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Falade CO, Orimadegun AE, Olusola FI, Michael OS, Anjorin OE, Funwei RI, Adedapo AD, Olusanya AL, Orimadegun BE, Mokuolu OA. Efficacy and safety of pyronaridine-artesunate versus artemether-lumefantrine in the treatment of acute uncomplicated malaria in children in South-West Nigeria: an open-labelled randomized controlled trial. Malar J 2023; 22:154. [PMID: 37179349 PMCID: PMC10182553 DOI: 10.1186/s12936-023-04574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND In Nigeria, declining responsiveness to artemether-lumefantrine (AL), the artemisinin-based combination therapy (ACT) of choice since 2005, has been reported. Pyronaridine-artesunate (PA) is a newer fixed-dose ACT recently prequalified by the WHO for the treatment of uncomplicated falciparum malaria. However, PA data from the Nigerian pediatric population is scarce. Therefore, the efficacy and safety of PA and AL using the WHO 28-day anti-malarial therapeutic efficacy study protocol in Ibadan, southwest Nigeria, were compared. METHODS In an open-labelled, randomized, controlled clinical trial, 172 children aged 3-144 months with a history of fever and microscopically confirmed uncomplicated Plasmodium falciparum malaria were enrolled in southwest Nigeria. Enrollees were randomly assigned to receive PA or AL at standard dosages according to body weight for 3 days. Venous blood was obtained for hematology, blood chemistry, and liver function tests on days 0, 3, 7, and 28 as part of the safety evaluation. RESULTS 165 (95.9%) of the enrolled individuals completed the study. About half (52.3%; 90/172) of enrollees were male. Eighty-seven (50.6%) received AL, while 85 (49.4%) received PA. Day 28, adequate clinical and parasitological response for PA was 92.7% [(76/82) 95% CI 83.1, 95.9] and 71.1% [(59/83) 95% CI 60.4, 79.9] for AL (0.001). Fever and parasite clearance were similar in both groups. Two of six and eight of 24 parasite recurrences were observed among PA- and AL-treated children, respectively. PCR-corrected Day-28 cure rates for PA were 97.4% (76/78) and 88.1% (59/67) for AL (= 0.04) in the per-protocol population after new infections were censored. Hematological recovery at day 28 was significantly better among PA-treated patients (34.9% 2.8) compared to those treated with AL (33.1% 3.0) (0.002). Adverse events in both treatment arms were mild and similar to the symptoms of malaria infection. Blood chemistry and liver function tests were mostly within normal limits, with an occasional marginal rise. CONCLUSION PA and AL were well-tolerated. PA was significantly more efficacious than AL in both the PCR-uncorrected and PCR-corrected per-protocol populations during this study. The results of this study support the inclusion of PA in the anti-malarial treatment guidelines in Nigeria. RETROSPECTIVE TRIAL REGISTRATION Clinicaltrials.gov: NCT05192265.
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Affiliation(s)
- Catherine O Falade
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Adebola E Orimadegun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Fiyinfoluwa I Olusola
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Obaro S Michael
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwafunmibi E Anjorin
- Department of Accident and Emergency, Obafemi Awolowo University Teaching, Hospital, Ile-Ife, Nigeria
| | - Roland I Funwei
- Department of Pharmacology, Babcock University, Ilisan, Remo, Ogun State, Nigeria
| | - Aduragbenro D Adedapo
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abiola L Olusanya
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bose E Orimadegun
- Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olugbenga A Mokuolu
- Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Asmerom H, Gemechu K, Bete T, Sileshi B, Gebremichael B, walle M, Arkew M. Platelet Parameters and Their Correlation with Parasitemia Levels Among Malaria Infected Adult Patients at Jinella Health Center, Harar, Eastern Ethiopia: Comparative Cross-Sectional Study. J Blood Med 2023; 14:25-36. [PMID: 36698775 PMCID: PMC9869896 DOI: 10.2147/jbm.s394704] [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: 10/24/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
Background Malaria is a major public health problem with the highest morbidity and mortality in developing countries. Hematological changes play a great role in malaria pathogenesis through platelets and platelet parameters. However, the changes in platelet parameters are not clearly described in Ethiopia. Therefore, this study aimed to compare platelet parameters and their correlation with parasitemia among malaria-infected adult patients and healthy adults. Methods An institutional-based comparative cross-sectional study was conducted involving 186 (93 malaria-infected patients and 93 healthy adults) study participants using a convenient sampling technique at Jinella health center, Harar, Eastern Ethiopia, from July 10-August 10, 2022. Five milliliters of venous blood were collected from each study participant, and platelet parameters were analyzed using a Unicel (DxH 800) automated hematologic analyzer. A drop of blood was taken from malaria-suspected patients for blood film preparation. Results between two groups were compared using the Mann-Whitney U-test. Spearman's rank correlation coefficient was used to evaluate the relationships between two continuous variables. A P-value of < 0.05 was considered statistically significant. Results Platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults (103 x103cells/μL vs 268 x103cells/μL, 0.13 fl vs 0.23 fl, and 9.6 fl vs 15.3 fl), respectively). Conversely, platelet distribution width and platelet large cell ratio were higher in malaria-infected patients than healthy adults (19.2% vs 15.3% and 0.35% vs 0.29%), respectively). Parasitemia levels had a moderately inverse correlation with platelet count (r= -0.419) and a weakly positive correlation with mean platelet volume (r=0.278). Conclusion The platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults. Malaria parasitemia had a moderate inverse correlation with platelet count and a weak positive correlation with mean platelet volume. Thrombocytopenia and alteration of platelet parameters should be considered in malaria patients.
