Malaria

Chloroquine is a 4-aminoquinoline used in the treatment and prophylaxis of malaria and hepatic amebiasis, as well as rheumatoid arthritis. Adverse effects are generally less common and less severe. Frequent effects include headache, GI disturbances, and diarrhea. Large doses may cause blurred vision and difficulty focusing. A common adverse effect on the eye is retinopathy. Parenteral therapy with chloroquine can be hazardous, and rapid intravenous injections may result in cardiovascular toxicity. Acute overdose is extremely dangerous death may occur within a few hours. Chloroquine should be used cautiously in patients with liver and kidney impairment. Chloroquine may aggravate the condition of myasthenia 

The taxon Apicomplexa includes members of a number of significant human parasites, including Babesiosis (Babesia), Toxoplasmosis (Toxoplasma) and Malaria (Plasmodium). Whilst each parasite is an important vector for human disease, we will focus on Plasmodium, and particularly P. falciparum in this review. 

Malaria is a devastating human disease that causes more than 850 000 deaths each year. The disease is caused by a protozoan parasite of the genus Plasmodium, which is obligate intracellular protozoan parasites of humans and animals, and the symptoms of the disease are largely a consequence of the asexual multiplication of these parasites within erythrocytes in the host. The Human disease is caused by the Plasmodium species P. falciparum, P. vivax, P. ovale and P. malariae. The life cycle of the Malaria parasite is extremely complex involving distinct cellular morphologies for infection of the host organism (human or other animal) and the infectious vector, the mosquito 

The Committee was pleased to note the cooperation and collaboration between Policy, Access and Rational Use (PAR) and QSM. The Committee was informed about the usefulness of its work, i.e. in the preparation of guidelines, monographs and good distribution practices and was requested to expedite the deliberations. 

The Committee expressed its appreciation of the immense contribution of various persons and groups, including the NICPBP (People s Republic of China), to the work on the development of monographs for artemisinin combination drugs, including that of artesunate. The Committee was informed of the emerging need for monographs for fixed-dose combinations (FDC) for antimalarial products. 

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M.p. I08-5 C. Ordinary DDT contains about 15% of the 2,4 -isomer, and is prepared from chloral, chlorobenzene and sulphuric acid. It is non-phytotoxic to most plants. It is a powerful and persistent insecticide, used most effectively to control mosquitoes in countries where malaria is a problem. It is stored in the bodies of animals and birds. 

Alkaloid of cinchona bark used to treat malaria)... 

Description of Method. Quinine is an alkaloid used in treating malaria (it also is found in tonic water). It is a strongly fluorescent compound in dilute solutions of H2SO4 (f = 0.55). The excitation spectrum of quinine shows two absorption bands at 250 nm and 350 nm, and the emission spectrum shows a single emission band at 450 nm. Quinine is rapidly excreted from the body in urine and is easily determined by fluorescence following its extraction from the urine sample. 

The path from squalene (114) to the corresponding oxide and thence to lanosterol [79-63-0] (126), C qH qO, cholesterol [57-88-5] (127), and cycloartenol [469-38-5] (128) (Fig. 6) has been demonstrated in nonphotosynthetic organisms. It has not yet been demonstrated that there is an obligatory path paralleling the one known for generation of plant sterols despite the obvious stmctural relationships of, for example, cycloartenol (128), C qH qO, to cyclobuxine-D (129), C25H42N2O. The latter, obtained from the leaves of Buxus sempervirens E., has apparentiy found use medicinally for many disorders, from skin and venereal diseases to treatment of malaria and tuberculosis. In addition to cyclobuxine-D [2241-90-9] (129) from the Buxaceae, steroidal alkaloids are also found in the Solanaceae, Apocynaceae, and LiUaceae. 

The value of insecticides in controlling human and animal diseases spread by insects has been dramatic. It has been shown that between 1942 and 1952, the use of DDT in pubHc health measures to control the mosquito vectors of malaria and the human body louse vector of typhus saved five million hves and prevented 100 million illnesses (4). Insecticides have provided the means to control such important human diseases as filariasis transmitted by Culex mosquitoes and onchocerciasis transmitted by Simulium blackflies. 

Lindane is used predominately as a seed dressing and soil insecticide, for the control of ectoparasites of humans and domestic animals, for the control of locusts and grasshoppers, and as a residual spray to control the Anopheles vectors of malaria. Because of its relatively high volatility it is useful to control wood-boring insects of timber, fmit trees, and ornamental plants. The mode of action is not well understood but is thought to be competitive blocking of the y-aminobutyric acid (GABA) transmitter of synaptic nerve transmission. 

