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Venishetty VK, Lecot J, Nguyen A, Zhang J, Prince WT. First-in-human, randomized, double-blind, placebo-controlled, single and multiple ascending doses clinical study to assess the safety, tolerability, and pharmacokinetics of cipargamin administered intravenously in healthy adults. Antimicrob Agents Chemother 2024; 68:e0128723. [PMID: 39058022 PMCID: PMC11373227 DOI: 10.1128/aac.01287-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/01/2024] [Indexed: 07/28/2024] Open
Abstract
This first-in-human study assessed safety, tolerability, and pharmacokinetics (PK) of cipargamin (intravenous) in healthy adults. It included part 1, single ascending dose [SAD: 10.5 mg-210 mg; n = 8 (active: 6, placebo: 2)], and part 2, multiple ascending dose [MAD: 60 and 120 mg daily for 5 days; n = 9 (active: 6, placebo: 3)]. Last dose follow-ups were on days 3, 4, and 6 for SAD and 7, 8, and 10 for MAD. Safety and PK review was done at completion of each cohort. We explored the cipargamin use for clinical development in patients with severe malaria. In SAD part, systemic exposure (maximum measured concentration and area under the curve) increased with increasing dose (10.5 mg-210 mg) following single intravenous dose. Cipargamin was eliminated with a mean T1/2 of 21.9-38.9 h. Volume of distribution (92.9 L-154 L) and clearance (2.43 L/h-4.33 L/h) was moderate and low, respectively, across the dose range. In MAD part, the mean accumulation ratio was 1.51 (60 mg) and 2.43 (120 mg) after once-daily cipargamin administration for 5 days. After day 5, the mean T1/2 was 35.5 (60 mg) and 31.9 h (120 mg) with twofold dose increase (60-120 mg) resulting in ~2-fold increased exposure. Cipargamin was well tolerated with commonly reported mild gastrointestinal, neurological, and genitourinary events. Increasing exposure to cipargamin showed higher baseline-corrected QTcF, and model-predicted ΔΔQTcF indicated that an effect on ΔΔQTcF ≥10 ms can be excluded up to 6470 ng/mL. However, these results should be interpreted with caution due to inadequate Fridericia's QT correction. CLINICAL TRIALS This study is registered with ClinicalTrials.gov as NCT04321252.
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Affiliation(s)
| | | | - Amanda Nguyen
- BioMedical Research, Novartis, Cambridge, Massachusetts, USA
| | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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Aninagyei E, Asmah RH, Duedu KO, Deku JG, Tanson KS, Mireku Y, Gbadago F, Acheampong DO. The use of the WHO criteria to detect severe malaria among patients clinically diagnosed with uncomplicated malaria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003158. [PMID: 39146283 PMCID: PMC11326616 DOI: 10.1371/journal.pgph.0003158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024]
Abstract
The World Health Organization (WHO) strict defining criteria were used to identify severe malaria among Ghanaian patients clinically diagnosed as uncomplicated malaria. From each study participant, blood haemoglobin (Hb) and plasma bilirubin levels were estimated using automated analyzers. According to the WHO, the criteria for diagnosing severe malaria among children (< 12 years) was assessed using Hb < 5 g/dL and among other patients ≥ 12 years, Hb < 7 g/dL with parasitemia > 10,000/μL, plasma bilirubin > 50 μmol/L amidst parasitemia > 100,000/μL and P. falciparum hyperparasitaemia (> 500,000 parasites/μL). Patients initially diagnosed with asymptomatic malaria (n = 347) were recruited. The parasitemia range was 540-863,402 parasite/μL. Overall, 86.2% of the patients had uncomplicated malaria while 13.8% of the patients were diagnosed with severe malaria of various origins. In children < 12 years, 10.8% (17/157) had Hb < 5g/dL with parasitaemia < 10,000 parasites/μL and in other patients (≥ 12 years), 6.3% (12/190) of them recorded Hb < 7g/dL with parasitaemia < 10,000 parasites/μL. Furthermore, 13.8% (48/347) had serum bilirubin levels > 50 μmol/L with parasitemia > 100,000/μL. In all the patients with hyperbilirubinemia, Hb levels fell below either 5g/dL or 7g/dL, for patients less than and 12 years or more, respectively. Finally, 1.7% (6/347) of the patients with malaria had parasite counts (> 500,000 parasites/μL). Irrespective of the etiology, patients diagnosed with severe malaria presented with pallor, vomiting, diarrhea, chills, fever and nausea, concurrently. Without comprehensive laboratory evaluation, patients with severe malaria could be misdiagnosed. Therefore, healthcare facilities need adequate human and logistical resources to be able to diagnose severe malaria for appropriate management to avert any untoward outcomes.
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Affiliation(s)
- Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Richard Harry Asmah
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- College of Life Sciences, Birmingham City University, City South Campus, Birmingham, United Kingdom
| | - John Gameli Deku
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Kelvin Senyo Tanson
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Yobo Mireku
- Laboratory Department, Ghana Health Service, Enyiresi Government Hospital, Enyiresi, Eastern Region, Ghana
| | - Fred Gbadago
- Laboratory Department, Ghana Health Service, Suhum Government Hospital, Suhum, Eastern Region, Ghana
| | - Desmond Omane Acheampong
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana
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Maitland K, Hamaluba M, Obonyo N, Oguda E, Mogoka C, Williams TN, Chaponda M, Miti S, Kamavu LK, Jonathan Gwasupika J, Connon R, Gibb DM, Dondorp A, Day N, White N, Walker AS, George EC. SEVUparin as a potential Adjunctive Treatment in children with severe malaria: A phase I trial safety and dose finding trial (SEVUSMAART). Wellcome Open Res 2024; 8:484. [PMID: 39219856 PMCID: PMC11362743 DOI: 10.12688/wellcomeopenres.20111.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Background Even on the best antimalarial treatments (injectable artesunate) African children with severe malaria have poor outcomes with most deaths occurring early in the course of hospital admission (<24hours). Lactic acidosis, largely due to impairment of the microcirculatory flow due to parasite sequestration, is a main risk factor for poor outcome. There are no adjuvant treatments for severe malaria that target this complication. Sevuparin, a heparin-like drug, binds to Plasmodium falciparum erythrocyte membrane protein blocking merozoite invasion, preventing cytoadherence and transiently de-sequestering infected erythrocytes. Leading to improved microcirculatory flow by reversing/preventing parasite sequestration. If given early during admission this could result in improvements in outcomes. Sevuparin has been shown to be safe and well tolerated in adults with only some mild transient effects on activated partial thromboplastin time (APTT) were reported, without clinical consequences. Methods A Phase I trial designed to provide data on safety, dosing, feasibility of sevuparin as an adjuvant therapy in Kenya and Zambian children with severe malaria complicated by lactic acidosis (> 2mmol/l). Three intravenous doses will be given at admission (0 hours), 8 and 16 hours. APPT will be measured 1 hour after each dose (to assess maximum toxicity). Studying 20 children will allow sufficient data on safety to be generated across a range of doses to identify the maximum tolerated dose (MTD) using the Continual Reassessment Method, which adapts or informs subsequent doses for each child based on the data from previously enrolled children. The MTD will be identified based on the dose-toxicity model updated by each previous patient's APTT results using standard methods. Conclusions The results of the Phase I trial will identify the final dose to be tested in a Phase II trial in terms of both efficacy and safety outcomes. Registration PACTR number: 202007890194806 (date 20/07/2020) ISRCTN32271864 (date 28/07/2021).
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Affiliation(s)
- Kathryn Maitland
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, England, UK
- Clinical Research, 1. KEMRI-Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
| | - Mainga Hamaluba
- Clinical Research, 1. KEMRI-Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
| | - Nchafatso Obonyo
- Clinical Research, 1. KEMRI-Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
| | - Emmanuel Oguda
- Clinical Research, 1. KEMRI-Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
| | - Christabel Mogoka
- Clinical Research, 1. KEMRI-Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
| | - Thomas N. Williams
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, England, UK
- Clinical Research, 1. KEMRI-Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
| | - Mike Chaponda
- Tropical Diseases Research Centre, Ndola, P.O Box 71769, Zambia
- St. Pauls’ Mission Hospital, Nchelenge, Luapula Province, Zambia
| | - Sam Miti
- Tropical Diseases Research Centre, Ndola, P.O Box 71769, Zambia
- St. Pauls’ Mission Hospital, Nchelenge, Luapula Province, Zambia
| | - Luc Kambale Kamavu
- St. Pauls’ Mission Hospital, Nchelenge, Luapula Province, Zambia
- Arthur Davison Children's Hospital, Ndola, P.O. Box 240227, Zambia
| | - Jonathan Jonathan Gwasupika
- Tropical Diseases Research Centre, Ndola, P.O Box 71769, Zambia
- St. Pauls’ Mission Hospital, Nchelenge, Luapula Province, Zambia
| | - Roisin Connon
- Medical Research Council Clinical Trials, University College London, London, England, WC1V 6LJ, UK
| | - Diana M. Gibb
- Medical Research Council Clinical Trials, University College London, London, England, WC1V 6LJ, UK
| | - Arjen Dondorp
- Clinical Trials, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
| | - Nick Day
- Clinical Trials, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
| | - Nick White
- Clinical Trials, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
| | - A. Sarah Walker
- Medical Research Council Clinical Trials, University College London, London, England, WC1V 6LJ, UK
| | - Elizabeth C. George
- Medical Research Council Clinical Trials, University College London, London, England, WC1V 6LJ, UK
| | - Severe Malaria in African Children A Research and Trials (SMAART) consortium
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, England, UK
- Clinical Research, 1. KEMRI-Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
- Tropical Diseases Research Centre, Ndola, P.O Box 71769, Zambia
- St. Pauls’ Mission Hospital, Nchelenge, Luapula Province, Zambia
- Arthur Davison Children's Hospital, Ndola, P.O. Box 240227, Zambia
- Medical Research Council Clinical Trials, University College London, London, England, WC1V 6LJ, UK
- Clinical Trials, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
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Birbeck GL, Seydel KB, Mwanza S, Tembo D, Chilombe M, Watts A, Ume-Ezeoke I, Mathews M, Patel AA, Mwenechanya M, Pensulo P, McDermott MP. Acetaminophen and Ibuprofen in Pediatric Central Nervous System Malaria: A Randomized Clinical Trial. JAMA Neurol 2024; 81:857-865. [PMID: 38857015 PMCID: PMC11165415 DOI: 10.1001/jamaneurol.2024.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/21/2024] [Indexed: 06/11/2024]
Abstract
Importance A third of children who survive malaria with neurological involvement (central nervous system [CNS] malaria) develop sequelae. A higher maximum temperature (Tmax) and seizures are risk factors for sequelae. Objective To compare aggressive antipyretic therapy using scheduled acetaminophen and ibuprofen vs usual care with acetaminophen alone given only for a temperature of 38.5 °C or higher. Design, Setting, and Participants This randomized clinical trial was conducted at inpatient pediatric services of 1 tertiary care and 1 district hospital in Zambia and a tertiary care center in Malawi. Included were children aged 2 to 11 years with CNS malaria (excluding those with creatinine >1.2 mg/dL), who were enrolled from 2019 to 2022. Data analysis took place from December 2022 to April 2023. Intervention The aggressive antipyretic group received acetaminophen (30 mg/kg load, then 15 mg/kg) plus ibuprofen, 10 mg/kg, every 6 hours, regardless of clinical temperature for 72 hours. The usual care group received 15 mg/kg of acetaminophen as needed every 6 hours for a temperature of 38.5 °C or higher. Main Outcomes and Measures The primary outcome variable was Tmax over 72 hours, the total duration of follow-up. Secondary outcomes included seizures and parasite clearance. Results Five hundred fifty-three patients were screened, 226 (40.9%) were ineligible, and 57 (10.3%) declined. A total 256 participants (n = 128/group) had a mean (SD) age of 4.3 (2.1) years; 115 (45%) were female, and 141 (55%) were male. The aggressive antipyretic group had a lower Tmax, 38.6 vs 39.2 °C (difference, -0.62 °C; 95% CI, -0.82 to -0.42; P < .001) and lower odds of experiencing multiple or prolonged seizures, 10 (8%) vs 34 children (27%) in the usual care group (odds ratio [OR], 0.26; 95% CI, 0.12 to 0.56). No group difference in parasite clearance time was detected. Severe adverse events occurred in 40 children (15%), 25 (20%) in the usual care group and 15 (12%) in the aggressive antipyretic group, including 13 deaths (10 [8%] and 3 [2%], respectively). Increased creatinine resulted in study drug discontinuation in 8 children (6%) in the usual care group and 13 children (10%) in the aggressive antipyretic group (OR, 1.74; 95% CI, 0.63 to 5.07). Conclusions and Relevance This study found that aggressive antipyretic therapy reduced mean Tmax to temperature levels comparable with the Tmax among children without neurological impairments in prior observational studies and improved acute seizure outcomes with no prolongation of parasitemia. Trial Registration ClinicalTrials.gov Identifier: NCT03399318.
