1/16. Late relapse of plasmodium ovale malaria--philadelphia, pennsylvania, November 2004.Approximately 1,300 cases of malaria are reported each year in the united states; nearly all of these cases occur in travelers, many of whom fail to receive or adhere to prescribed chemoprophylaxis or do not follow recommendations for prevention of mosquito bites. Malaria can persist if not treated or if treated incorrectly (e.g., with an ineffective drug or an incorrect dosage of an effective drug). Early treatment is required to avoid severe illness or death. Although malaria typically becomes clinically apparent within 1 month of infection, cases can occur years after the last presumed exposure. In November 2004, CDC received a report of a late relapse of malaria in a Nigerian man aged 23 years in philadelphia, pennsylvania. His malaria was determined to have been caused by plasmodium ovale, one of the four species of Plasmodium parasite that are transmitted by mosquitoes and cause malaria. The patient had been treated for malaria in nigeria on multiple occasions, most recently 6 years before onset of his illness in the united states. This report describes the philadelphia case, which underscores the importance of taking a detailed travel and immigration history when evaluating unexplained fever and considering malaria in the differential diagnosis.- - - - - - - - - - ranking = 1keywords = relapse (Clic here for more details about this article) |
2/16. Fatal relapse of hyperreactive malarial splenomegaly (HMS) in a 10-year old Nigerian female--a case report.BACKGROUND: The Hyperreactive Malarial splenomegaly syndrome (HMS) originally called the tropical splenomegaly syndrome (TSS) or Big spleen disease refers to cases of splenomegaly in the tropics for which no cause was found despite thorough investigation. It is restricted to the malarial belt, yet there are few reports on HMS in nigeria, probably due to a low index of suspicion and non-availability of laboratory facilities to determine titres of malarial antibodies. The objective of this paper is to highlight the features, management, risk of relapse and prognosis of HMS. METHOD/RESULT: We present a 10-year old female with recurrent massive splenomegaly with previous clinical response to antimalarials and evidence of hypersplenism. CONCLUSION: HMS should be suspected in any child with moderate to massive splenomegaly with evidence of hypersplenism and clinical response to antimalarials.- - - - - - - - - - ranking = 1keywords = relapse (Clic here for more details about this article) |
3/16. Use of immunoglobulin gene rearrangements to show clonal lymphoproliferation in hyper-reactive malarial splenomegaly.In africa, hyper-reactive malarial splenomegaly (HMS), which is also known as tropical splenomegaly syndrome, can be associated with a prominent lymphocytosis in blood and bone marrow that is difficult to distinguish clinically from chronic lymphocytic leukaemia (CLL). The observation that some patients with HMS become resistant to treatment with anti-malarial drugs has led to the suggestion that HMS may evolve into a malignant lymphoproliferative disorder. To test this hypothesis, 22 Ghanaian patients with HMS and/or lymphocytosis were categorised by degree of response to proguanil according to standard clinical criteria, and dna was extracted from peripheral blood cells and screened for rearrangements of the Jh region of the immunoglobulin gene with a dna probe. Clonal rearrangements of the Jh region were found in all 3 patients with no response, in none of 13 patients with sustained response, and in 2 of 6 patients with moderate response or relapse on proguanil therapy. The detection of such rearrangements, and hence clonal lymphoproliferation in individuals with clinical features intermediate between HMS and CLL, supports the hypothesis that HMS may evolve into a malignant lymphoproliferative disorder.- - - - - - - - - - ranking = 0.2keywords = relapse (Clic here for more details about this article) |
4/16. Seven patients with relapses of plasmodium vivax or P. ovale despite primaquine treatment.Seven relapses of plasmodium vivax or plasmodium ovale despite standard treatment with primaquine (3.0 mg Kg-1) daily for fourteen days are presented. The majority of patients came from areas outside the countries where resistance to primaquine is well known. The various possibilities of reasons for relapses are discussed.- - - - - - - - - - ranking = 1.2keywords = relapse (Clic here for more details about this article) |
