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Sissoko A, Othmene YB, Buffet P. Splenic filtration of red blood cells in physiology, malaria and sickle cell disease. Curr Opin Hematol 2024; 31:307-314. [PMID: 39259191 DOI: 10.1097/moh.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
PURPOSE OF REVIEW The human spleen clears the blood from circulating microorganisms and red blood cells (RBCs) displaying alterations. This review analyzes how generic mechanisms by which the spleen senses RBC, such pitting, trapping and erythrophagocytosis, impact the pathogenesis of two major spleen-related diseases, malaria and sickle cell disease (SCD). RECENT FINDINGS Scintigraphy, functional histology, comparison of circulating and splenic RBC, ex-vivo perfusion of human spleens and in-silico modeling enable relevant exploration of how the spleen retains and processes RBC in health and disease. Iterative cross-validations between medical observations, in-vitro experiments and in-silico modeling point to mechanical sensing of RBC as a central event in both conditions. Spleen congestion is a common pathogenic process explaining anemia and splenomegaly, the latter carrying a risk of severe complications such as acute splenic sequestration crisis and hypersplenism in SCD. Sickling of hemoglobin S-containing RBC may contribute to these complications without necessarily being the trigger. SUMMARY Ongoing progress in the exploration and understanding of spleen-related complications in malaria and SCD open the way to optimized prognosis evaluation and therapeutic applications.
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Affiliation(s)
| | | | - Pierre Buffet
- Université Paris Cité, Inserm, BIGR
- Assistance publique des hôpitaux de Paris
- Institut Pasteur, Université de Paris Cité, Paris, France
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2
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Lamsfus Calle C, Schaumburg F, Rieck T, Nkoma Mouima AM, Martinez de Salazar P, Breil S, Behringer J, Kremsner PG, Mordmüller B, Fendel R. Slow clearance of histidine-rich protein-2 in Gabonese with uncomplicated malaria. Microbiol Spectr 2024; 12:e0099424. [PMID: 39194289 PMCID: PMC11449231 DOI: 10.1128/spectrum.00994-24] [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: 05/30/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
Malaria rapid diagnostic tests (RDTs), which detect Plasmodium falciparum (Pf)-specific histidine-rich protein-2 (HRP2), have increasing importance for the diagnosis and control of malaria, especially also in regions where routine diagnosis by microscopy is not available. HRP2-based RDTs have a similar sensitivity to expert microscopy, but their reported low specificity can lead to high false positivity rates, particularly in high-endemic areas. Despite the widespread use of RDTs, models investigating the dynamics of HRP2 clearance following Pf treatment focus rather on short-term clearance of the protein. The goal of this observational cohort study was to determine the long-term kinetic of HRP2-levels in peripheral blood after treatment of uncomplicated malaria cases with Pf mono-infection using a 3-day course of artesunate/amodiaquine. HRP2 levels were quantified at enrollment and on days 1, 2, 3, 5, 7, 12, 17, 22, and 28 post-treatment initiation. The findings reveal an unexpectedly prolonged clearance of HRP2 after parasite clearance from capillary blood. Terminal HRP2 half-life was estimated to be 9 days after parasite clearance using a pharmacokinetic two-compartmental elimination model. These results provide evidence that HRP2 clearance has generally been underestimated, as the antigen remains detectable in capillary blood for up to 28 days following successful treatment, influencing RDT-based assessment following a malaria treatment for weeks. A better understanding of the HRP2 clearance dynamics is critical for guiding the diagnosis of malaria when relying on RDTs. IMPORTANCE Detecting Plasmodium falciparum, the parasite responsible for the severest form of malaria, typically involves microscopy, polymerase chain reaction (PCR), or rapid diagnostic tests (RDTs) targeting the histidine-rich protein 2 or 3 (HRP2/3). While microscopy and PCR quickly turn negative after the infection is cleared, HRP2 remains detectable for a prolonged period. The exact duration of HRP2 persistence had not been well defined. Our study in Gabon tracked HRP2 levels over 4 weeks, resulting in a new model for antigen clearance. We discovered that a two-compartment model accurately predicts HRP2 levels, revealing an initial rapid reduction followed by a much slower elimination phase that can take several weeks. These findings are crucial for interpreting RDT results, as lingering HRP2 can lead to false positives, impacting malaria diagnosis and treatment decisions.
