Case management

Provides an overview of methods of diagnosis, treatment and patient care in complex emergencies. This chapter: ■ provides guidelines for initial management, including emergency triage – for the rapid identifi cation and treatment of patients at greatest risk of dying – and clinical assessment ■ discusses confi rmatory diagnosis of malaria using microscopy and rapid diagnostic tests (RDTs) ■ outlines factors that determine the choice of antimalarial drug ■ describes antimalarial drug treatment for uncomplicated malaria, subsequent follow-up, and the management of treatment failures ■ describes the assessment and treatment of anaemia ■ describes the treatment of severe P. falciparum malaria and its associated complications, including resuscitation, treatment with antimalarial drugs, and nursing care ■ provides guidance on the prevention and treatment of malaria in special groups (pregnant women, malnourished patients, returning refugees and displaced persons)

Structural flexibility in the Burkholderia mallei genome

The complete genome sequence of Burkholderia mallei ATCC 23344 provides insight into this highly infectious bacterium's pathogenicity and evolutionary history. B. mallei, the etiologic agent of glanders, has come under renewed scientific investigation as a result of recent concerns about its past and potential future use as a biological weapon. Genome analysis identified a number of putative virulence factors whose function was supported by comparative genome hybridization and expression profiling of the bacterium in hamster liver in vivo. The genome contains numerous insertion sequence elements that have mediated extensive deletions and rearrangements of the genome relative to Burkholderia pseudomallei. The genome also contains a vast number (>12,000) of simple sequence repeats. Variation in simple sequence repeats in key genes can provide a mechanism for generating antigenic variation that may account for the mammalian host's inability to mount a durable adaptive immune response to a B. mallei infection