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Schaefer J, Clow W, Bhandari R, Kimura M, Williams L, Pellegrini M. Killing in self-defense: proapoptotic drugs to eliminate intracellular pathogens. Curr Opin Immunol 2022; 79:102263. [PMID: 36375234 DOI: 10.1016/j.coi.2022.102263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
Intracellular infections rely on host cell survival for replication and have evolved several mechanisms to prevent infected cells from dying. Drugs that promote apoptosis, a noninflammatory form of cell death, can dysregulate these survival mechanisms to kill infected cells via a mechanism that resists the evolution of drug resistance. Two such drug classes, known as SMAC mimetics and BH3 mimetics, have shown preclinical efficacy at mediating clearance of liver-stage malaria and chronic infections such as hepatitis-B virus and Mycobacterium tuberculosis. Emerging toxicity and efficacy data have reinforced the broad applicability of these drugs and form the foundations for preclinical and clinical studies into their various usage cases.
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Affiliation(s)
- Jan Schaefer
- Walter & Eliza Hall Institute Infectious Disease and Immune Defence Division, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - William Clow
- Walter & Eliza Hall Institute Infectious Disease and Immune Defence Division, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Reet Bhandari
- Walter & Eliza Hall Institute Infectious Disease and Immune Defence Division, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Mari Kimura
- Walter & Eliza Hall Institute Infectious Disease and Immune Defence Division, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Lewis Williams
- Walter & Eliza Hall Institute Infectious Disease and Immune Defence Division, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Marc Pellegrini
- Walter & Eliza Hall Institute Infectious Disease and Immune Defence Division, 1G Royal Parade, Parkville, VIC 3052, Australia.
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Health and Vaccination Status of Unaccompanied Minors After Arrival in a European Border Country: A Cross-sectional Study (2017-2020). Pediatr Infect Dis J 2022; 41:872-877. [PMID: 36102691 DOI: 10.1097/inf.0000000000003670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unaccompanied and separated children (UASC) are a high-risk group for infectious diseases and information on their vaccination status is scarce. Different approaches are used to screen newly arrived minors in Europe. The aim of this study was to describe the health status and serological protection against different vaccine-preventable diseases among UASC to inform public health decision-making. METHODS Retrospective study of all UASC seen at an international health reference center in Barcelona (Spain) between January 2017 and February 2020. Screening results were analyzed using binary logistic regression with adjustment for symptoms, geographic origin, and time since arrival. RESULTS We studied 289 UASC (88.9% males; median age, 17 years). At least one infection was diagnosed in 136 minors (47.1%). There was a high prevalence of intestinal parasites (22.8%), latent tuberculosis infection (22.5%), and hepatitis B (5.2%), even in asymptomatic individuals, and especially among UASC from sub-Saharan Africa (odds ratio, 2.5; 95% confidence interval, 1.5-4.0, P < 0.001). We did not observe a significant association between clinical symptoms and the presence of infection or differences in the prevalence of different infections according to number of months since arrival. Protection against hepatitis B virus (36%), measles (80%), and varicella (83%) was suboptimal. CONCLUSIONS Our results highlight the importance of screening and vaccination programs for UASC arriving in Europe, especially border countries. Protocols should be adjusted according to geographic origin. Absence of symptoms does not necessarily rule out infection, highlighting the importance of screening in asymptomatic minors. These programs are a public health priority and should not be neglected during the current COVID-19 pandemic.
