Malarious areas

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). 

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Travellers visiting remote, malarious areas for prolonged periods should carry standby treatment if they are likely to be more than 24 hours away from medical care. Patients should receive clear written instructions that urgent medical attention should be sought if fever (38°C or more) develops 7 days... 

The synthesis of IgG in African subjects unprotected from malaria was approximately twice (169 mg/kg/day) that of Africans protected from malaria and seven times that of Caucasians (23 mg/kg/day), implying that malaria must account for a good proportion of the high immunoglobulin levels found in persons in a malarious area (C18). In fact absorption experiments have shown that about 3-10% of the immune human IgG was specific malarial antibody (C25). 

Once the primary therapeutic objective has been achieved, attention can be focused on such additional considerations as elimination of the gametocytes and the tissue forms of the parasite. Success in these areas would help to ensure that relapses do not occur. Since no latent liver forms are associated with mosquito-induced, drug-sensitive P. falciparum malaria, administration of chloroquine for up to 3 months after the patient leaves a malarious area will usually bring about a complete or radical cure unless the organism is resistant to chloroquine. 

Malaria prophylaxis PO 30 mgbase daily. Begin 1 daybefore departure and continue for 7 days after leaving malarious area. 

Areas without known chloroquine-resistant P falciparum are Central America west of the Panama Canal, Haiti, Dominican Republic, Egypt, and most malarious countries of the Middle East. Malarone or mefloquine are currently recommended for other malarious areas except for border areas of Thailand, where doxycycline is recommended. 

Mefloquine is effective in prophylaxis against most strains of P falciparum and probably all other human malarial species. Mefloquine is therefore among the drugs recommended by the CDC for chemoprophylaxis in all malarious areas except for those with no chloroquine resistance (where chloroquine is preferred) and some rural areas of Southeast Asia with a high prevalence of mefloquine resistance. As with chloroquine, eradication of P vivax and P ovale requires a course of primaquine. 

Herrera-Portugal C, Ochoa H, Franco-Sanchez G, Yanez L, Diaz-Barriga F (2005) Environmental pathways of exposure to DDT for children living in a malarious area of Chiapas, Mexico. Environ Res, 99(2) 158-163. 

Y3fiez L, Ortiz-P6res D, Batres LE, Borja-Aburto VH, Diaz-Barriga F (2002a) Levels of dichlorodiphenyltrichloroethane and deltamethrin in humans and environmental samples in malarious areas of Mexico. Environ Res, 88 174-181. 

Mefloquine (t) 21 d) is similar in several respects to quinine although it does not intercalate with plasmodial DNA. It is used for malaria chemoprophylaxis, to treat uncomplicated Plasmodium falciparum (both chloroquine-sensitive and chloroquine resistant) and chloroquine-resistant Plasmodium vivax malaria. Mefloquine is rapidly absorbed from the gastrointestinal tract and its action is terminated by metabolism. When used for prophylaxis, 250 mg (base)/week should be taken, commencing 1-3 weeks before entering and continued for 4 weeks after leaving a malarious area. It should not be given to patients with hepatic or renal impairment. 

Halofantrine is not indicated for prophylactic use. However, of 480 army personnel who took two doses of 1500 mg each on the third and the tenth days after they had returned to a non-malarial area, only one had P. falciparum malaria during the next 5 months (SEDA-13, 820) (1). There were no adverse effects, except for one case of morbilliform rash possibly due to the halofantrine. 

Baudon D, Bernard J, Moulia-Pelat JP, Martet G, Sarrouy J, Toirze JE, Spiegel A, Lantrade P, Picq JJ. Halofantrine to prevent falciparum malaria on return from malarious areas. Lancet 1990 336(8711) 377. 

Pregnant women should exercise maximum protection, including avoiding malarious areas whenever possible ... 

Sulfadoxine (1500 mg) and pyrimethamine (75 mg) orally as a single dosage is indicated for the treatment of P. falciparum malaria in patients in whom chloroquine resistance is suspected. However, chloroquine remains the drug of choice for travelers to malarious areas, hi addition, sulfadoxine-pyrimethamine has been used as a prophylactic agent for the prevention of Pneumocystis carinii pneumonia in patients with AIDS, usually as a second-tine agent. 

THERAPEUTIC USES Proguanil as a single agent is not available in the U.S. but is prescribed in Europe for nonimmune travelers to malarious areas. Strains of P. falciparum resistant to proguanil emerge rapidly in areas where the drug is used exclusively, but breakthrough infections also may result from deficient conversion of this compound to its active antimalarial metabolite. 

Clinical use Recommended by the CDC for prophylaxis in all malarious areas except those with no chloroquine resistance. 

Parenteral iron is contraindicated in newborns of both non-malarious and malarious areas Treatment of anemia in malarious areas ... 

The 4-substituted quinolines are referred to as rapidly acting blood schizonticides, with activity against plasmodium in the erythrocytic stage. Chloroquine is the drug of choice, but unfortunately, the incidence of chloroquine-resistance infections are extremely common today. The spread of chloroquine resistance has reached almost all malarious areas of the world. In addition, multidrug-... 

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