151
|
Datta D, Conroy AL, Castelluccio PF, Ssenkusu JM, Park GS, Opoka RO, Bangirana P, Idro R, Saykin AJ, John CC. Elevated Cerebrospinal Fluid Tau Protein Concentrations on Admission Are Associated With Long-term Neurologic and Cognitive Impairment in Ugandan Children With Cerebral Malaria. Clin Infect Dis 2021; 70:1161-1168. [PMID: 31044219 DOI: 10.1093/cid/ciz325] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Elevated concentrations of cerebrospinal fluid (CSF) tau, a marker of axonal injury, have been associated with coma in severe malaria (cerebral malaria [CM]). However, it is unknown whether axonal injury is related to long-term neurologic deficits and cognitive impairment in children with CM. METHODS Admission CSF tau concentrations were measured in 145 Ugandan children with CM and compared to clinical and laboratory factors and acute and chronic neurologic and cognitive outcomes. RESULTS Elevated CSF tau concentrations were associated with younger age, increased disease severity (lower glucose and hemoglobin concentrations, malaria retinopathy, acute kidney injury, and prolonged coma duration, all P < .05), and an increased CSF:plasma albumin ratio, a marker of blood-brain barrier breakdown (P < .001). Admission CSF tau concentrations were associated with the presence of neurologic deficits at hospital discharge, and at 6, 12, and 24 months postdischarge (all P ≤ .02). After adjustment for potential confounding factors, elevated log10-transformed CSF tau concentrations correlated with worse cognitive outcome z scores over 2-year follow-up for associative memory (β coefficient, -0.31 [95% confidence interval [CI], -.53 to -.10]) in children <5 years of age, and for overall cognition (-0.69 [95% CI, -1.19 to -.21]), attention (-0.78 [95% CI, -1.34 to -.23]), and working memory (-1.0 [95% CI, -1.68 to -.31]) in children ≥5 years of age (all P < .006). CONCLUSIONS Acute axonal injury in children with CM is associated with long-term neurologic deficits and cognitive impairment. CSF tau concentrations at the time of the CM episode may identify children at high risk of long-term neurocognitive impairment.
Collapse
Affiliation(s)
- Dibyadyuti Datta
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indianapolis
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indianapolis
| | - Peter F Castelluccio
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | | | - Robert O Opoka
- Departments of Paediatrics and Child Health, Kampala, Uganda
| | - Paul Bangirana
- Departments of Psychiatry, Makerere University, Kampala, Uganda
| | - Richard Idro
- Departments of Paediatrics and Child Health, Kampala, Uganda
| | - Andrew J Saykin
- Indiana Alzheimer Disease Center and Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indianapolis.,University of Minnesota Medical School, Minneapolis
| |
Collapse
|
152
|
Aliyu I, Ibrahim H, Idris U, Akhiwu H, Ibrahim U, Mohammed I, Michael G. A review of presentations and outcome of severe malaria in a tertiary hospital in northwestern Nigeria. SAHEL MEDICAL JOURNAL 2021. [DOI: 10.4103/smj.smj_44_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
153
|
Boushab BM, Ould Ahmedou Salem MS, Ould Mohamed Salem Boukhary A, Parola P, Basco L. Clinical Features and Mortality Associated with Severe Malaria in Adults in Southern Mauritania. Trop Med Infect Dis 2020; 6:tropicalmed6010001. [PMID: 33375214 PMCID: PMC7838900 DOI: 10.3390/tropicalmed6010001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Severe malaria in adults is not well-studied in Sahelian Africa. Clinical features and mortality associated with severe Plasmodium falciparum malaria in adult patients hospitalized in Kiffa, southern Mauritania, were analysed. Patients over 15 years old admitted for severe malaria between August 2016 and December 2019 were included in the present retrospective study. The World Health Organization (WHO) criteria were used to define severe malaria. The presenting clinical characteristics and outcome were compared. Of 4266 patients hospitalized during the study period, 573 (13.4%) had a positive rapid diagnostic test for malaria, and 99 (17.3%; mean age, 37.5 years; range 15–79 years; sex-ratio M/F, 2.1) satisfied the criteria for severe malaria. On admission, the following signs and symptoms were observed in more than one-fourth of the patients: fever (98%), impairment of consciousness (81.8%), multiple convulsions (70.7%), cardiovascular collapse (61.6%), respiratory distress (43.4%), severe anaemia ≤ 80 g/L (36.4%), haemoglobinuria (27.3%), and renal failure (25.3%). Patients were treated with parenteral quinine or artemether. Fourteen (14.1%) patients died. Multiple convulsions, respiratory distress, severe anaemia, haemoglobinuria, acute renal failure, jaundice, and abnormal bleeding occurred more frequently (p < 0.05) in deceased patients. Mortality due to severe falciparum malaria is high among adults in southern Mauritania. An adoption of the WHO-recommended first-line treatment for severe malaria, such as parenteral artesunate, is required to lower the mortality rate associated with severe malaria.
Collapse
Affiliation(s)
- Boushab Mohamed Boushab
- Department of Internal Medicine and Infectious Diseases, Kiffa Regional Hospital, Assaba, Mauritania;
| | - Mohamed Salem Ould Ahmedou Salem
- Unité de Recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, BP 5026, Nouakchott, Mauritania; (M.S.O.A.S.); (A.O.M.S.B.)
| | - Ali Ould Mohamed Salem Boukhary
- Unité de Recherche Génomes et Milieux, Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau Campus Universitaire, BP 5026, Nouakchott, Mauritania; (M.S.O.A.S.); (A.O.M.S.B.)
- Institut de Recherche pour le Développement (IRD), Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, 13005 Marseille, France;
- Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 13005 Marseille, France
| | - Philippe Parola
- Institut de Recherche pour le Développement (IRD), Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, 13005 Marseille, France;
- Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 13005 Marseille, France
| | - Leonardo Basco
- Institut de Recherche pour le Développement (IRD), Aix-Marseille Université, IRD, AP-HM, SSA, VITROME, 13005 Marseille, France;
- Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 13005 Marseille, France
- Correspondence:
| |
Collapse
|
154
|
Afolayan FM, Adedoyin OT, Abdulkadir MB, Ibrahim OR, Biliaminu SA, Mokuolu OA, Ojuawo A. Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels. Sultan Qaboos Univ Med J 2020; 20:e312-e317. [PMID: 33414935 PMCID: PMC7757922 DOI: 10.18295/squmj.2020.20.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. Methods This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. Results Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). Conclusion Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria.
Collapse
Affiliation(s)
- Folake M Afolayan
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olanrewaju T Adedoyin
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Mohammed B Abdulkadir
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olayinka R Ibrahim
- Department of Pediatrics, Federal Medical Centre, Katsina State, Nigeria
| | - Sikiru A Biliaminu
- Department of Chemical Pathology & Immunology, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Chemical Pathology & Immunology, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olugbenga A Mokuolu
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Ayodele Ojuawo
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| |
Collapse
|
155
|
Das D, Dahal P, Dhorda M, Citarella BW, Kennon K, Stepniewska K, Felger I, Chappuis F, Guerin PJ. A Systematic Literature Review of Microscopy Methods Reported in Malaria Clinical Trials. Am J Trop Med Hyg 2020; 104:836-841. [PMID: 33350371 PMCID: PMC7941839 DOI: 10.4269/ajtmh.20-1219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 12/04/2022] Open
Abstract
Microscopy of stained blood films is essential for the diagnosis of malaria, differentiation of parasite species, and estimation of parasite density performed for assessments of antimalarial drug efficacy. The accuracy and comparability of these measures over time and space are vital to discern the emergence or spread of antimalarial drug resistance. Although evidence-based guidelines for malaria microscopy methods exist, the age-old microscopy techniques for parasitological assessments are subject to considerable methodological variations. The purpose of this review was to explore critically how microscopy methods were reported in published malarial studies between 2013 and 2017 with the focus on outlining the methodological differences and improving reporting standards in practice.
Collapse
Affiliation(s)
- Debashish Das
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Prabin Dahal
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Mehul Dhorda
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Barbara Wanjiru Citarella
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Kalynn Kennon
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Kasia Stepniewska
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Ingrid Felger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Philippe J Guerin
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| |
Collapse
|
156
|
Rodriguez JA, Roa AA, Leonso-Bravo AA, Khatiwada P, Eckardt P, Lemos-Ramirez J. A Case of Plasmodium falciparum Malaria Treated with Artesunate in a 55-Year-Old Woman on Return to Florida from a Visit to Ghana. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926097. [PMID: 33341821 PMCID: PMC7760320 DOI: 10.12659/ajcr.926097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 55-year-old Final Diagnosis: Severe malaria Symptoms: Altered mental status • dyspnea • fever Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases
Collapse
Affiliation(s)
- Jose A Rodriguez
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Alejandra A Roa
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | | | - Pratik Khatiwada
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Paula Eckardt
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
| | - Juan Lemos-Ramirez
- Division of Infectious Diseases, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
| |
Collapse
|
157
|
Abstract
Community-acquired acute kidney injury (CA-AKI) is the dominant form of AKI encountered in developing countries in Asia. Economic disparities, variations in access to health care services, geographic conditions, environmental risk factors, and sociocultural circumstances shape the causes and outcomes of CA-AKI. Infections, drugs, plant and chemical toxins, envenomations, and obstetric complications are common causes of CA-AKI. Previously healthy young individuals who often work outdoors in fields or farms are exposed to a wide variety of work-related or environmental risk factors for CA-AKI. Improving disease definitions, better data, and evolving host-pathogen interactions have changed disease descriptions and presentations over the past 20 years. Among infections, although the incidence of malaria has decreased, the number of cases with dengue and scrub typhus have increased sharply. The recognition of AKI in relation to Plasmodium knowlesi, Plasmodium vivax, scrub typhus, and leptospirosis in areas not traditionally considered at risk, association of infections with the future development of chronic kidney disease, and the role of complement dysregulation in infection-associated AKI are important new findings. Snake-bite-related toxic envenomation continues to be an important cause of AKI in some counties and is a neglected public health problem. On the other hand, significant decreases in the incidence of AKI related to acute diarrheal illness or obstetric causes are signs of hope. Coordinated efforts between administrative stakeholders, society, and health care delivery services at all levels have the potential to propel research and improve outcomes in CA-AKI.
Collapse
Affiliation(s)
- Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India; School of Public Health, Imperial College, London, UK; Manipal Academy of Higher Education, Manipal, India.
| |
Collapse
|
158
|
Spontaneous Pathologic Splenic Rupture in a Patient with Plasmodium falciparum Infection, First Case Reported in Israel. Infect Dis Rep 2020; 12:121-126. [PMID: 33302479 PMCID: PMC7768459 DOI: 10.3390/idr12030022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 12/05/2022] Open
Abstract
Travelers exposed to malaria may develop severe disease and complications. A less well-known complication is spontaneous pathologic splenic rupture, which is still under-reported and has never been reported in Israel. In this paper, we report a 23 years old healthy young man presenting in the emergency department, two weeks after coming back from Sierra Leone, with intermittent fever, mild tachycardia and mild left upper quadrant abdominal pain. The patient was diagnosed with Plasmodium falciparum infection and developed rapidly after hospital admission spleen rupture. He was managed conservatively at first but ultimately underwent splenectomy after being hemodynamically unstable. In the recovery period, the patient developed acute respiratory distress syndrome and was reintubated. A high level of suspicion is recommended in every malaria patient presenting with left upper quadrant abdominal pain, even if minimal. Ultrasonography availability in the internal medicine department may be a critical diagnostic tool, especially in non-endemic areas.
Collapse
|
159
|
Uyoga S, Macharia AW, Ndila CM, Nyutu G, Shebe M, Awuondo KO, Mturi N, Peshu N, Tsofa B, Scott JAG, Maitland K, Williams TN. Glucose-6-phosphate dehydrogenase deficiency and susceptibility to childhood diseases in Kilifi, Kenya. Blood Adv 2020; 4:5942-5950. [PMID: 33275767 PMCID: PMC7724908 DOI: 10.1182/bloodadvances.2020003015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/09/2020] [Indexed: 01/26/2023] Open
Abstract
Few previous studies have reported the effects of glucose-6-phosphate dehydrogenase (G6PD)-deficiency on child health in Africa. We conducted a case-control study in which cases (n = 6829) were children admitted, for any reason, to Kilifi County Hospital, Kenya, while controls (n = 10 179) were recruited from the surrounding community. Cases were subclassified based on their clinical and laboratory findings at admission. We calculated the prevalence of specific diseases by G6PD c.202 genotype, the only significant cause of G6PD-deficiency in this area, then estimated the association between genotype and admission with specific conditions using logistic regression. Among neonates, the prevalence of jaundice was higher in both G6PD c.202T heterozygotes (40/88; 45.5%; P = .004) and homo/hemizygotes (81/134; 60.5%; P < .0001) than in wild-type homozygotes (157/526; 29.9%). Median bilirubin levels also increased across the groups, being highest (239 mmol/L; interquartile range 96-390 mmol/L) in G6PD c.202T homo/hemizygotes. No differences were seen in admission hemoglobin concentrations or the prevalence of anemia or severe anemia by G6PD c.202 genotype. On case control analysis, G6PD heterozygosity was negatively associated with all-cause hospital admission (odds ratio 0.81; 95% confidence interval 0.73-0.90; P < .0001) and, specifically, admission with either pneumonia or Plasmodium falciparum parasitemia; while, conversely, it was positively associated with Gram-positive bacteremia. G6PD c.202T homo/heterozygosity was positively associated with neonatal jaundice, severe pneumonia, the receipt of a transfusion, and in-patient death. Our study supports the conclusion that G6PD c.202T is a balanced polymorphism in which a selective advantage afforded to heterozygous females against malaria is counterbalanced by increased risks of neonatal jaundice, invasive bacterial infections, and anemia.