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Affiliation(s)
- Gretchen L. Birbeck
- Epilepsy Division, Department of Neurology, University of Rochester, Rochester, New York
- University Teaching Hospitals Neurology Research Office, Lusaka, Zambia
- Department of Paediatrics and Child Health, University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
| | - Karl B. Seydel
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Suzanna Mwanza
- Department of Paediatrics and Child Health, Chipata Central Hospital, Chipata, Zambia
| | - Derby Tembo
- University Teaching Hospitals Neurology Research Office, Lusaka, Zambia
- Department of Paediatrics and Child Health, Chipata Central Hospital, Chipata, Zambia
- Department of Paediatrics and Child Health, University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
| | - Moses Chilombe
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Arthur Watts
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Ifunanya Ume-Ezeoke
- Epilepsy Division, Department of Neurology, University of Rochester, Rochester, New York
| | - Manoj Mathews
- Department of Paediatrics and Child Health, University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
| | - Archana A. Patel
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Musaku Mwenechanya
- Department of Paediatrics and Child Health, University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
| | - Paul Pensulo
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michael P. McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
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Adams JK, Pollmanns MR, Haverkamp M, Hohlstein P, Clusmann J, Trautwein C, Abu Jhaisha S, Koch A. Atraumatic splenic rupture - unexpected consequences of a world trip. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1216-1219. [PMID: 38917830 DOI: 10.1055/a-2213-1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Diagnostic routine and knowledge about the therapy regimes of infectious diseases like malaria gain in importance due to globalization, global warming, and increasing numbers of refugees. We report a case of a 66-year-old patient who presented with severe abdominal pain, most prominent in the left upper abdomen. He was recently hospitalized with severe falciparum malaria, diagnosed after returning from a trip around the world. Upon readmission, laboratory results showed post-artesunate delayed hemolysis. The ultrasound examination was highly suspicious of splenic rupture, confirmed by the immediately performed CT scan. In this case, the prompt diagnosis allowed the initiation of adequate conservative therapy including intensive care monitoring and hemodynamic stabilization.
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Affiliation(s)
- Jule K Adams
- Medizinische Klinik III, Klinik für Gastroenterologie, Stoffwechselkrankheiten und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Maike R Pollmanns
- Medizinische Klinik III, Klinik für Gastroenterologie, Stoffwechselkrankheiten und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Miriam Haverkamp
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, Aachen, Germany
| | - Philipp Hohlstein
- Medizinische Klinik III, Klinik für Gastroenterologie, Stoffwechselkrankheiten und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Jan Clusmann
- Medizinische Klinik III, Klinik für Gastroenterologie, Stoffwechselkrankheiten und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Christian Trautwein
- Medizinische Klinik III, Klinik für Gastroenterologie, Stoffwechselkrankheiten und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Samira Abu Jhaisha
- Medizinische Klinik III, Klinik für Gastroenterologie, Stoffwechselkrankheiten und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | - Alexander Koch
- Medizinische Klinik III, Klinik für Gastroenterologie, Stoffwechselkrankheiten und Internistische Intensivmedizin, Universitätsklinikum RWTH Aachen, Aachen, Germany
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Yoshida N, Kikuchi H, Hirai M, Balikagala B, Anywar DA, Taka H, Kaga N, Miura Y, Fukuda N, Odongo-Aginya EI, Kubohara Y, Mita T. A longer-chain acylated derivative of Dictyostelium differentiation-inducing factor-1 enhances the antimalarial activity against Plasmodium parasites. Biochem Pharmacol 2024; 225:116243. [PMID: 38697310 DOI: 10.1016/j.bcp.2024.116243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
The spread of malarial parasites resistant to first-line treatments such as artemisinin combination therapies is a global health concern. Differentiation-inducing factor 1 (DIF-1) is a chlorinated alkylphenone (1-(3,5-dichloro-2,6-dihydroxy-4-methoxyphenyl) hexan-1-one) originally found in the cellular slime mould Dictyostelium discoideum. We previously showed that some derivatives of DIF-1, particularly DIF-1(+2) (1-(3,5-dichloro-2,6-dihydroxy-4-methoxyphenyl) octan-1-one), exert potent antimalarial activities. In this study, we synthesised DIF-1(+3) (1-(3,5-dichloro-2,6-dihydroxy-4-methoxyphenyl) nonan-1-one). We then evaluated the effects of DIF-1(+3) in vitro on Plasmodium falciparum and in vivo over 7 days (50-100 mg/kg/day) in a mouse model of Plasmodium berghei. DIF-1(+3) exhibited a half-maximal inhibitory concentration of approximately 20-30 % of DIF-1(+2) in three laboratory strains with a selectivity index > 263, including in strains resistant to chloroquine and artemisinin. Parasite growth and multiplication were almost completely suppressed by treatment with 100 mg/kg DIF-1(+3). The survival time of infected mice was significantly increased (P = 0.006) with no apparent adverse effects. In summary, addition of an acyl group to DIF-1(+2) to prepare DIF-1(+3) substantially enhanced antimalarial activity, even in drug-resistant malaria, indicating the potential of applying DIF-1(+3) for malaria treatment.
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Affiliation(s)
- Naoko Yoshida
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Haruhisa Kikuchi
- Division of Natural Medicines, Faculty of Pharmacy, Keio University, Tokyo 105-8512, Japan
| | - Makoto Hirai
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Betty Balikagala
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Denis A Anywar
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Hikari Taka
- Laboratory of Proteomics and Biomolecular Science, Biomedical Research Core Facilities, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Naoko Kaga
- Laboratory of Proteomics and Biomolecular Science, Biomedical Research Core Facilities, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshiki Miura
- Laboratory of Proteomics and Biomolecular Science, Biomedical Research Core Facilities, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Naoyuki Fukuda
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | | | - Yuzuru Kubohara
- Laboratory of Health and Life Science, Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba 270-1695, Japan.
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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7
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Balerdi-Sarasola L, Muñoz J, Fleitas P, Rodriguez-Valero N, Almuedo-Riera A, Antequera A, Subirà C, Grafia-Perez I, Ortiz-Fernández M, de Alba T, Álvarez-Martínez MJ, Valls ME, Parolo C, Castro P, Camprubí-Ferrer D. Not all severe malaria cases are severe: Is it time to redefine severity criteria for malaria in non-endemic regions? Travel Med Infect Dis 2024; 60:102740. [PMID: 39002737 DOI: 10.1016/j.tmaid.2024.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The current definition of severe malaria in non-endemic areas follows WHO criteria, which mainly target children in malaria-endemic areas, potentially misclassifying cases in non-endemic regions. We assessed the performance of a modified severe malaria classification criteria within our patient cohort. METHODS A cohort study of patients managed for malaria in a non-endemic setting (2005-2023) was analyzed. We classified patients into severe malaria (SM) using WHO 2013 criteria except for hyperparasitemia, where 2 % threshold was applied. Patients with SM were distinguished as very severe malaria (VSM) when presenting at least one of the following conditions: parasitemia >10 %, pulmonary edema, impaired consciousness, seizures, renal failure, metabolic acidosis or hyperlactatemia, shock or hypoglycemia. In patients with SM and no criteria for VSM, less severe malaria (LSM) was defined by: 2-10 % parasitemia, hyperbilirubinemia, prostration, anemia or minor bleeding. The primary composite outcome was death or the need for a life-saving intervention, as analyzed in the three comparative groups. Secondary outcome was the prevalence of co-infections. RESULTS Among 506 patients with malaria, 176 (34.8 %) presented with SM. A total of 37 (7.3 %) patients developed a life-threatening condition, namely death (n = 4) and/or the need for life-saving interventions (n = 34). All fatalities and 33 out of the 34 life-saving interventions occurred in the VSM group. Patients in LSM group did not develop any life-threatening conditions. As to co-infections, 28 (5.5 %) patients had a community-acquired co-infection, with no differences between groups (p = 0.763). CONCLUSIONS Severity criteria definitions would benefit from a review when assessing patients with malaria in non-endemic areas. Within the spectrum of SM, patients reclassified as LSM have a low risk of developing a life-threatening condition and present low co-infection incidence and could benefit from management out of intensive care units and a restrictive use of empirical antibiotics.
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Affiliation(s)
- Leire Balerdi-Sarasola
- ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
| | - Jose Muñoz
- ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | | | - Natalia Rodriguez-Valero
- ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alba Antequera
- ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carme Subirà
- ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ignacio Grafia-Perez
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | | | - Tessa de Alba
- International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miriam J Álvarez-Martínez
- ISGlobal, Barcelona, Spain; Microbiology Department, Hospital Clinic-Universitat de Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - M Eugenia Valls
- Microbiology Department, Hospital Clinic-Universitat de Barcelona, Spain
| | - Claudio Parolo
- ISGlobal, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic-Universitat de Barcelona, Spain
| | - Daniel Camprubí-Ferrer
- ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
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Anyona SB, Cheng Q, Wasena SA, Osata SW, Guo Y, Raballah E, Hurwitz I, Onyango CO, Ouma C, Seidenberg PD, McMahon BH, Lambert CG, Schneider KA, Perkins DJ. Entire expressed peripheral blood transcriptome in pediatric severe malarial anemia. Nat Commun 2024; 15:5037. [PMID: 38866743 PMCID: PMC11169501 DOI: 10.1038/s41467-024-48259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/25/2024] [Indexed: 06/14/2024] Open
Abstract
This study on severe malarial anemia (SMA: Hb < 6.0 g/dL), a leading global cause of childhood morbidity and mortality, compares the entire expressed whole blood host transcriptome between Kenyan children (3-48 mos.) with non-SMA (Hb ≥ 6.0 g/dL, n = 39) and SMA (n = 18). Differential expression analyses reveal 1403 up-regulated and 279 down-regulated transcripts in SMA, signifying impairments in host inflammasome activation, cell death, and innate immune and cellular stress responses. Immune cell profiling shows decreased memory responses, antigen presentation, and immediate pathogen clearance, suggesting an immature/improperly regulated immune response in SMA. Module repertoire analysis of blood-specific gene signatures identifies up-regulation of erythroid genes, enhanced neutrophil activation, and impaired inflammatory responses in SMA. Enrichment analyses converge on disruptions in cellular homeostasis and regulatory pathways for the ubiquitin-proteasome system, autophagy, and heme metabolism. Pathway analyses highlight activation in response to hypoxic conditions [Hypoxia Inducible Factor (HIF)-1 target and Reactive Oxygen Species (ROS) signaling] as a central theme in SMA. These signaling pathways are also top-ranking in protein abundance measures and a Ugandan SMA cohort with available transcriptomic data. Targeted RNA-Seq validation shows strong concordance with our entire expressed transcriptome data. These findings identify key molecular themes in SMA pathogenesis, offering potential targets for new malaria therapies.
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Affiliation(s)
- Samuel B Anyona
- Department of Medical Biochemistry, School of Medicine, Maseno University, Maseno, 40105, Kenya.
- University of New Mexico-Kenya Global Health Programs, Kisumu and Siaya, 40100, Kenya.
| | - Qiuying Cheng
- Department of Internal Medicine, Center for Global Health, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Sharley A Wasena
- University of New Mexico-Kenya Global Health Programs, Kisumu and Siaya, 40100, Kenya
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, 40105, Kenya
| | - Shamim W Osata
- University of New Mexico-Kenya Global Health Programs, Kisumu and Siaya, 40100, Kenya
| | - Yan Guo
- Department of Public Health Sciences, University of Miami, Miami, 33136, USA
| | - Evans Raballah
- University of New Mexico-Kenya Global Health Programs, Kisumu and Siaya, 40100, Kenya
- Department of Medical Laboratory Sciences, School of Public Health, Biomedical Sciences and Technology, Masinde Muliro University of Science and Technology, Kakamega, 50100, Kenya
| | - Ivy Hurwitz
- Department of Internal Medicine, Center for Global Health, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Clinton O Onyango
- University of New Mexico-Kenya Global Health Programs, Kisumu and Siaya, 40100, Kenya
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, 40105, Kenya
| | - Collins Ouma
- University of New Mexico-Kenya Global Health Programs, Kisumu and Siaya, 40100, Kenya
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, 40105, Kenya
| | - Philip D Seidenberg
- Department of Emergency Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Benjamin H McMahon
- Theoretical Biology and Biophysics Group, Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Christophe G Lambert
- Department of Internal Medicine, Division of Translational Informatics, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Kristan A Schneider
- Department of Internal Medicine, Division of Translational Informatics, University of New Mexico, Albuquerque, NM, 87131-0001, USA
- Department Applied Computer and Bio-Sciences, University of Applied Sciences Mittweida, Mittweida, 09648, Germany
| | - Douglas J Perkins
- University of New Mexico-Kenya Global Health Programs, Kisumu and Siaya, 40100, Kenya.
- Department of Internal Medicine, Center for Global Health, University of New Mexico, Albuquerque, NM, 87131-0001, USA.
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9
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Shekarau E, Uzoanya M, Ogbulafor N. Severe malaria intervention status in Nigeria: workshop meeting report. Malar J 2024; 23:177. [PMID: 38840162 PMCID: PMC11155025 DOI: 10.1186/s12936-024-05001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 06/07/2024] Open
Abstract
Nigeria accounts for 39% of global malaria deaths in children under 5 years of age and the effective management of severe malaria is a health priority. The Annual Nigeria Severe Malaria Stakeholders Workshop, held on the 5-6th of July 2023 in Abuja, Nigeria brought together representatives from 36 States, the Federal Capital Territory, and other key stakeholders to address the management of severe malaria across all levels of the health service. Aims were to provide updates and review progress on severe malaria activities, the burden of disease, commodity logistics management, and pre-referral national policy implementation as well as to disseminate research findings. Two roundtable discussions were conducted to identify the challenges, barriers, and facilitators to the effective management of severe malaria in Nigeria. A key challenge was the limited awareness of updated guidelines and strategic documents among frontline health workers, leading to the misuse of non-recommended medications, like α-β-arteether. Further to this, the need to ensure appropriate treatments during pregnancy and the adoption of the WHO directive on the use of rectal artesunate were highlighted. To address these issues, innovative dissemination channels for guideline awareness were recommended and collaboration with professional organizations to enrich training materials emphasized. Other areas for improvement considered the processes involved in severe malaria management, with insufficient coordination among government agencies, inadequate referral linkages, and inadequate human resources identified as barriers. Recommendations focused on practical measures to minimize wastage of injectable artesunate, enhance data management through scaling up electronic medical records, and strengthen referral systems. The extension of severe malaria surveillance to patients older than 5 years was also proposed. To deliver these changes, actionable plans for sustained recruitment and training are needed, as well as committed advocacy at all levels to ensure timely fund disbursement and institutional support. A key overarching theme from the workshop was that a multifaceted approach was needed to address severe malaria in Nigeria, emphasizing collaborative efforts, evidence-based practices, and strategic resource allocation. With the largest malaria burden globally, the potential impact of addressing the challenges of severe malaria management in Nigeria cannot be understated and must be urgently addressed.