Dieldrin [60-57-1] or l,2,3,4,10,10-hexachloro-l,4,4t ,5,8,8t -hexahydro-6,7-epoxy-l,4- <7o, Aro-5,8-dimethanonaphthalene (34) (mp 176°C, vp 0.4 mPa at 20°C) is formed from aldrin by epoxidation with peracetic or perben2oic acids. It is soluble in water to 27 / g/L. Aldrin and dieldrin have had extensive use as soil insecticides and for seed treatments. Dieldrin, which is very persistent, has had wide use to control migratory locusts, as a residual spray to control the Anopheles vectors of malaria, and to control tsetse flies. Because of environmental persistence and propensity for bio accumulation, registrations in the United States were canceled in 1974. 

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

Sulfonamides in combination with dihydrofolate reductase inhibitors are of continuing value. Pyrimethamine [58-14-0] (5) in combination with sulfonamides is employed for toxoplasmosis (7), and a trimethoprim (6)-sulfamethoxa2ole preparation is used not only for urinary tract infections but also for bmceUosis, cholera, and malaria. 

Other Infections. The slowly excreted sulfonamides (eg, sulfamethoxypyrida2ine, sulfadimethoxine) are used for treatment of minor infections such as sinusitis or otitis, or for prolonged maintenance therapy. Soluble sulfonamides are sometimes used for proto2oal infections in combination with other agents. Pyrimethamine, combined with sulfonamides, has been used for toxoplasmosis or leishmaniasis, and trimethoprim with sulfonamides has been used in some types of malaria. In nocardiosis, sulfonamides have been used with cycloserine [68-41-7] (17). 

Preventive medicine through vaccination continues to be the most cost-effective pubHc health practice, even with the drastic advance in modern medicine. Mass vaccination programs have eradicated smallpox from the earth. The World Health Organization (WHO) has a major campaign underway to eradicate poHo by the year 2000. The development of vaccines has saved millions of Hves and prevented many more from suffering. However, there are stiU many diseases without effective vaccines, such as malaria. With the recent emergence of antibiotic-resistance strains and exotic vimses, an effective vaccine development program becomes a top priority of pubHc health poHcy. 

Malaria. Malaria infection occurs in over 30% of the world s population and almost exclusively in developing countries. Approximately 150 X 10 cases occur each year, with one million deaths occurring in African children (87). The majority of the disease in humans is caused by four different species of the malarial parasite. Vaccine development is problematic for several reasons. First, the parasites have a complex life cycle. They are spread by insect vectors and go through different stages and forms (intercellular and extracellular sexual and asexual) as they grow in the blood and tissues (primarily fiver) of their human hosts. In addition, malaria is difficult to grow in large quantities outside the natural host (88). Despite these difficulties, vaccine development has been pursued for many years. An overview of the state of the art is available (89). 

Development of a peptide vaccine is derived from the identification of the immunodominant epitope of an antigen (141). A polypeptide based on the amino acid sequence of the epitope can then be synthesized. Preparation of a peptide vaccine has the advantage of allowing for large-scale production of a vaccine at relatively low cost. It also allows for selecting the appropriate T- or B-ceU epitopes to be included in the vaccine, which may be advantageous in some cases. Several vaccines based on peptide approaches, such as SPf66 (95) for malaria and an HIV-1 peptide (142) have been in clinical trials. No peptide vaccines are Hcensed as yet. 

M. E. Good, A. Saul, and P. Graves, "Malaria Vaccines," in R. Ellis, ed.. Vaccines, Mew Approaches to Immunological Problems, Butterworth-Heinmann, Boston, Mass., 1992. 

T. Hodder, P. Crewther, M. Lett, and co-workers, "Apical Membrane Antigen 1 A potential Malaria Vaccine Candidate," 7th Malaria Meeting of British Society ofParasilolgy, London, Sept. 19—21,1995. 

Malaria affects an estimated 270 million people and causes 2—3 million deaths annually, approximately one million of which occur in children under the age of five. While primarily an affliction of the tropics and subtropics, it has occurred as far north as the Arctic Circle. The disease essentially has been eradicated in most temperate-zone countries, but some 1100 cases of malaria in U.S. citizens returning from abroad were reported to the Centers for Disease Control during 1990. Malaria is seen today in Southeast Asia, Africa, and Central and South America. It is on the increase in Afghanistan, Brazil, China, India, Mexico, the Philippines, Sri Lanka, Thailand, and Vietnam. Escalation of the disease is because of the discontinued use of the insecticide DDT which effectively kills mosquito larvae, but has been found to be toxic to Hvestock and wildlife. Also, chloroquine (6), a reUable dmg for the prophylaxis and treatment of falcipamm malaria, is ineffective in many parts of the world because of the spread of dmg-resistant strains. 

Malaria is transmitted by the bite of an infected female Anopheles mosquito, one of the few species of the insect capable of carrying the human malaria parasite. The responsible protozoa ate from the genus P/asmodium of which only four of some 100 species can cause the disease in humans. The remaining species affect rodents, reptiles, monkeys, birds, and Hvestock. The species that infect humans are P/asmodium falciparum Plasmodium vivax Plasmodium malariae and Plasmodium ovale. Note that concomitant multiple malaria infections are commonly seen in endemic areas, a phenomenon that further compHcates choice of treatment. 

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