Collapse
Affiliation(s)
- Sophie Uyoga
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alex W Macharia
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Carolyne M Ndila
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gideon Nyutu
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mohammed Shebe
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kennedy O Awuondo
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - Neema Mturi
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Norbert Peshu
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benjamin Tsofa
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Anthony G Scott
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - Kathryn Maitland
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College, St Mary's Hospital, London, United Kingdom
| | - Thomas N Williams
- Department of Epidemiology and Demography, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Faculty of Medicine, Imperial College, St Mary's Hospital, London, United Kingdom
| |
Collapse
|
160
|
Patel H, Dunican C, Cunnington AJ. Predictors of outcome in childhood Plasmodium falciparum malaria. Virulence 2020; 11:199-221. [PMID: 32063099 PMCID: PMC7051137 DOI: 10.1080/21505594.2020.1726570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
Plasmodium falciparum malaria is classified as either uncomplicated or severe, determining clinical management and providing a framework for understanding pathogenesis. Severe malaria in children is defined by the presence of one or more features associated with adverse outcome, but there is wide variation in the predictive value of these features. Here we review the evidence for the usefulness of these features, alone and in combination, to predict death and other adverse outcomes, and we consider the role that molecular biomarkers may play in augmenting this prediction. We also examine whether a more personalized approach to predicting outcome for specific presenting syndromes of severe malaria, particularly cerebral malaria, has the potential to be more accurate. We note a general need for better external validation in studies of outcome predictors and for the demonstration that predictors can be used to guide clinical management in a way that improves survival and long-term health.
Collapse
Affiliation(s)
- Harsita Patel
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Claire Dunican
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Aubrey J. Cunnington
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| |
Collapse
|
161
|
Bria YP, Yeh CH, Bedingfield S. Significant symptoms and nonsymptom-related factors for malaria diagnosis in endemic regions of Indonesia. Int J Infect Dis 2020; 103:194-200. [PMID: 33249286 DOI: 10.1016/j.ijid.2020.11.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study aims to identify significant symptoms and nonsymptom-related factors for malaria diagnosis in endemic regions of Indonesia. METHODS Medical records are collected from patients suffering from malaria and other febrile diseases from public hospitals in endemic regions of Indonesia. Interviews with eight Indonesian medical doctors are conducted. Feature selection and machine learning techniques are used to develop malaria classifiers for identifying significant symptoms and nonsymptom-related factors. RESULTS Seven significant symptoms (duration of fever, headache, nausea and vomiting, heartburn, severe symptom, dizziness, and joint pain) and patients' history of malaria as a nonsymptom-related factor contribute most to malaria diagnosis. As a symptom, fever duration is more significant than temperature or fever for distinguishing malaria from other febrile diseases. Shivering, fever, and sweating (known to indicate malaria presence in Indonesia) are shown to be less significant than other symptoms in endemic regions. CONCLUSIONS Three most suitable malaria classifiers have been developed to identify the significant features that can be used to predict malaria as distinct from other febrile diseases. With extensive experiments on the classifiers, the significant features identified can help medical doctors in the clinical diagnosis of malaria and raise public awareness of significant malaria symptoms at early stages.
Collapse
Affiliation(s)
- Yulianti Paula Bria
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria 3800, Australia.
| | - Chung-Hsing Yeh
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria 3800, Australia.
| | - Susan Bedingfield
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria 3800, Australia.
| |
Collapse
|
162
|
Abstract
Background Severe malaria remains a leading cause of death worldwide. A greater understanding of its impact on multiple organ systems is essential in reducing the burden of disease. In this review we will summarize previously reported cardiovascular parameters of both adults and children with severe malaria. Method For this systematic review we searched MEDLINE and PUBMED for all papers published on cardiac function in severe malaria from January 1, 1990 until September 1, 2019. Severe malaria was defined as per World Health Organization. Publications were included if there was data from echocardiography, Pulse Contour Cardiac Output (PiCCO), or Pulmonary Arterial catheters (PAC) reported. Studies were excluded if related to medication induced cardiac dysfunction, malaria in pregnancy, or included subjects with known pre-existing heart disease. Results Twenty-four studies met inclusion criteria, the majority of which were studies of adult patients or a mixed cohort. Six solely involved pediatric patients. Significant heterogeneity existed in the cardiac parameters measured and results reported. One pediatric and one adult study suggested a reduced preload state during severe malaria. Cardiac systolic function was reported primarily within, or above, normative numeric ranges established in uninfected pediatric patients without anemia. Extensive variability existed in adult studies with reports of an elevated cardiac index in two studies, normal cardiac function in two studies, and descriptions of decreased function in two studies. Two reports suggest afterload in pediatric severe malaria is reduced. Reports of changes in the systemic vascular resistance of adults with severe malaria are inconsistent, with two trials demonstrating an increase and two suggesting a decrease. Studies demonstrated a mild rise in pulmonary pressure in both pediatric and adult patients that normalized by discharge. Conclusion Based on limited data, the cardiovascular effects of severe malaria appear to be heterogeneous and vary depending on age. Further detailed studies are required to explore and understand the overall hemodynamic effects of this high burden disease.
Collapse
|
163
|
Riggle BA, Manglani M, Maric D, Johnson KR, Lee MH, Neto OLA, Taylor TE, Seydel KB, Nath A, Miller LH, McGavern DB, Pierce SK. CD8+ T cells target cerebrovasculature in children with cerebral malaria. J Clin Invest 2020; 130:1128-1138. [PMID: 31821175 DOI: 10.1172/jci133474] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/05/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUNDCerebral malaria (CM) accounts for nearly 400,000 deaths annually in African children. Current dogma suggests that CM results from infected RBC (iRBC) sequestration in the brain microvasculature and resulting sequelae. Therapies targeting these events have been unsuccessful; findings in experimental models suggest that CD8+ T cells drive disease pathogenesis. However, these data have largely been ignored because corroborating evidence in humans is lacking. This work fills a critical gap in our understanding of CM pathogenesis that is impeding development of therapeutics.METHODSUsing multiplex immunohistochemistry, we characterized cerebrovascular immune cells in brain sections from 34 children who died from CM or other causes. Children were grouped by clinical diagnosis (CM+ or CM-), iRBC sequestration (Seqhi, Seqlo, Seq0) and HIV status (HIV+ or HIV-).RESULTSWe identified effector CD3+CD8+ T cells engaged on the cerebrovasculature in 69% of CM+ HIV- children. The number of intravascular CD3+CD8+ T cells was influenced by CM status (CM+ > CM-, P = 0.004) and sequestration level (Seqhi > Seqlo, P = 0.010). HIV coinfection significantly increased T cell numbers (P = 0.017) and shifted cells from an intravascular (P = 0.004) to perivascular (P < 0.0001) distribution.CONCLUSIONWithin the studied cohort, CM is associated with cerebrovascular engagement of CD3+CD8+ T cells, which is exacerbated by HIV coinfection. Thus, CD3+CD8+ T cells are highly promising targets for CM adjunctive therapy, opening new avenues for the treatment of this deadly disease.FUNDINGThis research was supported by the Intramural Research Program of the National Institutes of Health.
Collapse
Affiliation(s)
- Brittany A Riggle
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Rockville, Maryland, USA
| | - Monica Manglani
- Viral Immunology and Intravital Imaging Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, Maryland, USA.,Medical Scientist Training Program, Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Kory R Johnson
- Information Technology Program, Division of Intramural Research, and
| | - Myoung-Hwa Lee
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, and
| | | | - Terrie E Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, Africa
| | - Karl B Seydel
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, Africa
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, and
| | - Louis H Miller
- Laboratory of Malaria Vector Research, National Institute of Allergy and Infectious Diseases, NIH, Rockville, Maryland, USA
| | - Dorian B McGavern
- Viral Immunology and Intravital Imaging Section, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, Maryland, USA
| | - Susan K Pierce
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Rockville, Maryland, USA
| |
Collapse
|
164
|
Gordeuk VR, Shah BN, Zhang X, Thuma PE, Zulu S, Moono R, Reading NS, Song J, Zhang Y, Nouraie M, Campbell A, Minniti CP, Rana SR, Darbari DS, Kato GJ, Niu M, Castro OL, Machado R, Gladwin MT, Prchal JT. The CYB5R3 c .350C>G and G6PD A alleles modify severity of anemia in malaria and sickle cell disease. Am J Hematol 2020; 95:1269-1279. [PMID: 32697331 PMCID: PMC8095369 DOI: 10.1002/ajh.25941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 12/18/2022]
Abstract
Genetic modifiers of anemia in Plasmodium falciparum infection and sickle cell disease (SCD) are not fully known. Both conditions are associated with oxidative stress, hemolysis and anemia. The CYB5R3 gene encodes cytochrome b5 reductase 3, which converts methemoglobin to hemoglobin through oxidation of NADH. CYB5R3c.350C > G encoding CYB5R3T117S , the most frequent recognized African-specific polymorphism, does not have known functional significance, but its high allele frequency (23% in African Americans) suggests a selection advantage. Glucose-6-phosphate dehydrogenase (G6PD) is essential for protection from oxidants; its African-polymorphic X-linked A+ and A- alleles, and other variants with reduced activity, coincide with endemic malaria distribution, suggesting protection from lethal infection. We examined the association of CYB5R3c.350C > G with severe anemia (hemoglobin <5 g/dL) in the context of G6PD A+ and A- status among 165 Zambian children with malaria. CYB5R3c.350C > G offered protection against severe malarial anemia in children without G6PD deficiency (G6PD wild type or A+/A- heterozygotes) (odds ratio 0.29, P = .022) but not in G6PD A+ or A- hemizygotes/homozygotes. We also examined the relationship of CYB5R3c.350C > G with hemoglobin concentration among 267 children and 321 adults and adolescents with SCD in the US and UK and found higher hemoglobin in SCD patients without G6PD deficiency (β = 0.29, P = .022 children; β = 0.33, P = .004 adults). Functional studies in SCD erythrocytes revealed mildly lower activity of native CYB5R3T117S compared to wildtype CYB5R3 and higher NADH/NAD+ ratios. In conclusion, CYB5R3c.350C > G appears to ameliorate anemia severity in malaria and SCD patients without G6PD deficiency, possibly accounting for CYB5R3c.350C > G selection and its high prevalence.
Collapse
Affiliation(s)
- Victor R. Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Binal N. Shah
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Xu Zhang
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | | | | | | | - Jihyun Song
- University of Utah and ARUP Laboratories, Salt Lake City, Utah
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Campbell
- Children’s National Medical Center, Washington, District of Columbia
| | - Caterina P. Minniti
- Center for Sickle Cell Disease, Montefiore Medical Center, New York, New York
| | - Sohail R. Rana
- Department of Pediatrics and Child Health, Howard University Hospital, Washington, District of Columbia
| | | | | | - Mei Niu
- Center for Sickle Cell Disease, Howard University, Washington, District of Columbia
| | - Oswaldo L. Castro
- Center for Sickle Cell Disease, Howard University, Washington, District of Columbia
| | | | - Mark T. Gladwin
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | |
Collapse
|
165
|
Roberson MT, Smith AT. Cerebral Malaria in a Patient with Recent Travel to the Congo Presenting with Delirium: A Case Report. Clin Pract Cases Emerg Med 2020; 4:533-536. [PMID: 33217265 PMCID: PMC7676766 DOI: 10.5811/cpcem.2020.8.47995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Cerebral malaria, a syndrome of altered consciousness, is a rare and severe neurologic complication resulting from Plasmodium falciparum. Historically, cerebral malaria has been seen more frequently in children rather than adults. To complicate the diagnosis, cerebral malaria has few specific symptoms and neurologic findings can vary with each case. CASE REPORT We describe a case of a 61-year-old male who returned from the Democratic Republic of Congo and presented to the emergency department with dehydration, fatigue, and intermittent confusion. He was ultimately diagnosed with cerebral malaria caused by P. falciparum. CONCLUSION Even with close monitoring and appropriate treatment, cerebral malaria carries a severe risk of long-term neurocognitive deficits and a high mortality rate.
Collapse
Affiliation(s)
- Megan T Roberson
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Austin T Smith
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| |
Collapse
|
166
|
Rénia L, Grau GE, Wassmer SC. CD8+ T cells and human cerebral malaria: a shifting episteme. J Clin Invest 2020; 130:1109-1111. [PMID: 32065593 DOI: 10.1172/jci135510] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Mosquito-transmitted Plasmodium falciparum infection can cause human cerebral malaria (HCM) with high mortality rates. The abundance of infected red blood cells that accumulate in the cerebral vasculature of patients has led to the belief that these brain-sequestered cells solely cause pathogenesis. However, animal models suggest that CD8+ T cells migrate to and accumulate in the brain, directly contributing to experimental cerebral malaria (ECM) mortality. In this issue of the JCI, Riggle et al. explored the brain vasculature from 34 children who died from HCM or other causes and frequently found CD3+ CD8+ T cells in contact with endothelial cells. Further, the authors show that coinfection with HIV enhanced such CD3+ CD8+ T cell luminal distribution. These findings suggest that the mouse model for cerebral malaria may accurately reflect human disease pathology. This study sheds new light on the mechanisms behind blood-brain barrier breakdown in this complicated neurological disease and opens up alternative approaches for treatment.