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Affiliation(s)
- Carlos Lamsfus Calle
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Frieder Schaumburg
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Thorsten Rieck
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Anne Marie Nkoma Mouima
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Pablo Martinez de Salazar
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Swiss Tropical and public Health Institute, Allschwil, Switzerland
| | - Saskia Breil
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Peter G Kremsner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rolf Fendel
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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3
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T R, C D, A R, Jc Y. Nine years of imported malaria in a teaching hospital in Belgium: Demographics, clinical characteristics, and outcomes. Diagn Microbiol Infect Dis 2024; 108:116206. [PMID: 38335879 DOI: 10.1016/j.diagmicrobio.2024.116206] [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: 07/27/2023] [Revised: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Imported malaria is often misdiagnosed due to the aspecific symptoms and lack of familiarity among clinicians. This study aims to evaluate a decade-long trend of imported malaria cases in a Belgian teaching hospital by analyzing demographics, clinical characteristics, and outcomes. METHODS Medical records of 223 patients with confirmed malaria diagnoses between 2010 and 2019 were analyzed. RESULTS Most patients were male (63.2%), aged 18-65 years (77.1%), and visiting friends or relatives (40.8%). Central Africa was the most common travel destination (54.3%), and 63.7% did not take prophylaxis. Symptoms were flu-like, with fever (91.9%) being most prevalent. P. falciparum was identified in 88.3% of cases. A high proportion of severe cases (41.7%) and a low mortality rate (0.9%) were recorded. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form (median of 5 vs. 4 days, p < 0.001). Thirty-five-point five percent [33/93] of patients with severe malaria have had a previous malaria infection compared to 50.8% [66/130] of uncomplicated patients (p= 0.013) wich was statistically significant. CONCLUSION Malaria disproportionately affects VFRs traveling to Central Africa, and flu-like symptoms should raise suspicion. Prophylaxis is essential to prevent the disease, and early diagnosis is critical for effective management. A severe form of the disease is associated with a more extended hospital stay than uncomplicated form and people with a previous history of malaria have a less severe disease.
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Affiliation(s)
- Ratovonjanahary T
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Danwang C
- Clinton Health Access Initiative, Inc., Boston, MA, USA
| | - Robert A
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Yombi Jc
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.
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4
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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: 32] [Impact Index Per Article: 32.0] [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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5
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Kamegai K, Hayakawa K, Yamamoto K, Nomoto H, Komaki-Yasuda K, Kano S, Ohmagari N. Imported severe Plasmodium falciparum infection in the first trimester of pregnancy complicated by post-artemisinin delayed hemolysis and intrauterine fetal death, a case report. Trop Med Health 2023; 51:25. [PMID: 37170175 PMCID: PMC10175055 DOI: 10.1186/s41182-023-00510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/04/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Post-artemisinin delayed hemolysis (PADH) is a serious complication in patients who recover from severe malaria after receiving artemisinin-based combined therapy (ACT), including artemether-lumefantrine. In Japan, among the antimalarial drugs recommended by the World Health Organization (WHO) guideline for severe malaria, intravenous quinine gluconate is available only in 29 designated hospitals, and intravenous artesunate is unavailable. Therefore, oral artemether-lumefantrine is occasionally administered as an alternative, even though it may be a suboptimal treatment. In non-endemic settings like Japan, a lack of knowledge of malaria and the side effects, such as post-artemisinin delayed hemolysis caused by the ACT, can have critical consequences. Like our patient, being a primigravida in the early stages of pregnancy is a serious risk factor for severe malaria and must be carefully monitored. CASE PRESENTATION This report describes a severe case of imported Plasmodium falciparum malaria complicated by fetal loss and prolonged anemia, requiring frequent blood transfusions. The patient was a previously healthy pregnant Japanese female in her 30 s. She developed a high fever 2 days after returning from Nigeria. The patient fulfilled the severe malaria criteria by WHO. On arrival, an abdominal ultrasound incidentally revealed a fetus of 5 week gestational age with a heartbeat in the uterus. Given her pregnancy and the severity of the disease, she was administered intravenous quinine 16 mg/kg as a loading dose. However, the second dose of quinine was not administered due to frequent vomiting and QTc prolongation. We initiated treatment with oral artemether-lumefantrine, and clearance of parasitemia was confirmed by microscopic observation on day 4. Miscarriage was noted on day 6 after admission. Moreover, the patient became feverish again up to 39 °C, and from days 14 to 22, the patient required multiple blood transfusions due to PADH. On day 40, follow-up was discontinued as the hemoglobin level exceeded 10 g/dL. CONCLUSIONS In patients who recover from severe malaria after ACT treatment, monitoring the hemoglobin level for at least a month is strongly recommended for prompt identification of PADH. Travelers to malaria-endemic countries, especially primigravida women, should be provided with adequate information on the risk and prevention of infection.
