Chloroquine Health Dictionary

An antimalarial related to quinine, tetracycline and halofantrine used to suppress blood parasites, especially chloroquine resistant strains of Plasmodium falciparum. There has been increasing resistance to mefloquine reported in malaria due to Plasmodium falciparum.... mefloquine

A parasitic disease caused by four species of PLASMODIUM: P. falciparum, P. vivax, P. ovale, and P. malariae. Clinically, malaria is characterised by recurrent episodes of high fever, sometimes associated with RIGOR; enlargement of the SPLEEN is common. P. falciparum infection can also be associated with several serious – often fatal – complications (see below): although other species cause chronic disease, death is unusual.

During a bite by the female mosquito, one or more sporozoites – a stage in the life-cycle of the parasite – are injected into the human circulation; these are taken up by the hepatocytes (liver cells). Following division, merozoites (minute particles resulting from the division) are liberated into the bloodstream where they invade red blood cells. These in turn divide, releasing further merozoites. As merozoites are periodically liberated into the bloodstream, they cause the characteristic fevers, rigors, etc.

Malaria occurs in many tropical and subtropical countries; P. falciparum is, however, con?ned very largely to Africa, Asia and South America. Malaria is present in increasingly large areas; in addition, the parasites are developing resistance to various preventative and treatment drugs. The disease constitutes a signi?cant problem for travellers, who must obtain sound advice on chemoprophylaxis before embarking on tropical trips – especially to a rural area where intense transmission can occur. Transmission has also been recorded at airports, and following blood transfusion.

The World Health Organisation (WHO) has listed malaria as one of Europe’s top ten infectious diseases. In 1992, 20,000 cases were reported: this had risen to more than 200,000 by the late 1990s. The resurgence of malaria has been worldwide, in part the result of the development of resistant strains of the disease, and in part because many countries have failed (or been unable) to implement environmental measures to eliminate mosquitoes. Nearly 40 years ago the WHO forecast that by 1980 only four million people would be affected worldwide; now, at the beginning of the 21st century, around 500 million people a year are contracting malaria with about 3,000 people a day dying from the infection – as many as 70 per cent of them children under the age of ?ve, according to WHO ?gures. The apparently steady advance of global warming means that countries with temperate climates may well warm up su?ciently to enable malaria to become established as an ENDEMIC disease. In any case, the great increase in international air travel has exposed many more people to the risk of malaria, and infected individuals may not exhibit symptoms until they are back home. Doctors seeing a recent traveller with unexplained pyrexia and illness should consider the possibility of malarial infection.

Diagnosis is by demonstration of trophozoites – a stage in the parasite’s life-cycle that takes place in red blood cells – in thick/thin blood-?lms of peripheral blood. Serological tests are of value in deciding whether an individual has had a past infection, but are of no value in acute disease.

P. vivax and P. ovale infections cause less severe disease than P. falciparum (see below), although overall there are many clinical similarities; acute complications are unusual, but chronic ANAEMIA is often present. Primaquine is necessary to eliminate the exoerythrocytic cycle in the hepatocyte (liver cell).

P. falciparum Complications of P. falciparum infection include cerebral involvement (see BRAIN – Cerebrum), due to adhesion of immature trophozoites on to the cerebral vascular endothelium; these lead to a high death rate when inadequately treated. Renal involvement (frequently resulting from HAEMOGLOBINURIA), PULMONARY OEDEMA, HYPOTENSION, HYPOGLYCAEMIA, and complications in pregnancy are also important. In complicated disease, HAEMODIALYSIS and exchange TRANSFUSION have been used. No adequate controlled trial using the latter regimen has been carried out, however, and possible bene?ts must be weighed against numerous potential side-effects – for instance, the introduction of a wide range of infections, overload of the circulatory system with infused ?uids, and other complications.

P. malariae usually produces a chronic infection, and chronic renal disease (nephrotic syndrome) is an occasional sequel, especially in tropical Africa.