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Affiliation(s)
- Emmanuel Shekarau
- National Malaria Elimination Programme, Public Health Department, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Miriam Uzoanya
- National Malaria Elimination Programme, Public Health Department, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Nnenna Ogbulafor
- National Malaria Elimination Programme, Public Health Department, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria.
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10
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Achan J, Barry A, Leroy D, Kamara G, Duparc S, Kaszubska W, Gandhi P, Buffet B, Tshilab P, Ogutu B, Taylor T, Krishna S, Richardson N, Ramachandruni H, Rietveld H. Defining the next generation of severe malaria treatment: a target product profile. Malar J 2024; 23:174. [PMID: 38835069 DOI: 10.1186/s12936-024-04986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/14/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Severe malaria is a life-threatening infection, particularly affecting children under the age of 5 years in Africa. Current treatment with parenteral artemisinin derivatives is highly efficacious. However, artemisinin partial resistance is widespread in Southeast Asia, resulting in delayed parasite clearance after therapy, and has emerged independently in South America, Oceania, and Africa. Hence, new treatments for severe malaria are needed, and it is prudent to define their characteristics now. This manuscript focuses on the target product profile (TPP) for new treatments for severe malaria. It also highlights preparedness when considering ways of protecting the utility of artemisinin-based therapies. TARGET PRODUCT PROFILE Severe malaria treatments must be highly potent, with rapid onset of antiparasitic activity to clear the infection as quickly as possible to prevent complications. They should also have a low potential for drug resistance selection, given the high parasite burden in patients with severe malaria. Combination therapies are needed to deter resistance selection and dissemination. Partner drugs which are approved for uncomplicated malaria treatment would provide the most rapid development pathway for combinations, though new candidate molecules should be considered. Artemisinin combination approaches to severe malaria would extend the lifespan of current therapy, but ideally, completely novel, non-artemisinin-based combination therapies for severe malaria should be developed. These should be advanced to at least phase 2 clinical trials, enabling rapid progression to patient use should current treatment fail clinically. New drug combinations for severe malaria should be available as injectable formulations for rapid and effective treatment, or as rectal formulations for pre-referral intervention in resource-limited settings. CONCLUSION Defining the TPP is a key step to align responses across the community to proactively address the potential for clinical failure of artesunate in severe malaria. In the shorter term, artemisinin-based combination therapies should be developed using approved or novel drugs. In the longer term, novel combination treatments should be pursued. Thus, this TPP aims to direct efforts to preserve the efficacy of existing treatments while improving care and outcomes for individuals affected by this life-threatening disease.
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Affiliation(s)
| | - Aïssata Barry
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Didier Leroy
- Medicines for Malaria Venture, Route de Pré-Bois 20, Post Box 1826, CH-1215, Geneva 15, Switzerland
| | - George Kamara
- Médecins Sans Frontières, Magburaka District Hospital, Freetown, Sierra Leone
| | - Stephan Duparc
- Medicines for Malaria Venture, Route de Pré-Bois 20, Post Box 1826, CH-1215, Geneva 15, Switzerland
| | - Wiweka Kaszubska
- Medicines for Malaria Venture, Route de Pré-Bois 20, Post Box 1826, CH-1215, Geneva 15, Switzerland
| | | | - Bénédicte Buffet
- Medicines for Malaria Venture, Route de Pré-Bois 20, Post Box 1826, CH-1215, Geneva 15, Switzerland
| | | | - Bernhards Ogutu
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Terrie Taylor
- Queen Elizabeth Central Hospital and Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sanjeev Krishna
- Institut Für Tropenmedizin, Eberhard Karls Universität Tübingen, and German Center for Infection Research (Dzif), Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Clinical Academic Group, Institute for Infection and Immunity, St. George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Hanu Ramachandruni
- Medicines for Malaria Venture, Route de Pré-Bois 20, Post Box 1826, CH-1215, Geneva 15, Switzerland.
| | - Hans Rietveld
- Medicines for Malaria Venture, Route de Pré-Bois 20, Post Box 1826, CH-1215, Geneva 15, Switzerland.
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11
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Rosenthal PJ, Asua V, Conrad MD. Emergence, transmission dynamics and mechanisms of artemisinin partial resistance in malaria parasites in Africa. Nat Rev Microbiol 2024; 22:373-384. [PMID: 38321292 DOI: 10.1038/s41579-024-01008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
Malaria, mostly due to Plasmodium falciparum infection in Africa, remains one of the most important infectious diseases in the world. Standard treatment for uncomplicated P. falciparum malaria is artemisinin-based combination therapy (ACT), which includes a rapid-acting artemisinin derivative plus a longer-acting partner drug, and standard therapy for severe P. falciparum malaria is intravenous artesunate. The efficacy of artemisinins and ACT has been threatened by the emergence of artemisinin partial resistance in Southeast Asia, mediated principally by mutations in the P. falciparum Kelch 13 (K13) protein. High ACT treatment failure rates have occurred when resistance to partner drugs is also seen. Recently, artemisinin partial resistance has emerged in Rwanda, Uganda and the Horn of Africa, with independent emergences of different K13 mutants in each region. In this Review, we summarize our current knowledge of artemisinin partial resistance and focus on the emergence of resistance in Africa, including its epidemiology, transmission dynamics and mechanisms. At present, the clinical impact of emerging resistance in Africa is unclear and most available evidence suggests that the efficacies of leading ACTs remain excellent, but there is an urgent need to better appreciate the extent of the problem and its consequences for the treatment and control of malaria.
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Affiliation(s)
| | - Victor Asua
- Infectious Diseases Research Collaboration, Kampala, Uganda
- University of Tübingen, Tübingen, Germany
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12
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White NJ, Peto T, Watson JA. Rectal artesunate: lives not saved. Trans R Soc Trop Med Hyg 2024:trae036. [PMID: 38794950 DOI: 10.1093/trstmh/trae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Affiliation(s)
- N J White
- 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, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - T Peto
- 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, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - J A Watson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
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13
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Maitland K, Obonyo N, Hamaluba M, Ogoda E, Mogaka C, Williams TN, Newton C, Kariuki SM, Gibb DM, Walker AS, Connon R, George EC. A Phase I trial of Non-invasive Ventilation and seizure prophylaxis with levetiracetam In Children with Cerebral Malaria Trial (NOVICE-M Trial). Wellcome Open Res 2024; 9:281. [PMID: 39184127 PMCID: PMC11342035 DOI: 10.12688/wellcomeopenres.21403.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 08/27/2024] Open
Abstract
Background African children with cerebral malaria and seizures caused Plasmodium falciparum are at greater risk of poor outcomes including death and neurological sequelae. The agonal events are severe hypoventilation and respiratory arrest often triggered by seizures. We hypothesised that prophylactic anti-seizure medication (ASM) could avert 'spikes' of intracranial pressure during or following seizures and that adequate ventilation could be supported by biphasic Cuirass Ventilation (BCV) which requires no intubation. Methods A Phase I trial conducted in Kilifi, Kenya designed to provide data on safety, feasibility and preliminary data on seizure control using prophylactic ASM (levetiracetam) and BCV as non-invasive ventilatory support in children with cerebral malaria. Children aged 3 months to 12-years hospitalised with P falciparum malaria (positive rapid diagnostic test or a malaria slide), a Blantyre Coma Score ≤2 and a history of acute seizures in this illness are eligible for the trial. In a phased evaluation we will study i) BCV alone for respiratory support (n=10); ii) prophylactic LVT: 40mg/kg loading dose then 30mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10) and; iii) prophylactic LVT: 60mg/kg loading dose then 45mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10). Primary outcome measure: cumulative time with a clinically detected seizures or number of observed seizures over 36 hours. Secondary outcomes will be assessed by feasibility or ability to implement BCV, and recovery from coma within 36 hours. Safety endpoints include: aspiration during admission; death at 28 days and 180 days; and de-novo neurological impairments at 180 days. Conclusions This is a Phase I trial largely designed to test the feasibility, tolerability and safety of using non-invasive ventilatory support and LVT prophylaxis in cerebral malaria. Registration ISRCTN76942974 (5.02.2019); PACTR202112749708968 (20.12.2021).
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Affiliation(s)
- Kathryn Maitland
- Department of Infectious Disease and Institute of Global Health and Innovation, Division of Medicine, Imperial College London, London, England, W2 1PG, UK
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Nchafasto Obonyo
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Mainga Hamaluba
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Emmanuel Ogoda
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Christabel Mogaka
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Thomas N. Williams
- Department of Infectious Disease and Institute of Global Health and Innovation, Division of Medicine, Imperial College London, London, England, W2 1PG, UK
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Charles Newton
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Symon M. Kariuki
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
- Department of Public Health, Pwani University, Kilifi, Kilifi County, Kenya
| | - Diana M. Gibb
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
| | - A. Sarah Walker
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
| | - Roisin Connon
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
| | - Elizabeth C. George
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
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Katayama Y, Shimada K, Katagiri D, Terakawa K, Sakamoto E, Niikura T, Suzuki M, Yoshizaki Y, Sato L, Yamada G, Akiyama Y, Taneda S, Takano H. Urinary liver-type fatty acid-binding protein level as a prognostic indicator of acute kidney injury secondary to severe falciparum malaria. CEN Case Rep 2024:10.1007/s13730-024-00886-y. [PMID: 38727797 DOI: 10.1007/s13730-024-00886-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024] Open
Abstract
Acute kidney injury (AKI) secondary to severe falciparum malaria possesses a high mortality rate; however, a prognostic marker of renal dysfunction has not yet been identified. Thus, we reported a case of a patient with AKI secondary to falciparum malaria who underwent hemodialysis and a renal biopsy due to prolonged renal dysfunction. The male patient, in his 50 s, presented to our hospital with vomiting, diarrhea, fever, and decreased level of consciousness. The Giemsa-stained peripheral blood film revealed approximately 5% parasitemia, and a rapid diagnostic test was positive for Plasmodium falciparum. He was diagnosed with severe falciparum malaria and was started on quinine hydrochloride. Hemodialysis was initiated due to the decreased urine output and fluid retention. Subsequently, he was weaned off hemodialysis. The histopathological analysis of a renal biopsy revealed interstitial fibrosis, tubular atrophy, and chronic inflammatory cell infiltration; thus, malarial nephropathy was diagnosed. Thereafter, his renal function stabilized, and he was discharged from the hospital. The urinary liver-type fatty acid-binding protein (L-FABP) level decreased before renal function improved. Our report highlighted that long-term follow-up is essential for severe AKI secondary to malaria. The urinary L-FABP level may be a useful prognostic indicator of AKI secondary to severe falciparum malaria.
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Affiliation(s)
- Yuri Katayama
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
| | - Keiki Shimada
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
| | - Daisuke Katagiri
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan.
| | - Kanako Terakawa
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
| | - Emi Sakamoto
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
| | - Takahito Niikura
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
| | - Minami Suzuki
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
| | - Yuki Yoshizaki
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
| | - Lubna Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gen Yamada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaro Akiyama
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sekiko Taneda
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Takano
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-Ku, Tokyo, Japan
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15
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Chilombe MB, Seydel KB, Hammond CA, Mwanza S, Patel AA, Lungu F, wa Somwe S, Kampondeni S, Potchen MJ, McDermott MP, Birbeck GL. Protocol for a magnetic resonance imaging study of participants in the fever RCT: Does fever control prevent brain injury in malaria? PLoS One 2024; 19:e0294823. [PMID: 38640099 PMCID: PMC11029645 DOI: 10.1371/journal.pone.0294823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Despite eradication efforts, ~135,000 African children sustained brain injuries as a result of central nervous system (CNS) malaria in 2021. Newer antimalarial medications rapidly clear peripheral parasitemia and improve survival, but mortality remains high with no associated decline in post-malaria neurologic injury. A randomized controlled trial of aggressive antipyretic therapy with acetaminophen and ibuprofen (Fever RCT) for malarial fevers being conducted in Malawi and Zambia began enrollment in 2019. We propose to use neuroimaging in the context of the RCT to further evaluate neuroprotective effects of aggressive antipyretic therapy. METHODS This observational magnetic resonance imaging (MRI) ancillary study will obtain neuroimaging and neurodevelopmental and behavioral outcomes in children previously enrolled in the Fever RCT at 1- and 12-months post discharge. Analysis will compare the odds of any brain injury between the aggressive antipyretic therapy and usual care groups based upon MRI structural abnormalities. For children unable to undergo imaging without deep sedation, neurodevelopmental and behavioral outcomes will be used to identify brain injury. DISCUSSION Neuroimaging is a well-established, valid proxy for neurological outcomes after brain injury in pediatric CNS malaria. This MRI ancillary study will add value to the Fever RCT by determining if treatment with aggressive antipyretic therapy is neuroprotective in CNS malaria. It may also help elucidate the underlying mechanism(s) of neuroprotection and expand upon FEVER RCT safety assessments.
