RESUMEN
Suspected tropical malaria is an acute emergency. Immediate effective pharmacological treatment is of the essence. As in the case of prevention, various antimalarials are now available for treatment. Complicated tropical malaria requires treatment in hospital and intensive monitoring. The risk of infection and serious illness leading to a fatal outcome can be considerably reduced by suitable chemoprophylaxis or the use of stand-by medication for self-treatment, which, however, must be matched to resistance zones and the incidence of the four species of Plasmodium, in particular Plasmodium falciparum.
Asunto(s)
Antimaláricos/administración & dosificación , Malaria/tratamiento farmacológico , Adolescente , Adulto , Animales , Niño , Preescolar , Urgencias Médicas , Humanos , Lactante , Malaria/parasitología , Malaria/prevención & control , Fenantrenos , Plasmodium falciparum/aislamiento & purificación , Quinina/uso terapéutico , Viaje , Clima TropicalRESUMEN
Year for year, some 2.1 million people die of malaria worldwide. In Germany, about 1,000 people go down with the disease after visiting malarious areas, and up to 3% will die--mostly of tropical malaria. Decisive factors for mortality are age over 60 and delays in effective pharmacological therapy. It is essential that, in the presence of an appropriate history, malaria be suspected early on. The diagnosis can still be established using the "thick drop", or a blood smear stained with Pappenheim's stain, or Diff-Quick. In the event of a strong suspicion, the two methods should be applied every 8 hours for three days.
Asunto(s)
Malaria/epidemiología , Clima Tropical , Adulto , África/epidemiología , Anciano , Antimaláricos/administración & dosificación , Femenino , Alemania/epidemiología , Humanos , América Latina/epidemiología , Malaria/diagnóstico , Malaria/mortalidad , Malaria/prevención & control , Masculino , Persona de Mediana Edad , ViajeRESUMEN
The rationale for exchange blood transfusion (ET) in severe falciparum malaria is threefold: reduction of parasitaemia, reduction of presumptive 'toxic' factors, and improvement of the rheological quality of the blood. We evaluated the records of 61 patients treated with ET to describe the present status of malaria treatment in Germany, Austria and Switzerland and to assess the efficacy of ET. Clinical data of 61 patients treated with ET were compared to data of 63 patients treated in 2 hospitals where ETs were generally not performed. We found that exchange transfusion is applied according to the clinician's subjective impression rather than strict guidelines. Logistic regression analysis adjusting for the differences in clinical parameters between patients treated with or without ET did not identify treatment as a prognostic indicator (odds ratio for relative risk of death with ET: 1.3; 95% CI: 0.4-4.9). Exchange transfusion did not significantly improve the unfavourable prognosis in cases of severe falciparum malaria. However, failure to reach statistical significance may be due to the retrospective design of the study and therefore non-systematic approach.