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Unread postPosted: Fri Dec 02, 2005 3:14 pm 
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Paris - Misuse of the world's most important anti-malaria drug is helping the disease's mosquito-borne parasite become resistant to the treatment, according to a study due to appear on Saturday.

Artemisinin, derived from a Chinese herb, has become the drug of choice for treating malaria after chloroquine, introduced in the 1950s, was rendered useless by resistance.

Researchers from the French-led Pasteur Institute Network took blood samples in 2001 from 530 malaria patients in Cambodia, French Guiana and Senegal, where there are different patterns of artemisinin use.

They then tested the samples in lab dishes, exposing the parasite, Plasmodium falciparum, to a range of malaria drugs.

Some samples from French Guiana and Senegal, where use of artemisinin is uncontrolled, showed signs of being insensitive to that drug. But samples from Cambodia, where the drug is controlled, showed no sign of resistance.

"All resistant isolates [samples] came from areas with uncontrolled use of artemisinin derivatives," said lead scientist Ronan Jambou. "This rise in resistance indicates the need for increased vigilance and a co-ordinated rapid deployment of drug combinations."

Extreme vigilance vital

The study appears on Saturday in The Lancet, the British medical weekly.

Its publication comes on the heels of a call on September 6 by the World Health Organisation (WHO), which called on countries to be extremely vigilant in the use of artemisinin-based drugs to avoid stoking resistance.

The new research pinpoints the problem to mutations in a gene in the parasite called SERCA-type Prtpase6 that is targeted by artemisinin.

Resistance by a bacteria, virus or parasite is encouraged when a patient fails to take a full course of drugs or uses drugs that are counterfeit or diluted.

Even though the symptoms may disappear, this action fails to kill all the microbes, leaving behind a colony that can reproduce and has a better chance of surviving an attack by those drugs.

Drug expensive

Mutations can also occur randomly through sloppy replication of a microbe's genetic code or by swapping DNA with a counterpart which is slightly different. The change may affect those parts of the pathogen which are targeted by the drug.

Artemisinin is vulnerable to the counterfeiters as it is relatively expensive. It is nearly 20 times more expensive than chloroquine - at more than $2.40 per course, it is way beyond the means of many sufferers, especially in Africa.

The drug may also be facing resistance problems because the compounds with which it is sometimes administered as a combination therapy are ineffective.

Malaria kills around one million people every year and at least 300 million cases of acute malaria occur each year, according to the WHO, although some experts suggest this is a serious under-estimate.

(source)

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Unread postPosted: Tue Dec 20, 2005 3:40 am 
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Hi folks.
I am researching anti malaria potions for a hastily arranged Jan trip to Kruger from the UK, and to summarise my understanding of what read in these last 9 pages and elsewhere:
1. Larium / mefloquine once a week 2-3 before, during trip to risk area and 4 weeks after. UK private prescription needed, 'mental health' side effects possible
2.Doxycycline cheap and no UK prescription, daily tabs start day before, during trip and 4 weeks after but major risk of sun exposure problems (and I always forget to reapply sunblock)
3. Malarone 'new kid on block', few known side effects but prescription needed both UK and SA and by far most expensive option in both countries. 1 day before, during trip and 7 days after.
Doubts over effectiveness of anything else assuming I want to minimise risk and will take sensible physical precautions as well.

Please could someone tell me if the above is correct, and primarily if 1 and 2 are widely available off prescription with approx costs in SA?


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Unread postPosted: Thu Dec 29, 2005 9:09 am 
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bucky wrote:
Keep in mind that kruger is listed as a seasonal malaria area , a lot of folks overlook this .
There is virtually no risk in winter , why not book a trip for winter time if you are not willing to take any risk , thats the times I went when my kids where very small.
For best up to date advice , phone the malaria line , or phone
a hospital/doctor in nelspruit or skukuza.


Unfortunately winter is also risky. My wife contracted malaria in May/June 2003.

I agree with others, preventing being bitten is the best safeguard. And detecting the symptoms early enough second best.

Like I have mentioned in the "Other" section. A high profile police chief in our special forces contracted falciparum most recently. he had taken anti-malarial drugs beforehand. It masked his symptoms and even traces of malaria on subsequent posts and he nearly died. They only just in time tracked down celebral malaria, which is why falciparum is so dangerous and managed to pull him from death's doorstep.

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Unread postPosted: Thu Dec 29, 2005 2:22 pm 
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LittleLeopard wrote:
wildtuinman wrote:
They only just in time tracked down celebral malaria, which is why falciparum is so dangerous and managed to pull him from death's doorstep.