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Affiliation(s)
- Moses B. Chilombe
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Karl B. Seydel
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, Michigan, United States of America
| | - Colleen A. Hammond
- Department of Radiology, Michigan State University, East Lansing, Michigan, United States of America
| | - Suzanna Mwanza
- Department of Pediatrics and Child Health, Chipata Central Hospital, Chipata, Zambia
| | - Archana A. Patel
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Frank Lungu
- Neurology Research Office, University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
| | - Somwe wa Somwe
- Neurology Research Office, University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
| | - Sam Kampondeni
- Mpingwe Clinic, Limbe, Malawi
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States of America
| | - Michael J. Potchen
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States of America
- Zambia College of Medicine and Surgery, Lusaka, Zambia
| | - Michael P. McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, United States of America
- Department of Neurology, University of Rochester, Rochester, New York, United States of America
| | - Gretchen L. Birbeck
- Neurology Research Office, University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
- Department of Neurology, University of Rochester, Rochester, New York, United States of America
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16
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Baro B, Bassat Q. sTREM-1 to Risk-Stratify Patients With Malaria: A Functional Crystal Ball to Improve Outcomes and Save Lives. J Infect Dis 2024; 229:923-925. [PMID: 38078563 DOI: 10.1093/infdis/jiad565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 04/13/2024] Open
Affiliation(s)
- Bàrbara Baro
- ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
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17
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Balerdi-Sarasola L, Pedro F, Bottieau E, Genton B, Petrone P, Muñoz J, Camprubí-Ferrer D. MALrisk: a machine-learning–based tool to predict imported malaria in returned travellers with fever. J Travel Med 2024:taae054. [PMID: 38578987 DOI: 10.1093/jtm/taae054] [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: 12/19/2023] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Early diagnosis is key to reducing the morbi-mortality associated with P. falciparum malaria among international travellers. However, access to microbiological tests can be challenging for some healthcare settings. Artificial Intelligence could improve the management of febrile travellers. METHODS Data from a multicentric prospective study of febrile travellers was obtained to build a machine-learning model to predict malaria cases among travellers presenting with fever. Demographic characteristics, clinical and laboratory variables were leveraged as features. Eleven machine-learning classification models were evaluated by 50-fold cross-validation in a Training set. Then, the model with the best performance, defined by the Area Under the Curve (AUC), was chosen for parameter optimization and evaluation in the Test set. Finally, a reduced model was elaborated with those features that contributed most to the model. RESULTS Out of eleven machine-learning models, XGBoost presented the best performance (mean AUC of 0.98 and a mean F1 score of 0.78). A reduced model (MALrisk) was developed using only six features: Africa as a travel destination, platelet count, rash, respiratory symptoms, hyperbilirubinemia and chemoprophylaxis intake. MALrisk predicted malaria cases with 100% (95%CI 96-100) sensitivity and 72% (95%CI 68-75) specificity. CONCLUSIONS The MALrisk can aid in the timely identification of malaria in non-endemic settings, allowing the initiation of empiric antimalarials and reinforcing the need for urgent transfer in healthcare facilities with no access to malaria diagnostic tests. This resource could be easily scalable to a digital application and could reduce the morbidity associated with late diagnosis.
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Affiliation(s)
| | - Fleitas Pedro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Blaise Genton
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Paula Petrone
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jose Muñoz
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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18
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Leys M, Bottieau E, Rebolledo J, Martin C. Imported malaria: A 20-year retrospective study from a tertiary public hospital in Brussels, Belgium. Infect Dis Now 2024; 54:104856. [PMID: 38311002 DOI: 10.1016/j.idnow.2024.104856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Malaria continues to cause a significant number of infections in non-endemic regions. In this paper, we describe the epidemiological trend and morbidity of imported malaria diagnosed in a tertiary hospital in Brussels. METHODS We conducted a retrospective study describing a cohort of malaria episodes (in- and outpatients) at Centre Hospitalier Universitaire Saint-Pierre from 1998 to 2017. Epidemiological and clinical data were collected by reviewing medical files. RESULTS A total of 1011 malaria episodes were analyzed. Median age at diagnosis was 35 years, and 66 % of patients were men (672/1011). Malaria cases significantly increased over the two decades (from 17 in 1998 to 79 in 2017). Plasmodium falciparum malaria was most often diagnosed (846/935, 89 %), primarily from Central (530/935, 57 %) and West Africa (324/935, 35 %). Many cases (383/764, 50 %) were diagnosed in patients "visiting friends and relatives". HIV-infected and other immunocompromised patients were significantly more likely to present with severe malaria (at least one severity criteria as defined by the WHO) compared to other patients (24/57, 42 % vs 138/732, 19 %, p < 0.01 and 15/21, 71 % vs 147/767, 19 %, p < 0.001). Severe malaria was diagnosed in 16.9 % and the mortality rate was low (5/1011, 0.5 %). CONCLUSION Imported malaria increased over the years with a large, albeit stable number of cases diagnosed in patients visiting friends and relatives. These findings, along with the high rate of severe malaria in HIV and immunocompromised patients, underscore an urgent need for strengthened malaria surveillance and targeted preventive interventions.
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Affiliation(s)
- Mikaël Leys
- Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Infectious Diseases Department, Brussels, Belgium
| | - Emmanuel Bottieau
- Department of Infectious Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Charlotte Martin
- Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Infectious Diseases Department, Brussels, Belgium.
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19
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Odera PA, Otieno G, Onyango JO, Owuor JJ, Oloo FA, Ongas M, Gathirwa J, Ogutu B. NANOPARTICLE-BASED formulation of dihydroartemisinin-lumefantrine duo-drugs: Preclinical Evaluation and enhanced antimalarial efficacy in a mouse model. Heliyon 2024; 10:e26868. [PMID: 38501019 PMCID: PMC10945123 DOI: 10.1016/j.heliyon.2024.e26868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Artemisinin-based combinations (ACTs) are World Health Organization-recommended treatment for malaria. Artemether (A) and lumefantrine (LUM) were the first co-formulated ACT and first-line treatment for malaria globally, artemether is dihydroartemisinin's (DHA's) prodrug. Artemisinins and LUM face low aqueous solubility while artemisinin has low bioavailability and short half-life thus requiring continuous dosage to maintain adequate therapeutic drug-plasma concentration. This study aimed at improving ACTs limitations by nano-formulating DHA-LUM using solid lipid nanoparticles (SLNs) as nanocarrier. SLNs were prepared by modified solvent extraction method based on water-in-oil-in-water double emulsion. Mean particle size, polydispersity index and zeta potential were 308.4 nm, 0.29 and -16.0 mV respectively. Nanoencapsulation efficiencies and drug loading of DHA and LUM were 93.9%, 33.7%, 11.9%, and 24.10% respectively. Nanoparticles were spherically shaped and drugs followed Kors-Peppas release model, steadily released for over 72 h. DHA-LUM-SLNs were 31% more efficacious than conventional oral doses in clearing Plasmodium berghei from infected Swiss albino mice.
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Affiliation(s)
- Pesila Akeyo Odera
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - Geoffrey Otieno
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - Joab Otieno Onyango
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - James Jorum Owuor
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
| | - Florence Anyango Oloo
- School of Chemistry and Material Science, Technical University of Kenya, Nairobi Kenya
- Centre for Research in Therapeutic Sciences, Strathmore University Medical Centre, Nairobi, Kenya
| | - Martin Ongas
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Research in Therapeutic Sciences, Strathmore University Medical Centre, Nairobi, Kenya
| | - Jeremiah Gathirwa
- Centre of Traditional Medicine and Drug Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Bernhards Ogutu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Research in Therapeutic Sciences, Strathmore University Medical Centre, Nairobi, Kenya
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20
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Watson JA, Peto TJ, White NJ. Where will rectal artesunate suppositories save lives? Lancet 2024; 403:1137-1138. [PMID: 38521556 DOI: 10.1016/s0140-6736(23)01794-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 03/25/2024]
Affiliation(s)
- James A Watson
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK.
| | - Thomas J Peto
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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21
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Zhang J, Shahbaz M, Ijaz M, Zhang H. Bibliometric analysis of antimalarial drug resistance. Front Cell Infect Microbiol 2024; 14:1270060. [PMID: 38410722 PMCID: PMC10895045 DOI: 10.3389/fcimb.2024.1270060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024] Open
Abstract
Background Malaria has always been a serious infectious disease prevalent in the world. Antimalarial drugs such as chloroquine and artemisinin have been the main compounds used to treat malaria. However, the massive use of this type of drugs accelerates the evolution and spread of malaria parasites, leading to the development of resistance. A large number of related data have been published by researchers in recent years. CiteSpace software has gained popularity among us researchers in recent years, because of its ability to help us obtain the core information we want in a mass of articles. In order to analyze the hotspots and develop trends in this field through visual analysis, this study used CiteSpace software to summarize the available data in the literature to provide insights. Method Relevant literature was collected from the Web of Science Core Collection (WOSCC) from 1 January 2015 to 29 March 2023. CiteSpace software and Microsoft Excel were used to analyze and present the data, respectively. Results A total of 2,561 literatures were retrieved and 2,559 literatures were included in the analysis after the removal of duplicates. An irrefutable witness of the ever-growing interest in the topic of antimalarial drug resistance could be expressed by the exponentially increased number of publications and related citations from 2015 to 2022, and its sustained growth trend by 2023. During the past 7 years, USA, Oxford University, and David A Fidock are the country, institution, and author with the most publications in this field of research, respectively. We focused on the references and keywords from literature and found that the research and development of new drugs is the newest hotspot in this field. A growing number of scientists are devoted to finding new antimalarial drugs. Conclusion This study is the first visual metrological analysis of antimalarial drug resistance, using bibliometric methods. As a baseline information, it is important to analyze research output published globally on antimalarial drug resistance. In order to better understand the current research situation and future research plan agenda, such baseline data are needed accordingly.
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Affiliation(s)
- Jialu Zhang
- Shandong University of Traditional Chinese Medicine, College of Pharmacy, Jinan, China
- Shandong Academy of Chinese Medicine, Institute of Chinese medicine analysis, Jinan, China
| | - Muhammad Shahbaz
- Shandong Academy of Chinese Medicine, Institute of Chinese medicine analysis, Jinan, China
- Department of Radiology, Qilu Hospital Affiliated to Shandong University, Jinan, China
- Research Center for Sectional and Imaging Anatomy, Digital Human Institute, School of Basic Medical Science, Shandong University, Jinan, Shandong, China
| | - Muhammad Ijaz
- The Faculty of Medicine, Qilu Institute of Technology, Jinan, China
- Department of Pharmacology, School of Pharmaceutical Science, Shandong University, Jinan, China
| | - Huimin Zhang
- Shandong Academy of Chinese Medicine, Institute of Chinese medicine analysis, Jinan, China
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22
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Ryan ET, Succi MD, Paras ML, Klontz EH. Case 4-2024: A 39-Year-Old Man with Fever and Headache after International Travel. N Engl J Med 2024; 390:549-556. [PMID: 38324489 DOI: 10.1056/nejmcpc2309382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Edward T Ryan
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
| | - Marc D Succi
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
| | - Molly L Paras
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
| | - Erik H Klontz
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
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23
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Varo R, Crowley VM, Mucasse H, Sitoe A, Bramugy J, Serghides L, Weckman AM, Erice C, Bila R, Vitorino P, Mucasse C, Valente M, Ajanovic S, Balanza N, Zhong K, Derpsch Y, Gladstone M, Mayor A, Bassat Q, Kain KC. Adjunctive rosiglitazone treatment for severe pediatric malaria: A randomized placebo-controlled trial in Mozambican children. Int J Infect Dis 2024; 139:34-40. [PMID: 38013152 DOI: 10.1016/j.ijid.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES We tested the hypothesis that adjunctive rosiglitazone treatment would reduce levels of circulating angiopoietin-2 (Angpt-2) and improve outcomes of Mozambican children with severe malaria. METHODS A randomized, double-blind, placebo-controlled trial of rosiglitazone vs placebo as adjunctive treatment to artesunate in children with severe malaria was conducted. A 0.045 mg/kg/dose of rosiglitazone or matching placebo were administered, in addition to standard of malaria care, twice a day for 4 days. The primary endpoint was the rate of decline of Angpt-2 over 96 hours. Secondary outcomes included the longitudinal dynamics of angiopoietin-1 (Angpt-1) and the Angpt-2/Angpt-1 ratio over 96 hours, parasite clearance kinetics, clinical outcomes, and safety metrics. RESULTS Overall, 180 children were enrolled; 91 were assigned to rosiglitazone and 89 to placebo. Children who received rosiglitazone had a steeper rate of decline of Angpt-2 over the first 96 hours of hospitalization compared to children who received placebo; however, the trend was not significant (P = 0.28). A similar non-significant trend was observed for Angpt-1 (P = 0.65) and the Angpt-2/Angpt-1 ratio (P = 0.34). All other secondary and safety outcomes were similar between groups (P >0.05). CONCLUSION Adjunctive rosiglitazone at this dosage was safe and well tolerated but did not significantly affect the longitudinal kinetics of circulating Angpt-2.
