Document Detail


Imported malaria: successful treatment of 31 patients in the era of chloroquine resistance.
MedLine Citation:
PMID:  10575838     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The diagnosis and management of imported malaria presents a continuing challenge in developed countries, including Taiwan. We retrospectively analyzed the records of all 31 patients with imported malaria treated at National Taiwan University Hospital from January 1984 through December 1998. Plasmodium falciparum was identified as the causative malarial parasite in 18 patients, P. vivax in 12, and P. ovale in one. All 31 patients had fever, but only 13 presented with the characteristic fever pattern. The most common initial laboratory abnormalities were thrombocytopenia (20/31), mild hyperbilirubinemia (20/31), and leukopenia (7/31). The median time from the onset of fever to the correct diagnosis was 4 days for P. falciparum and 5 days for P. vivax. In 28 cases, the clue that led to early diagnosis was the patient's travel history. Quinine, but not chloroquine, was effective in 17 out of 18 cases of falciparum malaria. Three patients treated with intravenous quinine required a change of regimen because of life-threatening quinine toxicity; artesunate served as a safe and effective alternative in this situation. While most patients with tertian malaria were cured with the standard chloroquine and primaquine regimen, a higher dosage was required for one case acquired in Papua New Guinea. All patients, including two with severe malaria, survived. We conclude that, the mortality of imported malaria in the chloroquine resistance era can be minimized with early recognition by obtaining a thorough travel history, and instituting appropriate antimalarial chemotherapy based on precise identification of species. Quinine toxicity should be closely monitoried, especially when this drug is given intravenously.
Authors:
C T Fang; S C Chang; H L Chang; Y C Chen; P R Hsueh; C C Hung; W C Hsieh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the Formosan Medical Association = Taiwan yi zhi     Volume:  98     ISSN:  0929-6646     ISO Abbreviation:  J. Formos. Med. Assoc.     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-12-09     Completed Date:  1999-12-09     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9214933     Medline TA:  J Formos Med Assoc     Country:  CHINA (REPUBLIC: 1949- )    
Other Details:
Languages:  eng     Pagination:  683-7     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antimalarials / therapeutic use*
Artemisinins*
Child
Chloroquine / therapeutic use*
Drug Resistance
Female
Humans
Malaria / drug therapy*
Male
Middle Aged
Primaquine / therapeutic use
Quinine / adverse effects,  therapeutic use
Retrospective Studies
Sesquiterpenes / therapeutic use
Travel*
Chemical
Reg. No./Substance:
0/Antimalarials; 0/Artemisinins; 0/Sesquiterpenes; 130-95-0/Quinine; 54-05-7/Chloroquine; 83507-69-1/artesunate; 90-34-6/Primaquine

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