Death may occur with any of the malarial species but is most frequent with complicated P. falciparum malaria. The likelihood of death is increased in children with preexisting health problems, such as measles, intestinal parasites, schistosomiasis, anemia, and malnutrition. Death is much more common in developing countries.
There are two components of malaria prevention: reduction of exposure to infected mosquitoes and chemoprophylaxis. Mosquito protection is necessary because no prophylactic regimen can guarantee protection in every instance due to the widespread development of resistant organisms.
Chemoprophylaxis is necessary for all visitors to and residents of the tropics who have not lived there since infancy. Children of nonimmune women should have chemoprophylaxis from birth. Children of women from endemic areas have passive immunity until 3 to 6 months of age, after which they are increasingly likely to acquire malaria. Specific chemoprophylaxis should be guided by the distribution of resistance pattern and determined before making specific recommendations ( http://www.cdc.gov/malaria/travelers/country_table/a.html ).Mefloquine, doxycycline, chloroquine, and Malarone are commonly prescribed medications.
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Splenomegaly Lymphadenopathy Petechiae/Purpura Fever of Unknown Origin
Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, an intracellular protozoan parasite. Infection is acquired by infectious oocysts, such as those excreted by newly infected cats, which play an important role in amplifying the organism in nature, or from ingesting cysts in contaminated, undercooked meat. Less commonly, transmission occurs transplacentally during acute infection of pregnant women. In the United States, the incidence of congenital infection is 1 to 2 per 1000 live births.
Acquired toxoplasmosis is usually asymptomatic. Symptomatic infection is typically a heterophile-negative mononucleosis syndrome that includes lymphadenopathy, fever,and hepatosplenomegaly. Disseminated infection, includingmyocarditis, pneumonia, and central nervous system (CNS)toxoplasmosis, is more common among immunocompromised persons, especially persons with acquired immunodeficiency syndrome (AIDS). Among women infected duringpregnancy, 40% to 60% give birth to an infected infant. Thelater in pregnancy that infection occurs, the more likely it isthat the fetus will be infected, but the less severe the illness (see Chapter 66). Serologic diagnosis can be established by afourfold increase in antibody titer or seroconversion, a positive IgM antibody titer, or positive polymerase chain reactionfor T. gondii in peripheral white blood cells, cerebrospinalfluid (CSF), serum, or amniotic fluid.
Treatment includes pyrimethamine and sulfadiazine, which act synergistically against Toxoplasma. Because these compounds are folic acid inhibitors, they are used in conjunction with folinic acid. Spiramycin, which is not licensed in the United States, also is used in therapy of pregnant women with toxoplasmosis. Corticosteroids are reserved for patients with acute CNS or ocular infection.
Ingesting only well-cooked meat and avoiding cats orsoil in areas where cats defecate are prudent measures forpregnant or immunocompromised persons. Administration of spiramycin to infected pregnant women has beenassociated with lower risks of congenital infection in theiroffspring.
Helminths are divided into three groups: roundworms, or nematodes, and two groups of flatworms, the trematodes (flukes) and the cestodes (tapeworms).