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  • Title: Persistent fever in severe malaria in children.
    Author: Commey J, Quarm-Goka B, Agyepong I.
    Journal: Cent Afr J Med; 1994 Sep; 40(9):257-60. PubMed ID: 7834716.
    Abstract:
    Plasmodium falciparum species with reduced susceptibility to chloroquine have emerged in West Africa since the mid 1980s. Local strains, however, remain sensitive to amodiaquine with peripheral parasite clearance achieved within seven days in the majority. Blood cultures from 33 children (aged two to 12 years), who remained pyrexial after clearance of their parasitaemia, isolated causative organisms in 19 (57.6 pc) samples, with Salmonella species the commonest (68.4 pc) of all isolates. Complicating septicaemia needs consideration and early institution of treatment with antibiotics in children with severe malaria. Persistent pyrexia in malaria is not always due to resistance to antimalarials in areas with recent emergence of chloroquine resistant strains. A combination of amodiaquine and cotrimoxazole is suggested as a useful initial treatment. During May 1988 to August 1989, pediatricians enrolled 33 children aged 6 months to 12 years into a study to examine the role of septicemia in cases of severe malaria. The children had persistent fever (5 or more days) despite treatment with chloroquine and were admitted to the Department of Child Health of the University of Ghana Medical School in Accra with severe malaria (Plasmodium falciparum). At admission, all the children had malaria parasites in their blood films, 87.9% of whom had heavy peripheral parasitemia. Chloroquine cleared parasitemia within 3 days of treatment in only 33.3%. Treatment with oral amodiaquine followed when chloroquine failed to resolve the fever in 20 (60.6%) children. Children who still experienced fever then received intravenous (IV) penicillin and IV chloramphenicol over 7-14 days. Two (6.1%) children who died on days 5 and 13 still had a fever at death. 27.3% of all children had neurological complications. Pathogenic bacteria were isolated in 57.6% of all blood samples. Salmonella species were the most frequent species (68.4% of all isolates). These findings have motivated one of the clinical researchers to use a combination of oral amodiaquine (25 mg/kg) and co-trimoxazole to treat children with severe malaria and persistent fever.
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