1/12. malaria deaths in visitors to canada and in Canadian travellers: a case series.Over the last decade there has been a marked increase in case of drug-resistant and severe malaria in Canadian travellers. We report 7 deaths due to falciparum malaria that occurred in canada or in Canadian travellers. Risks for malaria infection include inappropriate recommendations for malaria prevention by health care providers and lack of knowledge about or adherence to appropriate recommendations by the travelling public. Risks for death include delays in seeking medical attention, delays in diagnosis and inadequate care by Canadian physicians and hospitals, and lack of access to parenteral therapy for severe malaria. malaria infections and deaths are preventable. Better education of health care providers and travellers about the risks of malaria and appropriate prevention and treatment measures may decrease this unnecessary burden on the Canadian health care system.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. plasmodium falciparum malaria.A 13-year-old adolescent daughter of a missionary presented with fever and jaundice 1 week after returning from africa. Examination of peripheral blood film revealed the diagnosis of plasmodium falciparum infection. Therapy with oral quinine and doxycycline was curative. Diagnosis requires a travel history and a high index of suspicion. Because of the frequency of international travel, united states physicians need to be familiar with the presentation and management of imported P falciparum. Preparation for such travel must include careful counseling and optimal use of chemoprophylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. Nonoperative treatment of splenic rupture in malaria tropica: review of literature and case report.In many parts of the world malaria still is a major medical problem. Heavy international and transcontinental traveling carries malaria to non-endemic areas. Practicing physicians must be aware of the common, but also the rare and severe complications of malaria. During malaria changes in splenic structure can result in asymptomatic enlargement or complications such as hematoma formation, rupture, hypersplenism, ectopic spleen, torsion, or cyst formation. An abnormal immunological response may result in massive splenic enlargement. Spontaneous rupture of the spleen is an important and life threatening complication of plasmodium vivax infection, but is rarely seen in plasmodium falciparum malaria. The ability to properly diagnose and manage these complications is important. spleen-conserving procedures should be the standard whenever possible especially in patients with a high likelihood of future exposure to malaria.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. Imported malaria in pregnancy: report of four cases and review of management.malaria is a common infection worldwide. Increased travel by pregnant women makes it likely that physicians in the united states will see cases of malaria in this population. We observed four cases of malaria during pregnancy over an 8-month period at a general hospital in the united states. These cases illustrate the association between pregnancy and severe malaria in the mother and congenital infection in the newborn. We also noted delays in diagnosis because malaria was mistaken for other common illnesses. Therapy was complicated by concerns about the safety of antimalarial agents for the fetus and newborn as well as drug resistance. While chloroquine is safe for use in pregnancy, drug resistance is now common, especially when the etiologic organism is plasmodium falciparum. There are concerns about the safety of administering other antimalarial agents during pregnancy (e.g., mefloquine). Concerns about the safety and availability of these agents limit options for prophylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. thiamine deficiency: a cause of childhood ataxia not to be ignored.We report four cases of childhood ataxia with and without encephalopathies which were successfully managed with thiamine supplementation and diagnosed in retrospect as being caused by thiamine deficiency. The clinical presentations were similar to those previously reported amongst adolescents and adults who ingested the larvae of Anaphe venata, a local delicacy among the Ijeshas of south-western nigeria, during the rainy season. This has been called seasonal ataxia syndrome. The cases were of interest because the disorder was not described in children in the previous report, which might indicate a worsening nutritional status in these communities. This report is to alert child health physicians in the developing world to the possibility of a pre-existing thiamine deficiency progressing into ataxic disorders when certain foods are ingested.