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Abstract
IMPORTANCE Malaria is caused by protozoa parasites of the genus Plasmodium and is diagnosed in approximately 2000 people in the US each year who have returned from visiting regions with endemic malaria. The mortality rate from malaria is approximately 0.3% in the US and 0.26% worldwide. OBSERVATIONS In the US, most malaria is diagnosed in people who traveled to an endemic region. More than 80% of people diagnosed with malaria in the US acquired the infection in Africa. Of the approximately 2000 people diagnosed with malaria in the US in 2017, an estimated 82.4% were adults and about 78.6% were Black or African American. Among US residents diagnosed with malaria, 71.7% had not taken malaria chemoprophylaxis during travel. In 2017 in the US, P falciparum was the species diagnosed in approximately 79% of patients, whereas P vivax was diagnosed in an estimated 11.2% of patients. In 2017 in the US, severe malaria, defined as vital organ involvement including shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia, occurred in approximately 14% of patients, and an estimated 0.3% of those receiving a diagnosis of malaria in the US died. P falciparum has developed resistance to chloroquine in most regions of the world, including Africa. First-line therapy for P falciparum malaria in the US is combination therapy that includes artemisinin. If P falciparum was acquired in a known chloroquine-sensitive region such as Haiti, chloroquine remains an alternative option. When artemisinin-based combination therapies are not available, atovaquone-proguanil or quinine plus clindamycin is used for chloroquine-resistant malaria. P vivax, P ovale, P malariae, and P knowlesi are typically chloroquine sensitive, and treatment with either artemisinin-based combination therapy or chloroquine for regions with chloroquine-susceptible infections for uncomplicated malaria is recommended. For severe malaria, intravenous artesunate is first-line therapy. Treatment of mild malaria due to a chloroquine-resistant parasite consists of a combination therapy that includes artemisinin or chloroquine for chloroquine-sensitive malaria. P vivax and P ovale require additional therapy with an 8-aminoquinoline to eradicate the liver stage. Several options exist for chemoprophylaxis and selection should be based on patient characteristics and preferences. CONCLUSIONS AND RELEVANCE Approximately 2000 cases of malaria are diagnosed each year in the US, most commonly in travelers returning from visiting endemic areas. Prevention and treatment of malaria depend on the species and the drug sensitivity of parasites from the region of acquisition. Intravenous artesunate is first-line therapy for severe malaria.
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Affiliation(s)
- Johanna P Daily
- Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, Bronx, New York
| | - Aurelia Minuti
- D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, New York
| | - Nazia Khan
- Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, Bronx, New York
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Forniti A, Riccardi N, Sponga P, Buono C, Iapoce R, Suardi LR, Tiseo G, Falcone M, Menichetti F. Recrudescence of Plasmodium falciparum malaria 5 years after treatment in an HIV migrant: a case report with a peculiar presentation. LE INFEZIONI IN MEDICINA 2022; 30:304-308. [PMID: 35693061 PMCID: PMC9177190 DOI: 10.53854/liim-3002-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
In the last two decades, several cases of delayed-onset malaria in migrants from endemic areas were reported. The decrease of acquired immunity over time, often enhanced by immune suppression, represents a possible underlying mechanism for recrudescence. Here we describe a case of Plasmodium falciparum malaria occurring five years after exposure in a patient infected with human immunodeficiency virus, originating from Ivory Coast. Peculiarly, bilateral subsegmental pulmonary embolism in the absence of deep venous thrombosis was also detected, requiring anticoagulant therapy. Treatment with dihydroartemisinin/piperaquine was followed by clearance of trophozoites and the patient was discharged home.
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Affiliation(s)
- Arianna Forniti
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Niccolò Riccardi
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pietro Sponga
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Buono
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Iapoce
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Roberto Suardi
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Falcone
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Cordaillat R, Carnino L, Eperon G. Recrudescence of Plasmodium falciparum malaria in a migrant treated by tocilizumab. J Travel Med 2021; 28:6183287. [PMID: 33758947 DOI: 10.1093/jtm/taab043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 11/12/2022]
Abstract
We report an atypical case of recrudescence of Plasmodium falciparum in a migrant with 4% parasitemia, 7 years after leaving endemic country. This case supports the hypothesis of recrudescence of a latent and persistent sub-microscopic parasitemia, triggered by time-related decreasing immunity and immunosuppression (tocilizumab).
