Summary
Myalgic encephalomyelitis is a common disability but frequently misinterpreted. Amongst 6,000 patients referred for general microbiological diagnosis between 1975 and 1987, 420 cases were recognized. Coxsackie B neutralization tests, in 205 of these, demonstrated significant titres in 103/205 (50%), while of 124 additionally investigated for enteroviral IgM, 38/124 (31%) were positive. This illness is distinguished from a variety of other post-viral states by an unique clinical and epidemiological pattern characteristic of enteroviral infection. Prompt recognition and advice to avoid over-exertion is mandatory. Routine diagnosis, specific therapy and prevention, await further technical advances.
of mefloquine the cure rate was a remarkable 100°o. Our results indicate that at least 12 hours should elapse between the last dose of quinine and the dose of mefloquine to minimise gastrointestinal side effects. All the patients except two received 1-5 g mefloquine. The other two patients responded well although they received only 1-0 g. Possibly the quininemefloquine regimen will prove to be just as effective and less toxic using the lower dose of mefloquine. The fact that no repeat attacks of falciparum 'malaria occurred during follow up in the patients who received quinine-mefloquine suggests that repeat attacks after the other regimens were recrudescences and not reinfections.Sequential treatment with quinine and Fansidar is the most effective regimen using drugs that are, at the moment, commercially available. In this and a previous study,4 quinineFansidar had a 960' (342/357) cure rate. With both quininemefloquine and quinine-Fansidar at least four doses of quinine were needed to produce a consistently rapid clinical improvement. To achieve a virtually 100%' cure rate with quinineFansidar at least 10 doses of quinine would be required.The method developed in our studies of using mefloquine or Fansidar after a course of quinine receives support from studies by Peters et al of malaria in rodents.11 They concluded that mefloquine may with time lose its effectiveness against chloroquine-resistant malaria parasites and that by using it in combination with other antimalarial drugs its useful life could be extended. Sequential quinine-mefloquine is the most effective treatment yet tested for chloroquine-resistant falciparum malaria of all degrees of severity, and mefloquine alone will prove valuable for the single-dose treatment of mild falciparum malaria.6
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