Collapse
Affiliation(s)
- Laurent Rénia
- Singapore Immunology Network, Agency for Science, Technology, and Research (A*STAR), Singapore
| | - Georges Er Grau
- Vascular Immunology Unit, Department of Pathology, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Samuel C Wassmer
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
167
|
Mduluza-Jokonya TL, Naicker T, Jokonya L, Midzi H, Vengesai A, Kasambala M, Choto E, Rusakaniko S, Sibanda E, Mutapi F, Mduluza T. Association of Schistosoma haematobium infection morbidity and severity on co-infections in pre-school age children living in a rural endemic area in Zimbabwe. BMC Public Health 2020; 20:1570. [PMID: 33076903 PMCID: PMC7574170 DOI: 10.1186/s12889-020-09634-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
Background Individuals living in Schistosoma haematobium endemic areas are often at risk of having other communicable diseases simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking of schistosomiasis infection. In this study we investigated the prevalence and severity of coinfections in pre-school age children and further investigated associations between S. haematobium prevalence and under 5 mortality. Methods A community based cross-sectional survey was conducted in Shamva District, Zimbabwe. Using random selection, 465 preschool age children (1–5 years of age) were enrolled through clinical examination by two independent clinicians for the following top morbidity causing conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. The conditions and their severe sequels were diagnosed as per approved WHO standards. S. haematobium infection was diagnosed by urine filtration and the children were screened for conditions common in the study area which included HIV, tuberculosis, malnutrition and typhoid. Data was analysed using univariate and multinomial regression analysis and relative risk (RR) calculated. Results Prevalence of S. haematobium was 35% (145). The clinical conditions assessed had the following prevalence in the study population: upper respiratory tract infection 40% (229), fever of unknown origin 45% (189), dermatophytosis 18% and malaria 18% (75). The odds of co-infections observed with S. haematobium infection were: upper respiratory tract infection aOR = 1.22 (95% CI 0.80 to 1.87), dermatophytosis aOR = 4.79 (95% CI 2.78 to 8.25), fever of unknown origin aOR = 10.63 (95% CI 6.48–17.45) and malaria aOR = 0.91 (95% CI 0.51 to1.58). Effect of schistosomiasis coinfection on disease progression based on the odds of the diseases progressing to severe sequalae were: Severe pneumonia aOR = 8.41 (95% CI 3.09–22.93), p < 0.0001, complicated malaria aOR = 7.09 (95% CI 1.51–33.39), p = 0.02, severe dermatophytosis aOR = 20.3 (95% CI 4.78–83.20):p = 0.03, and fever of unknown origin aOR = 1.62 (95%CI 1.56–4.73), p = 0.02. Conclusion This study revealed an association between schistosomiasis and the comorbidity conditions of URTI, dermatophytosis, malaria and FUO in PSAC living in a schistosomiasis endemic area. A possible detrimental effect where coinfection led to severe sequels of the comorbidity conditions was demonstrated. Appropriate clinical diagnostic methods are required to identify associated infectious diseases and initiate early treatment of schistosomiasis and co-infections in PSAC.
Collapse
Affiliation(s)
- Tariro L Mduluza-Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa. .,Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.
| | - Thajasvarie Naicker
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Luxwell Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.,Department of Surgery, College of Health Sciences, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Herald Midzi
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Arthur Vengesai
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Maritha Kasambala
- Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Emilia Choto
- Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Elopy Sibanda
- Twin Palms Medical Centre, 113 Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute for Immunology and Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Rd., Edinburgh, EH9 3JT, UK
| | - Takafira Mduluza
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.,Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| |
Collapse
|
168
|
Lopez-Perez M, van der Puije W, Castberg FC, Ofori MF, Hviid L. Binding of human serum proteins to Plasmodium falciparum-infected erythrocytes and its association with malaria clinical presentation. Malar J 2020; 19:362. [PMID: 33032607 PMCID: PMC7545873 DOI: 10.1186/s12936-020-03438-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background The pathogenesis of Plasmodium falciparum malaria is related to the ability of parasite‑infected erythrocytes (IEs) to adhere to the vascular endothelium (cytoadhesion/sequestration) or to surrounding uninfected erythrocytes (rosetting). Both processes are mediated by the expression of members of the clonally variant PfEMP1 parasite protein family on the surface of the IEs. Recent evidence obtained with laboratory-adapted clones indicates that P. falciparum can exploit human serum factors, such as IgM and α2-macroglobulin (α2M), to increase the avidity of PfEMP1-mediated binding to erythrocyte receptors, as well as to evade host PfEMP1-specific immune responses. It has remained unclear whether PfEMP1 variants present in field isolates share these characteristics, and whether they are associated with clinical malaria severity. These issues were investigated here. Methods Children 1–12 years reporting with P. falciparum malaria to Hohoe Municipal Hospital, Ghana were enrolled in the study. Parasites from children with uncomplicated (UM) and severe malaria (SM) were collected. Binding of α2M and IgM from non-immune individuals to erythrocytes infected by P. falciparum isolates from 34 children (UM and SM) were analysed by flow cytometry. Rosetting in the presence of IgM or α2M was also evaluated. Experimental results were analysed according to the clinical presentation of the patients. Results Clinical data from 108 children classified as UM (n = 54) and SM cases (n = 54) were analysed. Prostration, severe malaria anaemia, and hyperparasitaemia were the most frequent complications. Three children were diagnosed with cerebral malaria, and one child died. Parasite isolates from UM (n = 14) and SM (n = 20) children were analysed. Most of the field isolates bound non-immune IgM (33/34), whereas the α2M-binding was less common (23/34). Binding of both non-immune IgM and α2M was higher but not significant in IEs from children with SM than from children with UM. In combination, IgM and α2M supported rosette formation at levels similar to that observed in the presence of 10% human serum. Conclusions The results support the hypothesis that binding of non-immune IgM and/or α2M to IEs facilitates rosette formation and perhaps contributes to P. falciparum malaria severity.
Collapse
Affiliation(s)
- Mary Lopez-Perez
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - William van der Puije
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.,West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.,Centre for Medical Parasitology, Department of Infectious Diseases and Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Filip C Castberg
- Centre for Medical Parasitology, Department of Infectious Diseases and Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Lars Hviid
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. .,Centre for Medical Parasitology, Department of Infectious Diseases and Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
169
|
Hanson J, Nyein PP, Aung NM, Kyi MM. Time for pragmatic, prospective clinical trials to determine the role of empirical antibacterial therapy in critically ill adults hospitalized with malaria. Int J Infect Dis 2020; 102:28-31. [PMID: 33017698 DOI: 10.1016/j.ijid.2020.09.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Children with severe falciparum malaria in malaria-endemic regions are predisposed to developing life-threatening bacterial co-infection. International guidelines therefore recommend empirical broad-spectrum antibacterial therapy in these children. Few studies have examined co-infection in adults, although it has been believed to be relatively rare; antibacterial therapy is therefore not routinely recommended in adults with falciparum malaria. DISCUSSION However, the fundamental pathophysiology of falciparum malaria in adults and children is the same; it is therefore unclear why adults would not also be predisposed to bacterial infection. Indeed, recent studies have identified bacteraemia in >10% of adults hospitalized with malaria. Some have suggested that these adults probably had bacterial sepsis, with the parasitaemia an incidental finding. However, it is usually impossible in resource-limited settings to determine-at presentation-whether critically ill, parasitaemic adults have severe malaria, bacterial sepsis, or both. Given the significant case-fatality rates of severe malaria and bacterial sepsis, the pragmatic initial approach would be to cover both possibilities. CONCLUSIONS Life-threatening bacterial co-infection may be more common in critically ill adults with malaria than previously believed. While further prospective data are awaited to confirm these findings, it might be more appropriate to provide empirical aantibacterial cover in these patients than current guidelines suggest.
Collapse
Affiliation(s)
- Josh Hanson
- The Kirby Institute, University of New South Wales, Sydney, Australia; University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar.
| | - Phyo Pyae Nyein
- Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar; Mingaladon Specialist Hospital, Mingaladon Township, Yangon, Myanmar
| | - Ne Myo Aung
- University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar; Insein General Hospital, Insein Township, Yangon, Myanmar
| | - Mar Mar Kyi
- University of Medicine 2, North Okkalapa Township, Yangon, Myanmar; Myanmar Australia Research Collaboration for Health (MARCH), Yangon, Myanmar; Insein General Hospital, Insein Township, Yangon, Myanmar
| |
Collapse
|
170
|
Ishioka H, Plewes K, Pattnaik R, Kingston HWF, Leopold SJ, Herdman MT, Mahanta K, Mohanty A, Dey C, Alam S, Srinamon K, Mohanty A, Maude RJ, White NJ, Day NPJ, Hossain MA, Faiz MA, Charunwatthana P, Mohanty S, Ghose A, Dondorp AM. Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study. J Infect Dis 2020; 221:285-292. [PMID: 31504666 PMCID: PMC6935998 DOI: 10.1093/infdis/jiz449] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/30/2019] [Indexed: 12/26/2022] Open
Abstract
Background Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined. Methods In a prospective observational study in adults with severe falciparum malaria, restrictive fluid management was provided at the discretion of the treating physician. The relationships between the volume of fluid and changes in renal function or tissue perfusion were evaluated. Results A total of 154 patients were studied, 41 (26.6%) of whom died. Median total fluid intake during the first 6 and 24 hours from enrollment was 3.3 (interquartile range [IQR], 1.8–5.1) mL/kg per hour and 2.2 (IQR, 1.6–3.2) mL/kg per hour, respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n = 116; rs = 0.16; P = .089) or lactate at 6 hours (n = 94; rs = −0.05; P = .660). Development of hypotensive shock or pulmonary edema within 24 hours after enrollment were not related to the volume of fluid administration. Conclusions Restrictive fluid management did not worsen kidney function and tissue perfusion in adult patients with severe falciparum malaria. We suggest crystalloid administration of 2–3 mL/kg per hour during the first 24 hours without bolus therapy, unless the patient is hypotensive.
Collapse
Affiliation(s)
- Haruhiko Ishioka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Anesthesiology and Critical Care, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Katherine Plewes
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Hugh W F Kingston
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Stije J Leopold
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - M Trent Herdman
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Chandan Dey
- Ispat General Hospital, Rourkela, Orissa, India
| | - Shamsul Alam
- Chittagong Medical College and Hospital, Chittagong, Bangladesh
| | - Ketsanee Srinamon
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Akshaya Mohanty
- Infectious Disease Biology Unit, Research Unit of Institute of Life Sciences, Ispat General Hospital, Rourkela, Orissa, India.,Institute of Life Sciences, Department of Biotechnology, Government of India, Bhubaneswar, Orissa, India
| | - Richard J Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.,Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Md Amir Hossain
- Chittagong Medical College and Hospital, Chittagong, Bangladesh
| | | | - Prakaykaew Charunwatthana
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Aniruddha Ghose
- Chittagong Medical College and Hospital, Chittagong, Bangladesh
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
171
|
Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, Challenger JD, Cunnington AJ, Datta D, Drakeley C, Ghani AC, Gordeuk VR, Grigg MJ, Hugo P, John CC, Mayor A, Migot-Nabias F, Opoka RO, Pasvol G, Rees C, Reyburn H, Riley EM, Shah BN, Sitoe A, Sutherland CJ, Thuma PE, Unger SA, Viwami F, Walther M, Whitty CJM, William T, Okell LC. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLoS Med 2020; 17:e1003359. [PMID: 33075101 PMCID: PMC7571702 DOI: 10.1371/journal.pmed.1003359] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Delay in receiving treatment for uncomplicated malaria (UM) is often reported to increase the risk of developing severe malaria (SM), but access to treatment remains low in most high-burden areas. Understanding the contribution of treatment delay on progression to severe disease is critical to determine how quickly patients need to receive treatment and to quantify the impact of widely implemented treatment interventions, such as 'test-and-treat' policies administered by community health workers (CHWs). We conducted a pooled individual-participant meta-analysis to estimate the association between treatment delay and presenting with SM. METHODS AND FINDINGS A search using Ovid MEDLINE and Embase was initially conducted to identify studies on severe Plasmodium falciparum malaria that included information on treatment delay, such as fever duration (inception to 22nd September 2017). Studies identified included 5 case-control and 8 other observational clinical studies of SM and UM cases. Risk of bias was assessed using the Newcastle-Ottawa scale, and all studies were ranked as 'Good', scoring ≥7/10. Individual-patient data (IPD) were pooled from 13 studies of 3,989 (94.1% aged <15 years) SM patients and 5,780 (79.6% aged <15 years) UM cases in Benin, Malaysia, Mozambique, Tanzania, The Gambia, Uganda, Yemen, and Zambia. Definitions of SM were standardised across studies to compare treatment delay in patients with UM and different SM phenotypes using age-adjusted mixed-effects regression. The odds of any SM phenotype were significantly higher in children with longer delays between initial symptoms and arrival at the health facility (odds ratio [OR] = 1.33, 95% CI: 1.07-1.64 for a delay of >24 hours versus ≤24 hours; p = 0.009). Reported illness duration was a strong predictor of presenting with severe malarial anaemia (SMA) in children, with an OR of 2.79 (95% CI:1.92-4.06; p < 0.001) for a delay of 2-3 days and 5.46 (95% CI: 3.49-8.53; p < 0.001) for a delay of >7 days, compared with receiving treatment within 24 hours from symptom onset. We estimate that 42.8% of childhood SMA cases and 48.5% of adult SMA cases in the study areas would have been averted if all individuals were able to access treatment within the first day of symptom onset, if the association is fully causal. In studies specifically recording onset of nonsevere symptoms, long treatment delay was moderately associated with other SM phenotypes (OR [95% CI] >3 to ≤4 days versus ≤24 hours: cerebral malaria [CM] = 2.42 [1.24-4.72], p = 0.01; respiratory distress syndrome [RDS] = 4.09 [1.70-9.82], p = 0.002). In addition to unmeasured confounding, which is commonly present in observational studies, a key limitation is that many severe cases and deaths occur outside healthcare facilities in endemic countries, where the effect of delayed or no treatment is difficult to quantify. CONCLUSIONS Our results quantify the relationship between rapid access to treatment and reduced risk of severe disease, which was particularly strong for SMA. There was some evidence to suggest that progression to other severe phenotypes may also be prevented by prompt treatment, though the association was not as strong, which may be explained by potential selection bias, sample size issues, or a difference in underlying pathology. These findings may help assess the impact of interventions that improve access to treatment.
