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Rodrigo C, Rajapakse S, Fernando SD. Compliance with Primary Malaria Chemoprophylaxis: Is Weekly Prophylaxis Better Than Daily Prophylaxis? Patient Prefer Adherence 2020; 14:2215-2223. [PMID: 33204072 PMCID: PMC7665499 DOI: 10.2147/ppa.s255561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chemoprophylaxis is an effective tool for individuals to minimize their risk of contracting malaria and serves an important public health role in preventing imported malaria. Yet, it is only effective if the traveller is fully compliant with the prescribed regimen. For many destinations, a choice of prophylactic agents is available, so historical compliance data can be helpful for both physicians and travellers to make an informed decision. METHODS We analyzed the historical self-reported compliance data for six chemoprophylactic agents currently recommended by CDC for primary malaria chemoprophylaxis by searching PubMed, Embase, CINAHL, Web of Science, and Scopus for observational studies reporting on travelers within the last 25 years. The quality of data was graded as "good" or "poor" using the NIH quality assessment tool for cohort and cross-sectional studies. Cumulative compliance data were compiled for all studies (gross compliance) and the subgroup of studies with "good" quality evidence (refined compliance). Subgroup analyses were performed for weekly vs daily administered regimens, between military and civilian travelers, and across each prophylactic agent. RESULTS Twenty-four eligible studies assessed compliance for mefloquine (n=20), atovaquone-proguanil (n=11), doxycycline (n=13), and chloroquine (n=3). No studies were found for primaquine or tafenoquine. Both gross and refined compliance were significantly better for weekly regimens than daily regimens (P<0.0001). Stopping chemoprophylaxis due to adverse events was significantly more for doxycycline (P<0.0001) compared to other drugs. Compliance was significantly worse in military travelers, but they were also more likely to be prescribed doxycycline. CONCLUSION Malaria chemoprophylaxis for a traveler should depend on prevailing resistance patterns at destination, current national guidelines, and patient preferences. However, when there is a choice, historical compliance data are useful to select a regimen that the traveler is more likely to comply with.
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Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW, Sydney, NSW, Australia
- Correspondence: Chaturaka Rodrigo Department of Pathology, School of Medical Sciences, University of New South Wales (UNSW), 207, Wallace Wurth Building, Sydney2052, NSW, AustraliaTel +61 2 9065 2186 Email
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Meltzer E, Rahav G, Schwartz E. Vivax Malaria Chemoprophylaxis: The Role of Atovaquone-Proguanil Compared to Other Options. Clin Infect Dis 2019; 66:1751-1755. [PMID: 29228132 DOI: 10.1093/cid/cix1077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/04/2017] [Indexed: 01/01/2023] Open
Abstract
Background Atovaquone-proguanil is considered causal prophylaxis (inhibition of liver-stage schizonts) for Plasmodium falciparum; however, its causal prophylactic efficacy for Plasmodium vivax is not known. Travelers returning to nonendemic areas provide a unique opportunity to study P. vivax prophylaxis. Methods In a retrospective observational study, for 11 years, Israeli rafters who had traveled to the Omo River in Ethiopia, a highly malaria-endemic area, were followed for at least 1 year after their return. Malaria prophylaxis used during this period included mefloquine, doxycycline, primaquine, and atovaquone-proguanil. Prophylaxis failure was divided into early (within a month of exposure) and late malaria. Results Two hundred fifty-two travelers were included in the study. Sixty-two (24.6%) travelers developed malaria, 56 (91.9%) caused by P. vivax, with 54 (87.1%) cases considered as late malaria. Among travelers using atovaquone-proguanil, there were no cases of early P. falciparum or P. vivax malaria. However, 50.0% of atovaquone-proguanil users developed late vivax malaria, as did 46.5% and 43.5% of mefloquine and doxycycline users, respectively; only 2 (1.4%) primaquine users developed late malaria (P < .0001). Conclusions Short-course atovaquone-proguanil appears to provide causal (liver schizont stage) prophylaxis for P. vivax, but is ineffective against late, hypnozoite reactivation-related attacks. These findings suggest that primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax.