I think cerebral malaria is the most dangerous one, not so :?:

I know of someone who died as a result of cerebral malaria after having been in a coma for about six weeks. Not someting to play with :naughty:


What very few people actually know is that falciparum is the most dangerous as it sets into celebral malaria which is not a type of malaria itself but is so being called because it affects the brain. Only about 2% of patients with celebral malaria will ever recover from the coma.

The other malaria's being: Vivax, Malariae and Ovale, not nearly on the same scary scale as Falciparum.

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Unread postPosted: Thu Dec 29, 2005 6:37 pm 
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Are april and may not the worst months ?

From June onwards it should settle down though , BUT of course it it all very dependant on when the end of the rainy season takes place , did your wife catch it after a year of heavy rain ?
Was she on anti malaria pills , and how soon did you pick it up ? I hope she made a full recovery .

The whole business of the drugs masking the symptoms are very worrying , I sometimes wonder how good they are :? and if there use is pushed for nothing more than commercial reasons.

NOTE - Please folks , make sure you check with a medical proffesional , who has experience with malaria before deciding on taking or not taking the prophylaxis drugs , a lot of what people are saying is speculation , especially as far as malaria drugs go , I for 1 am no medical profesional.
The preventative tips for not getting bitten are all very good though.


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Unread postPosted: Fri Dec 30, 2005 10:40 pm 
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The myth is that the risk is higher when it is wetter or you are near a river etc. Mozzies breed in stagnant water, therefor dry times can be even more dangerous.

Camps like Satara and Orpen carry the same risk, by the way the only person I know that got malaria picked it up in Orpen.

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Unread postPosted: Fri Dec 30, 2005 11:09 pm 
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Funny, Christo - I'd read the opposite. The malaria carrying mosquito prefers water to be fresh rather than stagnant. Another thing I read was that light has no effect on mosquitos. i.e they are not attracted to light, you can just see them better. The anopheles mosquito is also silent so you can't hear it coming for you :?


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Unread postPosted: Sat Dec 31, 2005 2:27 am 
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The dreaded Mozzie will breed in almost any water source, fresh, stagnant, salty, effluent or other. It will utilise the smallest of pools (rain collected in the angle of a tree branch for example) to the largest of lakes, as long as the water is not fast flowing.

I am told that the 'buzz' comes from the male (who feeds only upon plant nectar and whose sole purpose in life is to find a good woman with which to ensure the continuation of his genes) whilst the female is a silent hunter - but I don't believe a word of it and am not prepared to put it to the test! :)

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 Post subject: Vital new weapon in war on malaria
Unread postPosted: Wed Jan 04, 2006 3:15 pm 
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Quite a long read folks but very interesting nevertheless!!!!

Quote:
A technique for turning the sex organs of male mosquitoes fluorescent green has opened a new front in the battle against malaria.

The technique allows scientists to identify sterile male mosquitoes, which can be released into the wild to control the population of malaria-carrying females.

Using sterile males as a form of birth control was first conceived more than 40 years ago, but the plan suffered from an inability to tell the two sexes apart.

Scientists can now sex mosquitoes by introducing a fluorescent gene from a jelly fish into both male and female mosquitoes. The gene works by making the testicles of the males light up and has enabled scientists to sort thousands of mosquitoes an hour.

Releasing large numbers of sterile males into the wild is viewed as environmentally friendly because their sterility - caused by irradiation - only affects the population of the malaria species being targeted.

Female mosquitoes mate only once, even if their partner is infertile, so releasing sterile males into a malaria region could significantly decrease the risk of being bitten by a malaria-carrying insect. Sterile males can mate more than once, so releasing them could, in theory, prevent many more female mosquitoes from reproducing.

Releasing large numbers of sterile males has proved effective with other diseases caused by insects, such as the Mediterranean fruit fly, but these projects have been possible only because the sexes of these species are easily distinguishable.

However, it is difficult to tell the sexes apart for many of the species of mosquito that carry malaria, such as Anopheles stephani, says Christani, whose study is published in Nature Biotechnology.

Further research is needed, but scientists believe it could be employed to control malaria in urban areas of the developing world within five years. "I don't see any environmental difficulties. This is a techology that has been used for years - the males won't release the jellyfish gene because they are sterile, and they don't bite," Cristani said.

Drug-resistant forms of malaria are spreading because many medicines have become ineffective. So alternative methods of controllin the insect "vector" are seen as vital.

Nine out of every 10 cases of malaria occur in sub-Saharan Africa and 90% of those affected are children under the age of five. Poor families are disproportionately affected, with some spending up to a quarter of their monthly income on prevention and control measures.

Malaria is the most important disease transmitted by insects, affecting up to 500 million people in the world and causing 2 million deaths a year, mostly in young Africans. Attempts at controlling the populations of malaria-carrying mosquitoes with chemnical insecticides have helped, but have resulted in environmental pollution!