Gross SPLENOMEGALY (hyper-reactive malarious splenomegaly, or tropical splenomegaly syndrome) can complicate all four human Plasmodium spp. infections. The syndrome responds to long-term malarial chemoprophylaxis. BURKITT’S LYMPHOMA is found in geographical areas where malaria infection is endemic; the EPSTEIN BARR VIRUS is aetiologically involved.

Prophylaxis Malaria specialists in the United Kingdom have produced guidance for residents travelling to endemic areas for short stays. Drug choice takes account of:

risk of exposure to malaria;

extent of drug resistance;

e?cacy of recommended drugs and their side-effects;

criteria relevant to the individual (e.g. age, pregnancy, kidney or liver impairment). Personal protection against being bitten by

mosquitoes is essential. Permethrinimpregnated nets are an e?ective barrier, while skin barrier protection and vaporised insecticides are helpful. Lotions, sprays or roll-on applicators all containing diethyltoluamide (DEET) are safe and work when put on the skin. Their e?ect, however, lasts only for a few hours. Long sleeves and trousers should be worn after dark.

Drug prophylaxis should be started at least a week before travelling into countries where malaria is endemic (two or three weeks in the case of me?oquine). Drug treatment should be continued for at least four weeks after leaving endemic areas. Even if all recommended antimalarial programmes are followed, it is possible that malaria may occur any time up to three months afterwards. Medical advice should be sought if any illness develops. Chloroquine can be used as a prophylactic drug where the risk of resistant falciparum malaria is low; otherwise, me?oquine or proguanil hydrochloride should be used. Travellers to malaria-infested areas should seek expert advice on appropriate prophylactic treatment well before departing.

Treatment Various chemoprophylactic regimes are widely used. Those commmonly prescribed include: chloroquine + paludrine, me?oquine, and Maloprim (trimethoprim + dapsone); Fansidar (trimethoprim + sulphamethoxazole) has been shown to have signi?cant side-effects, especially when used in conjunction with chloroquine, and is now rarely used. No chemotherapeutic regimen is totally e?ective, so other preventive measures are again being used. These include people avoiding mosquito bites, covering exposed areas of the body between dusk and dawn, and using mosquito repellents.

Chemotherapy was for many years dominated by the synthetic agent chloroquine. However, with the widespread emergence of chloroquine-resistance, quinine is again being widely used. It is given intravenously in severe infections; the oral route is used subsequently and in minor cases. Other agents currently in use include me?oquine, halofantrine, doxycycline, and the artemesinin alkaloids (‘qinghaosu’).

Researchers are working on vaccines against malaria.... malaria

A drug used to treat vivax and ovale malaria. It is often given after prophylactic treatment with chloroquine has failed to prevent infection.

Adverse effects include nausea, vomiting, and abdominal pain. In people with G6PD deficiency, primaquine may cause haemolytic anaemia.... primaquine

Linn.

Family: Berberidaceae.

Habitat: Distributed in Northwestern Himalayas.

English: Common Barberry, True Barberry.

Ayurvedic: Daruharidraa (var.).

Folk: Chatrod, Kashmal.

Action: Root and bark—used for ailments of gastrointestinal tract, liver, gallbladder, kidney and urinary tract, respiratory tract, also as a febrifuge and blood purifier.

Key application: Listed by German Commission E among unapproved herbs.

An extract with 80% berberine and additional alkaloids stimulated the bile secretion of rats by 72%. (PDR.) As cholagogue. (The British Herbal Pharmacopoeia.)

The main alkaloid is berberine (well tolerated up to 0.5 g). Berries are safe.

Bererine in small doses stimulates the respiratory system; poisonings have been observed from overdoses. Poisonings from the total herb have not been reported. (German Commission E.)

Berberine is bactericidal, amoebici- dal and trypanocidal. Berberine is an- tidiarrhoeal, asitentersinto the cytosol or binds to the cell membrane and inhibits the catalytic unit of andenylate cyclase. It is active in vitro and in animals against cholera.

Berberine stimulates bile secretion and shows sedative, hypotensive, anti- convulsant and uterine stimulant activity in animals. Alkaloid bermarine is also strongly antibacterial. It has been shown to increase white blood cell and platelet counts in animals with iatro- genic leukocytopaenia.