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Affiliation(s)
- Kohei Kamegai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetoshi Nomoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kanako Komaki-Yasuda
- Department of Tropical Medicine and Malaria, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shigeyuki Kano
- Department of Tropical Medicine and Malaria, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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6
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Post-Artesunate Delayed Hemolysis: A Review of Current Evidence. Trop Med Infect Dis 2023; 8:tropicalmed8010049. [PMID: 36668956 PMCID: PMC9862382 DOI: 10.3390/tropicalmed8010049] [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] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Artesunate is the drug of choice for treating patients with severe malaria. Post-artesunate delayed hemolysis (PADH) is an uncommon adverse event from malaria treatment. Most patients with PADH are non-immune travelers. The pathophysiology of PADH is not fully understood, but the most likely mechanism is "pitting", in which red blood cells carrying dead parasites killed by artesunate's action are directed to the spleen for clearing the dead parasites. After the cleansing process, these red blood cells re-enter the circulation but with a smaller size and impaired integrity, resulting in a shortened lifespan of 7-21 days. Therefore, most patients with PADH usually present with clinical features of hemolytic anemia 7 days or later after the initiation of artesunate. To date, the benefits of artesunate treatment outweigh its adverse events, and no fatal cases have resulted from PADH. However, the hematological follow-up of patients with malaria treated with artesunate is recommended for clinicians to detect any delayed hemolytic event early and prevent potentially serious consequences.
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7
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Oulton T, Mahamar A, Sanogo K, Diallo M, Youssouf A, Niambele SM, Samaké S, Keita S, Sinaba Y, Sacko A, Traore SF, Lanke K, Collins KA, Bradley J, Drakeley C, Stone WJR, Dicko A. Persistence of Plasmodium falciparum HRP-2 antigenaemia after artemisinin combination therapy is not associated with gametocytes. Malar J 2022; 21:372. [PMID: 36474274 PMCID: PMC9724264 DOI: 10.1186/s12936-022-04387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In some settings, sensitive field diagnostic tools may be needed to achieve elimination of falciparum malaria. To this end, rapid diagnostic tests (RDTs) based on the detection of the Plasmodium falciparum protein HRP-2 are being developed with increasingly lower limits of detection. However, it is currently unclear how parasite stages that are unaffected by standard drug treatments may contribute to HRP-2 detectability and potentially confound RDT results even after clearance of blood stage infection. This study assessed the detectability of HRP-2 in periods of post-treatment residual gametocytaemia. METHODS A cohort of 100 P. falciparum infected, gametocyte positive individuals were treated with or without the gametocytocidal drug primaquine (PQ), alongside standard artemisinin-based combination therapy (ACT), in the context of a randomised clinical trial in Ouelessebougou, Mali. A quantitative ELISA was used to measure levels of HRP-2, and compared time to test negativity using a standard and ultra-sensitive RDT (uRDT) between residual gametocyte positive and negative groups. RESULTS Time to test negativity was longest by uRDT, followed by ELISA and then standard RDT. No significant difference in time to negativity was found between the treatment groups with and without residual gametocytes: uRDT (HR 0.79 [95% CI 0.52-1.21], p = 0.28), RDT (HR 0.77 [95% CI 0.51-1.15], p = 0.20) or ELISA (HR 0.88 [95% CI 0.59-1.32], p = 0.53). Similarly, no difference was observed when adjusting for baseline asexual parasite density. Quantified levels of HRP-2 over time were similar between groups, with differences attributable to asexual parasite densities. Furthermore, no difference in levels of HRP-2 was found between individuals who were or were not infectious to mosquitoes (OR 1.19 [95% CI 0.98-1.46], p = 0.077). CONCLUSIONS Surviving sexual stage parasites after standard ACT treatment do not contribute to the persistence of HRP-2 antigenaemia, and appear to have little impact on RDT results.