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Affiliation(s)
- Eyal Meltzer
- Center for Geographic Medicine and Tropical Diseases, Tel Hashomer, Israel.,Department of Medicine C, Tel Hashomer, Israel
| | - Galia Rahav
- Infectious Diseases Unit, The Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Eli Schwartz
- Center for Geographic Medicine and Tropical Diseases, Tel Hashomer, Israel.,Department of Medicine C, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
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Plasmodium vivax Infection in Multiple Family Members in Texas, USA. Case Rep Infect Dis 2019; 2019:8568710. [PMID: 31281691 PMCID: PMC6590619 DOI: 10.1155/2019/8568710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/23/2019] [Indexed: 11/29/2022] Open
Abstract
We report a cluster of 6 pediatric residents of Houston, Texas, USA, who presented with Plasmodium vivax infection within an eight-week period. All had immigrated to the United States from Afghanistan within the previous year. The clustering raises the possibilities of local mosquito vectored infection and/or synchronous relapses. Molecular typing and local mosquito testing are crucial in delineating the source of similar clusters in nonendemic regions. Single-dose hypnozoite eradication treatment may be considered in emigrating children to malaria nonendemic countries.
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Bakshi RP, Tatham LM, Savage AC, Tripathi AK, Mlambo G, Ippolito MM, Nenortas E, Rannard SP, Owen A, Shapiro TA. Long-acting injectable atovaquone nanomedicines for malaria prophylaxis. Nat Commun 2018; 9:315. [PMID: 29358624 PMCID: PMC5778127 DOI: 10.1038/s41467-017-02603-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 12/12/2017] [Indexed: 12/04/2022] Open
Abstract
Chemoprophylaxis is currently the best available prevention from malaria, but its efficacy is compromised by non-adherence to medication. Here we develop a long-acting injectable formulation of atovaquone solid drug nanoparticles that confers long-lived prophylaxis against Plasmodium berghei ANKA malaria in C57BL/6 mice. Protection is obtained at plasma concentrations above 200 ng ml-1 and is causal, attributable to drug activity against liver stage parasites. Parasites that appear after subtherapeutic doses remain atovaquone-sensitive. Pharmacokinetic-pharmacodynamic analysis indicates protection can translate to humans at clinically achievable and safe drug concentrations, potentially offering protection for at least 1 month after a single administration. These findings support the use of long-acting injectable formulations as a new approach for malaria prophylaxis in travellers and for malaria control in the field.
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Affiliation(s)
- Rahul P Bakshi
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
| | - Lee M Tatham
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool, L69 3GF, UK
| | - Alison C Savage
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, UK
| | - Abhai K Tripathi
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Department of Molecular Microbiology and Immunology, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Godfree Mlambo
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Department of Molecular Microbiology and Immunology, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Matthew M Ippolito
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Elizabeth Nenortas
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
| | - Steve P Rannard
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, UK.
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool, L69 3GF, UK.
| | - Theresa A Shapiro
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Department of Molecular Microbiology and Immunology, The Johns Hopkins University, Baltimore, MD, 21205, USA
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5
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Savelkoel J, Binnendijk KH, Spijker R, van Vugt M, Tan K, Hänscheid T, Schlagenhauf P, Grobusch MP. Abbreviated atovaquone-proguanil prophylaxis regimens in travellers after leaving malaria-endemic areas: A systematic review. Travel Med Infect Dis 2018; 21:3-20. [PMID: 29242073 PMCID: PMC10956543 DOI: 10.1016/j.tmaid.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We evaluated existing data on the prophylactic efficacy of atovaquone-proguanil (AP) in order to determine whether prophylaxis in travellers can be discontinued on the day of return from a malaria-endemic area instead of seven days after return as per currently recommended post-travel schedule. METHODS PubMed and Embase databases were searched to identify relevant studies. This PROSPERO-registered systematic review followed PRISMA guidelines. The search strategy included terms or synonyms relevant to AP combined with terms to identify articles relating to prophylactic use of AP and inhibitory and half-life properties of AP. Studies considered for inclusion were: randomized controlled trials, cohort studies, quasi-experimental studies, open-label trials, patient-control studies, cross-sectional studies; as well as case-series and non-clinical studies. Data on study design, characteristics of participants, interventions, and outcomes were extracted. Primary outcomes considered relevant were prophylactic efficacy and prolonged inhibitory activity and half-life properties of AP. RESULTS The initial search identified 1,482 publications, of which 40 were selected based on screening. Following full text review, 32 studies were included and categorized into two groups, namely studies in support of the current post-travel regimen (with a total of 2,866 subjects) and studies in support of an alternative regimen (with a total of 533 subjects). CONCLUSION There is limited direct and indirect evidence to suggest that an abbreviated post-travel regimen for AP may be effective. Proguanil, however, has a short half-life and is essential for the synergistic effect of the combination. Stopping AP early may result in mono-prophylaxis with atovaquone and possibly select for atovaquone-resistant parasites. Furthermore, the quality of the studies in support of the current post-travel regimen outweighs the quality of the studies in support of an alternative short, post-travel regimen, and the total sample size of the studies to support stopping AP early comprises a small percentage of the total sample size of the studies performed to establish the efficacy of the current AP regimen. Additional research is required - especially from studies evaluating impact on malaria parasitaemia and clinical illness and conducted among travellers in high malaria risk settings - before an abbreviated regimen can be recommended in current practice. PROSPERO REGISTRATION NUMBER CRD42017055244.
