We report a case of 40-year-old with chloroquine- and mefloquine-resistant Plasmodium falciparum. He had a single grand mal seizure 37 days following retreatment with quinine intravenously, which resulted in rapid clearance of fever and parasitemia, in addition to mefloquine. He had a long history of seizures, which were well controlled by phenytoin. Because he has never had such a seizure before and computerized tomographic scanning of the brain after admission showed no abnormal findings which caused convulsions, it seemed to be an adverse reaction caused by antimalarial drugs. It is possible that a double or triple combination treatment for the emergence of multiresistant falciparum malaria might more frequently produce severe side effects, such as psychiatric reactions and convulsions. This case suggests that physicians must have a long follow-up period for chronic toxicity of antimalarial drugs, especially after using drug combinations for falciparum malaria.

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The efficacy, safety and usefulness of murine anti-endotoxin monoclonal IgM antibody "E5, an intravenous dose of 2 mg/kg" were evaluated in 88 patients with suspected Gram-negative sepsis from 37 institutes in Japan. Out of these, 74 patients were evaluable for the efficacy, 85 for safety and 75 for clinical usefulness. In assessing the efficacy, the patients were divided into 3 groups based on the plasma endotoxin levels (Endospecy with new PCA treatment of plasma): H group with a level of above 9.8 pg/ml and M group with a level of 3.0-9.8 pg/ml and L group with a level of below 3.0 pg/ml. 1. The efficacy rates as assessed following administration of E5 were 73.1% in the H group, 70.4% in the M group and 38.1% in the L group being higher in the groups with significantly high plasma endotoxin levels. 2. In both the H and M groups in whom plasma endotoxin levels were significantly high, the majority of the patients showed rapid reduction of the levels after administration of E5. 3. In all groups, improvement in body temperature, pulse rate, blood TNF-alpha and blood IL-6 was observed after treatment with E5. In the H and M groups with an endotoxin level of > or = 3.0 pg/ml, improvement in platelet count as well as in CRP was noted. The H group showed also improvement in WBC. 4. Improvement in the shock score was noted in all the groups but was more outstanding in the H and M groups in the early stage of treatment. 5. Side effects were seen in 5 (5.9%) of 85 patients and all thought to be allergic in symptoms such as rash, itching, fever and flare. 6. The reaction to the prick test performed before administration of E5 was negative in all these 5 patients. For 3 of the 5 patients, anti-E5 IgE antibody was measured. In all of them, the IgE levels were higher than those of healthy controls. Also, in 47.6% of patients, an elevation of anti-E5 IgG antibody was noted two weeks after the administration. 7. Clinical laboratory abnormalities were observed in 3 (3.5%) of 85 patients. They were an elevation of S-GOT.S-GPT and lowering of BUN, increased Al-p and decreased CH50, increased neutrophilia (%) and were all slight in the degree of the changes. 8. The clinical usefulness of E5 was evaluated for 75 patients.(ABSTRACT TRUNCATED AT 400 WORDS)

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According to the statistics of protozoal and metazoal infected patients admitted to our hospital during 1965-1979, malaria was the most frequently encounted infection (104 cases) and filariasis (43), taeniasis saginata (29), diphillobothriasis latum (15), and giardiasis (8) followed in that order. Number of eosinophils were as follows. (Mean+ S.D./mm3) malaria: 69 79, toxoplasmosis: