Malaria Obstacles and Opportunities (1991) / Chapter Skim
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Pages 56-72
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From page 56... ...
4Clinical Medicine and the Disease Process WHERE WE WANT TO BE IN THE YEAR 2010 There will be a worldwide drop in deaths and debilitating illness resulting from many important changes in the way health providers around the world prevents, diagnose, and treat the disease. Unlike the situation at present, health providers will be able to identify and offer preventive therapy for persons at risk for severe and complicated malaria.
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WHERE WE ARE TODAY Despite the advances in the understanding of the pathogenic and clinical aspects of malaria, clinicians still do not know why some people tolerate malaria infections with few or no symptoms, whereas other are severely affected. Indeed, it remains a mystery why some people die of malaria but others do not.
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Cerebral malaria may develop very rapidly. In a study of 131 Malawian children with cerebral malaria, example, symptoms such as fever, malaise, or cough had been present for an average of 47 hours prior to admission, and altered consciousness had been present for a mean of 8 hours.
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cerebral blood flow may lead to anaerobic cerebral glycolysis and increased cerebral lactate production. Lactate levels are elevated both in arterial blood and in cerebrospinal fluid (CSF)
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Despite optimal care, between 10 and 30 percent of children with cerebral malaria die, and a similar proportion suffer neurological damage (Molyneux et al., 1989a)
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removed from the circulation by the spleen more rapidly than is normally the case. The loss of red blood cells from these various mechanism is therefore generally greater than would be expected from parasitemia alone and often causes significant anemia.
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Acute renal failure in malaria has the pathological characteristics of acute tubular necrosis, but the causal mechanism remains unknown. Hypovolemia from dehydration probably contributes to the problem in some severely ill patients, but it does not appear to explain all cases.
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because they already had or rapidly developed immune responses that controlled the disease, or because they had another, self-limiting disease such as the flu rather than malaria. Some patients for various reasons do not improve, and either return for more definitive care or seek help from other sources (traditional local treatments or over-the-counter medications)
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measured the clinical value and cost-effectiveness of this practice. In one placebo-controlled trial in the Gambia, malaria chemoprophylaxis (dapsone plus pyrimethamine)
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however, this method is not particularly useful for helping formulate national treatment policies in endemic areas. The ability to determine the level of local parasite sensitivities to different drugs is important.
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in the Malawian children examined in one study (Molyneux et al., 1989a) , and the mean duration of illness in Gambian children prior to death was three days (Greenwood et al., 1988)
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West African countries for the spread of chloroquine-resistant P falciparum malaria.
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Dumas, M., J
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Kwiatkowski, D., A
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Rieckmann, K
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World Health Organization.
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