Malaria in children

Sowunmi A, Ayede AI, Falade AG, Ndikum VN, Sowunmi CO, Adedeji AA, Falade CO, Happi TC, Oduola AM. Randomized comparison of chloroquine and amodiaquine in the treatment of acute, uncomplicated, Plasmodium falciparum malaria in children. Ann Trop Med Parasitol 2001 95(6) 549-58. 

Anabwani G, Canfield CJ, Hutchinson DB. Combination atovaquone and proguanil hydrochloride vs. halofantrine for treatment of acute Plasmodium falciparum malaria in children. Pediatr Infect Dis J 1999 18(5) 456-61. 

Di Perri G, Di Perri IG, Monteiro GB, Bonora S, Hennig C, Cassatella M, Micciolo R, Vento S, Dnsi S, Bassetti D, et al. Pentoxifylline as a supportive agent in the treatment of cerebral malaria in children. J Infect Dis 1995 171(5) 1317-22. 

Kremsner PG, Radloff P, Metzger W, Wildling E, Mordmuller B, Philipps J, Jenne L, Nkeyi M, Prada J, Bienzle U, et al. Quinine pins chndamycin improves chemotherapy of severe malaria in children. Antimicrob Agents Chemother 1995 39(7) 1603-5. 

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. 

In areas where malaria is hyper- or holoendemic, newborn infants had high titers of malarial antibody which decreased during the first 6 months of life and then showed a gradual rise throughout childhood until adult levels were attained. The pattern of the malarial fluorescent antibody titer in children in a malaria endemic area, reflected the development of the serum IgG more closely than that of any other immunoglobulins, and the early fall in the titer of the malaria fluorescent antibody coincided with that of the loss of maternal IgG from the children s circulation, implying that malarial antibody is quite capable of traversing the human placenta (M13) (Table 6, Fig. 6). 

Mutabingwa TK, Anthony D, Heller A, Hallett R, Ahmed J, Drakeley C et al. Amodiaquine alone, amodiaquine-i-sulfadoxine-pyrimethamine, amodi-aquine-i-artesunate, and artemether-lumefantrine for outpatient treatment of malaria in Tanzanian children a four-arm randomised effectiveness trial. Lancet 2005 365(9469) 1474-80. 

Quinine sulfate is appropriate first-line therapy for uncomplicated falciparum malaria except when the infection was transmitted in an area without documented chloroquine-resistant malaria. Quinine is commonly used with a second drug (most often doxycycline or, in children, clindamycin) to shorten quinine s duration of use (usually to 3 days) and limit toxicity. Quinine is less effective than chloroquine against other human malarias and is more toxic. Therefore, it is not used to treat infections with these parasites. 

Barnes KI et al Efficacy of rectal artesunate compared with parenteral quinine in initial treatment of moderately severe malaria in African children and adults A randomised study. Lancet 2004 363 1598. [PMID 15145633]... 

Dorsey G et al Combination therapy for uncomplicated falciparum malaria in Ugandan children A randomized trial. JAMA 2007 297 2210. [PMID 17519410]... 

Gordeuk. V. et at F.ffect ol Irnn Chelation Therapy oil Recovery front Deep Coma in Children until Cerebral Malaria.", V, Eng.. 1. Med. 14711 November 19, 19921. Gordeuk. V.. et al. Iron Overload in Alrieti — Interaction between a Gene and Dietary Iron Content.", V. Eng. J. Med., 95 tJanuarx 9, 1992 t. 

Nosten F, ter Kuile F, Chongsuphajaisiddhi T et al (1991) Mefloquine pharmacokinetics and resistance in children with acute falciparum malaria. Br J Clin Pharmacol 31(5) 556-559... 

A broad spectrum of diseases in children are known (or suspected) to be associated with unhealthy environments. For much of the world, traditional environmental health hazards continue to remain the primary source of ill-health. These include lack of adequate nutrition, poor sanitation, contaminated water, rampant disease vectors (e.g. mosquitoes and malaria), and unsafe waste disposal. In addition, rapid globalization and industrialization coupled with unsustainable patterns of production and consumption have released large quantities of chemical substances into the environment. Although the term environmental exposure can encompass a variety of factors, the focus of this document is specifically on environmental chemical exposures. Most of these substances have not been assessed for potential toxicity to children, nor have the most vulnerable subpopulations of children been identified. The incidence of a number of important paediatric diseases and disorders (e.g. asthma, neurobehavioural impairment) is increasing in several parts of the world. Although a variety of factors are likely to be involved, this may be due, in part, to the quality of the environment in which children live, grow, and play. 