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Affiliation(s)
- Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
| | - Valerie M Crowley
- S. A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Humberto Mucasse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Lena Serghides
- Toronto General Research Institute (TGRI), University Health Network, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Canada; Department of Immunology and Institute of Medical Sciences University of Toronto, Toronto, Canada
| | - Andrea M Weckman
- S. A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Clara Erice
- S. A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Rubao Bila
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Campos Mucasse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Marta Valente
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Sara Ajanovic
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Núria Balanza
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Kathleen Zhong
- S. A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Yiovanna Derpsch
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; School of Psychology, University of East Anglia, Norwich, United Kingdom
| | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique; Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Medicine, University of Toronto, Toronto, Canada
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Medicine, University of Toronto, Toronto, Canada; ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
| | - Kevin C Kain
- S. A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada; Toronto General Research Institute (TGRI), University Health Network, Toronto, Canada; Tropical Diseases Unit, Division of Infectious Diseases, Department of Medicine, UHN-Toronto General Hospital, Toronto, Canada
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24
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Rodari P, Tamarozzi F, Fittipaldo VA, Buonfrate D, Gobbi F. Physiopathology and clinical management of blackwater fever: a scoping review. Clin Microbiol Infect 2024; 30:59-65. [PMID: 37739261 DOI: 10.1016/j.cmi.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Blackwater fever (BWF) is a severe syndrome occurring in patients with malaria upon antimalarial treatment, characterized by massive intravascular haemolysis and haemoglobinuria. BWF is a neglected condition and management recommendations are unavailable. OBJECTIVES We performed a scoping review to appraise available data on clinical picture, treatment and physiopathology of BWF, which could guide rationally its clinical management. METHODS MEDLINE, EMBASE, LILACS, Web of Science, and Scopus databases, and the reference list of relevant publications, were searched. Papers reporting original data on BWF cases or investigating the physiopathology of BWF were eligible. Data regarding case characteristics, trigger event, clinical management and outcome were extracted. For papers investigating the physiopathology of BWF, study design and principal findings were extracted. No quality assessment was performed. Data are presented as numbers and percentages, and summary of findings, grouped by paper focus (clinical description or physiopathology). RESULTS 101 papers were included. The majority of BWF cases were observed in autochthonous children (75.7%) and adults (15.3%), in contrast with historical perception that BWF patients were typically expatriates. Clinical management was described for 794 cases; corticosteroids were used in 23. Outcome was reported for 535 patients, with 18.1% mortality. The trigger was reported for 552 (47.5%) cases; in 70.4% identified as quinine. However, two RCT comparing artesunate and quinine for falciparum malaria treatment did not find significant difference in BWF occurrence after their administration. Two case-control studies did not find significant difference in G6PDH deficiency between malaria patients with and without BWF. CONCLUSIONS The physiopathology and optimal treatment of BWF remain similarly unknown as they were over a century ago. Empirical supporting treatment approach seems reasonable, while change of antimalarial drug and use of corticosteroids remain object of debate.
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Affiliation(s)
- Paola Rodari
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy.
| | - Veronica A Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
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25
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Poespoprodjo JR, Douglas NM, Ansong D, Kho S, Anstey NM. Malaria. Lancet 2023; 402:2328-2345. [PMID: 37924827 DOI: 10.1016/s0140-6736(23)01249-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 11/06/2023]
Abstract
Malaria is resurging in many African and South American countries, exacerbated by COVID-19-related health service disruption. In 2021, there were an estimated 247 million malaria cases and 619 000 deaths in 84 endemic countries. Plasmodium falciparum strains partly resistant to artemisinins are entrenched in the Greater Mekong region and have emerged in Africa, while Anopheles mosquito vectors continue to evolve physiological and behavioural resistance to insecticides. Elimination of Plasmodium vivax malaria is hindered by impractical and potentially toxic antirelapse regimens. Parasitological diagnosis and treatment with oral or parenteral artemisinin-based therapy is the mainstay of patient management. Timely blood transfusion, renal replacement therapy, and restrictive fluid therapy can improve survival in severe malaria. Rigorous use of intermittent preventive treatment in pregnancy and infancy and seasonal chemoprevention, potentially combined with pre-erythrocytic vaccines endorsed by WHO in 2021 and 2023, can substantially reduce malaria morbidity. Improved surveillance, better access to effective treatment, more labour-efficient vector control, continued drug development, targeted mass drug administration, and sustained political commitment are required to achieve targets for malaria reduction by the end of this decade.
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Affiliation(s)
- Jeanne Rini Poespoprodjo
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Mimika District Hospital and District Health Authority, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Daniel Ansong
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Steven Kho
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia
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26
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Haghiri A, Price DJ, Fitzpatrick P, Dini S, Rajasekhar M, Fanello C, Tarning J, Watson J, White NJ, Simpson JA. Evidence Based Optimal Dosing of Intravenous Artesunate in Children with Severe Falciparum Malaria. Clin Pharmacol Ther 2023; 114:1304-1312. [PMID: 37666798 DOI: 10.1002/cpt.3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
The majority of deaths from malaria are in young African children. Parenteral artesunate (ARS) is the first-line treatment for severe falciparum malaria. Since 2015, the World Health Organization has recommended individual doses of 3 mg/kg for children weighing < 20 kg. Recently, the US Food and Drug Administration (FDA) has challenged this recommendation, based on a simulated pediatric population, and argued for a lower dose in younger children (2.4 mg/kg). In this study, we performed population pharmacokinetic (PK) modeling of plasma concentration data from 80 children with severe falciparum malaria in the Democratic Republic of Congo who were given 2.4 mg/kg of ARS intravenously. Bayesian hierarchical modeling and a two-compartment parent drug-metabolite PK model for ARS were used to describe the population PKs of ARS and its main biologically active metabolite dihydroartemisinin. We then generated a virtual population representative of the target population in which the drug is used and simulated the total first-dose exposures. Our study shows that the majority of younger children given the lower 2.4 mg/kg dose of intravenous ARS do not reach the same drug exposures as older children above 20 kg. This finding supports withdrawal of the FDA's recent lower ARS dose recommendation as parenteral ARS is an extremely safe and well-tolerated drug and there is potential for harm from underdosing in this rapidly lethal infection.
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Affiliation(s)
- Ali Haghiri
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Engineering, University of Leicester, Leicester, UK
| | - David J Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Phoebe Fitzpatrick
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Saber Dini
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Megha Rajasekhar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caterina Fanello
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Joel Tarning
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - James Watson
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J White
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Walker IS, Rogerson SJ. Pathogenicity and virulence of malaria: Sticky problems and tricky solutions. Virulence 2023; 14:2150456. [PMID: 36419237 PMCID: PMC9815252 DOI: 10.1080/21505594.2022.2150456] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Infections with Plasmodium falciparum and Plasmodium vivax cause over 600,000 deaths each year, concentrated in Africa and in young children, but much of the world's population remain at risk of infection. In this article, we review the latest developments in the immunogenicity and pathogenesis of malaria, with a particular focus on P. falciparum, the leading malaria killer. Pathogenic factors include parasite-derived toxins and variant surface antigens on infected erythrocytes that mediate sequestration in the deep vasculature. Host response to parasite toxins and to variant antigens is an important determinant of disease severity. Understanding how parasites sequester, and how antibody to variant antigens could prevent sequestration, may lead to new approaches to treat and prevent disease. Difficulties in malaria diagnosis, drug resistance, and specific challenges of treating P. vivax pose challenges to malaria elimination, but vaccines and other preventive strategies may offer improved disease control.
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Affiliation(s)
- Isobel S Walker
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
| | - Stephen J Rogerson
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
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Chilombe MB, Seydel KB, Hammond C, Mwanza S, Patel AA, Lungu F, Somwe SW, Kampondeni S, Potchen MJ, McDermott MP, Birbeck GL. Protocol for a Magnetic Resonance Imaging (MRI) Study of Participants in the Fever Randomized Controlled Trial: Does fever control prevent brain injury in malaria? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.10.23298374. [PMID: 37986869 PMCID: PMC10659499 DOI: 10.1101/2023.11.10.23298374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Despite eradication efforts, ~135,000 African children sustained brain injuries as a result of central nervous system (CNS) malaria in 2021. Newer antimalarial medications rapidly clear peripheral parasitemia and improve survival, but mortality remains high with no associated decline in post-malaria neurologic injury. A randomized controlled trial of aggressive antipyretic therapy with acetaminophen and ibuprofen (Fever RCT) for malarial fevers being conducted in Malawi and Zambia began enrollment in 2019. We propose to use neuroimaging in the context of the RCT to further evaluate neuroprotective effects of aggressive antipyretic therapy. Methods This observational magnetic resonance imaging (MRI) ancillary study will obtain neuroimaging and neurodevelopmental and behavioral outcomes in children previously enrolled in the Fever RCT at 1- and 12-months post discharge. Analysis will compare the odds of any brain injury between the aggressive antipyretic therapy and usual care groups based upon MRI structural abnormalities. For children unable to undergo imaging without deep sedation, neurodevelopmental and behavioral outcomes will be used to identify brain injury. Discussion Neuroimaging is a well-established, valid proxy for neurological outcomes after brain injury in pediatric CNS malaria. This MRI ancillary study will add value to the Fever RCT by determining if treatment with aggressive antipyretic therapy is neuroprotective in CNS malaria. It may also help elucidate the underlying mechanism(s) of neuroprotection and expand upon FEVER RCT safety assessments.
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Affiliation(s)
- Moses B. Chilombe
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Karl B. Seydel
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, Michigan, USA
| | - Colleen Hammond
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
| | - Suzanna Mwanza
- Department of Pediatrics and Child Health, Chipata Central Hospital, Chipata, Zambia
| | - Archana A. Patel
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Frank Lungu
- University Teaching Hospitals Children’s Hospital, Neurology Research Office, Lusaka, Zambia
| | - Somwe wa Somwe
- University Teaching Hospitals Children’s Hospital, Neurology Research Office, Lusaka, Zambia
| | - Sam Kampondeni
- Mpingwe Clinic, Limbe, Malawi
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Michael J. Potchen
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
- Zambia College of Medicine and Surgery, Lusaka, Zambia
| | - Michael P. McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Gretchen L. Birbeck
- University Teaching Hospitals Children’s Hospital, Neurology Research Office, Lusaka, Zambia
- Department of Neurology, University of Rochester, Rochester, New York, USA
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29
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Hadjilaou A, Brandi J, Riehn M, Friese MA, Jacobs T. Pathogenetic mechanisms and treatment targets in cerebral malaria. Nat Rev Neurol 2023; 19:688-709. [PMID: 37857843 DOI: 10.1038/s41582-023-00881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
Malaria, the most prevalent mosquito-borne infectious disease worldwide, has accompanied humanity for millennia and remains an important public health issue despite advances in its prevention and treatment. Most infections are asymptomatic, but a small percentage of individuals with a heavy parasite burden develop severe malaria, a group of clinical syndromes attributable to organ dysfunction. Cerebral malaria is an infrequent but life-threatening complication of severe malaria that presents as an acute cerebrovascular encephalopathy characterized by unarousable coma. Despite effective antiparasite drug treatment, 20% of patients with cerebral malaria die from this disease, and many survivors of cerebral malaria have neurocognitive impairment. Thus, an important unmet clinical need is to rapidly identify people with malaria who are at risk of developing cerebral malaria and to develop preventive, adjunctive and neuroprotective treatments for cerebral malaria. This Review describes important advances in the understanding of cerebral malaria over the past two decades and discusses how these mechanistic insights could be translated into new therapies.
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Affiliation(s)
- Alexandros Hadjilaou
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany.
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Johannes Brandi
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
| | - Mathias Riehn
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Jacobs
- Protozoen Immunologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Hamburg, Germany
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30
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Watson JA, Peto TJ, White NJ. Rectal artesunate suppositories for the pre-referral treatment of suspected severe malaria. PLoS Med 2023; 20:e1004312. [PMID: 37943884 PMCID: PMC10681301 DOI: 10.1371/journal.pmed.1004312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 11/27/2023] [Indexed: 11/12/2023] Open
Abstract
In this Policy Forum article, James A. Watson and colleagues discuss recent guidelines relating to pre-referral treatment of suspected severe malaria with rectal artesunate suppositories in remote areas.
