Ashley Croft –
EXTRACTS FROM – CLINICAL EVIDENCE – : MALARIA : PREVENTION IN TRAVELLERS
Insecticide treated nets
Likely to be beneficial :
Air conditioning and electric fans
Mosquito coils and vaporising mats
Insecticide treated clothing
Topical insect repellents
Doxycycline in adults
Antimalaria drugs for airline pilots
Biological control measures
Insect buzzers and electrocuters
Chloroquine plus proguanil
Atovaquone plus proguanil
Pyrimethamine plus dapsone
Antimalaria interventions in pregnant women
Likely to be ineffective or harmful:
Sulfadoxine plus pyrimethamine
Insect repellants containing diethyltoluamide or doxycycline in children.
David J Roberts, Arnab Pain, et al (Nuffield Department of Clinical Medicine and the National Blood Centre,John Radcliffe Hospital, Oxford.
Autoagglutination of malaria-infected red blood cells and malaria severity.
The Lancet 2000; April 22; 355: p.1427-1428
Red blood cells infected with Plasmodium falciparum can adhere to each other and so form large autoagglutinates. This phenotype is common in field isolates and is strongly associated with severe malaria.
Shete M (Department of Medicine, L.T.M.G. Hospital, Sion and P.D. Hinduja National Hospital and Research Centre,Mahim, Mumbai.
Severe Malaria: is P.vivax also the culprit ?
The Indian Practitioner; Nov.2000, 53(11), 715-716.
Cerebral malaria is one of the dreaded complications of P.falciparum malaria. Now it is being claimed that it could also be secondary to P.vivax infection. However careful search is necessary in ruling out co-existing P.falciparum infection before labelling it as P.vivax related cerebral malaria.
Madhavan K T, Jajoo UN, Bhalla A (Department of Medicine, MGIMS, Sevagram Wardha)
Severe and Complicated Malaria due to Plasmodium Vivax Species.
The Indian Practitioner, Nov.2000; 53(11), p.719-720.
During a 3-year period, cases with malaria were studied at Sevagram Wardha. 72 patients with severe and complicated malaria were studied. In 8 patients, infection was caused by Plasmodium Vivax. Search revealed that there was no associated co-infection with P.falciparum. One of the patients with severe malaria due to P.vivax infection died.
Lell Bertrand, Faucher Jean-Francois, et al.
Malaria chemoprophylaxis with tafenoquine: a randomised study.
Background : Tafenoquine is an analogue of primaquine with an improved therapeutic and safety profile. It has a long half-life and activity against liver-stage malaria parasites, so may be useful for chemoprophylaxis.
F Nosten, M van Vugt, et al (Department of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, Netherlands)
Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in Western Thailand: a prospective study.
Lancet, vol.356, July 22, 2000, p. 297-302.
Morbidity and mortality from plasmodium falciparum malaria is increasing in tropical areas. This increase results partly from the spread of drug resistance.
Authors have assessed incidence of plasmodium falciparum malaria and the in-vivo responses to mefloquine treatment over 13 years in 2 camps on northwest Thailand. During this time, standard mefloquine dose was first increased, and then combined artesunate and mefloquine was introduced as first-line treatment for uncomplicated plasmodium falciparum malaria.
In this area of Thailand, early diagnosis and treatment with combined artesunate and mefloquine has reduced the incidence of plasmodium falciparum malaria and halted progression of mefloquine resistance. Authors recommend that antimalarial drugs should be combined with artemisinin or a derivative to protect them against resistance.