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Affiliation(s)
- Jelmer Savelkoel
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Klaas Hendrik Binnendijk
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Rene Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Michèle van Vugt
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Kathrine Tan
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Hänscheid
- Instituto de Medicina Molecular and Department of Microbiology, University of Lisbon, Lisbon, Portugal
| | - Patricia Schlagenhauf
- University of Zürich Travel Clinic, WHO Collaborating Centre for Travellers' Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands.
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Tickell‐Painter M, Maayan N, Saunders R, Pace C, Sinclair D. Mefloquine for preventing malaria during travel to endemic areas. Cochrane Database Syst Rev 2017; 10:CD006491. [PMID: 29083100 PMCID: PMC5686653 DOI: 10.1002/14651858.cd006491.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mefloquine is one of four antimalarial agents commonly recommended for preventing malaria in travellers to malaria-endemic areas. Despite its high efficacy, there is controversy about its psychological side effects. OBJECTIVES To summarize the efficacy and safety of mefloquine used as prophylaxis for malaria in travellers. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published on the Cochrane Library; MEDLINE; Embase (OVID); TOXLINE (https://toxnet.nlm.nih.gov/newtoxnet/toxline.htm); and LILACS. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; http://www.who.int/ictrp/en/) and ClinicalTrials.gov (https://clinicaltrials.gov/ct2/home) for trials in progress, using 'mefloquine', 'Lariam', and 'malaria' as search terms. The search date was 22 June 2017. SELECTION CRITERIA We included randomized controlled trials (for efficacy and safety) and non-randomized cohort studies (for safety). We compared prophylactic mefloquine with placebo, no treatment, or an alternative recommended antimalarial agent. Our study populations included all adults and children, including pregnant women. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and risk of bias of trials, extracted and analysed data. We compared dichotomous outcomes using risk ratios (RR) with 95% confidence intervals (CI). Prespecified adverse outcomes are included in 'Summary of findings' tables, with the best available estimate of the absolute frequency of each outcome in short-term international travellers. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 20 RCTs (11,470 participants); 35 cohort studies (198,493 participants); and four large retrospective analyses of health records (800,652 participants). Nine RCTs explicitly excluded participants with a psychiatric history, and 25 cohort studies stated that the choice of antimalarial agent was based on medical history and personal preference. Most RCTs and cohort studies collected data on self-reported or clinician-assessed symptoms, rather than formal medical diagnoses. Mefloquine efficacyOf 12 trials comparing mefloquine and placebo, none were performed in short-term international travellers, and most populations had a degree of immunity to malaria. The percentage of people developing a malaria episode in the control arm varied from 1% to 82% (median 22%) and 0% to 13% in the mefloquine group (median 1%).In four RCTs that directly compared mefloquine, atovaquone-proguanil and doxycycline in non-immune, short-term international travellers, only one clinical case of malaria occurred (4 trials, 1822 participants). Mefloquine safety versus atovaquone-proguanil Participants receiving mefloquine were more likely to discontinue their medication due to adverse effects than atovaquone-proguanil users (RR 2.86, 95% CI 1.53 to 5.31; 3 RCTs, 1438 participants; high-certainty evidence). There were few serious adverse effects reported with mefloquine (15/2651 