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Affiliation(s)
- Tate Oulton
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Almahamoudou Mahamar
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Koualy Sanogo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Makonon Diallo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Ahamadou Youssouf
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidi M Niambele
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Siaka Samaké
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekouba Keita
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Youssouf Sinaba
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Adama Sacko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekou F Traore
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Kjerstin Lanke
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Katharine A Collins
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Will J R Stone
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Alassane Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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Introini V, Govendir MA, Rayner JC, Cicuta P, Bernabeu M. Biophysical Tools and Concepts Enable Understanding of Asexual Blood Stage Malaria. Front Cell Infect Microbiol 2022; 12:908241. [PMID: 35711656 PMCID: PMC9192966 DOI: 10.3389/fcimb.2022.908241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Forces and mechanical properties of cells and tissues set constraints on biological functions, and are key determinants of human physiology. Changes in cell mechanics may arise from disease, or directly contribute to pathogenesis. Malaria gives many striking examples. Plasmodium parasites, the causative agents of malaria, are single-celled organisms that cannot survive outside their hosts; thus, thost-pathogen interactions are fundamental for parasite’s biological success and to the host response to infection. These interactions are often combinations of biochemical and mechanical factors, but most research focuses on the molecular side. However, Plasmodium infection of human red blood cells leads to changes in their mechanical properties, which has a crucial impact on disease pathogenesis because of the interaction of infected red blood cells with other human tissues through various adhesion mechanisms, which can be probed and modelled with biophysical techniques. Recently, natural polymorphisms affecting red blood cell biomechanics have also been shown to protect human populations, highlighting the potential of understanding biomechanical factors to inform future vaccines and drug development. Here we review biophysical techniques that have revealed new aspects of Plasmodium falciparum invasion of red blood cells and cytoadhesion of infected cells to the host vasculature. These mechanisms occur differently across Plasmodium species and are linked to malaria pathogenesis. We highlight promising techniques from the fields of bioengineering, immunomechanics, and soft matter physics that could be beneficial for studying malaria. Some approaches might also be applied to other phases of the malaria lifecycle and to apicomplexan infections with complex host-pathogen interactions.
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Affiliation(s)
- Viola Introini
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
- Cavendish Laboratory, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Viola Introini,
| | - Matt A. Govendir
- European Molecular Biology Laboratory (EMBL) Barcelona, Barcelona, Spain
| | - Julian C. Rayner
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Pietro Cicuta
- Cavendish Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Maria Bernabeu
- European Molecular Biology Laboratory (EMBL) Barcelona, Barcelona, Spain
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9
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Matz JM. Plasmodium’s bottomless pit: properties and functions of the malaria parasite's digestive vacuole. Trends Parasitol 2022; 38:525-543. [DOI: 10.1016/j.pt.2022.02.010] [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: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
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10
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Abohelwa M, Agusala V, Hassan M, Gharamti A. Delayed autoimmune haemolytic anaemia after artesunate therapy for severe malaria. BMJ Case Rep 2022; 15:e245845. [PMID: 35039352 PMCID: PMC8768460 DOI: 10.1136/bcr-2021-245845] [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] [Accepted: 12/08/2021] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 51-year-old man with severe malaria, who developed delayed autoimmune haemolytic anaemia following artesunate therapy. Delayed autoimmune haemolytic anaemia following artesunate therapy has been previously described. Its diagnosis can be challenging in the setting of possible dengue coinfection. Clinicians should be vigilant of this potential side effect of artesunate therapy, especially in patients who later develop signs and symptoms of haemolytic anaemia.
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Affiliation(s)
- Mostafa Abohelwa
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Veena Agusala
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Mona Hassan
- Department of Internal Medicine, Hematology/Oncology Division, American University of Beirut, Beirut, Lebanon
| | - Amal Gharamti
- Department of Internal Medicine, Yale School of Medicine, Waterbury Hospital, Waterbury, Connecticut, USA
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11
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O'Connor R, Conlan C, Grant C, Kinsella N, Moriarty M, Carr B, Melanophy G, Doyle C, Merry C, Bannan C, Bergin C. Delayed haemolysis after IV artesunate therapy for P. falciparum infection. Travel Med Infect Dis 2021; 45:102230. [PMID: 34915170 DOI: 10.1016/j.tmaid.2021.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Colm Bergin
- St James Hospital, Dublin, Ireland; Trinity College, Dublin, Ireland
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12
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Roussel C, Ndour PA, Kendjo E, Larréché S, Taieb A, Henry B, Lebrun-Vignes B, Chambrion C, Argy N, Houzé S, Mouri O, Courtin D, Angoulvant A, Delacour H, Gay F, Siriez JY, Danis M, Bruneel F, Bouchaud O, Caumes E, Piarroux R, Thellier M, Jauréguiberry S, Buffet P. Intravenous Artesunate for the Treatment of Severe Imported Malaria: Implementation, Efficacy, and Safety in 1391 Patients. Clin Infect Dis 2021; 73:1795-1804. [PMID: 33581690 DOI: 10.1093/cid/ciab133] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intravenous artesunate is the World Health Organization-recommended first-line treatment for severe malaria worldwide, but it is still not fully licensed in Europe. Observational studies documenting its safety and efficacy in imported malaria are thus essential. METHODS We prospectively collected clinical and epidemiological features of 1391 artesunate-treated patients among 110 participant centers during the first 7 years (2011-2017) of a national program implemented by the French Drug Agency. RESULTS Artesunate became the most frequent treatment for severe malaria in France, rising from 9.9% in 2011 to 71.4% in 2017. Mortality was estimated at 4.1%. Treatment failure was recorded in 27 patients, but mutations in the Kelch-13 gene were not observed. Main reported adverse events (AEs) were anemia (136 cases), cardiac events (24, including 20 episodes of conduction disorders and/or arrhythmia), and liver enzyme elevation (23). Mortality and AEs were similar in the general population and in people with human immunodeficiency virus, who were overweight, or were pregnant, but the only pregnant woman treated in the first trimester experimented a hemorrhagic miscarriage. The incidence of post-artesunate-delayed hemolysis (PADH) was 42.8% when specifically assessed in a 98-patient subgroup, but was not associated with fatal outcomes or sequelae. PADH was twice as frequent in patients of European compared with African origin. CONCLUSIONS Artesunate was rapidly deployed and displayed a robust clinical benefit in patients with severe imported malaria, despite a high frequency of mild to moderate PADH. Further explorations in the context of importation should assess outcomes during the first trimester of pregnancy and collect rare but potentially severe cardiac AEs.