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Affiliation(s)
- James A. Watson
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, United Kingdom
| | - Thomas J. Peto
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J. White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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31
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Jajosky RP, Wu SC, Jajosky PG, Stowell SR. Plasmodium knowlesi ( Pk) Malaria: A Review & Proposal of Therapeutically Rational Exchange (T-REX) of Pk-Resistant Red Blood Cells. Trop Med Infect Dis 2023; 8:478. [PMID: 37888606 PMCID: PMC10610852 DOI: 10.3390/tropicalmed8100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Plasmodium knowlesi (Pk) causes zoonotic malaria and is known as the "fifth human malaria parasite". Pk malaria is an emerging threat because infections are increasing and can be fatal. While most infections are in Southeast Asia (SEA), especially Malaysia, travelers frequently visit this region and can present with Pk malaria around the world. So, clinicians need to know (1) patients who present with fever after recent travel to SEA might be infected with Pk and (2) Pk is often misdiagnosed as P. malariae (which typically causes less severe malaria). Here we review the history, pathophysiology, clinical features, diagnosis, and treatment of Pk malaria. Severe disease is most common in adults. Signs and symptoms can include fever, abdominal pain, jaundice, acute kidney injury, acute respiratory distress syndrome, hyponatremia, hyperparasitemia, and thrombocytopenia. Dengue is one of the diseases to be considered in the differential. Regarding pathophysiologic mechanisms, when Pk parasites invade mature red blood cells (RBCs, i.e., normocytes) and reticulocytes, changes in the red blood cell (RBC) surface can result in life-threatening cytoadherence, sequestration, and reduced RBC deformability. Since molecular mechanisms involving the erythrocytic stage are responsible for onset of severe disease and lethal outcomes, it is biologically plausible that manual exchange transfusion (ET) or automated RBC exchange (RBCX) could be highly beneficial by replacing "sticky" parasitized RBCs with uninfected, deformable, healthy donor RBCs. Here we suggest use of special Pk-resistant donor RBCs to optimize adjunctive manual ET/RBCX for malaria. "Therapeutically-rational exchange transfusion" (T-REX) is proposed in which Pk-resistant RBCs are transfused (instead of disease-promoting RBCs). Because expression of the Duffy antigen on the surface of human RBCs is essential for parasite invasion, T-REX of Duffy-negative RBCs-also known as Fy(a-b-) RBCs-could replace the majority of the patient's circulating normocytes with Pk invasion-resistant RBCs (in a single procedure lasting about 2 h). When sequestered or non-sequestered iRBCs rupture-in a 24 h Pk asexual life cycle-the released merozoites cannot invade Fy(a-b-) RBCs. When Fy(a-b-) RBC units are scarce (e.g., in Malaysia), clinicians can consider the risks and benefits of transfusing plausibly Pk-resistant RBCs, such as glucose-6-phosphate dehydrogenase deficient (G6PDd) RBCs and Southeast Asian ovalocytes (SAO). Patients typically require a very short recovery time (<1 h) after the procedure. Fy(a-b-) RBCs should have a normal lifespan, while SAO and G6PDd RBCs may have mildly reduced half-lives. Because SAO and G6PDd RBCs come from screened blood donors who are healthy and not anemic, these RBCs have a low-risk for hemolysis and do not need to be removed after the patient recovers from malaria. T-REX could be especially useful if (1) antimalarial medications are not readily available, (2) patients are likely to progress to severe disease, or (3) drug-resistant strains emerge. In conclusion, T-REX is a proposed optimization of manual ET/RBCX that has not yet been utilized but can be considered by physicians to treat Pk malaria patients.
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Affiliation(s)
- Ryan Philip Jajosky
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA; (S.-C.W.)
- Biconcavity Inc., Lilburn, GA 30047, USA
| | - Shang-Chuen Wu
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA; (S.-C.W.)
| | | | - Sean R. Stowell
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital, Harvard Medical School, 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA; (S.-C.W.)
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Tu D, Goyal MS, Dworkin JD, Kampondeni S, Vidal L, Biondo-Savin E, Juvvadi S, Raghavan P, Nicholas J, Chetcuti K, Clark K, Robert-Fitzgerald T, Satterthwaite TD, Yushkevich P, Davatzikos C, Erus G, Tustison NJ, Postels DG, Taylor TE, Small DS, Shinohara RT. Automated analysis of low-field brain MRI in cerebral malaria. Biometrics 2023; 79:2417-2429. [PMID: 35731973 PMCID: PMC10267853 DOI: 10.1111/biom.13708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
A central challenge of medical imaging studies is to extract biomarkers that characterize disease pathology or outcomes. Modern automated approaches have found tremendous success in high-resolution, high-quality magnetic resonance images. These methods, however, may not translate to low-resolution images acquired on magnetic resonance imaging (MRI) scanners with lower magnetic field strength. In low-resource settings where low-field scanners are more common and there is a shortage of radiologists to manually interpret MRI scans, it is critical to develop automated methods that can augment or replace manual interpretation, while accommodating reduced image quality. We present a fully automated framework for translating radiological diagnostic criteria into image-based biomarkers, inspired by a project in which children with cerebral malaria (CM) were imaged using low-field 0.35 Tesla MRI. We integrate multiatlas label fusion, which leverages high-resolution images from another sample as prior spatial information, with parametric Gaussian hidden Markov models based on image intensities, to create a robust method for determining ventricular cerebrospinal fluid volume. We also propose normalized image intensity and texture measurements to determine the loss of gray-to-white matter tissue differentiation and sulcal effacement. These integrated biomarkers have excellent classification performance for determining severe brain swelling due to CM.
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Affiliation(s)
- Danni Tu
- The Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Manu S. Goyal
- Mallinckrodt Institute of Radiology, Washington University in St. Louis
| | | | | | - Lorenna Vidal
- Department of Radiology, Children’s Hospital of Philadelphia
| | | | | | - Prashant Raghavan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
| | - Jennifer Nicholas
- University Hospitals Cleveland Medical Center, Department of Radiology, Case Western Reserve University
| | - Karen Chetcuti
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences
| | - Kelly Clark
- The Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Timothy Robert-Fitzgerald
- The Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | | | | | | | - Guray Erus
- Center for Biomedical Image Computing and Analysis (CBICA), Department of Radiology, University of Pennsylvania
| | | | - Douglas G. Postels
- Division of Neurology, George Washington University/Children’s National Medical Center
| | - Terrie E. Taylor
- Blantyre Malaria Project, Kamuzu University of Health Sciences
- College of Osteopathic Medicine, Michigan State University
| | | | - Russell T. Shinohara
- The Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
- Center for Biomedical Image Computing and Analysis (CBICA), Department of Radiology, University of Pennsylvania
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Selimaj Kontoni V, Goetghebuer T, Hainaut M, Vanderfaeillie A, Nguyen VTP, Jourdain S, Pace D. Imported Malaria in Children: A Study Over an 11-Year Period in Brussels. Pediatr Infect Dis J 2023; 42:733-738. [PMID: 37406181 DOI: 10.1097/inf.0000000000003986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Malaria is a major global public health concern in endemic countries and imported childhood malaria is increasing in malaria non-endemic countries. METHODS This was a retrospective case review of all laboratory-confirmed malaria cases in children 0-16 years admitted between 2009 and 2019 in 2 large university teaching Hospitals in Brussels. RESULTS A total of 160 children with a median age of 6.8 years (range 5-191 months) were included. We identified 109 (68%) children living in Belgium who had acquired malaria during their visit to malaria-endemic countries to visiting friends and relatives (VFRs), 49 children (31%) visitors or newly installed migrants, and 2 Belgian tourists. Peak seasonal incidence occurred between August and September. Plasmodium falciparum was responsible for 89% of all malaria cases. Almost 80% of children living in Belgium visited a travel clinic for advice, but only one-third reported having taken the prophylaxis schedule according to the recommendations. Based on WHO criteria, 31 children (19.3%) developed severe malaria; most of the patients with severe malaria were VFR travelers and were significantly younger, had higher leukocytosis, had more thrombocytopenia, higher CRP, and lower natremia compared with patients with an uncomplicated course. All children recovered fully. CONCLUSIONS Malaria is a significant cause of morbidity among returning travelers and newly arrived immigrants to Belgium. Most of the children had an uncomplicated disease course. Physicians should educate families about traveling to malaria-endemic areas to correct malaria preventive measures and prophylaxis.
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Affiliation(s)
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Hainaut
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Vanderfaeillie
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Vo Thanh Phuong Nguyen
- Department of Pediatrics, Laboratoire d'Hematologie, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Jourdain
- Department of Pediatrics, Hopital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - David Pace
- Department of Pediatrics, Mater Dei Hospital, Msida, Malta
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Agnandji ST, Recker M, Mordmüller B, Glöckner S, Adegnika AA, Lell B, Otieno L, Otieno W, Owusu-Agyei S, Asante KP, Agbenyega T, Ansong D, Macete E, Aide P, Sorgho H, Tinto H, Mturi N, Lusingu JPA, Gesase S, Hoffman I, Masoud NS, Newton CR, Bojang K, Krause G, Kremsner PG. Prostration and the prognosis of death in African children with severe malaria. Int J Infect Dis 2023; 134:240-247. [PMID: 37414210 DOI: 10.1016/j.ijid.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES Malaria is still one of the main reasons for hospitalization in children living in sub-Saharan Africa. Rapid risk stratification at admission is essential for optimal medical care and improved prognosis. Whereas coma, deep breathing, and, to a lesser degree, severe anemia are established predictors of malaria-related death, the value of assessing prostration for risk stratification is less certain. METHODS Here we used a retrospective multi-center analysis comprising over 33,000 hospitalized children from four large studies, including two observational studies from the Severe Malaria in African Children network, a randomized controlled treatment study, and the phase-3-clinical RTS,S-malaria vaccine trial, to evaluate known risk factors of mortality and with a specific emphasis on the role of prostration. RESULTS Despite comparable age profiles of the participants, we found significant inter- and intra-study variation in the incidence of fatal malaria as well as in the derived risk ratios associated with the four risk factors: coma, deep breathing, anemia, and prostration. Despite pronounced variations, prostration was significantly associated with an increased risk of mortality (P <0.001) and its consideration resulted in improved predictive performance, both in a multivariate model and a univariate model based on the Lambaréné Organ Dysfunction Score. CONCLUSION Prostration is an important clinical criterion to determine severe pediatric malaria with possible fatal outcomes.
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Affiliation(s)
- Selidji T Agnandji
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany
| | - Mario Recker
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Department of Ecology and Conservation, University of Exeter, Exeter, UK.
| | - Benjamin Mordmüller
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany; Radboud University Medical Centre, Department of Medical Microbiology, Nijmegen, The Netherlands
| | - Stephan Glöckner
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Translational Infrastructure Epidemiology, German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Akim A Adegnika
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Lucas Otieno
- Kenya Medical Research Institute, KEMRI-Walter Reed Project, Kombewa, Kenya
| | - Walter Otieno
- Kenya Medical Research Institute, KEMRI-Walter Reed Project, Kombewa, Kenya
| | | | | | - Tsiri Agbenyega
- Kwame Nkrumah University of Science and Technology, Agogo, Ghana
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Agogo, Ghana
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Hermann Sorgho
- Institut de Recherche en Science de la Santé, Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Science de la Santé, Nanoro, Burkina Faso
| | - Neema Mturi
- Kenya Medical Research Institute, KEMRI-Wellcome Trust Research Programme, Centre Medicine Research, Kilifi, Kenya
| | | | - Samwel Gesase
- NjugNational Institute for Medical Research, Korogwe, Tanzania
| | - Irving Hoffman
- University of North Carolina (UNC), Division of Infectious Diseases, North Carolina, USA; University of North Carolina (UNC) Project, Lilongwe, Malawi
| | - Nahya Salim Masoud
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam and Ifakara Health Institute, Bagamoyo, Tanzania
| | - Charles R Newton
- Kenya Medical Research Institute, KEMRI-Wellcome Trust Programme, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kalifa Bojang
- Medical Research Council (MRC) Unit at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Translational Infrastructure Epidemiology, German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Peter Gottfried Kremsner
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany
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35
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Saito M, Phyo AP, Chu C, Proux S, Rijken MJ, Beau C, Win HH, Archasuksan L, Wiladphaingern J, Phu NH, Hien TT, Day NP, Dondorp AM, White NJ, Nosten F, McGready R. Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study. BMC Med 2023; 21:320. [PMID: 37620809 PMCID: PMC10464355 DOI: 10.1186/s12916-023-02991-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Severe malaria in pregnancy causes maternal mortality, morbidity, and adverse foetal outcomes. The factors contributing to adverse maternal and foetal outcomes are not well defined. We aimed to identify the factors predicting higher maternal mortality and to describe the foetal mortality and morbidity associated with severe falciparum malaria in pregnancy. METHODS A retrospective cohort study was conducted of severe falciparum malaria in pregnancy, as defined by the World Health Organization severe malaria criteria. The patients were managed prospectively by the Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border or were included in hospital-based clinical trials in six Southeast Asian countries. Fixed-effects multivariable penalised logistic regression was used for analysing maternal mortality. RESULTS We included 213 (123 SMRU and 90 hospital-based) episodes of severe falciparum malaria in pregnancy managed between 1980 and 2020. The mean maternal age was 25.7 (SD 6.8) years, and the mean gestational age was 25.6 (SD 8.9) weeks. The overall maternal mortality was 12.2% (26/213). Coma (adjusted odds ratio [aOR], 7.18, 95% CI 2.01-25.57, p = 0.0002), hypotension (aOR 11.21, 95%CI 1.27-98.92, p = 0.03) and respiratory failure (aOR 4.98, 95%CI 1.13-22.01, p = 0.03) were associated with maternal mortality. Pregnant women with one or more of these three criteria had a mortality of 29.1% (25/86) (95%CI 19.5 to 38.7%) whereas there were no deaths in 88 pregnant women with hyperparasitaemia (> 10% parasitised erythrocytes) only or severe anaemia (haematocrit < 20%) only. In the SMRU prospective cohort, in which the pregnant women were followed up until delivery, the risks of foetal loss (23.3% by Kaplan-Meier estimator, 25/117) and small-for-gestational-age (38.3%, 23/60) after severe malaria were high. Maternal death, foetal loss and preterm birth occurred commonly within a week of diagnosis of severe malaria. CONCLUSIONS Vital organ dysfunction in pregnant women with severe malaria was associated with a very high maternal and foetal mortality whereas severe anaemia or hyperparasitaemia alone were not associated with poor prognosis, which may explain the variation of reported mortality from severe malaria in pregnancy. Access to antenatal care must be promoted to reduce barriers to early diagnosis and treatment of both malaria and anaemia.