Collapse
Affiliation(s)
- Andria Mousa
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
| | - Abdullah Al-Taiar
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, Virginia, United States of America
| | - Nicholas M. Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Cyril Badaut
- Unité de Biothérapie Infectieuse et Immunité, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
- Unité des Virus Emergents (UVE: Aix-Marseille Univ—IRD 190—Inserm 1207—IHU Méditerranée Infection), Marseille, France
| | - Bridget E. Barber
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joseph D. Challenger
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Aubrey J. Cunnington
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, United Kingdom
| | - Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Azra C. Ghani
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Victor R. Gordeuk
- Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Matthew J. Grigg
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Pierre Hugo
- Medicines for Malaria Venture, Geneva, Switzerland
| | - Chandy C. John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Robert O. Opoka
- Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda
| | - Geoffrey Pasvol
- Imperial College London, Department of Life Sciences, London, United Kingdom
| | - Claire Rees
- Centre for Global Public Health, Institute of Population Health Sciences, Barts & The London School of Medicine & Dentistry, London, United Kingdom
| | - Hugh Reyburn
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eleanor M. Riley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Binal N. Shah
- Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Colin J. Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Stefan A. Unger
- Department of Child Life and Health, University of Edinburgh, United Kingdom
- Department of Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Firmine Viwami
- Institut de Recherche Clinique du Bénin (IRCB), Cotonou, Benin
| | - Michael Walther
- Medical Research Council Unit, Fajara, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Christopher J. M. Whitty
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Gleneagles Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Lucy C. Okell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| |
Collapse
|
172
|
Batte A, Starr MC, Schwaderer AL, Opoka RO, Namazzi R, Phelps Nishiguchi ES, Ssenkusu JM, John CC, Conroy AL. Methods to estimate baseline creatinine and define acute kidney injury in lean Ugandan children with severe malaria: a prospective cohort study. BMC Nephrol 2020; 21:417. [PMID: 32993548 PMCID: PMC7526147 DOI: 10.1186/s12882-020-02076-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/18/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is increasingly recognized as a consequential clinical complication in children with severe malaria. However, approaches to estimate baseline creatinine (bSCr) are not standardized in this unique patient population. Prior to wide-spread utilization, bSCr estimation methods need to be evaluated in many populations, particularly in children from low-income countries. METHODS We evaluated six methods to estimate bSCr in Ugandan children aged 6 months to 12 years of age in two cohorts of children with severe malaria (n = 1078) and healthy community children (n = 289). Using isotope dilution mass spectrometry (IDMS)-traceable creatinine measures from community children, we evaluated the bias, accuracy and precision of estimating bSCr using height-dependent and height-independent estimated glomerular filtration (eGFR) equations to back-calculate bSCr or estimating bSCr directly using published or population-specific norms. RESULTS We compared methods to estimate bSCr in healthy community children against the IDMS-traceable SCr measure. The Pottel-age based equation, assuming a normal GFR of 120 mL/min per 1.73m2, was the more accurate method with minimal bias when compared to the Schwartz height-based equation. Using the different bSCr estimates, we demonstrated the prevalence of KDIGO-defined AKI in children with severe malaria ranged from 15.6-43.4%. The lowest estimate was derived using population upper levels of normal and the highest estimate was derived using the mean GFR of the community children (137 mL/min per 1.73m2) to back-calculate the bSCr. Irrespective of approach, AKI was strongly associated with mortality with a step-wise increase in mortality across AKI stages (p < 0.0001 for all). AKI defined using the Pottel-age based equation to estimate bSCr showed the strongest relationship with mortality with a risk ratio of 5.13 (95% CI 3.03-8.68) adjusting for child age and sex. CONCLUSIONS We recommend using height-independent age-based approaches to estimate bSCr in hospitalized children in sub-Saharan Africa due to challenges in accurate height measurements and undernutrition which may impact bSCr estimates. In this population the Pottel-age based GFR estimating equation obtained comparable bSCr estimates to population-based estimates in healthy children.
Collapse
Affiliation(s)
- Anthony Batte
- Child Health and Development Center, Makerere University College of Health Sciences, Kampala, Uganda
| | - Michelle C Starr
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew L Schwaderer
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ruth Namazzi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA.
| |
Collapse
|
173
|
Rajahram GS, Cooper DJ, William T, Grigg MJ, Anstey NM, Barber BE. Deaths From Plasmodium knowlesi Malaria: Case Series and Systematic Review. Clin Infect Dis 2020; 69:1703-1711. [PMID: 30624597 PMCID: PMC6821196 DOI: 10.1093/cid/ciz011] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Plasmodium knowlesi causes severe and fatal malaria, and incidence in Southeast Asia is increasing. Factors associated with death are not clearly defined. METHODS All malaria deaths in Sabah, Malaysia, from 2015 to 2017 were identified from mandatory reporting to the Sabah Department of Health. Case notes were reviewed, and a systematic review of these and all previously reported fatal P. knowlesi cases was conducted. Case fatality rates (CFRs) during 2010-2017 were calculated using incidence data from the Sabah Department of Health. RESULTS Six malaria deaths occurred in Sabah during 2015-2017, all from P. knowlesi. Median age was 40 (range, 23-58) years; 4 cases (67%) were male. Three (50%) had significant cardiovascular comorbidities and 1 was pregnant. Delays in administering appropriate therapy contributed to 3 (50%) deaths. An additional 26 fatal cases were included in the systematic review. Among all 32 cases, 18 (56%) were male; median age was 56 (range, 23-84) years. Cardiovascular-metabolic disease, microscopic misdiagnosis, and delay in commencing intravenous treatment were identified in 11 of 32 (34%), 26 of 29 (90%), and 11 of 31 (36%) cases, respectively. The overall CFR during 2010-2017 was 2.5/1000: 6.0/1000 for women and 1.7/1000 for men (P = .01). Independent risk factors for death included female sex (odds ratio, 2.6; P = .04), and age ≥45 years (odds ratio, 4.7; P < .01). CONCLUSIONS Earlier presentation, more rapid diagnosis, and administration of intravenous artesunate may avoid fatal outcomes, particularly in females, older adults, and patients with cardiovascular comorbidities.
Collapse
Affiliation(s)
- Giri S Rajahram
- Infectious Diseases Unit, Queen Elizabeth Hospital, Malaysia.,Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia
| | - Daniel J Cooper
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Matthew J Grigg
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nicholas M Anstey
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bridget E Barber
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| |
Collapse
|
174
|
Kotepui M, Kotepui KU, Milanez GDJ, Masangkay FR. Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection: a systematic review and meta-analysis. Infect Dis Poverty 2020; 9:134. [PMID: 32962765 PMCID: PMC7510069 DOI: 10.1186/s40249-020-00741-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Co-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment. The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection, the risk of severe diseases due to co-infection, and to describe the complications of severe malaria and severe dengue among patients with co-infection. METHODS Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved through a search of the ISI Web of Science, Scopus, and MEDLINE. The pooled prevalence and 95% confidence interval (CI) of severe malaria among patients with Plasmodium and DENV co-infection was estimated with a random-effects model to take into account the between-study heterogeneity of the included studies. The risks of severe malaria and severe diseases due to co-infection were estimated with the pooled odds ratio (OR) and 95% CI with a random-effects model. RESULTS Of the 5653 articles screened, 13 studies were included in the systematic review and meta-analysis. The results demonstrated that the pooled prevalence estimate of severe malaria among patients with co-infection was 32% (95% CI: 18-47%, I2 = 92.3%). Patients with co-infection had a higher risk of severe diseases than those with DENV mono-infection (odds ratio [OR] = 3.94, 95% CI: 1.96-7.95, I2 = 72%). Patients with co-infection had a higher risk of severe dengue than those with DENV mono-infection (OR = 1.98, 95% CI: 1.08-3.63, I2 = 69%). The most severe complications found in severe dengue were bleeding (39.6%), jaundice (19.8%), and shock/hypotension (17.9%), while the most severe complications found in severe malaria were severe bleeding/bleeding (47.9%), jaundice (32.2%), and impaired consciousness (7.43%). CONCLUSIONS The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection. Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications, but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection. TRIAL REGISTRATION The protocol of this study was registered at PROSPERO: CRD42020196792 .
Collapse
Affiliation(s)
- Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Giovanni De Jesus Milanez
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila, Philippines
| | - Frederick Ramirez Masangkay
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila, Philippines
| |
Collapse
|
175
|
Associations between Aminoquinoline Resistance Genotypes and Clinical Presentations of Plasmodium falciparum Infection in Uganda. Antimicrob Agents Chemother 2020; 64:AAC.00721-20. [PMID: 32660999 DOI: 10.1128/aac.00721-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/07/2020] [Indexed: 01/30/2023] Open
Abstract
Mutations that mediate resistance of Plasmodium falciparum to aminoquinoline antimalarials are selected by prior drug use and may alter parasite fitness, but associations with clinical presentations are uncertain. We evaluated genotypes in samples from a case-control study of determinants of severe malaria in Ugandan children 4 months to 10 years of age. We studied 274 cases with severe malaria matched by age and geography to 275 uncomplicated malaria controls and 179 asymptomatic parasitemic controls. The overall prevalence of mutations of interest (considering mixed results as mutant) was 67.0% for PfCRT K76T, 8.5% for PfMDR1 N86Y, 71.5% for PfMDR1 Y184F, and 14.7% for PfMDR1 D1246Y. Compared to asymptomatic controls, the odds of mutant PfCRT 76T were lower for uncomplicated (odds ratio, 0.42 [95% confidence interval, 0.24 to 0.72]; P < 0.001) or severe (0.56 [0.32 to 0.97]; P = 0.031) malaria; the odds of mutant PfMDR1 86Y were lower for uncomplicated (0.33 [0.16 to 0.65]; P < 0.001) or severe (0.21 [0.09 to 0.45]; P < 0.001) malaria; and the odds of mutant PfMDR1 1246Y were higher for uncomplicated (1.83 [0.90 to 3.98]; P = 0.076) or severe (2.06 [1.01 to 4.55]; P = 0.033) malaria. The odds of mutant PfMDR1 184F were lower in severe than asymptomatic (0.59 [0.37 to 0.92]; P = 0.016) or uncomplicated (0.61 [0.41 to 0.90]; P = 0.009) malaria. Overall, the PfCRT 76T and PfMDR1 86Y mutations were associated with decreased risk of symptomatic malaria, PfMDR1 1246Y was associated with increased risk of symptomatic malaria, and PfMDR1 184F was associated with decreased risk of severe malaria. These results offer insights into parasite genotypes in children with different presentations, although the basis for the identified associations is likely complex.