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Affiliation(s)
- Camille Roussel
- Biologie Intégrée du Globule Rouge, INSERM, Université de Paris, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France
| | - Papa Alioune Ndour
- Biologie Intégrée du Globule Rouge, INSERM, Université de Paris, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France
| | - Eric Kendjo
- Center National de Référence du Paludisme Paris, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sébastien Larréché
- Département de biologie médicale, Hôpital d'Instruction Des Armées Bégin, Saint-Mandé, France
| | - Aida Taieb
- Center National de Référence du Paludisme Paris, Paris, France
| | - Benoît Henry
- Biologie Intégrée du Globule Rouge, INSERM, Université de Paris, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Hôpital Necker Enfants Malades, Service des maladies infectieuses et tropicales, APHP, Center d'Infectiologie Necker-Pasteur, Institut Imagine, Paris, France
| | | | - Charlotte Chambrion
- Biologie Intégrée du Globule Rouge, INSERM, Université de Paris, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France
| | - Nicolas Argy
- Center National de Référence du Paludisme Paris, Paris, France.,Université de Paris, MERIT, IRD, Paris, France.,Laboratoire de parasitologie-mycologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Sandrine Houzé
- Center National de Référence du Paludisme Paris, Paris, France.,Université de Paris, MERIT, IRD, Paris, France.,Laboratoire de parasitologie-mycologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Oussama Mouri
- Center National de Référence du Paludisme Paris, Paris, France.,Laboratoire de parasitologie-mycologie, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | | | - Adela Angoulvant
- Laboratoire de Parasitologie-Mycologie, Hôpital Bicêtre, APHP, Kremlin Bicêtre, France.,GQE Le Moulon, INRA, CNRS, AgroParisTech, University Paris-Sud, Université Paris-Saclay, Orsay, France
| | - Hervé Delacour
- Département de biologie médicale, Hôpital d'Instruction Des Armées Bégin, Saint-Mandé, France
| | - Frédérick Gay
- Center National de Référence du Paludisme Paris, Paris, France.,Laboratoire de parasitologie-mycologie, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - Jean-Yves Siriez
- Service d'accueil des urgences pédiatriques, Hôpital Robert Debré, Paris, France
| | - Martin Danis
- Center National de Référence du Paludisme Paris, Paris, France
| | - Fabrice Bruneel
- Service de réanimation, Center Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
| | - Olivier Bouchaud
- Service des maladies infectieuses et tropicales, Hôpital Avicenne, Bobigny, France
| | - Eric Caumes
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,Service des maladies infectieuses et tropicales, Hôpital Pitié Salpêtrière, APHP, Paris, France.,Société Française de Médecine des Voyages, Paris, France
| | - Renaud Piarroux
- Center National de Référence du Paludisme Paris, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,Laboratoire de parasitologie-mycologie, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - Marc Thellier
- Center National de Référence du Paludisme Paris, Paris, France.,Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,Laboratoire de parasitologie-mycologie, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - Stéphane Jauréguiberry
- Center National de Référence du Paludisme Paris, Paris, France.,Société Française de Médecine des Voyages, Paris, France.,Service des maladies infectieuses et tropicales, Hôpital Bicêtre, APHP, Kremlin Bicêtre, France.,Université de Paris Saclay, INSERM, CESP (Centre de Recherche en Epidémiologie et Santé des Populations) Villejuif, France
| | - Pierre Buffet
- Biologie Intégrée du Globule Rouge, INSERM, Université de Paris, Université des Antilles, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Center National de Référence du Paludisme Paris, Paris, France
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13
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Starck T, Bulstra CA, Tinto H, Rouamba T, Sie A, Jaenisch T, Bärnighausen T. The effect of malaria on haemoglobin concentrations: a nationally representative household fixed-effects study of 17,599 children under 5 years of age in Burkina Faso. Malar J 2021; 20:416. [PMID: 34688294 PMCID: PMC8542337 DOI: 10.1186/s12936-021-03948-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background Although the association between malaria and anaemia is widely studied in patient cohorts, the population-representative causal effects of malaria on anaemia remain unknown. This study estimated the malaria-induced decrease in haemoglobin levels among young children in malaria-endemic Burkina Faso. Methods The study was based on pooled individual-level nationally representative health survey data (2010–2011, 2014, 2017–2018) from 17 599 children under 5 years of age. This data was used to estimate the effects of malaria on haemoglobin concentration, controlling for household fixed-effects, age, and sex in a series of regression analyses. The fixed-effects controlled for observed and unobserved