Berberine, berbamine and jatror- rhizine are hypotensive and sedative.

Many of the alkaloids are antineo- plastic.

The alkaloid berbamine (50 mg three times daily for 1-4 weeks) helped reverse leukopaenia induced by benzene, cancer chemotherapy or radiotherapy in a clinical study. (Francis Brinker.)

Berberine, when combined with pyrimethamine, was more effective than combinations with other antibiotics in treating chloroquine-resistant malaria. (Sharon M. Herr.)... berberis vulgaris

Miers.

Synonym: C. peltata Hook. F & Thoms.

Family: Menispermaceae.

Habitat: Throughout South and East India and in the Andaman and Nicobar Islands.

Ayurvedic: Raaj-Paathaa (bigger var. of Paathaa, Cissampelos pareira Linn.).

Siddha/Tamil: Para.

Action: Roots—used in smallpox, bone fractures, malarial fever, jaundice, stomachache.

The root yielded tetrandrine as the major alkaloid. Tetrandrine (0.1 g/day) was found effective in the treatment of chloroquine resistant malaria.

Tetrandrine possesses cytotoxic and immunomodulatory properties and is indicated in the treatment of chronic inflammatory diseases. It shows an- tihypertensive, cardiac depressant and vasodilator effect. It also exhibits antiallergic activity.... cyclea arnotii

See also Tefanoquine. An anti-relapse drug used to prevent relapses in malaria due to Plasmodium vivax or P. ovale. When used with a chemotherapeutic drug such as chloroquine for these malaria species, it thus can achieve a radical cure.... etaquine

Disease caused by the liver ?uke, Fasciola hepatica. This is found in sheep, cattle and other herbivorous animals, in which it is the cause of the condition known as liver rot. It measures about 35 × 13 mm, and is transmitted to humans from the infected animals by snails. In Britain it is the most common disease found in animal slaughterhouses. The danger to humans is in eating vegetables – particularly wild watercress – that have been infected by snails; there have been several outbreaks of fascioliasis in Britain due to eating contaminated wild watercress, and much larger outbreaks from the same cause have been reported in France. The disease is characterised by fever, dyspepsia (indigestion), heavy sweating, loss of appetite, abdominal pain, URTICARIA, and a troublesome cough. In the more serious cases there may be severe damage to the LIVER, with or without JAUNDICE. The diagnosis is clinched by the ?nding of the eggs of the ?uke in the stools. The two drugs used in treatment are bithionol and chloroquine. Even though many cases are quite mild and recover spontaneously, prevention is particularly important. This consists primarily of never eating wild watercress, as this is the main cause of infestation. Lettuces have also been found to be infested.... fascioliasis

The latent liver forms in Plasmodium vivax and P.ovale which give rise to clinical relapses of malaria byinvasion of the circulating erythrocytes.The hypnozoites are not eliminated by the usual chemotherapeutic drugs used in the treatment of malaria (chloroquine, quinine etc) and to achieve a radical cure in these relapsing malarias an antirelapse drug must be added to the treatment regime (e.g. primaquine or etaquine/Tefanoquine).... hypnozoite

A tropical disease found mainly in the Far East. It is caused by infections of the lungs by a parasitic ?uke called Paragonimus westermani. The infection is acquired by eating insu?ciently cooked shell?sh. The affected person has symptoms similar to those of chronic BRONCHITIS; treatment is with the drugs CHLOROQUINE and bithionol.... paragonimiasis

A synthetic antimalarial drug usually used with CHLOROQUINE to prevent infection with MALARIA. Occasionally the drug is used to treat uncomplicated falciparum malaria in combination with atovaquone.... proguanil hydrochloride

The greying or whitening of hair which takes place with age is due to a loss of its pigment, MELANIN, and the collection of air bubbles in the shaft of the hair. There is no evidence that hair ever goes white overnight, whether in response to shock, strain or any other cause. Rapid whitening may occur patchily in a matter of days, but it is more often a matter of weeks or months. In the more rapid cases the cause is thought to be a form of ALOPECIA in which the dark hairs which fall out are replaced by white hairs. An alternative cause is VITILIGO. Certain drugs, including mephenesin and CHLOROQUINE, may also cause whitening of the hair.... white hair