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Affiliation(s)
- Romain Cordaillat
- Division of Tropical and Humanitarian Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Luisa Carnino
- Division of Tropical and Humanitarian Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
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Clark NF, Taylor-Robinson AW. An Ecologically Framed Comparison of The Potential for Zoonotic Transmission of Non-Human and Human-Infecting Species of Malaria Parasite. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:361-373. [PMID: 34211355 PMCID: PMC8223545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The threats, both real and perceived, surrounding the development of new and emerging infectious diseases of humans are of critical concern to public health and well-being. Among these risks is the potential for zoonotic transmission to humans of species of the malaria parasite, Plasmodium, that have been considered historically to infect exclusively non-human hosts. Recently observed shifts in the mode, transmission, and presentation of malaria among several species studied are evidenced by shared vectors, atypical symptoms, and novel host-seeking behavior. Collectively, these changes indicate the presence of environmental and ecological pressures that are likely to influence the dynamics of these parasite life cycles and physiological make-up. These may be further affected and amplified by such factors as increased urban development and accelerated rate of climate change. In particular, the extended host-seeking behavior of what were once considered non-human malaria species indicates the specialist niche of human malaria parasites is not a limiting factor that drives the success of blood-borne parasites. While zoonotic transmission of non-human malaria parasites is generally considered to not be possible for the vast majority of Plasmodium species, failure to consider the feasibility of its occurrence may lead to the emergence of a potentially life-threatening blood-borne disease of humans. Here, we argue that recent trends in behavior among what were hitherto considered to be non-human malaria parasites to infect humans call for a cross-disciplinary, ecologically-focused approach to understanding the complexities of the vertebrate host/mosquito vector/malaria parasite triangular relationship. This highlights a pressing need to conduct a multi-species investigation for which we recommend the construction of a database to determine ecological differences among all known Plasmodium species, vectors, and hosts. Closing this knowledge gap may help to inform alternative means of malaria prevention and control.
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Affiliation(s)
- Nicole F. Clark
- Institute for Applied Ecology, University of Canberra,
Bruce, Australia,College of Medicine and Public Health, Flinders
University, Australia
| | - Andrew W. Taylor-Robinson
- Infectious Diseases Research Group, School of Health,
Medical & Applied Sciences, Central Queensland University, Brisbane,
Australia,College of Health & Human Sciences, Charles Darwin
University, Casuarina, Australia,To whom all correspondence should be addressed:
Prof Andrew W. Taylor-Robinson, Infectious Diseases Research Group, School of
Health, Medical & Applied Sciences, Central Queensland University, 160 Ann
Street, Brisbane, QLD 4000, Australia; Tel: +61 7 3295 1185;
; ORCID iD: https://orcid.org/0000-0001-7342-8348
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Shu Kurizky P, Dos Santos Neto LL, Barbosa Aires R, Henrique da Mota LM, Martins Gomes C. Opportunistic tropical infections in immunosuppressed patients. Best Pract Res Clin Rheumatol 2020; 34:101509. [PMID: 32299676 DOI: 10.1016/j.berh.2020.101509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Autoimmune and autoinflammatory diseases are associated with severe morbidity, and represent an impactful health and economic burden worldwide. The treatment of these diseases can include a course with detrimental side effects. Immunosuppression increases the risk of opportunistic infections, but in some cases, the abrupt discontinuation of these medications can result in immune reconstitution inflammatory syndrome. Special attention must be directed to endemic tropical infections, such as leishmaniasis, Chagas disease, malaria, arbovirosis, yellow fever, leprosy, paracoccidioidomycosis, disseminated strongyloidiasis, and ectoparasitosis. These endemic diseases of developing countries can be considered as possible emerging diseases in developed regions partially because of environmental factors and migration. In the present article, we aim to review the evidence-based aspects of the most important opportunistic tropical infections in immunosuppressed patients. We also aim to review the important aspects of vaccination, chemical prophylaxis, and treatment for these infections in people with medication-induced immunosuppression.