confounding on the household level and allowed to determine the impact of malaria infection status on haemoglobin levels and anaemia prevalence. Furthermore, the diagnostic results from microscopy and rapid diagnostic tests were leveraged to provide a quasi-longitudinal perspective of acute and prolonged effects after malaria infection. Results The prevalence of both malaria (survey prevalence ranging from 17.4% to 65.2%) and anaemia (survey prevalence ranging from 74% to 88.2%) was very high in the included surveys. Malaria was estimated to significantly reduce haemoglobin levels, with an overall effect of − 7.5 g/dL (95% CI − 8.5, − 6.5). Acute malaria resulted in a − 7.7 g/dL (95% CI − 8.8, − 6.6) decrease in haemoglobin levels. Recent malaria without current parasitaemia decreased haemoglobin concentration by − 7.1 g/dL (95% CI − 8.3, − 5.9). The in-sample predicted prevalence of severe anaemia was 9.4% among malaria positives, but only 2.2% among children without malaria. Conclusion Malaria infection has a strong detrimental effect on haemoglobin levels among young children in Burkina Faso. This effect seems to carry over even after acute infection, indicating prolonged haemoglobin reductions even after successful parasite-elimination. The quasi-experimental fixed-effect approach adds a population level perspective to existing clinical evidence. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03948-z.
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Affiliation(s)
- Tim Starck
- Heidelberg Institute of Global Health, Heidelberg University Medical Cente, Heidelberg, Germany.
| | - Caroline A Bulstra
- Heidelberg Institute of Global Health, Heidelberg University Medical Cente, Heidelberg, Germany.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Ali Sie
- National Institute of Public Health (INSP), Nouna Health Research Centre (CRSN), Nouna, Burkina Faso
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health, Heidelberg University Medical Cente, Heidelberg, Germany.,Center for Global Health, Colorado School of Public Health, Aurora, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Medical Cente, Heidelberg, Germany.,Harvard Center for Population and Development Studies, Boston, USA.,Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
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14
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Singh B, McCaffery JN, Kong A, Ah Y, Wilson S, Chatterjee S, Tomar D, Aidoo M, Udhayakumar V, Rogier E. Purification of native histidine-rich protein 2 (nHRP2) from Plasmodium falciparum culture supernatant, infected RBCs, and parasite lysate. Malar J 2021; 20:405. [PMID: 34657602 PMCID: PMC8522059 DOI: 10.1186/s12936-021-03946-1] [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: 07/30/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Despite the widespread use of histidine-rich protein 2 (HRP2)-based rapid diagnostic tests (RDTs), purified native HRP2 antigen is not standardly used in research applications or assessment of RDTs used in the field. Methods This report describes the purification of native HRP2 (nHRP2) from the HB3 Plasmodium falciparum culture strain. As this culture strain lacks pfhrp3 from its genome, it is an excellent source of HRP2 protein only and does not produce the closely-related HRP3. The nHRP2 protein was isolated from culture supernatant, infected red blood cells (iRBCs), and whole parasite lysate using nickel-metal chelate chromatography. Biochemical characterization of nHRP2 from HB3 culture was conducted by SDS-PAGE and western blotting, and nHRP2 was assayed by RDT, ELISA, and bead-based immunoassay. Results Purified nHRP2 was identified by SDS-PAGE and western blot as a − 60 kDa protein that bound anti-HRP-2 monoclonal antibodies. Mouse anti-HRP2 monoclonal antibody was found to produce high optical density readings between dilutions of 1:100 and 1:3,200 by ELISA with assay signal observed up to a 1:200,000 dilution. nHRP2 yield from HB3 culture by bead-based immunoassay revealed that both culture supernatant and iRBC lysate were practical sources of large quantities of this antigen, producing a total yield of 292.4 µg of nHRP2 from two pooled culture preparations. Assessment of nHRP2 recognition by RDTs revealed that Carestart Pf HRP2 and HRP2/pLDH RDTs detected purified nHRP2 when applied at concentrations between 20.6 and 2060 ng/mL, performing within a log-fold dilution of commercially-available recombinant HRP2. The band intensity observed for the nHRP2 dilutions was equivalent to that observed for P. falciparum culture strain dilutions of 3D7 and US06 F Nigeria XII between 12.5 and 1000 parasites/µL. Conclusions Purified nHRP2 could be a valuable reagent for laboratory applications as well as assessment of new and existing RDTs prior to their use in clinical settings. These results establish that it is possible to extract microgram quantities of the native HRP2 antigen from HB3 culture and that this purified protein is well recognized by existing monoclonal antibody lines and RDTs. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03946-1.