Collapse
|
176
|
Moyo SJ, Manyahi J, Blomberg B, Tellevik MG, Masoud NS, Aboud S, Manji K, Roberts AP, Hanevik K, Mørch K, Langeland N. Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania. Front Microbiol 2020; 11:2118. [PMID: 33013772 PMCID: PMC7511546 DOI: 10.3389/fmicb.2020.02118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022] Open
Abstract
Background Febrile illness is the commonest cause of hospitalization in children <5 years in sub-Saharan Africa, and bacterial bloodstream infections and malaria are major causes of death. Methods From March 2017 to July 2018, we enrolled 2,226 children aged 0–5 years hospitalized due to fever in four major public hospitals of Dar es Salaam, namely, Amana, Temeke, and Mwananyamala Regional Hospitals and Muhimbili National Hospital. We recorded social demographic and clinical data, and we performed blood-culture and HIV-antibody testing. We used qPCR to quantify Plasmodium falciparum parasitaemia and Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) to identify bacterial isolates. Disk diffusion method was used for antimicrobial susceptibility testing. Results Nineteen percent of the children (426/2,226) had pathogens detected from blood. Eleven percent (236/2,226) of the children had bacteraemia/fungaemia and 10% (204/2,063) had P. falciparum malaria. Ten children had concomitant malaria and bacteraemia. Gram-negative bacteria (64%) were more frequent than Gram-positive (32%) and fungi (4%). Over 50% of Gram-negative bacteria were extended-spectrum beta-lactamase (ESBL) producers and multidrug resistant. Methicillin resistant Staphylococcus aureus (MRSA) was found in 11/42 (26.2%). The most severe form of clinical malaria was associated with high parasitaemia (>four million genomes/μL) of P. falciparum in plasma. Overall, in-hospital death was 4% (89/2,146), and it was higher in children with bacteraemia (8%, 18/227) than malaria (2%, 4/194, p = 0.007). Risk factors for death were bacteraemia (p = 0.03), unconsciousness at admission (p < 0.001), and admission at a tertiary hospital (p = 0.003). Conclusion Compared to previous studies in this region, our study showed a reduction in malaria prevalence, a decrease in in-hospital mortality, and an increase in antimicrobial resistance (AMR) including ESBLs and multidrug resistance. An increase of AMR highlights the importance of continued strengthening of diagnostic capability and antimicrobial stewardship programs. We also found malaria and bacteraemia contributed equally in causing febrile illness, but bacteraemia caused higher in-hospital death. The most severe form of clinical malaria was associated with P. falciparum parasitaemia.
Collapse
Affiliation(s)
- Sabrina J Moyo
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Marit Gjerde Tellevik
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Nahya Salim Masoud
- Department of Paediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Adam P Roberts
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kurt Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kristine Mørch
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
177
|
Olupot-Olupot P, Engoru C, Nteziyaremye J, Chebet M, Ssenyondo T, Muhindo R, Nyutu G, Macharia AW, Uyoga S, Ndila CM, Karamagi C, Maitland K, Williams TN. The clinical spectrum of severe childhood malaria in Eastern Uganda. Malar J 2020; 19:322. [PMID: 32883291 PMCID: PMC7470679 DOI: 10.1186/s12936-020-03390-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Few recent descriptions of severe childhood malaria have been published from high-transmission regions. In the current study, the clinical epidemiology of severe malaria in Mbale, Eastern Uganda, is described, where the entomological inoculation rate exceeds 100 infective bites per year. METHODS A prospective descriptive study was conducted to determine the prevalence, clinical spectrum and outcome of severe Plasmodium falciparum malaria at Mbale Regional Referral Hospital in Eastern Uganda. All children aged 2 months-12 years who presented on Mondays to Fridays between 8.00 am and 5.00 pm from 5th May 2011 until 30th April 2012 were screened for parasitaemia. Clinical and laboratory data were then collected from all P. falciparum positive children with features of WHO-defined severe malaria by use of a standardized proforma. RESULTS A total of 10 208 children were screened of which 6582 (64%) had a positive blood film. Of these children, 662 (10%) had clinical features of severe malaria and were consented for the current study. Respiratory distress was the most common severity feature (554; 83.7%), while 365/585 (62.4%) had hyperparasitaemia, 177/662 (26.7%) had clinical jaundice, 169 (25.5%) had severe anaemia, 134/660 (20.2%) had hyperlactataemia (lactate ≥ 5 mmol/L), 93 (14.0%) had passed dark red or black urine, 52 (7.9%) had impaired consciousness and 49/662 (7.4%) had hypoxaemia (oxygen saturations < 90%). In-hospital mortality was 63/662 (9.5%) overall but was higher in children with either cerebral malaria (33.3%) or severe anaemia (19.5%). Factors that were independently associated with mortality on multivariate analysis included severe anaemia [odds ratio (OR) 5.36; 2.16-1.32; P = 0.0002], hyperlactataemia (OR 3.66; 1.72-7.80; P = 0.001), hypoxaemia (OR) 3.64 (95% CI 1.39-9.52; P = 0.008), and hepatomegaly (OR 2.29; 1.29-4.06; P = 0.004). No independent association was found between mortality and either coma or hyperparasitaemia. CONCLUSIONS Severe childhood malaria remains common in Eastern Uganda where it continues to be associated with high mortality. An unusually high proportion of children with severe malaria had jaundice or gave a history of having recently passed dark red or black urine, an issue worthy of further investigation.
Collapse
Affiliation(s)
- Peter Olupot-Olupot
- Faculty of Health Sciences, Busitema University, Mbale Campus, P.O. Box 1460, Mbale, Uganda.
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda.
| | - Charles Engoru
- Soroti Regional Referral Hospital, P.O. Box 289, Soroti, Uganda
| | - Julius Nteziyaremye
- Faculty of Health Sciences, Busitema University, Mbale Campus, P.O. Box 1460, Mbale, Uganda
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Martin Chebet
- Faculty of Health Sciences, Busitema University, Mbale Campus, P.O. Box 1460, Mbale, Uganda
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Tonny Ssenyondo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Rita Muhindo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Gideon Nyutu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Alexander W Macharia
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Carolyne M Ndila
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Charles Karamagi
- Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Institute of Global Health Innovation, Imperial College, Medical School Building St Mary's Campus, Imperial College, London, W2 1PG, UK
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Institute of Global Health Innovation, Imperial College, Medical School Building St Mary's Campus, Imperial College, London, W2 1PG, UK
| |
Collapse
|
178
|
MacCormick IJC, Barrera V, Beare NAV, Czanner G, Potchen M, Kampondeni S, Heyderman RS, Craig AG, Molyneux ME, Mallewa M, White VA, Milner D, Hiscott P, Taylor TE, Seydel KB, Harding SP. How Does Blood-Retinal Barrier Breakdown Relate to Death and Disability in Pediatric Cerebral Malaria? J Infect Dis 2020; 225:1070-1080. [PMID: 32845969 PMCID: PMC8922008 DOI: 10.1093/infdis/jiaa541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background In cerebral malaria, the retina can be used to understand disease pathogenesis. The mechanisms linking sequestration, brain swelling, and death remain poorly understood. We hypothesized that retinal vascular leakage would be associated with brain swelling. Methods We used retinal angiography to study blood-retinal barrier integrity. We analyzed retinal leakage, histopathology, brain magnatic resonance imaging (MRI), and associations with death and neurological disability in prospective cohorts of Malawian children with cerebral malaria. Results Three types of retinal leakage were seen: large focal leak (LFL), punctate leak (PL), and vessel leak. The LFL and PL were associated with death (odds ratio [OR] = 13.20, 95% confidence interval [CI] = 5.21–33.78 and OR = 8.58, 95% CI = 2.56–29.08, respectively) and brain swelling (P < .05). Vessel leak and macular nonperfusion were associated with neurological disability (OR = 3.71, 95% CI = 1.26–11.02 and OR = 9.06, 95% CI = 1.79–45.90). Large focal leak was observed as an evolving retinal hemorrhage. A core of fibrinogen and monocytes was found in 39 (93%) white-centered hemorrhages. Conclusions Blood-retina barrier breakdown occurs in 3 patterns in cerebral malaria. Associations between LFL, brain swelling, and death suggest that the rapid accumulation of cerebral hemorrhages, with accompanying fluid egress, may cause fatal brain swelling. Vessel leak, from barrier dysfunction, and nonperfusion were not associated with severe brain swelling but with neurological deficits, suggesting hypoxic injury in survivors.
Collapse
Affiliation(s)
- Ian J C MacCormick
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Valentina Barrera
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK.,NHS Blood and Transplant, Tissue and Eye Services R&D, Liverpool UK
| | - Nicholas A V Beare
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK.,St. Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Gabriela Czanner
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK.,Department of Applied Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Michael Potchen
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Samuel Kampondeni
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Division of Infection & Immunity, University College London, London, UK
| | - Alister G Craig
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Malcolm E Molyneux
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Macpherson Mallewa
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Valerie A White
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dan Milner
- American Society for Clinical Pathology, Chicago, IL, USA
| | - Paul Hiscott
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK
| | - Terrie E Taylor
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, USA
| | - Karl B Seydel
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, USA
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK.,St. Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| |
Collapse
|
179
|
Pádua TA, Souza MC. Heme on Pulmonary Malaria: Friend or Foe? Front Immunol 2020; 11:1835. [PMID: 32983096 PMCID: PMC7477073 DOI: 10.3389/fimmu.2020.01835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022] Open
Abstract
Malaria is a hemolytic disease that, in severe cases, can compromise multiple organs. Pulmonary distress is a common symptom observed in severe malaria caused by Plasmodium vivax or Plasmodium falciparum. However, biological components involved in the development of lung malaria are poorly studied. In experimental models of pulmonary malaria, it was observed that parasitized red blood cell-congested pulmonary capillaries are related to intra-alveolar hemorrhages and inflammatory cell infiltration. Thus, it is very likely that hemolysis participates in malaria-induced acute lung injury. During malaria, heme assumes different biochemical structures such as hemin and hemozoin (biocrystallized structure of heme inside Plasmodium sp.). Each heme-derived structure triggers a different biological effect: on the one hand, hemozoin found in lung tissue is responsible for the infiltration of inflammatory cells and consequent tissue injury; on the other hand, heme stimulates heme oxygenase-1 (HO-1) expression and CO production, which protect mice from severe malaria. In this review, we discuss the biological mechanism involved in the dual role of heme response in experimental malaria-induced acute lung injury.
Collapse
Affiliation(s)
- Tatiana Almeida Pádua
- Laboratory of Applied Pharmacology, Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mariana Conceição Souza
- Laboratory of Applied Pharmacology, Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
180
|
Pamplona A, Silva-Santos B. γδ T cells in malaria: a double-edged sword. FEBS J 2020; 288:1118-1129. [PMID: 32710527 PMCID: PMC7983992 DOI: 10.1111/febs.15494] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/16/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
Malaria remains a devastating global health problem, resulting in many annual deaths due to the complications of severe malaria. However, in endemic regions, individuals can acquire ‘clinical immunity’ to malaria, characterized by a decrease in severe malaria episodes and an increase of asymptomatic Plasmodium falciparum infections. Recently, it has been reported that tolerance to ‘clinical malaria’ and reduced disease severity correlates with a decrease in the numbers of circulating Vγ9Vδ2 T cells, the major subset of γδ T cells in the human peripheral blood. This is particularly interesting as this population typically undergoes dramatic expansions during acute Plasmodium infections and was previously shown to play antiparasitic functions. Thus, regulated γδ T‐cell responses may be critical to balance immune protection with severe pathology, particularly as both seem to rely on the same pro‐inflammatory cytokines, most notably TNF and IFN‐γ. This has been clearly demonstrated in mouse models of experimental cerebral malaria (ECM) based on Plasmodium berghei ANKA infection. Furthermore, our recent studies suggest that the natural course of Plasmodium infection, mimicked in mice through mosquito bite or sporozoite inoculation, includes a major pathogenic component in ECM that depends on γδ T cells and IFN‐γ production in the asymptomatic liver stage, where parasite virulence is seemingly set and determines pathology in the subsequent blood stage. Here, we discuss these and other recent advances in our understanding of the complex—protective versus pathogenic—functions of γδ T cells in malaria.
Collapse
Affiliation(s)
- Ana Pamplona
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Bruno Silva-Santos
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| |
Collapse
|
181
|
Uyoga S, Wanjiku P, Rop JC, Makale J, Macharia AW, Nyutu GM, Shebe M, Awuondo KA, Mturi N, Woodrow CJ, Dondorp AM, Maitland K, Williams TN. Plasma Plasmodium falciparum Histidine-Rich Protein-2 concentrations in children with malaria infections of differing severity in Kilifi, Kenya. Clin Infect Dis 2020; 73:e2415-e2423. [PMID: 32772115 PMCID: PMC8492128 DOI: 10.1093/cid/ciaa1141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background Most previous studies support a direct link between total parasite load and the clinical severity of Plasmodium falciparum malaria infections. Methods We estimated P. falciparum parasite loads in 3 groups of children with malaria infections of differing severity: (1) children with World Health Organization–defined severe malaria (n = 1544), (2) children admitted with malaria but without features of severity (n = 200), and (3) children in the community with asymptomatic parasitemia (n = 33). Results Peripheral parasitemias were highest in those with uncomplicated malaria (geometric mean [GM] parasite count, 111 064/μL; 95% confidence interval, CI, 86 798–141 819/μL), almost 3 times higher than in those with severe malaria (39 588/μL; 34 990–44 791/μL) and >100 times higher than in those with asymptomatic malaria (1092/μL; 523–2280/μL). However, the GM P. falciparum histidine-rich protein 2 (PfHRP2) values (95% CI) increased with severity, being 7 (4–12) ng/mL in asymptomatic malaria, 843 (655–1084) ng/mL in uncomplicated malaria, and 1369 (1244–1506) ng/mL in severe malaria. PfHRP2 concentrations were markedly lower in the subgroup of patients with severe malaria and concomitant invasive bacterial infections of blood or cerebrospinal fluid (GM concentration, 312 ng/mL; 95% CI, 175–557 ng/mL; P < .001) than in those without such infections (1439 ng/mL; 1307–1584; P < .001). Conclusions The clinical severity of malaria infections related strongly to the total burden of P. falciparum parasites. A quantitative test for plasma concentrations of PfHRP2 could be useful in identifying children at the greatest clinical risk and identifying critically ill children in whom malaria is not the primary cause.