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Affiliation(s)
- Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Correspondence: Haftu Asmerom, School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia, Tel +251913889039, Email
| | - Kabtamu Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Bete
- School of Nursing and Midwifery, Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Beza Sileshi
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhe Gebremichael
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Muluken walle
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Nkansah C, Bannison Bani S, Mensah K, Appiah SK, Osei-Boakye F, Abbam G, Daud S, Agyare EM, Agbadza PE, Derigubah CA, Serwaa D, Apodola FA, Quansah Y, Issah R, Dindiok SY, Chukwurah FE. Serum anti-erythropoietin antibodies among pregnant women with Plasmodium falciparum malaria and anaemia: A case-control study in northern Ghana. PLoS One 2023; 18:e0283427. [PMID: 36989322 PMCID: PMC10058094 DOI: 10.1371/journal.pone.0283427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Anaemia in pregnancy is common in underdeveloped countries, and malaria remains the predominant cause of the condition in Ghana. Anti-erythropoietin (anti-EPO) antibody production may be implicated in the pathogenesis of Plasmodium falciparum malaria-related anaemia in pregnancy. This study ascertained the prevalence of anti-EPO antibody production and evaluated the antibodies' relationship with Plasmodium falciparum malaria and malaria-related anaemia in pregnancy. METHODS This hospital-based case-control study recruited a total of 85 pregnant women (55 with Plasmodium falciparum malaria and 30 controls without malaria). Venous blood was taken from participants for thick and thin blood films for malaria parasite microscopy. Complete blood count (CBC) analyses were done using an automated haematology analyzer. Sandwich enzyme-linked immunosorbent assay (ELISA) was used to assess serum erythropoietin (EPO) levels and anti-EPO antibodies. Data were analyzed using IBM SPSS version 22.0. RESULTS Haemoglobin (p<0.001), RBC (p<0.001), HCT (p = 0.006) and platelet (p<0.001) were significantly lower among pregnant women infected with Plasmodium falciparum. Of the 85 participants, five (5.9%) had anti-EPO antibodies in their sera, and the prevalence of anti-EPO antibody production among the Plasmodium falciparum-infected pregnant women was 9.1%. Plasmodium falciparum-infected pregnant women with anti-EPO antibodies had lower Hb (p<0.001), RBC (p<0.001), and HCT (p<0.001), but higher EPO levels (p<0.001). Younger age (p = 0.013) and high parasite density (p = 0.004) were significantly associated with Plasmodium falciparum-related anti-EPO antibodies production in pregnancy. Also, younger age (p = 0.039) and anti-EPO antibody production (p = 0.012) related to the development of Plasmodium falciparum malaria anaemia in pregnancy. CONCLUSION The prevalence of anti-EPO antibodies among pregnant women with Plasmodium falciparum malaria was high. Plasmodium falciparum parasite density and younger age could stimulate the production of anti-EPO antibodies, and the antibodies may contribute to the development of malarial anaemia in pregnancy. Screening for anti-EPO antibodies should be considered in pregnant women with P. falciparum malaria.
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Affiliation(s)
- Charles Nkansah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Sciences, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Simon Bannison Bani
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Kofi Mensah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Sciences, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Samuel Kwasi Appiah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Sciences, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Felix Osei-Boakye
- Department of Medical Laboratory Technology, Faculty of Applied Science and Technology, Sunyani Technical University, Sunyani, Ghana
| | - Gabriel Abbam
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Samira Daud
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Eugene Mensah Agyare
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Peace Esenam Agbadza
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Charles Angnataa Derigubah
- Department of Medical Laboratory Technology, School of Applied Science and Arts, Bolgatanga Technical University, Bolgatanga, Ghana
| | - Dorcas Serwaa
- Department of Obstetrics and Gynecology, C4C Homeopathic Medical College, Accra, Ghana
| | - Francis Atoroba Apodola
- Department of Medical Diagnostics, College of Nursing and Allied Health Sciences, Nalerigu, Ghana
| | - Yeduah Quansah
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Rahama Issah
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Samuel Yennuloom Dindiok
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Felix Ejike Chukwurah
- Department of Medical Laboratory Sciences, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
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Malaria Infection, Parasitemia, and Hemoglobin Levels in Febrile Patients Attending Sibu Sire Health Facilities, Western Ethiopia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6161410. [PMID: 35993053 PMCID: PMC9391188 DOI: 10.1155/2022/6161410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/19/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022]
Abstract
Background Malaria is endemic in tropical and subtropical regions and causes up to one million deaths each year. It mostly affects sub-Saharan African countries including Ethiopia. In Ethiopia, it was estimated that about 75% of the land and 68% of the population are exposed to malaria. The aim of the current study was to determine malaria cases, its impact on the level of hemoglobin, and parasitemia and predisposing factors among febrile patients who visited Sibu Sire Health Care centers. Methods Institution-based cross-sectional study was undertaken from May to October, 2020. Febrile patients who visited Sibu Sire Health Care centers were purposefully selected as the target population for the present study. Blood samples were collected and thick and thin smears stained with Giemsa. Hemoglobin level was determined using HemoCue Hb 301. Structured questionnaire and SPSS statistical software were used to collect and analyze data. P value < 0.05 was stated as statistically significant. Results The overall prevalence of malaria was 168/979 (17.2%) out of which Plasmodium falciparum was 132/168 (78.5%), Plasmodium vivax was 27/168 (16.1%), and mixed infection was 9/168 (5.4%). To assess factors associated with dependent variable and determine the strength of association, binary logistic regression was used at adjusted odds ratios with 95% confidence intervals. The associations between malaria cases, hemoglobin levels, and parasitemia were estimated to evaluate the impacts of malaria on hemoglobin levels and parasitemia level. Out of 979 febrile patients (male 453 and female 526), 168 (male 99 and female 69) individuals were infected with Plasmodium species and Plasmodium falciparum were the predominant parasites. The majority of the study participants 144/168 (85.7%) were from rural residences. Highest malaria-infected patients 74/168 (44%) were aged between 15 and 30 years old. The level of hemoglobin and parasitemia was highly associated with malaria cases; hence, in this study area, intensities of hemoglobin and parasitemia are significantly associated with Plasmodium species. Conclusion There was a moderate prevalence of malaria parasitemia and hemoglobin level among patients visiting Sibu Sire Health Care center; however, it needs further intervention to prevent and control malaria transmission in this malaria hotspot area.