A clinical state arising from invasive colo-rectal disease; it is accompanied by abdominal colic, diarrhoea, and passage of blood/mucus in the stool. Although the two major forms are caused by Shigella spp. (bacillary dysentery) and Entamoeba histolytica (amoebic dysentery), other organisms including entero-haemorrhagic Escherichia coli (serotypes 0157:H7 and 026:H11) and Campylobacter spp. are also relevant. Other causes of dysentery include Balantidium coli and that caused by schistosomiasis (bilharzia) – Schistosoma mansoni and S. japonicum infection.

Shigellosis This form is usually caused by Shigella dysenteriae-1 (Shiga’s bacillus), Shigella ?exneri, Shigella boydii, and Shigella sonnei; the latter is the most benign and occurs in temperate climates also. It is transmitted by food and water contamination, by direct contact, and by ?ies; the organisms thrive in the presence of overcrowding and insanitary conditions. The incubation is between one and seven days, and the severity of the illness depends on the strain responsible. Duration of illness varies from a few days to two weeks and can be particularly severe in young, old, and malnourished individuals. Complications include perforation and haemorrhage from the colo-rectum, the haemolytic uraemic syndrome (which includes renal failure), and REITER’S SYNDROME. Diagnosis is dependent on demonstration of Shigella in (a) faecal sample(s) – before or usually after culture.

If dehydration is present, this should be treated accordingly, usually with an oral rehydration technique. Shigella is eradicated by antibiotics such as trimethoprimsulphamethoxazole, trimethoprim, ampicillin, and amoxycillin. Recently, a widespread resistance to many antibiotics has developed, especially in Asia and southern America, where the agent of choice is now a quinolone compound, for example, cipro?oxacin; nalidixic acid is also e?ective. Prevention depends on improved hygiene and sanitation, careful protection of food from ?ies, ?y destruction, and garbage disposal. A Shigella carrier must not be allowed to handle food.

Entamoeba histolytica infection Most cases occur in the tropics and subtropics. Dysentery may be accompanied by weight loss, anaemia, and occasionally DYSPNOEA. E. histolytica contaminates food (e.g. uncooked vegetables) or drinking water. After ingestion of the cyst-stage, and following the action of digestive enzymes, the motile trophozoite emerges in the colon causing local invasive disease (amoebic colitis). On entering the portal system, these organisms may gain access to the liver, causing invasive hepatic disease (amoebic liver ‘abscess’). Other sites of ‘abscess’ formation include the lungs (usually right) and brain. In the colo-rectum an amoeboma may be di?cult to di?erentiate from a carcinoma. Clinical symptoms usually occur within a week, but can be delayed for months, or even years; onset may be acute – as for Shigella spp. infection. Perforation, colo-rectal haemorrhage, and appendicitis are unusual complications. Diagnosis is by demonstration of E. histolytica trophozoites in a fresh faecal sample; other amoebae affecting humans do not invade tissues. Research techniques can be used to di?erentiate between pathogenic (E. dysenteriae) and non-pathogenic strains (E. dispar). Alternatively, several serological tests are of value in diagnosis, but only in the presence of invasive disease.

Treatment consists of one of the 5nitroimidazole compounds – metronidazole, tinidazole, and ornidazole; alcohol avoidance is important during their administration. A ?ve- to ten-day course should be followed by diloxanide furoate for ten days. Other compounds – emetine, chloroquine, iodoquinol, and paromomycin – are now rarely used. Invasive disease involving the liver or other organ(s) usually responds favourably to a similar regimen; aspiration of a liver ‘abscess’ is now rarely indicated, as controlled trials have indicated a similar resolution rate whether this technique is used or not, provided a 5-nitroimidazole compound is administered.... dysentery

Lichen, or licheni?cation, is a term used to describe a thickening of chronically in?amed skin to give a tree-bark-like appearance.

