The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · Jan 1996
Impairment of a pregnant woman's acquired ability to limit Plasmodium falciparum by infection with human immunodeficiency virus type-1.
In Africa, the human immunodeficiency virus (HIV) is the most serious emerging infection and Plasmodium falciparum malaria is one of the most prevalent infectious diseases. Both infections have serious consequences in pregnant women, their fetuses, and infants. We examined the association between HIV and P. falciparum in pregnant women enrolled in a malaria chemoprophylaxis study in rural Malawi. ⋯ Compared with infants born to HIV(-) women, newborns born to HIV(+) women had higher rates of umbilical cord blood parasitemia. Both HIV(+) and HIV(-) women had similar rates of parasitemia 2-6 months postpartum. The HIV infection diminishes a pregnant woman's capacity to control P. falciparum parasitemia and placental and newborn infection, the major determinants of the impact of P. falciparum on fetal growth and infant survival.
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Am. J. Trop. Med. Hyg. · Sep 1995
Randomized Controlled Trial Clinical TrialEfficacy of antivenom in the treatment of severe local envenomation by the hump-nosed viper (Hypnale hypnale).
In Sri Lanka, the usual treatment for severe local envenomation by the hump-nosed viper (Hypnale hypnale) is with polyspecific snake antivenom. We carried out a prospective, randomized, placebo-controlled, single-blind clinical trial to determine the efficacy and safety of polyspecific snake antivenom in the treatment of severe local envenomation by this snake. Sixty-three patients with signs and symptoms of local envenomation by the hump-nosed viper Lanka were randomized to receive either polyspecific snake antivenom or normal saline. ⋯ There was no significant difference between the antivenom and placebo groups in the time taken for complete resolution of the local envenomation (5.52 days versus 4.77 days; P = 0.53, by the Mann-Whitney U test). There was a 44.82% incidence of adverse reactions associated with treatment with antivenom. We conclude that polyspecific snake antivenom is not indicated for severe local envenomation by the hump-nosed viper.
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Am. J. Trop. Med. Hyg. · Jun 1995
Snake bites by the Papuan taipan (Oxyuranus scutellatus canni): paralysis, hemostatic and electrocardiographic abnormalities, and effects of antivenom.
One hundred sixty-six patients with enzyme immunoassay-proven bites by taipans (Oxyuranus scutellatus canni) were studied in Port Moresby, Papua New Guinea. One hundred thirty-nine (84%) showed clinical evidence of envenoming: local signs were trivial, but most developed hemostatic disorders and neurotoxicity. The blood of 77% of the patients was incoagulable and 35% bled spontaneously, usually from the gums. ⋯ However, early antivenom treatment was associated statistically with decreased incidence and severity of neurotoxic signs. The low case fatality rate of 4.3% is attributable mainly to the use of mechanical ventilation, a technique rarely available in Papua New Guinea. Earlier use of increased doses of antivenoms of improved specificity might prove more effective.
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Am. J. Trop. Med. Hyg. · Mar 1995
Efficacy of antivenom therapy for neutralizing circulating venom antigens in patients stung by Tityus serrulatus scorpions.
Enzyme-linked immunosorbent assays for detection of Tityus serrulatus venom antigen and of horse anti-T. serrulatus venom antibodies were carried out before antivenom treatment and at 1, 6, 12, and 24 hr after antivenom therapy in 18 patients with systemic manifestations following T. serrulatus scorpion sting. Increased levels of circulating venom antigens were detected in the patients before antivenom treatment, but were no longer detected 1 hr after specific antivenom therapy. ⋯ The cardiorespiratory manifestations disappeared 6-24 hr after the administration of antivenom and all patients recovered completely. This study demonstrates the efficacy of antivenom therapy in neutralizing circulating venom antigens and supports the prompt administration of a potent antivenom to patients with systemic manifestations of envenoming.