At the global level, an analysis of the WHO database on burden of disease (http //www.who.int/evidence) shows that most of these deaths result from a handful of causes (WHO, 2005a). Figure 1 shows the major causes of death in children under five years of age. Estimates from the 2000-2003 database attribute 37% of these deaths to neonatal causes, 19% to pneumonia, 17% to diarrhoea, 20% to other — including injuries, measles, and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) — and 8% to malaria. 

In order to control malaria, DDT was used in Mexico until the year 2000. As a result, DDT contamination was widespread, and it has been shown that children can be exposed to this insecticide by soil ingestion, household dust ingestion/inhalation, fish consumption, and human milk (Diaz-Barriga et ah, 2003 Herrera-Portugal et ah, 2005). In these areas, DDT levels in blood in children are higher than those in adults (Diaz-Barriga et ah, 2003). 

Perch M, Kofoed P, Fischer TK, Co F, Rombo L, Aaby P, et al. Serum levels of soluble urokinase plasminogen activator receptor is associated with parasitemia in children with acute Plasmodium falciparum malaria infection. Parasite Immunol 2004 26(5) 207-211. 

Perkins DJ, Kremsner PG, Weinberg JB. Inverse relationship of plasma prostaglandin E2 and blood mononuclear cell cyclo-oxygenase-2 with disease severity in children with Plasmodium falciparum malaria. J. Infect. Dis. 2001 183 113-118. 

The perception of risks and benefits changes with time as the history of DDT illustrates. DDT was first synthesized in 1874 by the German chemist Zeidler. However, the insecticidal properties of DDT were discovered only later, in 1939, by Paul Mueller in Switzerland, who received the Nobel Prize for his discovery. After it became available on the market, DDT was accepted immediately and used on a large scale. For the first time in history, people could control insects effectively. Mothers could relieve their children from lice, farmers could protect their livestock and harvest. DDT has probably been responsible for saving more lives than any other synthetic chemical, perhaps with the exception of antibiotics. It is estimated that around 1940 ca 300 million people suffered from malaria. The mortality rate was about 1 percent. Thirty years later DDT and WHO (World Health organization) malaria program had eradicated malaria in many parts of the world. DDT also... 

Malaria has been described as the world s greatest public health problem. It is caused by one of several strains of the Plasmodium protozoan, a one-celled parasite that is transmitted by the bite of the Anopheles mosquito. Hundreds of millions of persons are struck by malaria each year, resulting in 1-3 million deaths annually, primarily in children under five-years-old in sub-Saharan Africa, where 90% of malaria deaths occur. Malaria has essentially been eradicated in North America, Europe, and Russia, although infected travelers and immigrants can reintroduce the disease if bitten by an infected mosquito. Malaria is on the increase worldwide and presents a major burden for tropical communities and travelers, particularly in areas where the parasite has evolved resistance to the drugs used to treat it. 

Rezbach, R, Some, E., Taylor, W.R.J. Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children a randomized, multicentre trial. Lancet 2002 359 1365-1372... 

A12. Allison, A. C., Malaria in carriers of the sickle cell trait and in newborn children. Exp. Parasitol. 6, 418-447 (1957). 

The novel combination (Artekin ) of dihydroartemisinin and piperaquine has been assessed in 106 patients (76 children and 30 adults) with uncomplicated Plasmodium falciparum malaria in Cambodia (19). The respective doses of dihydroartemisinin and piperaquine, which were given at 0,8, 24, and 32 hours, were 9.1 mg/kg and 74 mg/kg in children and 6.6 and 53 mg/kg in adults. AH the patients became aparasitemic within 72 hours. Excluding the results in one child who died on day 4, there was a 97% 28-day cure rate (99% in children and 92% in adults). Patients who had recrudes-cent infections used low doses of Artekin. Adverse effects, most commonly gastrointestinal complaints, were reported by 22 patients (21%) but did not necessitate premature withdrawal. 

Hatz C, Abdulla S, Mull R, Schellenberg D, Gathmann I, Kibatala P, Beck HP, Tanner M, Royce C. Efficacy and safety of CGP 56697 (artemether and benflumetol) compared with chloroquine to treat acute falciparum malaria in Tanzanian children aged 1-5 years. Trop Med Int Health 1998 3(6) 498-504. 

Anyalebechi C, Gosling R, Coleman R, Ude Jl, Sadiq A, Duraisingh M, Warhurst D, Alloueche A, Target G, McAdam K, Greenwood B, Walraven G, Olliaro P, Doherty T. Efficacy of artesunate plus pyrimethamine-sul-phadoxine for uncomphcated malaria in Gambian children a double-blind, randomised, controlled trial. Lancet 2000 355(9201) 352-7. 

Lell B, Luckner D, Ndjave M, Scott T, Kremsner PG. Randomised placebo-controlled study of atovaquone plus proguanil for malaria prophylaxis in children. Lancet 1998 351(9104) 709-13. 

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