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Overview :
Geraghty et al describe a case of severe falciparum malaria in
a patient being treated with infliximab for rheumatoid arthritis. Infliximab is
an antibody to tumor necrosis factor (TNF-alpha) and its has been associated
with a number of serious opportunistic infections.
Features of overwhelming falciparum malaria:
(1) cerebral malaria with depressed mental status and seizures
(2) parasitemia > 50%
(3) severe anemia and thrombocytopenia
Recommendations for a patient receiving an antibody to
TNF-alpha:
(1) Avoid regions
where falciparum malaris can be acquired.
(2) Take extensive
precautions against exposure to mosquitoes (repellants, mosquito nets at night,
etc.)
(3) Take suitable
chemoprophylaxis against malaria.
(4) Monitor health
during and after the trip, with prompt medical evaluation of fever or other
symptoms.
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