NATURE Biotechnology.


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Unread postPosted: Wed Jan 04, 2006 5:41 pm 
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Interesting article and as far as I am concerned anything that can be done in the fight of this dreaded disease is a good thing.
More power to the scientists and bio-technicians who are working to find a solution to this huge problem.

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Unread postPosted: Tue Jan 10, 2006 12:41 am 
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Never heard of CV problems with Larium, but I am very surprised that your doctor advised you to take it. Most doctors avoid prescribing it unless the alternatives are definitely not suitable. I can attest to psychiatric problems from Larium. I was signed off work for 3 months with depression within a month of returning from SA. I will only take Malarone now - expensive but it agrees very well with me.

I've just had a quick scout around the internet and found the following quote from a medical website:
Quote:
Concomitant administration of Lariam and quinine or quinidine may produce electrocardiographic abnormalities.

and
Quote:
Parenteral studies in animals show that mefloquine, a myocardial depressant, possesses 20% of the antifibrillatory action of quinidine and produces 50% of the increase in the PR interval reported with quinine. The effect of mefloquine on the compromised cardiovascular system has not been evaluated. However, transitory and clinically silent ECG alterations have been reported during the use of mefloquine. Alterations included sinus bradycardia, sinus arrhythmia, first degree AV-block, prolongation of the QTc interval and abnormal T waves (see also cardiovascular effects under PRECAUTIONS : Drug Interactions and ADVERSE REACTIONS ). The benefits of Lariam therapy should be weighed against the possibility of adverse effects in patients with cardiac disease.

Not quite what you mentioned, I know, but I hadn't heard of this either! If you want to read more, here is the link I got this info from.


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Unread postPosted: Tue Jan 10, 2006 12:54 am 
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Krokodile wrote:
Never heard of CV problems with Larium, but I am very surprised that your doctor advised you to take it. Most doctors avoid prescribing it unless the alternatives are definitely not suitable.


My GP told me, after I returned to UK and I was telling him what had happened to me and what I had been told in the Republic, that Larium is the preferred drug in the eyes of the School of Hygiene and Tropical Medicine which is supposed to be a world authority!


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Unread postPosted: Wed Jan 11, 2006 12:02 am 
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Krokodile wrote:
That's what I hate about the NHS - so inconsistent. There is a travel clinic at my doctors surgery (in East Sussex) and they actually said that they don't like prescribing Larium due to the potential side effects. Also I believe that Quinine is often used to treat Malaria, so if you did happen to catch the disease whilst taking larium, the side effects of the combination, as mentioned in the article, are not exactly going to make you feel better!

Malarone is a relatively new drug, and as mentioned before, very expensive, but I really thought that doctors had stopped prescribing Larium as a matter of course many years ago, unless it was specifically requested by the patient.

Mmmm - interesting. When I went to SA last April my surgery (in West Sussex) prescribed Larium. I take quinine nightly for cramp and they allegedly looked into potential side effects of the combination and assured me that there was only a risk to patients who already had some sort of cardio-vascular problem. They made no reference to any alternative malaria prophylactic.

As you say, Krok, no consistency.

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 Post subject:
Unread postPosted: Fri Jan 13, 2006 2:46 pm 
Krokodile wrote:
New development in the fight against Malaria here.

Sounds like an excellent idea for those people (like Jumbo, for example) who live in a malarial area and therefore cannot take prophylaxis all the time.


Thanks for the valuable posting Krokodile. This is indeed very interesting! :thumbs_up:
I think a device like this (maybe a bit smaller), will also come in very handy to detect malaria in children/babies. (I have sent this out to a few people whom I’m sure can benefit from it )
For me: being pricked by a needle four times a day….. :big_eyes: Don’t like injections and needle thingies very much (even if it is microscopic). :? Will rather wear a burning mosquito coil around my neck.


Just something on the Larium (based on our personal experience):
I cannot take Larium at all – it really makes me feel horrible.
But my SO used Larium permanently for the first five months we were in Moz. – was in malaria season, he had malaria before and wasn’t planning to get it again. He had no side effects at all – even did liver tests on him after the five months to make sure there was no damage. So it seems that the effect on people varies.


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Unread postPosted: Wed Jan 18, 2006 3:45 pm 
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Meg wrote:
Does anyone know what Malaria is like in the Park in March? I'm lucky, having never caught it despite living in the Lowveld for most of my life. However, with a little one in tow it would be good to know what the stats are like for March. I'd love to take him in, even just for a couple of hours, and certainly not overnight.


Meg, be carefull, malaria is spreading into Pholokwane and Louis Trichardt areas even. Don't get caught out. MArch is dangerous especially after this much rain.

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