travellers) and none with atovaquone-proguanil (940 travellers).One RCT and six cohort studies reported on our prespecified adverse effects. In the RCT with short-term travellers, mefloquine users were more likely to report abnormal dreams (RR 2.04, 95% CI 1.37 to 3.04, moderate-certainty evidence), insomnia (RR 4.42, 95% CI 2.56 to 7.64, moderate-certainty evidence), anxiety (RR 6.12, 95% CI 1.82 to 20.66, moderate-certainty evidence), and depressed mood during travel (RR 5.78, 95% CI 1.71 to 19.61, moderate-certainty evidence). The cohort studies in longer-term travellers were consistent with this finding but most had larger effect sizes. Mefloquine users were also more likely to report nausea (high-certainty evidence) and dizziness (high-certainty evidence).Based on the available evidence, our best estimates of absolute effect sizes for mefloquine versus atovaquone-proguanil are 6% versus 2% for discontinuation of the drug, 13% versus 3% for insomnia, 14% versus 7% for abnormal dreams, 6% versus 1% for anxiety, and 6% versus 1% for depressed mood. Mefloquine safety versus doxycyclineNo difference was found in numbers of serious adverse effects with mefloquine and doxycycline (low-certainty evidence) or numbers of discontinuations due to adverse effects (RR 1.08, 95% CI 0.41 to 2.87; 4 RCTs, 763 participants; low-certainty evidence).Six cohort studies in longer-term occupational travellers reported our prespecified adverse effects; one RCT in military personnel and one cohort study in short-term travellers reported adverse events. Mefloquine users were more likely to report abnormal dreams (RR 10.49, 95% CI 3.79 to 29.10; 4 cohort studies, 2588 participants, very low-certainty evidence), insomnia (RR 4.14, 95% CI 1.19 to 14.44; 4 cohort studies, 3212 participants, very low-certainty evidence), anxiety (RR 18.04, 95% CI 9.32 to 34.93; 3 cohort studies, 2559 participants, very low-certainty evidence), and depressed mood (RR 11.43, 95% CI 5.21 to 25.07; 2 cohort studies, 2445 participants, very low-certainty evidence). The findings of the single cohort study reporting adverse events in short-term international travellers were consistent with this finding but the single RCT in military personnel did not demonstrate a difference between groups in frequencies of abnormal dreams or insomnia.Mefloquine users were less likely to report dyspepsia (RR 0.26, 95% CI 0.09 to 0.74; 5 cohort studies, 5104 participants, low certainty-evidence), photosensitivity (RR 0.08, 95% CI 0.05 to 0.11; 2 cohort studies, 1875 participants, very low-certainty evidence), vomiting (RR 0.18, 95% CI 0.12 to 0.27; 4 cohort studies, 5071 participants, very low-certainty evidence), and vaginal thrush (RR 0.10, 95% CI 0.06 to 0.16; 1 cohort study, 1761 participants, very low-certainty evidence).Based on the available evidence, our best estimates of absolute effect for mefloquine versus doxycyline were: 2% versus 2% for discontinuation, 12% versus 3% for insomnia, 31% versus 3% for abnormal dreams, 18% versus 1% for anxiety, 11% versus 1% for depressed mood, 4% versus 14% for dyspepsia, 2% versus 19% for photosensitivity, 1% versus 5% for vomiting, and 2% versus 16% for vaginal thrush.Additional analyses, including comparisons of mefloquine with chloroquine, added no new information. Subgroup analysis by study design, duration of travel, and military versus non-military participants, provided no conclusive findings. AUTHORS' CONCLUSIONS The absolute risk of malaria during short-term travel appears low with all three established antimalarial agents (mefloquine, doxycycline, and atovaquone-proguanil).The choice of antimalarial agent depends on how individual travellers assess the importance of specific adverse effects, pill burden, and cost. Some travellers will prefer mefloquine for its once-weekly regimen, but this should be balanced against the increased frequency of abnormal dreams, anxiety, insomnia, and depressed mood.