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Affiliation(s)
- Makoto Saito
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Marcus J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Candy Beau
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Htun Htun Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Laypaw Archasuksan
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Nguyen H Phu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran T Hien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nick P Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Pinheiro ADS, Kazura JW, Pinheiro AA, Schmaier AH. Is there a role for bradykinin in cerebral malaria pathogenesis? Front Cell Infect Microbiol 2023; 13:1184896. [PMID: 37637466 PMCID: PMC10448822 DOI: 10.3389/fcimb.2023.1184896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Malaria is a parasitic disease of global health significance and a leading cause of death in children living in endemic regions. Although various Plasmodium species are responsible for the disease, Plasmodium falciparum infection accounts for most severe cases of the disease in humans. The mechanisms of cerebral malaria pathogenesis have been studied extensively in humans and animal malaria models; however, it is far from being fully understood. Recent discoveries indicate a potential role of bradykinin and the kallikrein kinin system in the pathogenesis of cerebral malaria. The aim of this review is to highlight how bradykinin is formed in cerebral malaria and how it may impact cerebral blood-brain barrier function. Areas of interest in this context include Plasmodium parasite enzymes that directly generate bradykinin from plasma protein precursors, cytoadhesion of P. falciparum infected red blood cells to brain endothelial cells, and endothelial cell blood-brain barrier disruption.
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Affiliation(s)
- Alessandro de Sa Pinheiro
- Department of Medicine, Hematology and Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - James W. Kazura
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University, Cleveland, OH, United States
| | - Ana Acacia Pinheiro
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alvin H. Schmaier
- Department of Medicine, Hematology and Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
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Beare NAV. Cerebral malaria-using the retina to study the brain. Eye (Lond) 2023; 37:2379-2384. [PMID: 36788363 PMCID: PMC10397347 DOI: 10.1038/s41433-023-02432-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Cerebral malaria (CM) remains a common cause of death of children in Africa with annual mortality of 400 000. Malarial retinopathy is a unique set of fundus signs which has diagnostic and prognostic value in CM. Assessment of malarial retinopathy is now widely utilised in clinical care, and routinely incorporated into clinical studies to refine entry criteria. As a visible part of the central nervous system, the retina provides insights into the pathophysiology of this infectious small-vessel vasculitis with adherent parasitised red blood cells. Fluorescein angiography and optical coherence tomography (OCT) have shown that patchy capillary non-perfusion is common and causes ischaemic changes in the retina in CM. It is likely this is mirrored in the brain and may cause global neurological impairments evident on developmental follow up. Three types of blood-retina barrier breakdown are evident: large focal, punctate, and vessel leak. Punctate and large focal leak (haemorrhage in formation) are associated with severe brain swelling and fatal outcome. Vessel leak and capillary non-perfusion are associated with moderate brain swelling and neurological sequelae. These findings imply that death and neurological sequelae have separate mechanisms and are not a continuum of severity. Each haemorrhage causes a temporary uncontrolled outflow of fluid into the tissue. The rapid accumulation of haemorrhages, as evidenced by multiple focal leaks, is a proposed mechanism of severe brain swelling, and death. Current studies aim to use optic nerve head OCT to identify patients with severe brain swelling, and macula OCT to identify those at risk of neurological sequelae.
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Affiliation(s)
- Nicholas A V Beare
- Department of Eye and Vision Science, University of Liverpool, Liverpool, L7 8TX, UK.
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Shepherd JM, Ross J, Anton L, Rourke C, Brentnall AR, Tarning J, White NJ, Thiemermann C, Brohi K. Safety and efficacy of artesunate treatment in severely injured patients with traumatic hemorrhage. The TOP-ART randomized clinical trial. Intensive Care Med 2023; 49:922-933. [PMID: 37470832 PMCID: PMC10425486 DOI: 10.1007/s00134-023-07135-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/27/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE This study aimed at determining whether intravenous artesunate is safe and effective in reducing multiple organ dysfunction syndrome in trauma patients with major hemorrhage. METHODS TOP-ART, a randomized, blinded, placebo-controlled, phase IIa trial, was conducted at a London major trauma center in adult trauma patients who activated the major hemorrhage protocol. Participants received artesunate or placebo (2:1 randomization ratio) as an intravenous bolus dose (2.4 mg/kg or 4.8 mg/kg) within 4 h of injury. The safety outcome was the 28-day serious adverse event (SAE) rate. The primary efficacy outcome was the 48 h sequential organ failure assessment (SOFA) score. The per-protocol recruitment target was 105 patients. RESULTS The trial was terminated after enrolment of 90 patients because of safety concerns. Eighty-three participants received artesunate (n = 54) or placebo (n = 29) and formed the safety population and 75 met per-protocol criteria (48 artesunate, 27 placebo). Admission characteristics were similar between groups (overall 88% male, median age 29 years, median injury severity score 22), except participants who received artesunate were more shocked (median base deficit 9 vs. 4.7, p = 0.042). SAEs occurred in 17 artesunate participants (31%) vs. 5 who received placebo (17%). Venous thromboembolic events (VTE) occurred in 9 artesunate participants (17%) vs. 1 who received placebo (3%). Superiority of artesunate was not supported by the 48 h SOFA score (median 5.5 artesunate vs. 4 placebo, p = 0.303) or any of the trial's secondary endpoints. CONCLUSION Among critically ill trauma patients, artesunate is unlikely to improve organ dysfunction and might be associated with a higher VTE rate.
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Affiliation(s)
- Joanna M Shepherd
- Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London, London, E1 4AT, UK.
| | - Jennifer Ross
- Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London, London, E1 4AT, UK
| | - Lourdes Anton
- Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London, London, E1 4AT, UK
- Chelsea Research Center, The Royal Marsden NHS Foundation Trust, 2nd Floor Wallace Wing, 203 Fulham Rd, Chelsea, London, SW3 6JJ, UK
| | - Claire Rourke
- Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London, London, E1 4AT, UK
- NHS Blood and Transplant Clinical Trials Unit, Cambridge Blood Centre, Long Road, Cambridge, CB20PT, UK
| | - Adam R Brentnall
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - 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 Clinical Medicine, University of Oxford, Oxford, UK
| | - 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, UK
| | - Christoph Thiemermann
- Centre for Translational Medicine and Therapeutics, The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Karim Brohi
- Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London, London, E1 4AT, UK
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Saidi AM, Zhang B, Jiang M, Kawaza K, Musaya J, Taylor T, Seydel K. Differential Effects of Antimalarial Drugs on Parasite Clearance Rates Are Reflected by Plasmodium falciparum Ring Ratio. Open Forum Infect Dis 2023; 10:ofad380. [PMID: 37520418 PMCID: PMC10375422 DOI: 10.1093/ofid/ofad380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background The location of Plasmodium falciparum within the body is determined by the life cycle of the parasite; young rings are in the peripheral blood, whereas mature parasites are sequestered in deep tissues. We can calculate a "ring ratio," the proportion of parasites in the periphery to the total number of parasites in the body. Artesunate acts on all parasite life stages, whereas quinine is effective only on sequestered parasites. Children with cerebral malaria (CM) treated with artesunate clear parasites faster than those treated with quinine. In this study, we established the relationship between ring ratio and parasite clearance rate and used the ring ratio to determine if the benefit derived from artesunate treatment could be attributed to its broader effect on life cycle stages. Methods Ring ratios were calculated for 400 hospitalized children with CM in Blantyre, Malawi between 2010 and 2019 (quinine: 2010-2013, artesunate: 2014-2019). Results In both treatment groups, parasite clearance rates were positively associated with the ring ratios, with a stronger association in the artesunate era than the quinine era. In the quinine era, an increase of 1-unit log10 difference between parasitemia and plasma P falciparum histidine-rich protein 2 (a proxy for ring ratio) resulted in a 0.27-unit increase in the parasite clearance rate, whereas in the artesunate era an equal increase resulted in a 0.41-unit increase (P = .04 for the difference). Conclusions This analysis provides in vivo evidence supporting the hypothesis that more rapid parasite clearance rates in artesunate recipients are due to its superiority over quinine in killing ring-stage parasites.
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Affiliation(s)
- Alexuse M Saidi
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Bo Zhang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Melody Jiang
- Department of Statistics, University of Washington, Seattle, Washington, USA
| | | | | | - Terrie Taylor
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Karl Seydel
- Correspondence: Karl Seydel, MD, PhD, Department of Osteopathic Medical Specialties, School of Osteopathic Medicine, Michigan State University, 909 Wilson Rd, West Fee Hall, Room B-305, East Lansing, MI 48824 ()
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Balerdi-Sarasola L, Parolo C, Fleitas P, Cruz A, Subirà C, Rodríguez-Valero N, Almuedo-Riera A, Letona L, Álvarez-Martínez MJ, Valls ME, Vera I, Mayor A, Muñoz J, Camprubí-Ferrer D. Host biomarkers for early identification of severe imported Plasmodium falciparum malaria. Travel Med Infect Dis 2023; 54:102608. [PMID: 37348666 DOI: 10.1016/j.tmaid.2023.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Severe imported P. falciparum malaria is a source of morbi-mortality in non-endemic regions. WHO criteria don't accurately classify patients at risk of complications. There is a need to evaluate new tools such as biomarkers to better identify patients with severe imported malaria. METHODS A case-control study was conducted in Barcelona, from January 2011-January 2021. Adult patients with microbiologically confirmed P. falciparum malaria were classified according to WHO criteria. Patients with imported non-malarial fevers were included as controls. In each group, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble triggering receptor expressed on myeloid cells (sTREM-1), C-reactive protein (CRP) and platelets were measured and their concentrations were compared between groups. New groups were made with a modified WHO severity classification and biomarkers' performance was evaluated using multiple imputation models. RESULTS 131 participants were included: 52 severe malaria, 30 uncomplicated malaria and 49 non-malarial fever cases. All biomarkers except sTREM-1 showed significant differences between groups. Using the modified WHO severity classification, Ang-2 and CRP presented the best AUROC; 0.79 (95%CI 0.64-0.94) and 0.80(95%CI 0.67-0.93). A model combining CRP and Ang-2 showed the best AUROC, of 0.84(95%CI 0.68-0.99), with the highest sensitivity and specificity: 84.6%(95%CI 58.9-98.1) and 77.4% (95%CI 65.9-87.7), respectively. CONCLUSIONS The combination of Ang-2 and CRP may be a reliable tool for the early identification of severe imported malaria. The use of a rapid prognostic test including the mentioned biomarkers could optimize imported malaria management, with the potential to decrease the rate of complications and hospitalizations in patients with imported malaria.
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Affiliation(s)
| | - C Parolo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - P Fleitas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Cruz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - A Almuedo-Riera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - L Letona
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M J Álvarez-Martínez
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - M Eugenia Valls
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - I Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - D Camprubí-Ferrer
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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DANIS M. [Malaria today]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i2.2023.375. [PMID: 37525676 PMCID: PMC10387315 DOI: 10.48327/mtsi.v3i2.2023.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 08/02/2023]
Abstract
Malaria, a parasitic disease the pathogen of which was discovered by Alphonse Laveran in 1880 in the blood of febrile patients, remains in 2022 the most frequent endemic disease in tropical and subtropical countries. In its latest "World Malaria Report" available in November 2021, the WHO deals in great detail with the data collected in the field in 2019-2020, their progression over the last 20 years, and the measures to be taken to try to better control this life-threatening endemic. The number of malaria cases is estimated at 232 million in 2019 in 87 endemic countries, down from 245 million in 2000. The WHO African Region alone accounts for 94% of cases and the most frequent and severe infections due to Plasmodium falciparum species. If children under the age of 5 are not treated promptly, they can die. Globally, the number of malaria deaths declined steadily over the period 2000-2019, from 897,000 in 2000 to 568,000 in 2019, with nearly 95% of deaths occurring in 31 countries, primarily in sub-Saharan Africa. In other WHO regions, including Southeast Asia, malaria deaths decreased by 74%, with 35,000 deaths in 2000 compared to 9,000 in 2019. Malaria can be controlled worldwide, and possibly eradicated, if public information campaigns are strengthened and sufficient funds are made available.
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FICKO C, CONAN PL. [Malaria in 2022: clinical and therapeutic aspects]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i2.2023.378. [PMID: 37525671 PMCID: PMC10387310 DOI: 10.48327/mtsi.v3i2.2023.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 08/02/2023]
Abstract
In 2022 as in 1884, the clinical presentation of uncomplicated malaria is unspecific: fever of variable intensity, continuous or rhythmic, chills, flu syndrome, headache, respiratory and digestive disorders. At any time, it can evolve into a severe form (ex-pernicious attack or cerebral malaria) or even lethal. By reading again Alphonse Laveran's book on malarial fevers, we realized to what extent the observations made at that time allowed for a methodical and orderly description of the clinical forms of malaria, very close to what we can still observe today. No symptom or sign is pathognomonic of the disease. Only the detection of plasmodia or "malaria microbes" by direct or immuno-chromatographic methods allows for diagnostic confirmation, which is a prerequisite for the implementation of a curative treatment.Serendipity, synthetic chemistry and traditional medicine are the three methods that led to the discovery and large-scale production of antimalarial drugs. Serendipity for quinine, synthetic chemistry for chloroquine, and research conducted around traditional Chinese medicine for artemisinin and its derivatives. The latter have marked a real revolution in the management of malaria, both in its uncomplicated and severe forms. However, as with other antimalarial drugs, its medium- and long-term efficacy is compromised by the emergence and spread of resistance in malaria parasites, particularly P. falciparum. The control and eradication of malaria therefore require continued research in both prevention and therapy.The disease so well described by Alphonse Laveran has not yet said its last word….
