RESUMO
Since its introduction to the market in 1985, mefloquine has been used for malaria chemoprophylaxis by more than 35 million travellers. In Europe, in 2014, the European Medicines Agency (EMA) issued recommendations on strengthened warnings, prescribing checklists and updates to the product information of mefloquine. Some malaria prevention advisors question the scientific basis for the restrictions and suggest that this cost-effective, anti-malarial drug will be displaced as a first-line anti-malaria medication with the result that vulnerable groups such as VFR and long-term travellers, pregnant travellers and young children are left without a suitable alternative chemoprophylaxis. This commentary looks at the current position of mefloquine prescribing and the rationale of the new EMA recommendations and restrictions. It also describes the new recommendations for malaria prophylaxis that have been adapted by Switzerland, Germany, Austria and Italy where chemoprophylaxis use is restricted to high-risk malaria-endemic areas.
Assuntos
Antimaláricos , Malária , Mefloquina , Antimaláricos/uso terapêutico , Quimioprevenção/métodos , Contraindicações , Europa (Continente) , Humanos , Malária/tratamento farmacológico , Malária/prevenção & controle , Mefloquina/uso terapêuticoRESUMO
Mansonella perstans is rarely pathogenic. The rare reports of symptomatic cases, however, include severe complications. Three cases of symptomatic hypereosinophilia with multi-organ involvement are described in a missionary family returning from tropical Africa. Pathogenicity may be related to the induction of hypereosinophilia rather than direct host-parasite interactions.
Assuntos
Filaricidas/uso terapêutico , Síndrome Hipereosinofílica/etiologia , Mansonella/isolamento & purificação , Mansonelose/complicações , Insuficiência da Valva Mitral/etiologia , Adolescente , Adulto , Animais , Criança , Feminino , Próteses Valvulares Cardíacas , Humanos , Síndrome Hipereosinofílica/sangue , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/parasitologia , Ivermectina/uso terapêutico , Masculino , Mansonella/efeitos dos fármacos , Mansonella/imunologia , Mansonelose/sangue , Mansonelose/tratamento farmacológico , Missionários , Insuficiência da Valva Mitral/cirurgia , Prednisolona/uso terapêutico , Missões Religiosas , Viagem , Resultado do TratamentoRESUMO
An 11-year-old boy with severe mitral regurgitation due to hypereosinophilia caused by infection with a filaria (Mansonella perstans) required mitral valve replacement with a prosthetic valve. During recurrent postoperative hypereosinophilia, the patient experienced severe mitral stenosis due to thrombosis of the mitral prosthesis. Despite adequate anticoagulation, the prosthesis had to be replaced as an emergency with a second prosthetic valve. Permanent control of the eosinophil count was achieved with chronic oral steroid administration. In contrast to other microfilariae, M. perstans is non-pathogenic to humans; nevertheless, longstanding hypereosinophilia may lead to severe cardiac involvement endangering the patient's life.