. It is worthy of note that blood had been donated by this patient in four instances, without his condition having been diagnosed. The necessity of organizing an integrated Public Health Service to take more efficient care of such cases is stressed.

[Socioeconomic aspects of subjects with imported malaria in the metropolitan area of São Paulo, Brazil. I. Characterization of the population and knowledge about the disease]. / Aspectos sócio-econômicos dos indivíduos com malária importada na Região Metropolitana de São Paulo, Brasil. I--Caracterização da população e conhecimento sobre a doença.

With a view to discovering the social and economic characteristics of people from endemic malarial areas of Brazil, 566 suspected malaria cases were studied at the S. Paulo City Metropolitan Region Malaria Laboratory. Data were obtained by means of the application of standardized questionnaires over the period from November 1986 to June 1987 to individuals with as history of transit to Brazil's endemic malarial region. Of the population studied, 345 (61.0%) lived in the endemic area; 479 (84.6%) were males, 513 (90.7%) were between 15 and 55 years old and 307 (54.2%) presented positive plasmodium haemoscopia. The analysis by educational level indicated that 486 (85.9%) had primary or secondary education; 109 (19.3%) worked in mineral extraction; 74 (13.2%) were farmers, and 46 (8.1%) were related to terrestrial transportation activities. With respect, to knowledge of the disease, 384 (67.8%) had at least 1 bout of malaria before and 491 (86.8%) associated the disease with the presence of the vector. Of the 221 residents in S. Paulo, 207 (93.7%), as well as 336 (97.4%) of those residing in the endemic area already know of the risks of infection prior to travelling through the area of transmission. The interval between the first symptoms and the seeking for medical care varied from 0 to 3 days in 386 cases (68.2%). The frequencies of the variables studied analysed according to the haemoscopic result and the place of residence, were statistically significant.

[Malaria outbreak in users of injectable drugs]. / Nota sobre surto de malária em usuários de drogas injetáveis.

An outbreak of Plasmodium vivax malaria among drug addicts in Bauru, S. Paulo State, Brazil, is reported. Until July 1989, 12 cases had been confirmed by thick smear examinations and 20 contacts were being investigated. All of them reported frequent use of intravenous cocaine and sharing of needles and syringes but deny having travelled through endemic malarial areas.

Avaliaçäo da resposta do Plasmodium falciparum à cloroquina, quinino e mefloquina / Evaluation of Plasmodium falciparum response to chloroquine, quinine and mefloquine

Nosso estudo envolveu a análise de cepas de Plasmodium falciparum provenientes da Regiäo Amazônica Brasileira, coletadas no Laboratório de Malária da SUCEN. Os estudos "in vitro" foram efetuados com a cloroquina (46 ensaios), quinino (42 ensaios) e mefloquina (51 ensaios). Os resultados mostraram resistência de 100% en relaçäo à cloroquina, 2,4% ao quinino e 31,4% à mefloquina, na análise "in vitro". Sete pacientes foram tratados com quinino isolado e nove com a associaçäo mefloquina + pirimetamina-sulfadoxina, näo mostrando correlaçäo com os testes "in vitro"

Emprego da associaçäo tetraciclina e quinino no tratamento da malária causada pelo Plasmodium falciparum / Use of the combination tetracycline and quinine in the treatment of malaria caused by Plasmodium falciparum

Cento e dez pacientes com malária falciparum näo complicada, provenientes da Amazônia brasileira, foram tratados com cloridrato de tetraciclina, na dose de 250 mg a cada 6 horas por 7 dias, associado ao sulfato de quinino na dose de 1,5 a 2,0 gramas/dia no 3 ou 4 dias iniciais de tratamento. Os pacientes tiveram acompanhamento clínico e parasitológico por pelo menos 7 dias e em todos observou-se a negativaçäo da parasitemia após o tratamento. Setenta e cinco pacientes foram acompanhados por 28 dias ou mais e destes 71 tiveram resposta do tipo S e 4 do tipo RI. O cloridrato de tetraciclina associado ao sulfato de quinino mostrou-se altamente eficaz no tratamento de malária falciparum näo complicada, sendo bem tolerado e portanto útil na terapêutica das infecçöes por P. falciparum multirresistentes contraídas na Amazônia