FIS 98 Abstracts

SCHISTOSOMIASLS IN U.K. TRAVELLERS. .I. Salmon and E.L.C. Ong, Department of Infection and Tropical Medicine, Newcastle General Hospital, Newcastle-upon-Tyne, UK.

We retrospectively reviewed the medical notes of eleven patients with schistosomiasis. ‘The age range was 7-55 years and comprised of 6 males and 5 females. Countries visited included Mozambique, Malawi, South Africa, Botswana, Ghana, Namibia Tanzania and Papua New Guinea. The diagnosis of schistosomiasis was made by positive microscopy or histology, or a positive ELBA result in association with a raised eosinophil count which subsequently decreased with appropriate therapy. Ten cases had visited Malawi, none complained of “swimmer’s itch” Four patients w-ere symptom free and four complained of urinary symptoms. All patients had positive ELISA serum antibody results, Praziquantel was used successfully in 10/l 1 patients, one patient required metriphonate in addition.

MEFLOQUKNE PHARMACOKINETICS WHEN COMBINED WITH ARTESUNATE IN CHILDREN

WITH ACUTE FALCIPARUM MALARIA RN Price’ J Simpson *, F Nosten ‘,*, NJ White ‘. Shoklo Malaria -1 Research Unit, Thailand ’ Nuftield Department of Clinical Medicine, John Radcliffe Hospital. Headington, Oxford, UK ’

A three day course of artesunate combined with mefloquine is now the treatment of choice for uncomplicated multi-drug resistant falciparum malaria on the western or eastern borders of Thailand. In order to optimise mefloquine administration in this combination, a large prospective study of mefloquine pharmacokinetics was conducted in 120 children with acute falciparum malaria. The patients all received artesunate 4mg/kg/day for 3 days and mefloquine as either (A) single dose (25mg/kg) on day 2 with food, (B) split dose: 15 mg/kg day 2 and lOmg/kg on day 3 with food, (C) single dose (25mgikg) on day 0 without food, or (D) single dose (25mg/kg) on day 2 without food. When mefloquine administration was delayed until day 2 the oral bioavailability was increased by a mean of 72% [95% confidence interval: 36% to 109%] compared to administration on admission. On day 2 coadministration with food did not increase mefloquine absorption significantly, and there were no significant differences between split and single dose administration. In combination with artesunate, mefloquine administration should be delayed until the second or third day aRer presentation.

TRAVEL HEALTH ADVICE FOR UK MEDICAL STUDENTS ON OVERSEAS ELECTIVE STUDY PERIODS. Moss PJ, Beeching NJ, Dept. of Tropical Medicine, Liverpool School of Tropical Medicine

Objective: To assess the provision of travel health advice and support provided by UK medical schools for students spending elective study periods abroad. Design: Postal questionnaire to all UK medical Schools, with telephone follow up. Results: Completed questionnaires were received from 21126 (81%) of medical schools. 17121 (81%) respondents gave pre- travel advice but the quality and the form in which it was given varied considerably between schools. 10/2 1 (48%) schools made no checks to ensure that students had taken appropriate prophylactic measures before travelling. Few schools had considered the provision of post-exposure prophylaxis in the event of possible exposure to HIV infection Conclusions: Many medical students are going on overseas elective study periods as part of their training, without necessarily receiving adequate information about the relevant health hazards. Very few elective students working in the developing world would have ready access to counselling and post- exposure prophylaxis in the event of occupational exposure to HIV. There is a need for national guidelines to ensure that all students are given adequate advice and prophylaxis before travelling abroad on elective study periods

THE PATHOPHYSIOLOGICAL AND PROGNOSTIC SIGNIFICANCE OF ACIDOSIS IN SEVERE ADULT PALARIA. N. Day’, N. Phu2: T. Hien’ and N. White’. Nuffield Department of Medicine, Oxford University,

Oxford, UK, and 2Centre for Tropical Diseases, Ho Chi Minh City, Viet Nam.

Baseline acid-base studies including arterial blood gases were performed on 296 consecutive Vietnamese adults with severe falciparum malaria, of whom 49 (17%) died. Overall 198 (67%) were acidotic (standard base deficit (SBD) > 3.3 mmol/L or metabolic acidosis, of w R

CO2 > 6 kPa); 195 of these had a om 62 had inadequate respiratory

compensation with a pHc7.35, and 3 had a respiratory acidosis (2 with metabolic compensation). Hyperlactataemia (venous lactate >4 mmol/L) occurred in 86 patients (30%), and was significantly associated with acidosis (89% of hyperlactataemic patients had a metabolic acidosis). Hyperlactataemia, metabolic acidosis (SBD>3.3), and acidaemia (pHc7.35) were all strongly positively associated with fatal outcome (relative risks (95% CI) 4.3 (1.8 to 10.6), 5.0 (3.0 to 8.1) and 2.7 (1.8 to 4.1) respectively). The overall median (IQR) lactate:pyruvate ratio was raised at 30.6 (20.6 - 62.3) (normal range <15) suggesting hypoxia and anaerobic glycolysis, and was significantly higher in fatal cases (p<O.OOOl). In a multivariate model the two &ain contributors to metabolic acidosis were creatinine, as a measure of renal dysfunction, and lactate, together accounting for 56% of the variance in SBD. In univariate analyses they contributed 30% and 26% respectively. These results confirm the importance of acidosis in the patho hysiology .of severe adult malaria, and suggest a

.P . multi actonal aetIology involving both tissue hypoxia and impaired renal handling of bicarbonate.