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Arya A, Chaudhry S, Meena SS, Matlani M, Pande V, Singh V. Studying the disease severity in clinical isolates of Plasmodium vivax. Microb Pathog 2022; 166:105516. [DOI: 10.1016/j.micpath.2022.105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/21/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Loufouma Mbouaka A, Gamble M, Wurst C, Jäger HY, Maixner F, Zink A, Noedl H, Binder M. The elusive parasite: comparing macroscopic, immunological, and genomic approaches to identifying malaria in human skeletal remains from Sayala, Egypt (third to sixth centuries AD). ARCHAEOLOGICAL AND ANTHROPOLOGICAL SCIENCES 2021; 13:115. [PMID: 34149953 PMCID: PMC8202054 DOI: 10.1007/s12520-021-01350-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/19/2021] [Indexed: 05/12/2023]
Abstract
UNLABELLED Although malaria is one of the oldest and most widely distributed diseases affecting humans, identifying and characterizing its presence in ancient human remains continue to challenge researchers. We attempted to establish a reliable approach to detecting malaria in human skeletons using multiple avenues of analysis: macroscopic observations, rapid diagnostic tests, and shotgun-capture sequencing techniques, to identify pathological changes, Plasmodium antigens, and Plasmodium DNA, respectively. Bone and tooth samples from ten individuals who displayed skeletal lesions associated with anaemia, from a site in southern Egypt (third to sixth centuries AD), were selected. Plasmodium antigens were detected in five of the ten bone samples, and traces of Plasmodium aDNA were detected in six of the twenty bone and tooth samples. There was relatively good synchronicity between the biomolecular findings, despite not being able to authenticate the results. This study highlights the complexity and limitations in the conclusive identification of the Plasmodium parasite in ancient human skeletons. Limitations regarding antigen and aDNA preservation and the importance of sample selection are at the forefront of the search for malaria in the past. We confirm that, currently, palaeopathological changes such as cribra orbitalia are not enough to be certain of the presence of malaria. While biomolecular methods are likely the best chance for conclusive identification, we were unable to obtain results which correspond to the current authentication criteria of biomolecules. This study represents an important contribution in the refinement of biomolecular techniques used; also, it raises new insight regarding the consistency of combining several approaches in the identification of malaria in past populations. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12520-021-01350-z.