5/16. Relapsing malaria infection acquired in kenya.An American physician-traveler to East africa presented with manifestations of cerebral malaria and was treated with intravenous quinidine for chloroquine-resistant falciparum malaria. He later relapsed with plasmodium ovale infection, despite previous primaquine therapy. Treatment of chloroquine-resistant malaria is discussed. The difficulty in diagnosing P. ovale infections and the predominance of this malaria species over P. vivax in East africa are reviewed.- - - - - - - - - - ranking = 0.2keywords = relapse (Clic here for more details about this article) |
6/16. Vivax malaria.Malaria occurs in the united states infrequently and is found exclusively among immigrants and travelers returning from areas where the disease is endemic. Cases of acute relapses of plasmodium vivax infection can present to the emergency department. patients are often immigrants from developing countries who were symptom-free in this country for weeks or months preceding their illness. The clinical presentation and current treatment of malaria are reviewed. Malarial infection may become apparent months after leaving endemic areas despite adherence to prophylactic regimens. The disease usually responds to appropriate drug therapy with rapid and often dramatic results, but it can be fatal if unrecognized.- - - - - - - - - - ranking = 0.2keywords = relapse (Clic here for more details about this article) |
7/16. Imported cases of chloroquine-resistant falciparum malaria in iran.Six imported cases of chloroquine-resistant Falciparum malaria have been studied since October 1984. In five cases including two Iranian men, returned from india, two Afghan and one Bengalee immigrants came to iran through pakistan, recrudescence occurred following treatment with chloroquine. In these five cases resistance of P. falciparum to chloroquine was clinically (by the in vivo test) at R1 level in all patients. The resistance was also confirmed by the macro in vitro susceptibility test which was carried out in four of them. These five chloroquine-resistant cases were treated, one with sulfadiazine-pyrimethamine, three with quinine-sulfadiazine-pyrimethamine and one with sulfadoxine-pyrimethamine (Fansidar) successfully. In the sixth case who was a Pakistani tourist the parasites showed resistance in the macro in vitro test, but apparently responded to chloroquine treatment in three days. It seems the resistance in this case was also at R1 level as other cases.- - - - - - - - - - ranking = 9445.1823450349keywords = recrudescence (Clic here for more details about this article) |
8/16. chloroquine-resistant plasmodium falciparum malaria in kenya.A case of chloroquine-resistant plasmodium falciparum malaria in a non-immune male is reported. Primary attack came 19 days after return to a non-malarious country from a visit to kenya. Recrudescences occurred three times with intervals of 30 to 33 days after standard chloroquine treatment. The WHO extended field test for sensitivity of falciparum malaria to chloroquine was followed by recrudescence 31 days later. Treatment with Fansidar terminated the infection. If continuous treatment of the patient with lithium does not interfere with the schizontocidal action of chloroquine, this strain shows a resistance pattern of R I delayed recrudescence.- - - - - - - - - - ranking = 18890.36469007keywords = recrudescence (Clic here for more details about this article) |
9/16. Possible chloroquine-resistant plasmodium falciparum in nigeria.A 42-year-old hospital worker had a recrudescence of falciparum malaria after chloroquine therapy. Further adequate treatment with chloroquine given orally did not clear the infection. He was then given a combination of sulphadiazine and pyrimethamine, which produced a radical cure. This points to the possibility of chloroquine-resistant plasmodium falciparum in nigeria, an African country where this has been thought to be unlikely. Because of this and earlier reports, clinicians should be on the alert to the possibility of chloroquine-resistant P. falciparum in this area, and efforts should be made to establish or reject the presence of malarial parasites resistant to chloroquine in africa.- - - - - - - - - - ranking = 9445.1823450349keywords = recrudescence (Clic here for more details about this article) |
10/16. chloroquine resistant malignant subtertian malaria unmasked by systematic steroid therapy.We report a case of a Nepalese who developed a recrudescence of malignant falciparum malaria whilst taking systemic corticosteroids. The malaria was resistant to chloroquine at the RI level, the first such case reported from BMH Dharan.- - - - - - - - - - ranking = 9445.1823450349keywords = recrudescence (Clic here for more details about this article) |
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