Collapse
Affiliation(s)
- Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Jesse C Rop
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | | | | | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Charles J Woodrow
- Mahidol-Oxford Research Unit,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health,Nuffield Department of Medicine,University of Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Research Unit,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health,Nuffield Department of Medicine,University of Oxford, UK
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Infectious Diseases, Imperial College, London, UK
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Infectious Diseases, Imperial College, London, UK
| |
Collapse
|
182
|
Attaher O, Zaidi I, Kwan JL, Issiaka D, Samassekou MB, Cisse KB, Coulibaly B, Keita S, Sissoko S, Traore T, Diarra K, Diarra BS, Dembele A, Kanoute MB, Mahamar A, Barry A, Fried M, Dicko A, Duffy PE. Effect of Seasonal Malaria Chemoprevention on Immune Markers of Exhaustion and Regulation. J Infect Dis 2020; 221:138-145. [PMID: 31584094 DOI: 10.1093/infdis/jiz415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) is a novel strategy to reduce malaria infections in children. Infection with Plasmodium falciparum results in immune dysfunction characterized by elevated expression of markers associated with exhaustion, such as PD1 and LAG3, and regulatory CD4+FOXP3+ T cells. METHODS In the current study, the impact of seasonal malaria chemoprevention on malaria-induced immune dysfunction, as measured by markers associated with exhaustion and regulatory T cells, was explored by flow cytometry. RESULTS Children that received seasonal malaria chemoprevention had fewer malaria episodes and showed significantly lower fold changes in CD4+PD1+ and CD4+PD1+LAG3+ compared to those that did not receive SMC. Seasonal malaria chemoprevention had no observable effect on fold changes in CD8 T cells expressing PD1 or CD160. However, children receiving SMC showed greater increases in CD4+FOXP3+ T regulatory cells compared to children not receiving SMC. CONCLUSIONS These results provide important insights into the dynamics of malaria-induced changes in the CD4 T-cell compartment of the immune system and suggest that the reduction of infections due to seasonal malaria chemoprevention may also prevent immune dysfunction. CLINICAL TRIALS REGISTRATION NCT02504918.
Collapse
Affiliation(s)
- Oumar Attaher
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Irfan Zaidi
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jennifer L Kwan
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Djibrilla Issiaka
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Mamoudou B Samassekou
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Kadidia B Cisse
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Barou Coulibaly
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Sekouba Keita
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Sibiri Sissoko
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Tiangoua Traore
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Kalifa Diarra
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Bacary S Diarra
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Adama Dembele
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Moussa B Kanoute
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Almahamoudou Mahamar
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Amadou Barry
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alassane Dicko
- Malaria Research and Training Center, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
183
|
Gorki V, Walter NS, Singh R, Chauhan M, Dhingra N, Salunke DB, Kaur S. β-Carboline Derivatives Tackling Malaria: Biological Evaluation and Docking Analysis. ACS OMEGA 2020; 5:17993-18006. [PMID: 32743172 PMCID: PMC7391373 DOI: 10.1021/acsomega.0c01256] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/15/2020] [Indexed: 05/12/2023]
Abstract
Increasing resistance to presently available antimalarial drugs urges the need to look for new promising compounds. The β-carboline moiety, present in several biologically active natural products and drugs, is an important scaffold for antimalarial drug discovery. The present study explores the antimalarial activity of a β-carboline derivative (1R,3S)-methyl 1-(benzo[d][1,3]dioxol-5-yl)-2,3,4,9-tetrahydro-1H-pyrido[3,4-b]indole-3-carboxylate (9a) alone in vitro against Plasmodium falciparum and in vivo in combination therapy with the standard drug artesunate against Plasmodium berghei. Compound 9a inhibited both 3D7 and RKL-9 strains of P. falciparum with half-maximal inhibitory concentration (IC50) < 1 μg/mL, respectively. The compound was nontoxic (50% cytotoxic concentration (CC50) > 640 μg/mL) to normal dermal fibroblasts. Selectivity index was >10 against both the strains. The compound exhibited considerable in vivo antimalarial activity (median effective dose (ED50) = 27.74 mg/kg) in monotherapy. The combination of 9a (100 mg/kg) and artesunate (50 mg/kg) resulted in 99.69% chemosuppression on day 5 along with a mean survival time of 25.8 ± 4.91 days with complete parasite clearance. Biochemical studies indicated the safety of the HIT compound to hepatic and renal functions of mice. Molecular docking also highlighted the suitability of 9a as a potential antimalarial candidate.
Collapse
Affiliation(s)
- Varun Gorki
- Parasitology
Laboratory, Department of Zoology, Panjab
University, Chandigarh 160014, India
| | - Neha Sylvia Walter
- Parasitology
Laboratory, Department of Zoology, Panjab
University, Chandigarh 160014, India
| | - Rahul Singh
- Department
of Chemistry and Centre of Advanced Studies in Chemistry, Panjab University, Chandigarh 160014, India
| | - Monika Chauhan
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
| | - Neelima Dhingra
- University
Institute of Pharmaceutical Sciences, Panjab
University, Chandigarh 160014, India
| | - Deepak B. Salunke
- Department
of Chemistry and Centre of Advanced Studies in Chemistry, Panjab University, Chandigarh 160014, India
| | - Sukhbir Kaur
- Parasitology
Laboratory, Department of Zoology, Panjab
University, Chandigarh 160014, India
| |
Collapse
|
184
|
Varo R, Erice C, Johnson S, Bassat Q, Kain KC. Clinical trials to assess adjuvant therapeutics for severe malaria. Malar J 2020; 19:268. [PMID: 32709257 PMCID: PMC7382078 DOI: 10.1186/s12936-020-03340-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/17/2020] [Indexed: 01/07/2023] Open
Abstract
Despite potent anti-malarial treatment, mortality rates associated with severe falciparum malaria remain high. To attempt to improve outcome, several trials have assessed a variety of potential adjunctive therapeutics, however none to date has been shown to be beneficial. This may be due, at least partly, to the therapeutics chosen and clinical trial design used. Here, we highlight three themes that could facilitate the choice and evaluation of putative adjuvant interventions for severe malaria, paving the way for their assessment in randomized controlled trials. Most clinical trials of adjunctive therapeutics to date have been underpowered due to the large number of participants required to reach mortality endpoints, rendering these study designs challenging and expensive to conduct. These limitations may be mitigated by the use of risk-stratification of participants and application of surrogate endpoints. Appropriate surrogate endpoints include direct measures of pathways causally involved in the pathobiology of severe and fatal malaria, including markers of host immune and endothelial activation and microcirculatory dysfunction. We propose using circulating markers of these pathways to identify high-risk participants that would be most likely to benefit from adjunctive therapy, and further by adopting these biomarkers as surrogate endpoints; moreover, choosing interventions that target deleterious host immune responses that directly contribute to microcirculatory dysfunction, multi-organ dysfunction and death; and, finally, prioritizing where possible, drugs that act on these pathways that are already approved by the FDA, or other regulators, for other indications, and are known to be safe in target populations, including children. An emerging understanding of the critical role of the host response in severe malaria pathogenesis may facilitate both clinical trial design and the search of effective adjunctive therapeutics.
Collapse
Affiliation(s)
- Rosauro Varo
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Clara Erice
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | | | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Kevin C Kain
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, ON, Canada. .,Department of Medicine, Division of Infectious Diseases, Tropical Disease Unit, University of Toronto, Toronto, Canada.
| |
Collapse
|
185
|
Schiess N, Villabona-Rueda A, Cottier KE, Huether K, Chipeta J, Stins MF. Pathophysiology and neurologic sequelae of cerebral malaria. Malar J 2020; 19:266. [PMID: 32703204 PMCID: PMC7376930 DOI: 10.1186/s12936-020-03336-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/13/2020] [Indexed: 12/14/2022] Open
Abstract
Cerebral malaria (CM), results from Plasmodium falciparum infection, and has a high mortality rate. CM survivors can retain life-long post CM sequelae, including seizures and neurocognitive deficits profoundly affecting their quality of life. As the Plasmodium parasite does not enter the brain, but resides inside erythrocytes and are confined to the lumen of the brain's vasculature, the neuropathogenesis leading to these neurologic sequelae is unclear and under-investigated. Interestingly, postmortem CM pathology differs in brain regions, such as the appearance of haemorragic punctae in white versus gray matter. Various host and parasite factors contribute to the risk of CM, including exposure at a young age, parasite- and host-related genetics, parasite sequestration and the extent of host inflammatory responses. Thus far, several proposed adjunctive treatments have not been successful in the treatment of CM but are highly needed. The region-specific CM neuro-pathogenesis leading to neurologic sequelae is intriguing, but not sufficiently addressed in research. More attention to this may lead to the development of effective adjunctive treatments to address CM neurologic sequelae.
Collapse
Affiliation(s)
- Nicoline Schiess
- Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 6-113, Baltimore, MD, 21287, USA
| | - Andres Villabona-Rueda
- Malaria Research Institute, Dept Molecular Microbiology Immunology, Johns Hopkins School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Karissa E Cottier
- Malaria Research Institute, Dept Molecular Microbiology Immunology, Johns Hopkins School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.,BioIVT, 1450 South Rolling Road, Baltimore, MD, USA
| | | | - James Chipeta
- Department of Paediatrics, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Monique F Stins
- Malaria Research Institute, Dept Molecular Microbiology Immunology, Johns Hopkins School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| |
Collapse
|
186
|
Rivera-Correa J, Yasnot-Acosta MF, Tovar NC, Velasco-Pareja MC, Easton A, Rodriguez A. Atypical memory B-cells and autoantibodies correlate with anemia during Plasmodium vivax complicated infections. PLoS Negl Trop Dis 2020; 14:e0008466. [PMID: 32687495 PMCID: PMC7392348 DOI: 10.1371/journal.pntd.0008466] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/30/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023] Open
Abstract
Malaria caused by Plasmodium vivax is a highly prevalent infection world-wide, that was previously considered mild, but complications such as anemia have been highly reported in the past years. In mice models of malaria, anti-phosphatidylserine (anti-PS) autoantibodies, produced by atypical B-cells, bind to uninfected erythrocytes and contribute to anemia. In human patients with P. falciparum malaria, the levels of anti-PS, atypical B-cells and anemia are strongly correlated to each other. In this study, we focused on assessing the relationship between autoantibodies, different B-cell populations and hemoglobin levels in two different cohorts of P. vivax patients from Colombia, South America. In a first longitudinal cohort, our results show a strong inverse correlation between different IgG autoantibodies tested (anti-PS, anti-DNA and anti-erythrocyte) and atypical memory B-cells (atMBCs) with hemoglobin in both P. vivax and P. falciparum patients over time. In a second cross-sectional cohort, we observed a stronger relation between hemoglobin levels, atMBCs and autoantibodies in complicated P. vivax patients compared to uncomplicated ones. Altogether, these data constitute the first evidence of autoimmunity associating with anemia and complicated P. vivax infections, suggesting a role for its etiology through the expansion of autoantibody-secreting atMBCs. Malaria is one of the top global infections causing high mortality and morbidity every year. Plasmodium vivax is the most prevalent malarial infection, particularly in the region of the Americas. Complications associated with P. vivax, such as anemia, are a growing reported phenomenon, but the mechanisms leading to them are poorly understood. Here, we report the first evidence of autoantibodies and Atypical Memory B-cells correlating with anemia in two different cohorts of P. vivax patients, particularly during complicated infections. These findings point to Atypical Memory B-cells as key pathological players, possibly through the secretion of autoantibodies, and attributes a role for autoimmunity in mediating complications during P. vivax infections.