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Affiliation(s)
- Alvie Loufouma Mbouaka
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Michelle Gamble
- Bioarchaeology Department, Austrian Archaeological Institute at the Austrian Academy of Sciences, Franz Klein-Gasse 1, 1190 Vienna, Austria
- Present Address: Heritage and Archaeological Research Practice, 101 Rose Street South Lane, EH2 3JG Edinburgh, Scotland
| | - Christina Wurst
- Institute for Mummy Studies, EURAC Research, Viale Druso 1, 39100 Bolzano, Italy
| | - Heidi Yoko Jäger
- Institute for Mummy Studies, EURAC Research, Viale Druso 1, 39100 Bolzano, Italy
| | - Frank Maixner
- Institute for Mummy Studies, EURAC Research, Viale Druso 1, 39100 Bolzano, Italy
| | - Albert Zink
- Institute for Mummy Studies, EURAC Research, Viale Druso 1, 39100 Bolzano, Italy
| | - Harald Noedl
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
- Present Address: Malaria Research Initiative Bandarban, Vienna, Austria
| | - Michaela Binder
- Bioarchaeology Department, Austrian Archaeological Institute at the Austrian Academy of Sciences, Franz Klein-Gasse 1, 1190 Vienna, Austria
- Present Address: Planen und Bauen im Bestand, Novetus, Belvederegasse 41, 1040 Vienna, Austria
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Upmanyu K, Matlani M, Yadav P, Rathi U, Mallick PK, Singh R. Allelic variation of msp-3α gene in Plasmodium vivax isolates and its correlation with the severity of disease in vivax malaria. INFECTION GENETICS AND EVOLUTION 2020; 85:104530. [PMID: 32896637 DOI: 10.1016/j.meegid.2020.104530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022]
Abstract
Malaria is a global socio-economic burden of which Plasmodium vivax contributes for about 70-80 million cases on an annual basis worldwide and 60-65% cases in India. Diversity observed in highly polymorphic Merozoite Surface Protein-3α (msp-3α) encoded by MSP-3 gene family, has been used efficiently for genotyping of P. vivax infection. This study aims to correlate the severity of clinical symptoms with parasite load, genotype of P. vivax and multiplicity of infection. Based on clinical symptoms classification, 31 (67.9%) out of 46 cases were found to be severe while 15 (32.6%) were non-severe and correlation of the severity of vivax infection with parasite load was not observed. Analysis of msp3-α allele genotype showed that out of 31 severe cases, 19 (61.2%) were single-clone infection cases whereas 12 (38.7%) were multi-clone infections. Similarly, out of 15 non-severe cases, 9 (60%) were single clone and 6 (40%) were multi-clone infections indicating the absence of a correlation between the multiplicity of infection and disease severity. Allele frequency observed was 65.9%, 23.4%, 23.4%, and 28.2% for allele A, B, C and D, respectively. An important finding was the greater distribution of allele D than alleles B and C, which has been reported as a rare allele otherwise. Further, of 13 cases with allele D, 76.9% (10/13) cases were severe. This study showed the absence of a correlation between the severity of clinical symptoms with parasite load and multiplicity of infection but at the same time drives a possibility of severe vivax malarial symptoms to have an association with the persistence of allele D in the population. This upon exploration can lead to the development of a target in detection of severe cases of malaria.
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Affiliation(s)
- Kirti Upmanyu
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Monika Matlani
- Department of Microbiology, VMMC, Safdarjung Hospital Campus, New Delhi, India
| | - Priya Yadav
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Utkarsh Rathi
- Department of Microbiology, VMMC, Safdarjung Hospital Campus, New Delhi, India
| | | | - Ruchi Singh
- ICMR-National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India.
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Cai FY, DeSimone TM, Hansen E, Jennings CV, Bei AK, Ahouidi AD, Mboup S, Duraisingh MT, Buckee CO. Accounting for red blood cell accessibility reveals distinct invasion strategies in Plasmodium falciparum strains. PLoS Comput Biol 2020; 16:e1007702. [PMID: 32315315 PMCID: PMC7194430 DOI: 10.1371/journal.pcbi.1007702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 05/01/2020] [Accepted: 01/31/2020] [Indexed: 11/19/2022] Open
Abstract
The growth of the malaria parasite Plasmodium falciparum in human blood causes all the symptoms of malaria. To proliferate, non-motile parasites must have access to susceptible red blood cells, which they invade using pairs of parasite ligands and host receptors that define invasion pathways. Parasites can switch invasion pathways, and while this flexibility is thought to facilitate immune evasion, it may also reflect the heterogeneity of red blood cell surfaces within and between hosts. Host genetic background affects red blood cell structure, for example, and red blood cells also undergo dramatic changes in morphology and receptor density as they age. The in vivo consequences of both the accessibility of susceptible cells, and their heterogeneous susceptibility, remain unclear. Here, we measured invasion of laboratory strains of P. falciparum relying on distinct invasion pathways into red blood cells of different ages. We estimated invasion efficiency while accounting for red blood cell accessibility to parasites. This approach revealed different tradeoffs made by parasite strains between the fraction of cells they can invade and their invasion rate into them, and we distinguish "specialist" strains from "generalist" strains in this context. We developed a mathematical model to show that generalist strains would lead to higher peak parasitemias in vivo compared to specialist strains with similar overall proliferation rates. Thus, the ecology of red blood cells may play a key role in determining the rate of P. falciparum parasite proliferation and malaria virulence.
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Affiliation(s)
- Francisco Y. Cai
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tiffany M. DeSimone
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Elsa Hansen
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Cameron V. Jennings
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Amy K. Bei
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ambroise D. Ahouidi
- Laboratory of Bacteriology and Virology, Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Souleymane Mboup
- Laboratory of Bacteriology and Virology, Le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Manoj T. Duraisingh
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Caroline O. Buckee
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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Greenhalgh S, Chandwani V. Advocating an attack against severe malaria: a cost-effectiveness analysis. BMC Public Health 2020; 20:17. [PMID: 31910842 PMCID: PMC6947859 DOI: 10.1186/s12889-019-8141-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/30/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. METHODS Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. RESULTS Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries. CONCLUSION Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.