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Affiliation(s)
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Rachel Saunders
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - Cheryl Pace
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
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Baird JK. Management of Plasmodium vivax risk and illness in travelers. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2017; 3:7. [PMID: 28883977 PMCID: PMC5531091 DOI: 10.1186/s40794-017-0049-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/17/2017] [Indexed: 12/18/2022]
Abstract
Malaria poses an exceptionally complex problem for providers of travel medicine services. Perceived high risk of exposure during travel typically prompts prescribing protective antimalarial drugs. Suppressive chemoprophylactic agents have dominated strategy for that practice for over 70 years. This broad class of therapeutic agents kills parasites after they emerge from the liver and attempt development in red blood cells. The dominance of suppressive chemoprophylaxis in travel medicine stems largely from the view of Plasmodium falciparum as the utmost threat to the patient – these drugs are poorly suited to preventing Plasmodium vivax and Plasmodium ovale due to inactivity against the latent liver stages of these species not produced by P. falciparum. Those hypnozoites awaken to cause multiple clinical attacks called relapses in the months following infection. Causal prophylactic agents kill parasites as they attempt development in hepatic cells. The only drug proven effective for causal prophylaxis against P. vivax is primaquine. That drug is not widely recommended for primary prophylaxis for travelers despite preventing both primary attacks of all the plasmodia and relapses of P. vivax. The long-held perception of P. vivax as causing a benign malaria in part explains the dominance of suppressive chemoprophylaxis strategies poorly suited to its prevention. Recent evidence from both travelers and patients hospitalized in endemic areas reveals P. vivax as a pernicious clinical threat capable of progression to severe disease syndromes associated with fatal outcomes. Effective prevention of clinical attacks of vivax malaria following exposure during travel requires primary causal prophylaxis or post-travel presumptive anti-relapse therapy following suppressive prophylaxis.
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Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No.69, Jakarta, 10430 Indonesia.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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8
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Weitzel T, Labarca J, Cortes CP, Rosas R, Balcells ME, Perret C. Cluster of Imported Vivax Malaria in Travelers Returning From Peru. J Travel Med 2015; 22:415-8. [PMID: 26354673 DOI: 10.1111/jtm.12234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/01/2015] [Accepted: 07/29/2015] [Indexed: 12/25/2022]
Abstract
We report a cluster of imported vivax malaria in three of five Chilean travelers returning from Peru in March 2015. The cluster highlights the high risk of malaria in the Loreto region in northern Peru, which includes popular destinations for international nature and adventure tourism. According to local surveillance data, Plasmodium vivax is predominating, but Plasmodium falciparum is also present, and the incidence of both species has increased during recent years. Travelers visiting this region should be counseled about the prevention of malaria and the options for chemoprophylaxis.
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Affiliation(s)
- Thomas Weitzel
- Programa Medicina del Viajero, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Santiago, Chile.,Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Jaime Labarca
- Departamento de Enfermedades Infecciosas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia P Cortes
- Departamento de Infectología, Clínica Santa María, Santiago, Chile.,Departamento de Medicina, Escuela de Medicina, Universidad de Chile, Santiago, Chile
| | - Reinaldo Rosas
- Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - M Elvira Balcells
- Departamento de Enfermedades Infecciosas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Perret
- Departamento de Enfermedades Infecciosas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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9
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Senn H, Alattas N, Boggild AK, Morris SK. Mixed-species Plasmodium falciparum and Plasmodium ovale malaria in a paediatric returned traveller. Malar J 2014; 13:78. [PMID: 24593188 PMCID: PMC3975726 DOI: 10.1186/1475-2875-13-78] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/26/2014] [Indexed: 12/02/2022] Open
Abstract
Malaria is a common and potentially fatal cause of febrile illness in returned travellers. Endemic areas for different malaria parasites overlap, but mixed species infections are rare. An adolescent male returned from a trip to Ghana in late summer 2013. He subsequently presented with blood smears positive for two species of malaria parasite, Plasmodium falciparum and Plasmodium ovale, on two isolated hospital visits within a six-week period. The epidemiology of mixed infections, likely pathophysiology of his presentation, and the implications for malaria testing and treatment in returned travellers are discussed.
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Affiliation(s)
- Heather Senn
- University of Toronto Faculty of Medicine, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Nadia Alattas
- Division of Infectious Diseases, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Department of Medicine, University of Toronto, Suite RFE 3–805, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- Public Health Ontario Laboratories, 81 Resources Road, Etobicoke, ON M9P 3T1, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada
- Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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10
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Nayak SK, Mallik SB, Kanaujia SP, Sekar K, Ranganathan KR, Ananthalakshmi V, Jeyaraman G, Saralaya SS, Rao KS, Shridhara K, Nagarajan K, Row TNG. Crystal structures and binding studies of atovaquone and its derivatives with cytochrome bc1: a molecular basis for drug design. CrystEngComm 2013. [DOI: 10.1039/c3ce40336j] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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