Collapse
Affiliation(s)
- Juan Rivera-Correa
- New York University School of Medicine, New York, United States of America
- * E-mail: (JRC); (AR)
| | | | - Nubia Catalina Tovar
- New York University School of Medicine, New York, United States of America
- Grupo de Investigaciones Microbiológicas y Biomédicas de Córdoba, Universidad de Córdoba, Colombia
- Universidad del Sinú, Montería, Colombia
- Universidad de Cartagena, Bolívar, Colombia
| | | | - Alice Easton
- New York University School of Medicine, New York, United States of America
| | - Ana Rodriguez
- New York University School of Medicine, New York, United States of America
- * E-mail: (JRC); (AR)
| |
Collapse
|
187
|
Elmardi KA, Adam I, Malik EM, Abdelrahim TA, Elhag MS, Ibrahim AA, Babiker MA, Elhassan AH, Kafy HT, Elshafie AT, Nawai LM, Abdin MS, Kremers S. Prevalence and determinants of anaemia in women of reproductive age in Sudan: analysis of a cross-sectional household survey. BMC Public Health 2020; 20:1125. [PMID: 32680488 PMCID: PMC7367227 DOI: 10.1186/s12889-020-09252-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anaemia is a global health problem and women in reproductive age (WRA) are amongst the most affected population. Its consequences include low birth weight and maternal mortality. This study aimed to assess the prevalence of anaemia and to identify its determinants in Sudanese women in reproductive age. METHODS A population-based cross-sectional study was conducted in Sudan in 2016. A multi-stage stratified cluster sampling design was executed with consideration of rural population, urban population, and internally displaced persons/refugees camps residents. All women in reproductive age (15-49 years), classified by pregnancy status, in the targeted households were surveyed and personal characteristic data were collected. Their haemoglobin level and malaria infection (using rapid diagnostic test, RDT) were assessed. The World Health Organization (WHO) haemoglobin level cut-off for defining anaemia and severe anaemia in pregnant and non-pregnant women was used. Logistic regression analyses were performed. RESULTS A total of 4271 women (WRA) of which 421 (9.9%) pregnant women (PW) were included in the study. The overall anaemia prevalence in WRA was 35.6%. It was 36.0 and 35.5% in PW and non-pregnant women (NPW), respectively. The average haemoglobin level was found to be 113.9 g/L (SD 16.3) and 123.2 g/L (SD 15.7) for PW and NPW respectively. Severe anaemia prevalence was 1.2% in each group. In the logistic regression model, anaemia was associated with malaria infection in PW (aOR 4.100, 95%CI 1.523-11.039, p = 0.003), NPW (aOR 2.776, 95%CI 1.889-4.080, p < 0.001), and WRA (aOR 2.885, 95%CI 2.021-4.119, p < 0.001). Other identified determinants of anaemia in NPW was living in camps (aOR 1.499, 95%CI 1.115-2.017, p = 0.007) and in WRA was being in the poorest economic class (aOR 1.436, 95%CI 1.065-1.936, p = 0.018). CONCLUSIONS Anaemia is a public health problem in Sudan. The study supported the association between malaria infection and anaemia, but not with low and moderate malaria transmission areas. Resources need to be allocated for all anaemic populations with special attention for the populations in most need and interventions need to be implemented based on local variations. Malaria control interventions, specifically case management, may have a major impact in reducing anaemia prevalence in low to moderate malaria transmission areas.
Collapse
Affiliation(s)
- Khalid Abdelmutalab Elmardi
- Health Information, Monitoring and Evaluation and Evidence Department, Federal Ministry of Health, Khartoum, Sudan.
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | | | - Tarig Abdalla Abdelrahim
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Mousab Siddig Elhag
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Abdalla Ahmed Ibrahim
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Mariam Adam Babiker
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | | | - Hmooda Toto Kafy
- Directorate General of Primary Health Care, Federal Ministry of Health, Khartoum, Sudan
| | - Azza Tageldin Elshafie
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Lubna Mohammed Nawai
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Mujahid Sheikhedin Abdin
- Health Information, Monitoring and Evaluation and Evidence Department, Federal Ministry of Health, Khartoum, Sudan
| | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| |
Collapse
|
188
|
Lev D, Yahalom G, Rabinowicz S, Leshem E, Schwartz E. Opsoclonus-myoclonus as a presentation of post-malaria neurological syndrome. J Travel Med 2020; 27:5821018. [PMID: 32299096 DOI: 10.1093/jtm/taaa051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Dana Lev
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel
| | - Gilad Yahalom
- Department of Neurology and Movement Disorders Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shira Rabinowicz
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel
| | - Eyal Leshem
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eli Schwartz
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
189
|
Akech S, Chepkirui M, Ogero M, Agweyu A, Irimu G, English M, Snow RW. The Clinical Profile of Severe Pediatric Malaria in an Area Targeted for Routine RTS,S/AS01 Malaria Vaccination in Western Kenya. Clin Infect Dis 2020; 71:372-380. [PMID: 31504308 PMCID: PMC7353324 DOI: 10.1093/cid/ciz844] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The malaria prevalence has declined in western Kenya, resulting in the risk of neurological phenotypes in older children. This study investigates the clinical profile of pediatric malaria admissions ahead of the introduction of the RTS,S/AS01 vaccine. METHODS Malaria admissions in children aged 1 month to 15 years were identified from routine, standardized, inpatient clinical surveillance data collected between 2015 and 2018 from 4 hospitals in western Kenya. Malaria phenotypes were defined based on available data. RESULTS There were 5766 malaria admissions documented. The median age was 36 months (interquartile range, 18-60): 15% were aged between 1-11 months of age, 33% were aged 1-23 months of age, and 70% were aged 1 month to 5 years. At admission, 2340 (40.6%) children had severe malaria: 421/2208 (19.1%) had impaired consciousness, 665/2240 (29.7%) had an inability to drink or breastfeed, 317/2340 (13.6%) had experienced 2 or more convulsions, 1057/2340 (45.2%) had severe anemia, and 441/2239 (19.7%) had severe respiratory distress. Overall, 211 (3.7%) children admitted with malaria died; 163/211 (77% deaths, case fatality rate 7.0%) and 48/211 (23% deaths, case fatality rate 1.4%) met the criteria for severe malaria and nonsevere malaria at admission, respectively. The median age for fatal cases was 33 months (interquartile range, 12-72) and the case fatality rate was highest in those unconscious (44.4%). CONCLUSIONS Severe malaria in western Kenya is still predominantly seen among the younger pediatric age group and current interventions targeted for those <5 years are appropriate. However, there are increasing numbers of children older than 5 years admitted with malaria, and ongoing hospital surveillance would identify when interventions should target older children.
Collapse
Affiliation(s)
- Samuel Akech
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mercy Chepkirui
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Morris Ogero
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ambrose Agweyu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Mike English
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert W Snow
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
190
|
Postels DG, Osei-Tutu L, Seydel KB, Xu Q, Li C, Taylor TE, John CC, Mallewa M, Solomon T, Agbenyega T, Ansong D, Opoka RO, Khan LM, Ramachandran PS, Leon KE, DeRisi JL, Langelier C, Wilson MR. Central Nervous System Virus Infection in African Children with Cerebral Malaria. Am J Trop Med Hyg 2020; 103:200-205. [PMID: 32342847 PMCID: PMC7356427 DOI: 10.4269/ajtmh.19-0962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/30/2020] [Indexed: 11/07/2022] Open
Abstract
We aimed to identify the contribution of central nervous system (CNS) viral coinfection to illness in African children with retinopathy-negative or retinopathy-positive cerebral malaria (CM). We collected cerebrospinal fluid (CSF) from 272 children with retinopathy-negative or retinopathy-positive CM and selected CSF from 111 of these children (38 retinopathy positive, 71 retinopathy negative, 2 retinopathy unknown) for analysis by metagenomic next-generation sequencing. We found CSF viral coinfections in 7/38 (18.4%) retinopathy-positive children and in 18/71 (25.4%) retinopathy-negative children. Excluding HIV-1, human herpesviruses (HHV) represented 61% of viruses identified. Excluding HIV-1, CNS viral coinfection was equally likely in children who were retinopathy positive and retinopathy negative (P = 0.1431). Neither mortality nor neurological morbidity was associated with the presence of virus (odds ratio [OR] = 0.276, 95% CI: 0.056-1.363). Retinopathy-negative children with a higher temperature, lower white blood cell count, or being dehydrated were more likely to have viral coinfection. Level of consciousness at admission was not associated with CNS viral coinfection in retinopathy-negative children. Viral CNS coinfection is unlikely to contribute to coma in children with CM. The herpesviruses other than herpes simplex virus may represent incidental bystanders in CM, reactivating during acute malaria infection.
Collapse
Affiliation(s)
- Douglas G. Postels
- Address correspondence to Douglas G. Postels, Department of Neurology, Children’s National Medical Center, George Washington University, 111 Michigan Ave. NW, Washington, DC 20010. E-mail:
| | | | | | - Qian Xu
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | | | - Chandy C. John
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Tsiri Agbenyega
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Robert O. Opoka
- Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda
| | - Lillian M. Khan
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California
| | - Prashanth S. Ramachandran
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Kristoffer E. Leon
- UCSF School of Medicine, University of California San Francisco, San Francisco, California
| | | | - Charles Langelier
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California
| |
Collapse
|
191
|
Varo R, Chaccour C, Bassat Q. Update on malaria. Med Clin (Barc) 2020; 155:395-402. [PMID: 32620355 DOI: 10.1016/j.medcli.2020.05.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/25/2023]
Abstract
Despite recent successful efforts to reduce the global malaria burden, this disease remains a significant global health problem. Only in 2018, malaria caused 228 million clinical episodes, 2-4 million of which were severe malaria cases, and 405,000 were fatal. Most of the malaria attributable mortality occurred among children in sub-Saharan Africa. Nowadays, rapid diagnostic tests and artemisinin derivatives are two of the main pillars for the management of malaria. However, considering the current situation, these strategies are not sufficient to maintain a reducing trend in malaria incidence and mortality. New insights into the pathophysiology of malaria have highlighted the importance of the host response to infection. Understanding this response would help to develop new diagnostic and therapeutic tools. Vector and parasite drug resistance are two major challenges for malaria control that require special attention. The most advanced malaria vaccine (RTS,S) is currently being piloted in 3 African countries.
Collapse
Affiliation(s)
- Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Carlos Chaccour
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Ifakara Health Institute, Ifakara, United Republic of Tanzania; Facultad de Medicina, Universidad de Navarra, Pamplona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Deu (University of Barcelona), Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Publica (CIBERESP), Madrid, Spain.
| |
Collapse
|
192
|
Padilla-Rodríguez JC, Olivera MJ, Guevara-García BD. Parasite density in severe malaria in Colombia. PLoS One 2020; 15:e0235119. [PMID: 32574179 PMCID: PMC7310729 DOI: 10.1371/journal.pone.0235119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Colombia has officially adopted the parasite density levels of severe malaria established by the WHO (>50,000 parasites/μl). These values have been inferred from areas of high transmission in Africa and are not consistent with the dynamics of low and unstable transmission in Colombia. The objective of this study was therefore to determine the parasite density values observed in patients with severe malaria and their distribution in the different ecoepidemiological regions of Colombia. METHODS A retrospective and descriptive study of confirmed cases of severe malaria was conducted in endemic areas of malaria in Colombia over the period 2014-2017. Data were collected from secondary sources of the Subnational Programs of Malaria Prevention and Control. Person, place, and time variables were selected. The official definition of severe malaria was adopted, and compliance with these criteria was determined. Univariate and bivariate analyses were conducted with absolute and relative frequency measures, and the relevant statistical tests were applied. RESULTS The overall parasite density values in Colombia showed a geometric mean of 5,919 parasites/μl (95% CI: 5,608-6,248). By parasite species, the values were 6,151 (95% CI: 5,631-6,718) for Plasmodium falciparum and 5,815 (95% CI: 5,428-6,230) for Plasmodium vivax. The highest parasite density values were recorded in the Amazon ecoepidemiological region (8,177; 95% CI: 6,015-11,116), and the lowest values were recorded in the Andean region (5,026; 95% CI: 2,409-10,480). CONCLUSIONS In endemic areas of low and unstable malaria transmission in the Colombian territory, the parasite density levels observed in populations with severe malaria are lower than the officially established values. The parasite density criterion is not really a relevant criterion for the definition of severe cases in Colombia and it certainly not be used to make a clinical decision about the severity of the disease.
Collapse
Affiliation(s)
| | - Mario J. Olivera
- Grupo de Parasitología, Instituto Nacional de Salud, Bogotá, D.C., Colombia
- * E-mail:
| | | |
Collapse
|
193
|
Nghochuzie NN, Olwal CO, Udoakang AJ, Amenga-Etego LNK, Amambua-Ngwa A. Pausing the Fight Against Malaria to Combat the COVID-19 Pandemic in Africa: Is the Future of Malaria Bleak? Front Microbiol 2020; 11:1476. [PMID: 32625198 PMCID: PMC7314964 DOI: 10.3389/fmicb.2020.01476] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
Malaria remains a major global health burden, killing hundreds of thousands annually, especially in sub-Saharan Africa. In 2019, a Phase IV Expanded Programme on Immunization (EPI)-linked malaria vaccine implementation was underway. However, in December 2019, a novel pneumonia condition termed coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with many clinical, epidemiological, and biological parallels to malaria, was reported in Wuhan, China. COVID-19 is spreading rapidly, and, as of the 3rd of June, 2020, more than 382,507 persons had died from COVID-19. Children under 5 years who suffer high malaria-attributable mortalities are largely asymptomatic for COVID-19. Considering that the malaria burden is highest in low-income tropical countries with little capacity to fund malaria control and eradication programs, the fight against malaria in these regions is likely to be hampered. Access to healthcare has generally been limited, while malaria interventions, such as seasonal malaria chemotherapy and distribution of insecticide-treated bed nets, have been suspended due to lockdowns. Likewise, the repurposing of antimalarials for treatment of COVID-19 shared symptoms and the shift in focus from the production of malaria rapid diagnostic tests (RDTs) to COVID-19 RDTs is a cause for concern in malaria-endemic regions. Children are less affected by the COVID-19 pandemic compared to the elderly. However, due to the fears of contracting SARS-CoV-2, the elderly who are worst affected by COVID-19 may not take children for malaria medication, resulting in high malaria-related mortalities among children. COVID-19 has disproportionately affected developed countries, threatening their donation capacity. These are likely to thwart malaria control efforts in low-income regions. Here, we present perspectives on the collateral impact of COVID-19 on malaria, especially in Africa.