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Affiliation(s)
- Scott Greenhalgh
- Department of Mathematics, Siena College, 515 Loudon Road, Loudonville, NY, 12211, USA.
| | - Veda Chandwani
- Department of Biology, Siena College, 515 Loudon Road, Loudonville, NY, 12211, USA
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Loiseau C, Cooper MM, Doolan DL. Deciphering host immunity to malaria using systems immunology. Immunol Rev 2019; 293:115-143. [PMID: 31608461 DOI: 10.1111/imr.12814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
Abstract
A century of conceptual and technological advances in infectious disease research has changed the face of medicine. However, there remains a lack of effective interventions and a poor understanding of host immunity to the most significant and complex pathogens, including malaria. The development of successful interventions against such intractable diseases requires a comprehensive understanding of host-pathogen immune responses. A major advance of the past decade has been a paradigm switch in thinking from the contemporary reductionist (gene-by-gene or protein-by-protein) view to a more holistic (whole organism) view. Also, a recognition that host-pathogen immunity is composed of complex, dynamic interactions of cellular and molecular components and networks that cannot be represented by any individual component in isolation. Systems immunology integrates the field of immunology with omics technologies and computational sciences to comprehensively interrogate the immune response at a systems level. Herein, we describe the system immunology toolkit and report recent studies deploying systems-level approaches in the context of natural exposure to malaria or controlled human malaria infection. We contribute our perspective on the potential of systems immunity for the rational design and development of effective interventions to improve global public health.
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Affiliation(s)
- Claire Loiseau
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Qld, Australia
| | - Martha M Cooper
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Qld, Australia
| | - Denise L Doolan
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Qld, Australia
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Ishtiaq F, Barve S. Do avian blood parasites influence hypoxia physiology in a high elevation environment? BMC Ecol 2018; 18:15. [PMID: 29754586 PMCID: PMC5950187 DOI: 10.1186/s12898-018-0171-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/23/2018] [Indexed: 12/22/2022] Open
Abstract
Background Montane birds which engage in elevational movements have evolved to cope with fluctuations in environmental hypoxia, through changes in physiological parameters associated with blood oxygen-carrying capacity such as haemoglobin concentration (Hb) and haematocrit (Hct). In particular, elevational migrants which winter at low elevations, encounter varying intensities of avian haemosporidian parasites as they traverse heterogeneous environments. Whilst high intensity parasite infections lead to anaemia, one can expect that the ability to cope with haemosporidian infections should be a key trait for elevational migrants that must be balanced against reducing the oxygen-carrying capacity of blood in response to high elevation. In this study, we explored the links between environmental hypoxia, migration, and disease ecology by examining natural variation in infections status and intensity of avian haemoporidians across a suite of Himalayan birds with different migratory strategies while controlling for host phylogeny. Results We found predictably large variation in haemoglobin levels across the elevational gradient and this pattern was strongly influenced by season and whether birds are elevational migrants. The overall malaria infection intensity declined with elevation whereas Hb and Hct decreased with increase in parasite intensity, suggesting an important role of malaria parasites on hypoxia stressed birds in high elevation environments. Conclusions Our results provide a key insight into how physiological measures and sub-clinical infections might affect dynamics of high-elevation bird populations. We suggest a potential impact of avian elevational migration on disease dynamics and exposure to high intensity infections with disease spread in the face of climate change, which will exacerbate hypoxic stress and negative effects of chronic avian malaria infection on survival and reproductive success in wild birds. Future work on chronic parasite infections must consider parasite intensity, rather than relying on infection status alone. Electronic supplementary material The online version of this article (10.1186/s12898-018-0171-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farah Ishtiaq
- Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, India.
| | - Sahas Barve
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, 23529, USA
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Okamgba OC, Ifeanyichukwu MO, Ilesanmi AO, Chigbu LN. Variations in the leukocyte and cytokine profiles between placental and maternal circulation in pregnancy-associated malaria. Res Rep Trop Med 2018; 9:1-8. [PMID: 30050350 PMCID: PMC6047617 DOI: 10.2147/rrtm.s137829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Activation of immune cells by malaria infection induces the secretion of cytokines and the synthesis of other inflammatory mediators. This study compared the cytokine levels and leukocyte count between malaria-infected peripheral and placental blood of pregnant women before delivery and postpartum. The cytokines assessed include interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6) and interleukin-10 (IL-10). MATERIALS AND METHODS The subjects comprised 144 malaria-infected pregnant women and 60 malaria-infected women at post-partum stage (for placental blood collection). Others were 60 malaria-uninfected pregnant women and 40 malaria-uninfected women at postpartum stage (for placental blood collection). Forty malaria-infected and 40 malaria-uninfected nonpregnant women served as control subjects. The test groups were asymptomatic, and the control groups were apparently healthy subjects. All were aged between 17 and 44 years. Ethical approval for the study was obtained at Abia State University Teaching Hospital and Living Word Mission Hospital, Aba. Informed consent was obtained from the participants. Blood samples were aseptically collected initially from the maternal peripheral circulation and from the placenta on delivery, and tested for HIV and malaria using standard methods. IFN-γ, TNF-α, IL-4, IL-6 and IL-10 were measured by enzyme-linked immunosorbent assay technique. Kruskal-Wallis test was used for comparison of the groups. RESULTS IFN-γ was significantly higher in the peripheral than in placental blood (P=0.001). IL-4 and IL-10 were significantly lower in the peripheral than in placental blood (P=0.001 and P=0.004, respectively). The total leukocytes, neutrophils and lymphocyte counts were significantly higher in the placenta than in peripheral blood (P=0.001), and the mixed differential count was significantly higher in the placenta than in peripheral blood (P=0.012). CONCLUSION This study has shown that the cytokine levels and leukocyte counts may differ between the peripheral and placental blood of the same women. Therefore, measurement of parameters in the peripheral circulation may not always reflect the levels in the placental blood for the assessment of immune cellular response at the materno-fetal interface.