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Affiliation(s)
- Patrícia Shu Kurizky
- Programa de Pós-graduação em Ciências Médicas, Hospital Universitário de Brasília, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Leopoldo Luiz Dos Santos Neto
- Programa de Pós-graduação em Ciências Médicas, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Rodrigo Barbosa Aires
- Programa de Pós-graduação em Ciências Médicas, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Licia Maria Henrique da Mota
- Programa de Pós-graduação em Ciências Médicas, Hospital Universitário de Brasília, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Ciro Martins Gomes
- Programa de Pós-graduação em Ciências Médicas, Programa de Pós-Graduação em Medicina Tropical, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
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Bekono BD, Ntie-Kang F, Onguéné PA, Lifongo LL, Sippl W, Fester K, Owono LCO. The potential of anti-malarial compounds derived from African medicinal plants: a review of pharmacological evaluations from 2013 to 2019. Malar J 2020; 19:183. [PMID: 32423415 PMCID: PMC7236213 DOI: 10.1186/s12936-020-03231-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background African Traditional Medicine (ATM) is used for the healthcare of about 80% of the rural populations of the continent of Africa. The practices of ATM make use of plant-products, which are known to contain plant-based secondary metabolites or natural products (NPs), likely to play key roles in drug discovery, particularly as lead compounds. For various reasons, including resistance of strains of Plasmodium to known anti-malarial drugs, local African populations often resort to plant-based treatments and/or a combination of this and standard anti-malarial regimens. Emphasis has been laid in this review to present the anti-malarial virtue of the most recently published phytochemicals or natural products, which have been tested by in vitro and in vivo assays. Methods The data was based on the current version of the African Compound Libraries, which are constantly being updated based on inputs from journal articles and student theses (M.Sc/Ph.D) from African University libraries. Emphasis was laid on data published after 2012. In order to carry out the original data collection, currently being included in the African Compounds Database, individual journal websites were queried using the country names in Africa as search terms. Over 40,000 articles “hits” were originally retrieved, then reduced to about 9000 articles. The retained articles/theses was further queried with the search terms “malaria”, “malarial”, “plasmodium”, “plasmodial” and a combination of them, resulting in over 500 articles. Those including compounds with anti-malarial activities for which the measured activities fell within the established cut off values numbered 55, which were all cited in the review as relevant references. Results and discussion Pure compounds derived from African medicinal plants with demonstrated anti-malarial/antiplasmodial properties with activities ranging from “very active” to “weakly active” have been discussed. The majority of the 187 natural products were terpenoids (30%), followed by flavonoids (22%), alkaloids (19%) and quinones (15%), with each of the other compound classes being less than 5% of the entire compound collection. It was also observed that most of the plant species from which the compounds were identified were of the families Rubiaceae, Meliaceae and Asphodelaceae. The review is intended to continue laying the groundwork for an African-based anti-malarial drug discovery project.
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Affiliation(s)
- Boris D Bekono
- Department of Physics, Ecole Normale Supérieure, University of Yaoundé I, P. O. Box 47, Yaoundé, Cameroon
| | - Fidele Ntie-Kang
- Department of Chemistry, Faculty of Science, University of Buea, P. O. Box 63, Buea, Cameroon. .,Department of Pharmaceutical Chemistry, Martin-Luther University of Halle-Wittenberg, Kurt-Mothes Str. 3, 06120, Halle (Saale), Germany. .,Institut für Botanik, Technische Universität Dresden, Zellescher Weg 20b, 01062 , Dresden, Germany.
| | - Pascal Amoa Onguéné
- Department of Chemistry, University Institute of Wood Technology Mbalmayo, University of Yaoundé I, BP 50, Mbalmayo, Cameroon
| | - Lydia L Lifongo
- Department of Chemistry, Faculty of Science, University of Buea, P. O. Box 63, Buea, Cameroon
| | - Wolfgang Sippl
- Department of Pharmaceutical Chemistry, Martin-Luther University of Halle-Wittenberg, Kurt-Mothes Str. 3, 06120, Halle (Saale), Germany
| | - Karin Fester
- Faculty of Natural and Environmental Sciences, Zittau/Görlitz University of Applied Sciences, Theodor-Körner-Allee 16, 02763, Zittau, Germany
| | - Luc C O Owono
- Department of Physics, Ecole Normale Supérieure, University of Yaoundé I, P. O. Box 47, Yaoundé, Cameroon.
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