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Psychosis with paranoid delusions after a therapeutic dose of mefloquine: a case report.BACKGROUND: Convenient once-a-week dosing has made mefloquine a popular choice as malaria prophylaxis for travel to countries with chloroquine-resistant malaria. However, the increased use of mefloquine over the past decade has resulted in reports of rare, but severe, neuropsychiatric adverse reactions, such as anxiety, depression, hallucinations and psychosis. A direct causality between mefloquine and severe reactions among travelers has been partly confounded by factors associated with foreign travel and, in the case of therapeutic doses of mefloquine, the central nervous system manifestations of Plasmodium infection itself. The present case provides a unique natural history of mefloquine-induced neuropsychiatric toxicity and revisits its dose-dependent nature. CASE PRESENTATION: This report describes an acute exacerbation of neuropsychiatric symptoms after an unwarranted therapeutic dose (1250 mg) of mefloquine in a 37-year-old male previously on a once-a-week prophylactic regimen. Neuropsychiatric symptoms began as dizziness and insomnia of several days duration, which was followed by one week of escalating anxiety and subtle alterations in behaviour. The patient's anxiety culminated into a panic episode with profound sympathetic activation. One week later, he was hospitalized after developing frank psychosis with psychomotor agitation and paranoid delusions. His psychosis remitted with low-dose quetiapine. CONCLUSION: This report suggests that an overt mefloquine-induced psychosis can be preceded by a prodromal phase of moderate symptoms such as dizziness, insomnia, and generalized anxiety. It is important that physicians advise patients taking mefloquine prophylaxis and their relatives to recognize such symptoms, especially when they are accompanied by abrupt, but subtle, changes in behaviour. patients with a history of psychiatric illness, however minor, may be at increased risk for a mefloquine-induced neuropsychiatric toxicity. physicians must explicitly caution patients not to self-medicate with a therapeutic course of mefloquine when a malaria diagnosis has not been confirmed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/12. Concurrent falciparum malaria and salmonella bacteremia in travelers: report of two cases.fever in travelers or immigrants from the tropics is an increasingly common problem facing physicians in urban centers of north america. malaria and typhoid fever are endemic in developing countries and affect millions of people annually. An association between falciparum malaria and salmonella bacteremia has been noted for many years, although the underlying mechanisms have not been fully elucidated. We report on two travelers with falciparum malaria and concomitant salmonella bacteremia and review the possible mechanisms that may explain this association.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Management of chloroquine-resistant plasmodium falciparum malaria in a pregnant Ethiopian immigrant--a case report.plasmodium falciparum malaria is infrequently recognized in israel as a cause of infection during pregnancy. We expect that with increasing frequency physicians in israel will confront patients with malaria. Special concern should be given to malaria in pregnancy because of its serious complications. Thus, prompt diagnosis and treatment are essential. While chloroquine is safe for use in pregnancy, drug resistance is common, especially with plasmodium falciparum. There is concern about the safety of other antimalarial agents during pregnancy. We recently observed a case of chloroquine-resistant plasmodium falciparum malaria during pregnancy in a new immigrant primigravida from ethiopia. malaria in patients from endemic regions is less severe than in nonimmune hosts. Therefore, we elected to follow the patient's parasitemia periodically without additional antimalarial treatment until after delivery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. Falciparum malaria in an overseas traveler complicated by disseminated intravascular coagulation and pulmonary edema.A 24-year-old woman was infected with falciparum malaria during travel to kenya, complicated by intravascular coagulation and pulmonary edema. She was successfully treated with anti-malarial drugs including chloroquine, quinine sulfate and pyrimethamine, with a combined regimen of heparin, antithrombin iii and nafamostat mesilate for disseminated intravascular coagulation, and with methylprednisolone pulse therapy for pulmonary edema. The present case emphasizes the importance of early diagnosis and appropriate treatment in terms of falciparum malaria. This case, in particular, is believed to be worth reporting as overseas travel is increasing and yet anti-malarial drugs are not readily available to most physicians in japan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. Fatal falciparum malaria in Canadian travellers.The authors report 2 cases of severe falciparum malaria in Canadians that had fatal outcomes. In the first case a man presented to a local hospital shortly after returning from africa, but a diagnosis of malaria was not considered. He was transferred to a secondary and then to a tertiary care facility, where he subsequently died. Intravenous quinidine therapy, the treatment of choice, was unavailable at all 3 hospitals. In the second case, a woman taking chloroquine prophylaxis while visiting nigeria developed cerebral malaria and died. These cases illustrate critical management issues: appropriate advice on malaria prevention before departure; consideration of malaria in all febrile people returning from an endemic area; ready access to parenteral therapy for severe malaria in Canadian hospitals; and an increase in awareness of travel medicine among family physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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