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Affiliation(s)
- Okezie Caleb Okamgba
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikwe University, Nnewi Campus, Nnewi, Anambra State
| | - Martin O Ifeanyichukwu
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikwe University, Nnewi Campus, Nnewi, Anambra State
| | - Ayodele O Ilesanmi
- Department of Medical Laboratory Science, Kwara State University, Malete, Kwara State,
| | - Lawrence N Chigbu
- Department of Microbiology, College of Medicine, Abia State University, Uturu, Abia State, Nigeria
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Mensah-Brown HE, Abugri J, Asante KP, Dwomoh D, Dosoo D, Atuguba F, Conway DJ, Awandare GA. Assessing the impact of differences in malaria transmission intensity on clinical and haematological indices in children with malaria. Malar J 2017; 16:96. [PMID: 28249579 PMCID: PMC5333465 DOI: 10.1186/s12936-017-1745-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/20/2017] [Indexed: 11/17/2022] Open
Abstract
Background Malaria control interventions have led to a decline in transmission intensity in many endemic areas, and resulted in elimination in some areas. This decline, however, will lead to delayed acquisition of protective immunity and thus impact disease manifestation and outcomes. Therefore, the variation in clinical and haematological parameters in children with malaria was assessed across three areas in Ghana with varying transmission intensities. Methods A total of 568 children between the ages of 2 and 14 years with confirmed malaria were recruited in hospitals in three areas with varying transmission intensities (Kintampo > Navrongo > Accra) and a comprehensive analysis of parasitological, clinical, haematological and socio-economic parameters was performed. Results Areas of lower malaria transmission tended to have lower disease severity in children with malaria, characterized by lower parasitaemias and higher haemoglobin levels. In addition, total white cell counts and percent lymphocytes decreased with decreasing transmission intensity. The heterozygous sickle haemoglobin genotype was protective against disease severity in Kintampo (P = 0.016), although this was not significant in Accra and Navrongo. Parasitaemia levels were not a significant predictor of haemoglobin level after controlling for age and gender. However, higher haemoglobin levels in children were associated with certain socioeconomic factors, such as having fathers who had any type of employment (P < 0.05) and mothers who were teachers (P < 0.05). Conclusions The findings demonstrate significant differences in the haematological presentation and severity of malaria among areas with different transmission intensity in Ghana, indicating that these factors need to be considered in planning the management of the disease as the endemicity is expected to decline after control interventions.
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Affiliation(s)
- Henrietta E Mensah-Brown
- West African Centre for Cell Biology of Infectious Pathogens and Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Volta Road, Legon, P. O. Box LG 54, Accra, Ghana
| | - James Abugri
- West African Centre for Cell Biology of Infectious Pathogens and Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Volta Road, Legon, P. O. Box LG 54, Accra, Ghana.,Department of Applied Chemistry and Biochemistry, Faculty of Applied Sciences, University for Development Studies, Navrongo Campus, Navrongo, Ghana
| | - Kwaku P Asante
- Department of Biostatistics, Room A9, School of Public Health, University of Ghana, Legon, Akilagpa Sawyerr Rd, Legon, P.O. Box LG13, Accra, Ghana
| | - Duah Dwomoh
- Kintampo Health Research Centre, P. O. Box AH 200, Kintampo, Ghana
| | - David Dosoo
- Department of Biostatistics, Room A9, School of Public Health, University of Ghana, Legon, Akilagpa Sawyerr Rd, Legon, P.O. Box LG13, Accra, Ghana
| | | | - David J Conway
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens and Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Volta Road, Legon, P. O. Box LG 54, Accra, Ghana.
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Hermansyah B, Fitri LE, Sardjono TW, Endharti AT, Arifin S, Budiarti N, Candradikusuma D, Sulistyaningsih E, Berens-Riha N. Clinical features of severe malaria: Protective effect of mixed plasmodial malaria. Asian Pac J Trop Biomed 2017. [DOI: 10.1016/j.apjtb.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Righi E, Merelli M, Arzese A, Siega PD, Scarparo C, Bassetti M. Determination of PCT on admission is a useful tool for the assessment of disease severity in travelers with imported Plasmodium falciparum malaria. Acta Parasitol 2016; 61:412-8. [PMID: 27078668 DOI: 10.1515/ap-2016-0055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/20/2016] [Indexed: 01/01/2023]
Abstract
Procalcitonin (PCT) and C-reactive protein (CRP) may be useful to predict complicated forms of malaria. A total of 30 consecutive travelers diagnosed with Plasmodium falciparum malaria over a two-year period were included in the study. Patients with complicated Plasmodium falciparum malaria showed higher levels of parasitemia (P = 0.0001), PCT (P = 0.0018), CRP (P = 0.0005), bilirubinemia (P = 0.004), and a lower platelet count (P<0.0001) compared with patients with uncomplicated forms. PCT levels above 5 ng/mL showed the highest value of specificity (0.86) and positive predictive factor (0.67) among other parameters, and equal sensitivity (0.67) was displayed by CRP levels above 150 mg/dl. None of the patients with complicated malaria showed PCT levels within normal limits (<0.5 ng/ml). Both PCT and CRP correlated with parasitemia (P<0.001) and showed areas under ROC curve of 0.83. At multivariate analysis, only PCT was associated with an increased risk of complicated malaria (OR 8.2, IC 95% 1.2-57.2, P = 0.03). The determination of PCT on admission showed better results compared to CRP, platelet count, and bilirubinemia and can be useful in non-endemic areas for the initial clinical assessment of disease severity in travelers with Plasmodium falciparum malaria.