Collapse
Affiliation(s)
- Nora Nganyewo Nghochuzie
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Charles Ochieng' Olwal
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Aniefiok John Udoakang
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Lucas Naam-Kayagre Amenga-Etego
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Alfred Amambua-Ngwa
- Medical Research Council Unit The Gambia at LSHTM, Banjul, The Gambia
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| |
Collapse
|
194
|
Kamau A, Mtanje G, Mataza C, Mwambingu G, Mturi N, Mohammed S, Ong'ayo G, Nyutu G, Nyaguara A, Bejon P, Snow RW. Malaria infection, disease and mortality among children and adults on the coast of Kenya. Malar J 2020; 19:210. [PMID: 32552891 PMCID: PMC7301992 DOI: 10.1186/s12936-020-03286-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malaria transmission has recently fallen in many parts of Africa, but systematic descriptions of infection and disease across all age groups are rare. Here, an epidemiological investigation of parasite prevalence, the incidence of fevers associated with infection, severe hospitalized disease and mortality among children older than 6 months and adults on the Kenyan coast is presented. METHODS A prospective fever surveillance was undertaken at 6 out-patients (OPD) health-facilities between March 2018 and February 2019. Four community-based, cross sectional surveys of fever history and infection prevalence were completed among randomly selected homestead members from the same communities. Paediatric and adult malaria at Kilifi county hospital was obtained for the 12 months period. Rapid Diagnostic Tests (CareStart™ RDT) to detect HRP2-specific to Plasmodium falciparum was used in the community and the OPD, and microscopy in the hospital. Crude and age-specific incidence rates were computed using Poisson regression. RESULTS Parasite prevalence gradually increased from childhood, reaching 12% by 9 years of age then declining through adolescence into adulthood. The incidence rate of RDT positivity in the OPD followed a similar trend to that of infection prevalence in the community. The incidence of hospitalized malaria from the same community was concentrated among children aged 6 months to 4 years (i.e. 64% and 70% of all hospitalized and severe malaria during the 12 months of surveillance, respectively). Only 3.7% (12/316) of deaths were directly attributable to malaria. Malaria mortality was highest among children aged 6 months-4 years at 0.57 per 1000 person-years (95% CI 0.2, 1.2). Severe malaria and death from malaria was negligible above 15 years of age. CONCLUSION Under conditions of low transmission intensity, immunity to disease and the fatal consequences of infection appear to continue to be acquired in childhood and faster than anti-parasitic immunity. There was no evidence of an emerging significant burden of severe malaria or malaria mortality among adults. This is contrary to current modelled approaches to disease burden estimation in Africa and has important implications for the targeting of infection prevention strategies based on chemoprevention or vector control.
Collapse
Affiliation(s)
- Alice Kamau
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Grace Mtanje
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christine Mataza
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Ministry of Health, Kilifi County Government, Kilifi, Kenya
| | | | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Gideon Nyutu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Amek Nyaguara
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Robert W Snow
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
195
|
Mulholland K. Management of childhood pneumonia in Nigeria. Pediatr Pulmonol 2020; 55 Suppl 1:S34-S36. [PMID: 32203644 PMCID: PMC7318196 DOI: 10.1002/ppul.24717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/24/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Kim Mulholland
- Infection and Immunity, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
196
|
Watson JA, Holmes CC. Graphing and reporting heterogeneous treatment effects through reference classes. Trials 2020; 21:386. [PMID: 32381030 PMCID: PMC7204233 DOI: 10.1186/s13063-020-04306-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exploration and modelling of heterogeneous treatment effects as a function of baseline covariates is an important aspect of precision medicine in randomised controlled trials (RCTs). Randomisation generally guarantees the internal validity of an RCT, but heterogeneity in treatment effect can reduce external validity. Estimation of heterogeneous treatment effects is usually done via a predictive model for individual outcomes, where one searches for interactions between treatment allocation and important patient baseline covariates. However, such models are prone to overfitting and multiple testing and typically demand a transformation of the outcome measurement, for example, from the absolute risk in the original RCT to log-odds of risk in the predictive model. METHODS We show how reference classes derived from baseline covariates can be used to explore heterogeneous treatment effects via a two-stage approach. We first estimate a risk score which captures on a single dimension some of the heterogeneity in outcomes of the trial population. Heterogeneity in the treatment effect can then be explored via reweighting schemes along this axis of variation. This two-stage approach bypasses the search for interactions with multiple covariates, thus protecting against multiple testing. It also allows for exploration of heterogeneous treatment effects on the original outcome scale of the RCT. This approach would typically be applied to multivariable models of baseline risk to assess the stability of average treatment effects with respect to the distribution of risk in the population studied. CASE STUDY We illustrate this approach using the single largest randomised treatment trial in severe falciparum malaria and demonstrate how the estimated treatment effect in terms of absolute mortality risk reduction increases considerably in higher risk strata. CONCLUSIONS 'Local' and 'tilting' reweighting schemes based on ranking patients by baseline risk can be used as a general approach for exploring, graphing and reporting heterogeneity of treatment effect in RCTs. TRIAL REGISTRATION ISRCTN clinical trials registry: ISRCTN50258054. Prospectively registered on 22 July 2005.
Collapse
Affiliation(s)
- James A Watson
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Chris C Holmes
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Department of Statistics, University of Oxford, Oxford, UK.
| |
Collapse
|
197
|
Severe malaria. Current concepts and practical overview: What every intensivist should know. Intensive Care Med 2020; 46:907-918. [PMID: 32347322 DOI: 10.1007/s00134-020-06019-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
|
198
|
Imported Malaria in Countries where Malaria Is Not Endemic: a Comparison of Semi-immune and Nonimmune Travelers. Clin Microbiol Rev 2020; 33:33/2/e00104-19. [PMID: 32161068 DOI: 10.1128/cmr.00104-19] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The continuous increase in long-distance travel and recent large migratory movements have changed the epidemiological characteristics of imported malaria in countries where malaria is not endemic (here termed non-malaria-endemic countries). While malaria was primarily imported to nonendemic countries by returning travelers, the proportion of immigrants from malaria-endemic regions and travelers visiting friends and relatives (VFRs) in malaria-endemic countries has continued to increase. VFRs and immigrants from malaria-endemic countries now make up the majority of malaria patients in many nonendemic countries. Importantly, this group is characterized by various degrees of semi-immunity to malaria, resulting from repeated exposure to infection and a gradual decline of protection as a result of prolonged residence in non-malaria-endemic regions. Most studies indicate an effect of naturally acquired immunity in VFRs, leading to differences in the parasitological features, clinical manifestation, and odds for severe malaria and clinical complications between immune VFRs and nonimmune returning travelers. There are no valid data indicating evidence for differing algorithms for chemoprophylaxis or antimalarial treatment in semi-immune versus nonimmune malaria patients. So far, no robust biomarkers exist that properly reflect anti-parasite or clinical immunity. Until they are found, researchers should rigorously stratify their study results using surrogate markers, such as duration of time spent outside a malaria-endemic country.
Collapse
|
199
|
Chan XHS, Win YN, Haeusler IL, Tan JY, Loganathan S, Saralamba S, Chan SKS, Ashley EA, Barnes KI, Baiden R, Bassi PU, Djimde A, Dorsey G, Duparc S, Hanboonkunupakarn B, ter Kuile FO, Lacerda MVG, Nasa A, Nosten FH, Onyeji CO, Pukrittayakamee S, Siqueira AM, Tarning J, Taylor WRJ, Valentini G, van Vugt M, Wesche D, Day NPJ, Huang CLH, Brugada J, Price RN, White NJ. Factors affecting the electrocardiographic QT interval in malaria: A systematic review and meta-analysis of individual patient data. PLoS Med 2020; 17:e1003040. [PMID: 32134952 PMCID: PMC7058280 DOI: 10.1371/journal.pmed.1003040] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Electrocardiographic QT interval prolongation is the most widely used risk marker for ventricular arrhythmia potential and thus an important component of drug cardiotoxicity assessments. Several antimalarial medicines are associated with QT interval prolongation. However, interpretation of electrocardiographic changes is confounded by the coincidence of peak antimalarial drug concentrations with recovery from malaria. We therefore reviewed all available data to characterise the effects of malaria disease and demographic factors on the QT interval in order to improve assessment of electrocardiographic changes in the treatment and prevention of malaria. METHODS AND FINDINGS We conducted a systematic review and meta-analysis of individual patient data. We searched clinical bibliographic databases (last on August 21, 2017) for studies of the quinoline and structurally related antimalarials for malaria-related indications in human participants in which electrocardiograms were systematically recorded. Unpublished studies were identified by the World Health Organization (WHO) Evidence Review Group (ERG) on the Cardiotoxicity of Antimalarials. Risk of bias was assessed using the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) checklist for adverse drug events. Bayesian hierarchical multivariable regression with generalised additive models was used to investigate the effects of malaria and demographic factors on the pretreatment QT interval. The meta-analysis included 10,452 individuals (9,778 malaria patients, including 343 with severe disease, and 674 healthy participants) from 43 studies. 7,170 (68.6%) had fever (body temperature ≥ 37.5°C), and none developed ventricular arrhythmia after antimalarial treatment. Compared to healthy participants, patients with uncomplicated falciparum malaria had shorter QT intervals (-61.77 milliseconds; 95% credible interval [CI]: -80.71 to -42.83) and increased sensitivity of the QT interval to heart rate changes. These effects were greater in severe malaria (-110.89 milliseconds; 95% CI: -140.38 to -81.25). Body temperature was associated independently with clinically significant QT shortening of 2.80 milliseconds (95% CI: -3.17 to -2.42) per 1°C increase. Study limitations include that it was not possible to assess the effect of other factors that may affect the QT interval but are not consistently collected in malaria clinical trials. CONCLUSIONS Adjustment for malaria and fever-recovery-related QT lengthening is necessary to avoid misattributing malaria-disease-related QT changes to antimalarial drug effects. This would improve risk assessments of antimalarial-related cardiotoxicity in clinical research and practice. Similar adjustments may be indicated for other febrile illnesses for which QT-interval-prolonging medications are important therapeutic options.
Collapse
Affiliation(s)
- Xin Hui S. Chan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Yan Naung Win
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Health and Diseases Control Unit, Naypyidaw, Myanmar
| | - Ilsa L. Haeusler
- WorldWide Antimalarial Research Network, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jireh Y. Tan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shanghavie Loganathan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Christ Church College, University of Oxford, Oxford, United Kingdom
| | - Sompob Saralamba
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shu Kiat S. Chan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Singapore Armed Forces Medical Corps, Singapore
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao PDR
| | - Karen I. Barnes
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- WorldWide Antimalarial Resistance Network, Cape Town, South Africa
| | | | - Peter U. Bassi
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Abdoulaye Djimde
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science Techniques and Technologies of Bamako, Bamako, Mali
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | | | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Marcus V. G. Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Fundação Oswaldo Cruz, Manaus, Brazil
| | - Amit Nasa
- Sun Pharmaceutical Industries Ltd, Gurgaon, Haryana, India
| | - François H. Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Sasithon Pukrittayakamee
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Royal Society of Thailand, Dusit, Bangkok, Thailand
| | - André M. Siqueira
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- WorldWide Antimalarial Research Network, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Walter R. J. Taylor
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Michèle van Vugt
- Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - David Wesche
- Certara, Princeton, New Jersey, United States of America
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ric N. Price
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
200
|
Meneses GC, da Silva GB, Tôrres PPBF, de Castro VQ, Lopes RL, Martins AMC, Daher EDF. Novel kidney injury biomarkers in tropical infections: a review of the literature. Rev Inst Med Trop Sao Paulo 2020; 62:e14. [PMID: 32074217 PMCID: PMC7032010 DOI: 10.1590/s1678-9946202062014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 12/29/2022] Open
Abstract
Tropical diseases are mainly found in the tropical regions of Asia, Africa and Latin America. They are a major Public Health problem in these regions, most of them are considered neglected diseases and remain as important contributors to the development of AKI (Acute Kidney Injury), which is associated with increased patients' morbidity and mortality. In most countries, kidney disease associated to tropical diseases is attended at health services with poor infrastructure and inadequate preventive measures. The long-term impacts of these infections on kidney tissue may be a main cause of future kidney disease in these patients. Therefore, the investigation of novel kidney injury biomarkers in these tropical diseases is of utmost importance to explain the mechanisms of kidney injury, to improve their diagnosis and prognosis, as well as the assessment to health systems by these patients. Since 2011, our group has been studying renal biomarkers in visceral and cutaneous leishmaniasis, schistosomiasis, leptospirosis and leprosy. This study has increased the knowledge on the pathophysiology of kidney disease in the presence of these infections and has contributed to the early diagnosis of kidney injury, pointing to glomerular, endothelial and inflammatory involvement as the main causes of the mechanisms leading to nephropathy and clinical complications. Future perspectives comprise establishing long-term cohort groups to assess the development of kidney disease and the patients' survival, as well as the use of new biomarkers such as urinary exosomes to detect risk groups and to understand the progression of kidney injuries.
Collapse
Affiliation(s)
- Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Paulo Pacelli Bezerra Filizola Tôrres
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Valeska Queiroz de Castro
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Renata Lima Lopes
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
| |
Collapse
|