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Affiliation(s)
- Balwan Singh
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jessica N McCaffery
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Amy Kong
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Yong Ah
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Scott Wilson
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Deepak Tomar
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA.,Lowance Center for Human Immunology, Emory University, Atlanta, GA, USA
| | - Michael Aidoo
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
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15
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Sardar S, Abdurabu M, Abdelhadi A, Habib MB, Jamshaid MB, Hajjar AH, Abu Ageila M, Abdalla T, Kartha A, Farooqui K. Artesunate-induced hemolysis in severe complicated malaria - A diagnostic challenge: A case report and literature review of anemia in malaria. IDCases 2021; 25:e01234. [PMID: 34377668 PMCID: PMC8329521 DOI: 10.1016/j.idcr.2021.e01234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022] Open
Abstract
Malaria infection, which results due to the parasitic protozoan Plasmodium, has several known etiologies of hemolytic anemia as a possible complication in cases such as concurrent G6PD deficiency, severe parasitemia, or use of parenteral antimalarials. Although artemisinin-based antimalarial therapies are generally well-tolerated, several cases of severe post-artemisinin delayed hemolysis (PADH) have been recently reported, which present a diagnostic challenge, and affect morbidity and mortality in patients with malarial infection. We highlight the case of a young lady with Plasmodium falciparum severe parasitemia who developed hemolytic anemia after parenteral artesunate therapy.
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Affiliation(s)
- Sundus Sardar
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Abdurabu
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Abdelhadi
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mhd Baraa Habib
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Munir Abu Ageila
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Anand Kartha
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Farooqui
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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16
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Wang H, Li S, Cui Z, Qin T, Shi H, Ma J, Li L, Yu G, Jiang T, Li C. Analysis of spleen histopathology, splenocyte composition and haematological parameters in four strains of mice infected with Plasmodium berghei K173. Malar J 2021; 20:249. [PMID: 34090420 PMCID: PMC8180108 DOI: 10.1186/s12936-021-03786-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a fatal disease that presents clinically as a continuum of symptoms and severity, which are determined by complex host-parasite interactions. Clearance of infection is believed to be accomplished by the spleen and mononuclear phagocytic system (MPS), independent of artemisinin treatment. The spleen filters infected red blood cells (RBCs) from circulation through immune-mediated recognition of the infected RBCs followed by phagocytosis. This study evaluated the tolerance of four different strains of mice to Plasmodium berghei strain K173 (P. berghei K173), and the differences in the role of the spleen in controlling P. berghei K173 infection. METHODS Using different strains of mice (C57BL/6, BALB/C, ICR, and KM mice) infected with P. berghei K173, the mechanisms leading to splenomegaly, histopathology, splenocyte activation and proliferation, and their relationship to the control of parasitaemia and host mortality were examined and evaluated. RESULTS Survival time of mice infected with P. berghei K173 varied, although the infection was uniformly lethal. Mice of the C57BL/6 strain were the most resistant, while mice of the strain ICR were the most susceptible. BALB/c and KM mice were intermediate. In the course of P. berghei K173 infection, all infected mice experienced significant splenomegaly. Parasites were observed in the red pulp at 3 days post infection (dpi) in all animals. All spleens retained late trophozoite stages as well as a fraction of earlier ring-stage parasites. The percentages of macrophages in infected C57BL/6 and KM mice were higher than uninfected mice on 8 dpi. Spleens of infected ICR and KM mice exhibited structural disorganization and remodelling. Furthermore, parasitaemia was significantly higher in KM versus C57BL/6 mice at 8 dpi. The percentages of macrophages in ICR infected mice were lower than uninfected mice, and the parasitaemia was higher than other strains. CONCLUSIONS The results presented here demonstrate the rate of splenic mechanical filtration and that splenic macrophages are the predominant roles in controlling an individual's total parasite burden. This can influence the pathogenesis of malaria. Finally, different genetic backgrounds of mice have different splenic mechanisms for controlling malaria infection.