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Portnoy E, Vakruk N, Bishara A, Shmuel M, Magdassi S, Golenser J, Eyal S. Indocyanine Green Liposomes for Diagnosis and Therapeutic Monitoring of Cerebral Malaria. Am J Cancer Res 2016; 6:167-76. [PMID: 26877776 PMCID: PMC4729766 DOI: 10.7150/thno.13653] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/12/2015] [Indexed: 01/13/2023] Open
Abstract
Cerebral malaria (CM) is a major cause of death of Plasmodium falciparum infection. Misdiagnosis of CM often leads to treatment delay and mortality. Conventional brain imaging technologies are rarely applicable in endemic areas. Here we address the unmet need for a simple, non-invasive imaging methodology for early diagnosis of CM. This study presents the diagnostic and therapeutic monitoring using liposomes containing the FDA-approved fluorescent dye indocyanine green (ICG) in a CM murine model. Increased emission intensity of liposomal ICG was demonstrated in comparison with free ICG. The Liposomal ICG's emission was greater in the brains of the infected mice compared to naïve mice and drug treated mice (where CM was prevented). Histological analyses suggest that the accumulation of liposomal ICG in the cerebral vasculature is due to extensive uptake mediated by activated phagocytes. Overall, liposomal ICG offers a valuable diagnostic tool and a biomarker for effectiveness of CM treatment, as well as other diseases that involve inflammation and blood vessel occlusion.
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Gaudreault V, Wirbel J, Jardim A, Rohrbach P, Scorza T. Red Blood Cells Preconditioned with Hemin Are Less Permissive to Plasmodium Invasion In Vivo and In Vitro. PLoS One 2015; 10:e0140805. [PMID: 26465787 PMCID: PMC4605744 DOI: 10.1371/journal.pone.0140805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Malaria is a parasitic disease that causes severe hemolytic anemia in Plasmodium-infected hosts, which results in the release and accumulation of oxidized heme (hemin). Although hemin impairs the establishment of Plasmodium immunity in vitro and in vivo, mice preconditioned with hemin develop lower parasitemia when challenged with Plasmodium chabaudi adami blood stage parasites. In order to understand the mechanism accounting for this resistance as well as the impact of hemin on eryptosis and plasma levels of scavenging hemopexin, red blood cells were labeled with biotin prior to hemin treatment and P. c. adami infection. This strategy allowed discriminating hemin-treated from de novo generated red blood cells and to follow the infection within these two populations of cells. Fluorescence microscopy analysis of biotinylated-red blood cells revealed increased P. c. adami red blood cells selectivity and a decreased permissibility of hemin-conditioned red blood cells for parasite invasion. These effects were also apparent in in vitro P. falciparum cultures using hemin-preconditioned human red blood cells. Interestingly, hemin did not alter the turnover of red blood cells nor their replenishment during in vivo infection. Our results assign a function for hemin as a protective agent against high parasitemia, and suggest that the hemolytic nature of blood stage human malaria may be beneficial for the infected host.
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Affiliation(s)
- Véronique Gaudreault
- Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Jakob Wirbel
- Institute of parasitology, McGill University, Montréal, Québec, Canada
| | - Armando Jardim
- Institute of parasitology, McGill University, Montréal, Québec, Canada
| | - Petra Rohrbach
- Institute of parasitology, McGill University, Montréal, Québec, Canada
| | - Tatiana Scorza
- Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
- * E-mail:
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Chu K, Smith ZJ, Wachsmann-Hogiu S. Development of inexpensive blood imaging systems: where are we now? Expert Rev Med Devices 2015; 12:613-27. [PMID: 26305840 DOI: 10.1586/17434440.2015.1075388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinical applications in the developing world, such as malaria and anemia diagnosis, demand a change in the medical paradigm of expensive care given in central locations by highly trained professionals. There has been a recent explosion in optical technologies entering the consumer market through the widespread adoption of smartphones and LEDs. This technology commoditization has enabled the development of small, portable optical imaging systems at an unprecedentedly low cost. Here, we review the state-of-the-field of the application of these systems for low-cost blood imaging with an emphasis on cellular imaging systems. In addition to some promising results addressing specific clinical issues, an overview of the technology landscape is provided. We also discuss several key issues that need to be addressed before these technologies can be commercialized.
