Le paludisme; immuables paramètres de la transmission et grandissants problèmes de traitement

Malaria, steadfast transmission parameters, increasing problems of treatment. Details of the cycle of human plasmodia are given in order to analyse the circumstances of transmission of these parasites in relation to their geographical distribution and to drug- (particularly chloroquine-) resistance of P. falciparum. The occurence of this phenomenon, recent in Africa, more remote in Asia and South America, causes much concern among health workers, because alternative treatments can only rely on associations of known drugs or their prolongea administration. Chloroquine remains however the basis of all prophylactic schemes. Paludrine is added in regions where resistance occurs. Fansidar and Maloprim, even in a weekly administration are not advised for long term use, because of the possible occurence of severe secondary effects. Quinine is the basis of curative schemes in case of chloroquine resistance. It can be associated with a single dose of Fansidar or with tetracyclin antibiotics. Parenteral administration are to be used in severe cases (cerebral malaria) or in cases of severe digestive disturbances (vomiting, diarrhoea).