Lichen simplex (neurodermatitis) is a form of eczema (see DERMATITIS) perpetuated by constant rubbing of the affected skin. Typically, well-de?ned plaques occur on one or both sides of the nape of the neck, on the ulnar forearm near the elbow, or on the sides of the calves. It is often associated with emotional stress.

Lichen planus is a less common in?ammation of the skin characterised by small, shiny, ?at-topped violaceous papules which may coalesce to form large plaques. Itching can be intense. Typically seen on the ?exor aspects of the wrists, the lower back and on the legs below the knees, it may also affect the mucous membranes of the mouth and lips. The cause is unknown. While in some patients the disorder appears to be nervous or emotional in origin, it can be caused by certain drugs such as CHLOROQUINE. Severe cases may require oral CORTICOSTEROIDS to control the eruption.... lichen

Drugs used to treat malaria. One antimalarial drug, chloroquine, is also used to treat arthritis.... antimalarial drugs

A group of drugs used to treat rheumatoid arthritis and types of arthritis that are caused by other autoimmune disorders such as systemic lupus erythematosus.

Antirheumatic drugs affect the disease process and may limit joint damage, unlike nonsteroidal anti-inflammatory drugs, which only relieve pain and stiffness.

The main antirheumatic drugs are corticosteroid drugs, immunosuppressant drugs, chloroquine, gold, penicillamine, and sulfasalazine.

Many of these drugs can have serious side effects, and treatment must be under specialist supervision.... antirheumatic drugs

n. a drug similar to *chloroquine, used mainly to treat lupus erythematosus and rheumatoid arthritis (see disease-modifying antirheumatic drug). Side-effects such as skin reactions, headache, and digestive upsets may occur and prolonged use can lead to eye damage.... hydroxychloroquine

n. any abnormality of the *macula of the eye. For example, bull’s-eye maculopathy describes the appearance of the macula in some toxic conditions (e.g. chloroquine toxicity) and in some hereditary disorders of the macula. See also epiretinal membrane.... maculopathy

Inner ear disorder. Constriction of cerebral blood vessels (vasospasm) increases pressure of fluids in the balancing mechanism. Ages 40-60; more in men.

Etiology. Obscure; though cases may be traced to auto-toxaemia, Vitamin B deficiency, menstruation, malaria drugs (chloroquine).

Symptoms: dizziness, nausea, vomiting, tinnitus, sound distortions, heavy sweating, loss of hearing; usually in one ear only. Early diagnosis essential for effective treatment. This may mean reference to a department of otolaryngology or otoneurology.

Treatment. Antispasmodics. Nervines. Sometimes a timely diuretic reduces severity – Uva Ursi, Dandelion root, Wild Carrot.

Alternatives. Current European practice: Betony, German Chamomile, Passion flower, Hawthorn, Hops, Feverfew, White Willow.

Tea. Combine, equal parts: Valerian, Wild Carrot, Agrimony. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup every 2 hours during attack; thrice daily thereafter.

Decoction. Mistletoe: 2 teaspoons to each cup cold water steeped overnight. Bring to boil. Allow to cool. Half-1 cup, as above.

Tablets/capsules. Feverfew, Mistletoe, Prickly Ash.

Formula. Ginkgo 2; Dandelion 1; Black Cohosh 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Feverfew tincture. See: FEVERFEW.

Dr J. Christopher: inject into ears, at night, few drops oil of Garlic (or contents of Garlic capsule).

Cider vinegar. 2 teaspoons to glass water: as desired.

Aromatherapy. Inhalants: Eucalyptus or Rosemary oils.

Diet: gluten-free, low salt; good responses observed. High fibre. Avoid dairy products and chocolate. Vitamins: B-complex, B1; B2; B6; E; F. Brewer’s yeast, Niacin.

Minerals: Calcium. Magnesium. Phosphorus. Dolomite. ... meniere’s disease

n. a drug that kills malaria parasites and is used in combination with atovaquone for the prevention and treatment of malignant (falciparum) *malaria. Alone or (more usually) in combination with *chloroquine, it may be used for the prevention of malaria. It rarely causes side-effects.... proguanil