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Affiliation(s)
- Kaiqin Chu
- a 1 Center for Biophotonics, University of California Davis, Sacramento, CA 95817, USA
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Kotepui M, Piwkham D, PhunPhuech B, Phiwklam N, Chupeerach C, Duangmano S. Effects of malaria parasite density on blood cell parameters. PLoS One 2015; 10:e0121057. [PMID: 25807235 PMCID: PMC4373695 DOI: 10.1371/journal.pone.0121057] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/04/2015] [Indexed: 11/18/2022] Open
Abstract
Changes in blood cell parameters are already a well-known feature of malarial infections. To add to this information, the objective of this study was to investigate the varying effects that different levels of parasite density have on blood cell parameters. Patients diagnosed with malaria at Phobphra Hospital, Tak Province, Thailand between January 1st 2009 and January 1st 2012 were recruited as subjects for data collection. Blood cell parameters of 2,024 malaria-infected patients were evaluated and statistically analyzed. Neutrophil and platelet counts were significantly higher, however, RBC count was significantly lower in patients with P. falciparum infection compared to those with P. vivax infection (p<0.0001). Leukocyte counts were also significantly higher in patients with high parasitemia compared to those with low and moderate parasitemia. In terms of differential leukocyte count, neutrophil count was significantly higher in patients with high parasitemia compared to those with low and moderate parasitemia (p<0.0001). On the other hand, both lymphocyte and monocyte counts were significantly lower in patients with high parasitemia (p<0.0001). RBC count and Hb concentration, as well as platelet count were also significantly reduced (p<0.05) and (p<0.0001), respectively. To summarize, patients infected with different malaria parasites exhibited important distinctive hematological parameters, with neutrophil and eosinophil counts being the two hematological parameters most affected. In addition, patients infected with different malarial densities also exhibited important changes in leukocyte count, platelet count and hemoglobin concentration during the infection. These findings offer the opportunity to recognize and diagnose malaria related anemia, help support the treatment thereof, as well as relieve symptoms of severe malaria in endemic regions.
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Affiliation(s)
- Manas Kotepui
- Medical Technology Program, School of Allied Health Sciences and Public Health, Walailak University, Nakhon Si Thammarat, Thailand
- * E-mail:
| | - Duangjai Piwkham
- Medical Technology Program, School of Allied Health Sciences and Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Bhukdee PhunPhuech
- Medical Technology Laboratory, Phop Phra Hospital, Phop Phra District, Tak Province, Thailand
| | - Nuoil Phiwklam
- Medical Technology Laboratory, Phop Phra Hospital, Phop Phra District, Tak Province, Thailand
| | | | - Suwit Duangmano
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Human natural killer cells control Plasmodium falciparum infection by eliminating infected red blood cells. Proc Natl Acad Sci U S A 2014; 111:1479-84. [PMID: 24474774 DOI: 10.1073/pnas.1323318111] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Immunodeficient mouse-human chimeras provide a powerful approach to study host-specific pathogens, such as Plasmodium falciparum that causes human malaria. Supplementation of immunodeficient mice with human RBCs supports infection by human Plasmodium parasites, but these mice lack the human immune system. By combining human RBC supplementation and humanized mice that are optimized for human immune cell reconstitution, we have developed RBC-supplemented, immune cell-optimized humanized (RICH) mice that support multiple cycles of P. falciparum infection. Depletion of human natural killer (NK) cells, but not macrophages, in RICH mice results in a significant increase in parasitemia. Further studies in vitro show that NK cells preferentially interact with infected RBCs (iRBCs), resulting in the activation of NK cells and the elimination of iRBCs in a contact-dependent manner. We show that the adhesion molecule lymphocyte-associated antigen 1 is required for NK cell interaction with and elimination of iRBCs. Development of RICH mice and validation of P. falciparum infection should facilitate the dissection of human immune responses to malaria parasite infection and the evaluation of therapeutics and vaccines.
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No asymptomatic malaria parasitaemia found among 108 young children at one health facility in Dar es Salaam, Tanzania. Malar J 2013; 12:417. [PMID: 24228811 PMCID: PMC3830543 DOI: 10.1186/1475-2875-12-417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/12/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Asymptomatic malaria parasitaemia has been reported in areas with high malaria transmission. It may serve as a reservoir for continued transmission, and furthermore complicates diagnostics, as not all individuals with a positive malaria test are necessarily ill due to malaria, although they may present with malaria-like symptoms. Asymptomatic malaria increases with age as immunity to malaria gradually develops. As mortality and morbidity of malaria is higher among younger children it is important to know the prevalence of asymptomatic malaria parasitaemia in this population in order to interpret laboratory results for malaria correctly. METHODS A total of 108 children that had neither been treated for malaria nor had a fever the previous four weeks were recruited consecutively at a maternal and child health clinic (MCHC) in Dar es Salaam, Tanzania. A rapid diagnostic test (RDT) for malaria and dried blood spot (DBS) on filter paper were taken from each child. Social and clinical data were recorded. DNA was extracted from the DBS of study participants by a method using InstaGene™ matrix. PCR targeting the Plasmodium mitochondrial genome was performed on all samples. RESULTS Median age was 4.6 months (range 0.5-38). All the RDTs were negative. PCR was negative for all study subjects. CONCLUSION The study suggests that asymptomatic malaria may not be present in apparently healthy children up to the age of three years in Dar es Salaam, Tanzania. However, because of the small sample size and low median age of the study population, the findings cannot be generalized. Larger studies, including higher age groups, need to be done to clarify whether asymptomatic malaria parasitaemia is present in the general population in the Dar es Salaam area.
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Wilairatana P, Tangpukdee N, Krudsood S. Definition of hyperparasitemia in severe falciparum malaria should be updated. Asian Pac J Trop Biomed 2013; 3:586. [PMID: 23835631 PMCID: PMC3695588 DOI: 10.1016/s2221-1691(13)60119-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/23/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
- Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Noppadon Tangpukdee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Srivicha Krudsood
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Thailand
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