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Affiliation(s)
- Cécile FICKO
- Service de maladies infectieuses et tropicales, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France
- École du Val-de-Grâce, Paris, France
| | - Pierre-Louis CONAN
- Service de maladies infectieuses et tropicales, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France
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Ren Y, Yan C, Yang H. Erythrocytes: Member of the Immune System that Should Not Be Ignored. Crit Rev Oncol Hematol 2023; 187:104039. [PMID: 37236411 DOI: 10.1016/j.critrevonc.2023.104039] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/27/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
Erythrocytes are the most abundant type of cells in the blood and have a relatively simple structure when mature; they have a long life-span in the circulatory system. The primary function of erythrocytes is as oxygen carriers; however, they also play an important role in the immune system. Erythrocytes recognize and adhere to antigens and promote phagocytosis. The abnormal morphology and function of erythrocytes are also involved in the pathological processes of some diseases. Owing to the large number and immune properties of erythrocytes, their immune functions should not be ignored. Currently, research on immunity is focused on immune cells other than erythrocytes. However, research on the immune function of erythrocytes and the development of erythrocyte-mediated applications is of great significance. Therefore, we aimed to review the relevant literature and summarize the immune functions of erythrocytes.
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Affiliation(s)
- Yijun Ren
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China, 410000.
| | - Chengkai Yan
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China, 410000.
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China, 410000.
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Ekeh BC, Bah E, Jobe YFBM, Daboer AF, Gomez M, Lanlokun RA. Post-malarial neurological syndrome in a Gambian adult residing in the Gambia: a case report and a review of literature. Malar J 2023; 22:153. [PMID: 37173726 PMCID: PMC10182665 DOI: 10.1186/s12936-023-04579-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Post malarial neurological syndrome (PMNS) occurs as a sequel of cerebral malaria which is the most deadly form of severe malaria. In holo-endemic regions (areas of high malarial transmission) all forms of severe malaria as well as cerebral malaria usually occur in children and those who are semi or non-immune like pregnant women, migrants as well as tourists. It also occurs in hypo-endemic regions (areas of limited malarial transmission with low immunity) and malaria- free zones. Survivors however may have neurologic complications after recovery. PMNS has been reported in many parts of the world. Being a sequel to cerebral malaria, it is uncommon in adults who were born and reside in a holo-endemic region all their lives. CASE REPORT This is the case of an 18 year old Gambian who has lived in The Gambia all his life that had PMNS five days after recovery from cerebral malaria. METHODS This was a predominantly web based literature search. The search comprise all case reports, original articles and reviews on PMNS or neurological deficits associated with malaria or noted after malaria infection. The search engines used were Google, Yahoo and Google scholar. RESULTS A total of 62 papers were found. These were used for this review of the literature. CONCLUSION Cerebral malaria also occurs in adults in holo-endemic areas though rare and some of the survivors may develop PMNS. It is commoner in the youth age group. There is need for further studies since the youth may be a possible new 'vulnerable group' in holoendemic areas. This may lead to the widening the targeted group for malaria control in the regions of high malarial transmission.
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Affiliation(s)
- Bertha C Ekeh
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
- Department of Internal Medicine, University of Uyo, Uyo, Nigeria.
| | - Ebrima Bah
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ya Fatou B M Jobe
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Aji F Daboer
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Mariama Gomez
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ridhwan A Lanlokun
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
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Conroy AL, Datta D, Opoka RO, Batte A, Bangirana P, Gopinadhan A, Mellencamp KA, Akcan-Arikan A, Idro R, John CC. Cerebrospinal fluid biomarkers provide evidence for kidney-brain axis involvement in cerebral malaria pathogenesis. Front Hum Neurosci 2023; 17:1177242. [PMID: 37200952 PMCID: PMC10185839 DOI: 10.3389/fnhum.2023.1177242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction Cerebral malaria is one of the most severe manifestations of malaria and is a leading cause of acquired neurodisability in African children. Recent studies suggest acute kidney injury (AKI) is a risk factor for brain injury in cerebral malaria. The present study evaluates potential mechanisms of brain injury in cerebral malaria by evaluating changes in cerebrospinal fluid measures of brain injury with respect to severe malaria complications. Specifically, we attempt to delineate mechanisms of injury focusing on blood-brain-barrier integrity and acute metabolic changes that may underlie kidney-brain crosstalk in severe malaria. Methods We evaluated 30 cerebrospinal fluid (CSF) markers of inflammation, oxidative stress, and brain injury in 168 Ugandan children aged 18 months to 12 years hospitalized with cerebral malaria. Eligible children were infected with Plasmodium falciparum and had unexplained coma. Acute kidney injury (AKI) on admission was defined using the Kidney Disease: Improving Global Outcomes criteria. We further evaluated blood-brain-barrier integrity and malaria retinopathy, and electrolyte and metabolic complications in serum. Results The mean age of children was 3.8 years (SD, 1.9) and 40.5% were female. The prevalence of AKI was 46.3% and multi-organ dysfunction was common with 76.2% of children having at least one organ system affected in addition to coma. AKI and elevated blood urea nitrogen, but not other measures of disease severity (severe coma, seizures, jaundice, acidosis), were associated with increases in CSF markers of impaired blood-brain-barrier function, neuronal injury (neuron-specific enolase, tau), excitatory neurotransmission (kynurenine), as well as altered nitric oxide bioavailability and oxidative stress (p < 0.05 after adjustment for multiple testing). Further evaluation of potential mechanisms suggested that AKI may mediate or be associated with CSF changes through blood-brain-barrier disruption (p = 0.0014), ischemic injury seen by indirect ophthalmoscopy (p < 0.05), altered osmolality (p = 0.0006) and through alterations in the amino acids transported into the brain. Conclusion In children with cerebral malaria, there is evidence of kidney-brain injury with multiple potential pathways identified. These changes were specific to the kidney and not observed in the context of other clinical complications.
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Affiliation(s)
- Andrea L. Conroy
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Robert O. Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
- Undergraduate Medical Education, The Aga Khan University, Nairobi, Kenya
| | - Anthony Batte
- Global Health Uganda, Kampala, Uganda
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Bangirana
- Global Health Uganda, Kampala, Uganda
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adnan Gopinadhan
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kagan A. Mellencamp
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ayse Akcan-Arikan
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, United States
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, United States
| | - Richard Idro
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Chandy C. John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, United States
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Ozodiegwu ID, Ambrose M, Galatas B, Runge M, Nandi A, Okuneye K, Dhanoa NP, Maikore I, Uhomoibhi P, Bever C, Noor A, Gerardin J. Application of mathematical modelling to inform national malaria intervention planning in Nigeria. Malar J 2023; 22:137. [PMID: 37101146 PMCID: PMC10130303 DOI: 10.1186/s12936-023-04563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND For their 2021-2025 National Malaria Strategic Plan (NMSP), Nigeria's National Malaria Elimination Programme (NMEP), in partnership with the World Health Organization (WHO), developed a targeted approach to intervention deployment at the local government area (LGA) level as part of the High Burden to High Impact response. Mathematical models of malaria transmission were used to predict the impact of proposed intervention strategies on malaria burden. METHODS An agent-based model of Plasmodium falciparum transmission was used to simulate malaria morbidity and mortality in Nigeria's 774 LGAs under four possible intervention strategies from 2020 to 2030. The scenarios represented the previously implemented plan (business-as-usual), the NMSP at an 80% or higher coverage level and two prioritized plans according to the resources available to Nigeria. LGAs were clustered into 22 epidemiological archetypes using monthly rainfall, temperature suitability index, vector abundance, pre-2010 parasite prevalence, and pre-2010 vector control coverage. Routine incidence data were used to parameterize seasonality in each archetype. Each LGA's baseline malaria transmission intensity was calibrated to parasite prevalence in children under the age of five years measured in the 2010 Malaria Indicator Survey (MIS). Intervention coverage in the 2010-2019 period was obtained from the Demographic and Health Survey, MIS, the NMEP, and post-campaign surveys. RESULTS Pursuing a business-as-usual strategy was projected to result in a 5% and 9% increase in malaria incidence in 2025 and 2030 compared with 2020, while deaths were projected to remain unchanged by 2030. The greatest intervention impact was associated with the NMSP scenario with 80% or greater coverage of standard interventions coupled with intermittent preventive treatment in infants and extension of seasonal malaria chemoprevention (SMC) to 404 LGAs, compared to 80 LGAs in 2019. The budget-prioritized scenario with SMC expansion to 310 LGAs, high bed net coverage with new formulations, and increase in effective case management rate at the same pace as historical levels was adopted as an adequate alternative for the resources available. CONCLUSIONS Dynamical models can be applied for relative assessment of the impact of intervention scenarios but improved subnational data collection systems are required to allow increased confidence in predictions at sub-national level.
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Affiliation(s)
- Ifeoma D Ozodiegwu
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA.
| | | | - Beatriz Galatas
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Manuela Runge
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Aadrita Nandi
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Kamaldeen Okuneye
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Neena Parveen Dhanoa
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA
| | - Ibrahim Maikore
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Abdisalan Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
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Keating C. Artesunate versus quinine: the controlled trials watershed. Lancet 2023; 401:1329-1331. [PMID: 37087160 DOI: 10.1016/s0140-6736(23)00778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Affiliation(s)
- Conrad Keating
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland.
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Ojha SB, Sah RK, Madan E, Bansal R, Roy S, Singh S, Dhangadamajhi G. Cuscuta reflexa Possess Potent Inhibitory Activity Against Human Malaria Parasite: An In Vitro and In Vivo Study. Curr Microbiol 2023; 80:189. [PMID: 37074472 DOI: 10.1007/s00284-023-03289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
Drug resistance to practically all antimalarial drugs in use necessitate the development of new chemotherapeutics against malaria. In this aspect, traditionally used plants with folklore reputation are the pillar for drug discovery. Cuscuta reflexa being traditionally used in the treatment of malaria in Odisha, India we aimed to experimentally validate its antimalarial potential. Different solvent extracts of C. reflexa or column fractions from a promising solvent extract were evaluated for in vitro anti-plasmodial activity against Plasmodium falciparum strain Pf3D7. Potent fractions were further evaluated for inhibition of parasite growth against different drug resistant strains. Safety of these fractions was determined by in vitro cyto-toxicity, and therapeutic effectiveness was evaluated by suppression of parasitemia and improvement in survival of experimental mice. Besides, their immunomodulatory effect was investigated in Pf-antigen stimulated RAW cells. GCMS fingerprints of active fractions was determined. Column separation of methanol extract which showed the highest in vitro antiplasmodial activity (IC50 = 14.48 μg/ml) resulted in eleven fractions, three of which (F2, F3, and F4) had anti-plasmodial IC50 ranging from ≤ 10 to 2.2 μg/ml against various P. falciparum strains with no demonstration of in vitro cytotoxicity. F4 displayed the highest in vivo parasite suppression, and had a mean survival time similar to artesunate (19.3 vs. 20.6 days). These fractions significantly modulated expression of inflammatory cytokines in Pf-antigen stimulated RAW cells. The findings of the study confirm the antimalarial potential of C. reflexa. Exploration of phyto-molecules in GCMS fingerprints of active fractions is warranted for possible identification of lead anti-malarial phyto-drugs.
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Affiliation(s)
- Sashi Bhusan Ojha
- Department of Biotechnology, Maharaja Sriram Chandra Bhanja Deo University, Baripada, Odisha, 757003, India
| | - Raj Kumar Sah
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Evanka Madan
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Ruby Bansal
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Shaktirekha Roy
- Department of Biotechnology, Maharaja Sriram Chandra Bhanja Deo University, Baripada, Odisha, 757003, India
| | - Shailja Singh
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067, India.
| | - Gunanidhi Dhangadamajhi
- Department of Biotechnology, Maharaja Sriram Chandra Bhanja Deo University, Baripada, Odisha, 757003, India.
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Valecha N. Keeping the momentum: suggestions for treatment policy updates in the final push to eliminate malaria in India. Malar J 2023; 22:128. [PMID: 37072795 PMCID: PMC10114449 DOI: 10.1186/s12936-023-04558-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
Malaria case management with prompt and effective treatment is critical to minimize morbidity and mortality, reduce transmission and to prevent the emergence and spread of anti-malarial drug resistance. India has the highest burden of malaria in South East Asia Region and has made impressive progress in the reduction of the malaria burden in recent years. Since the last revision to the Indian national malaria treatment policy in 2013, guidelines on new treatment strategies have been published for the control/ elimination of malaria by the World Health Organisation (WHO). The most recent update was in March 2023 based on the new evidence available. India's success is the Region's success. Therefore, to meet the national as well as regional targets of elimination, the Indian National Programme needs to consider WHO guidelines, deliberate with stakeholders and experts so as to tailor and adapt to the local context, and update National policies to incorporate the relevant ones. Technical aspects of new WHO guidelines which need to be considered for updating India's treatment policy are discussed.
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50
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Watson JA, Peto TJ, White NJ. The CARAMAL study could not assess the effectiveness of rectal artesunate in treating suspected severe malaria. BMC Med 2023; 21:118. [PMID: 36991487 PMCID: PMC10060129 DOI: 10.1186/s12916-023-02776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/09/2023] [Indexed: 03/31/2023] Open
Abstract
CARAMAL was a large observational study which recorded mortality in children with suspected severe malaria before and after the roll-out of rectal artesunate in Nigeria, Uganda and the Democratic Republic of the Congo. The results of CARAMAL have had a huge impact on public health policy leading to a World Health Organization moratorium on the roll-out of rectal artesunate. The conclusion reported in the abstract uses strong causal language, stating that "pre-referral RAS [rectal artesunate suppositories] had no beneficial effect on child survival". We argue that this causal interpretation of the study results is not justified. Data from the CARAMAL study inform chiefly on the strengths and weaknesses of referral systems in these three countries and do not inform reliably as to the beneficial effect of providing access to a known life-saving treatment.
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Affiliation(s)
- James A Watson
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Thomas J Peto
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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