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Affiliation(s)
- Huajing Wang
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Shuo Li
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Zhao Cui
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Tingting Qin
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Hang Shi
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Ji Ma
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Lanfang Li
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Guihua Yu
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Tingliang Jiang
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Canghai Li
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China.
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17
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Laboratory Detection of Malaria Antigens: a Strong Tool for Malaria Research, Diagnosis, and Epidemiology. Clin Microbiol Rev 2021; 34:e0025020. [PMID: 34043447 DOI: 10.1128/cmr.00250-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The identification and characterization of proteins produced during human infection with Plasmodium spp. have guided the malaria community in research, diagnosis, epidemiology, and other efforts. Recently developed methods for the detection of these proteins (antigens) in the laboratory have provided new types of data that can inform the evaluation of malaria diagnostics, epidemiological investigations, and overall malaria control strategies. Here, the focus is primarily on antigens that are currently known to be detectable in human specimens and on their impact on the understanding of malaria in human populations. We highlight historical and contemporary laboratory assays for malaria antigen detection, the concept of an antigen profile for a biospecimen, and ways in which binary results for a panel of antigens could be interpreted and utilized for different analyses. Particular emphasis is given to the direct comparison of field-level malaria diagnostics and laboratory antigen detection for the development of an external evaluation scheme. The current limitations of laboratory antigen detection are considered, and the future of this developing field is discussed.
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18
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Highly Sensitive and Rapid Quantitative Detection of Plasmodium falciparum Using an Image Cytometer. Microorganisms 2020; 8:microorganisms8111769. [PMID: 33187123 PMCID: PMC7696876 DOI: 10.3390/microorganisms8111769] [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: 10/16/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
The gold standard for malaria diagnosis is microscopic examination of blood films by expert microscopists. It is important to detect submicroscopic and asymptomatic Plasmodium infections in people, therefore the development of highly sensitive devices for diagnosing malaria is required. In the present study, we investigated whether an imaging cytometer was useful for the highly sensitive quantitative detection of parasites. Whole blood samples were prepared from uninfected individuals spiked with Plasmodium falciparum-infected erythrocytes. Thereafter, erythrocytes were purified using a push column comprising of a syringe filter unit with SiO2-nanofiber filters. After adding the erythrocytes, stained with nuclear stain, to a six-well plate, quantitative detection of the parasites was performed using an image cytometer, CQ1. Imaging of 2.6 × 106 erythrocytes was completed in 3 min, and the limit of detection indicated parasitemia of 0.00010% (≈5 parasites/μL of blood). In addition to rapid, highly sensitive, and quantitative detection, the ease of application and economic costs, image cytometry could be efficiently applied to diagnose submicroscopic parasites in infected people from endemic countries.
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19
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Hashimoto M, Yokota K, Kajimoto K, Matsumoto M, Tatsumi A, Yamamoto K, Hyodo T, Matsushita K, Minakawa N, Mita T, Oka H, Kataoka M. Quantitative Detection of Plasmodium falciparum Using, LUNA-FL, A Fluorescent Cell Counter. Microorganisms 2020; 8:microorganisms8091356. [PMID: 32899795 PMCID: PMC7564040 DOI: 10.3390/microorganisms8091356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/24/2023] Open
Abstract
The microscopic examination of Giemsa-stained thin and/or thick blood films (Giemsa microscopy) is the standard method of malaria diagnosis. However, the results of the diagnosis significantly depend on the skills of clinical technicians. Furthermore, sample preparation and analysis are laborious and time-consuming. Therefore, in this study, we investigated if a commercially available fluorescent cell counter, LUNA-FL, was useful for the detection of Plasmodium parasite and the estimation of parasitemia. Whole blood samples from uninfected persons, spiked with P. falciparum-infected erythrocytes, were analysed. Most of the leucocytes and platelets were removed from whole blood samples with SiO2-nanofiber filters set on spin columns. The filtered samples were stained with acridine orange, and automatic detection, as well as counting of erythrocytes and parasites, were performed using LUNA-FL. Whole blood, with various levels of parasites, was analysed by Giemsa microscopy or with LUNA-FL to estimate parasitemia, and a comparative analysis was performed. The coefficient determination value of the regression line was high (R2 = 0.98), indicating that accurate quantitative parasite detection could be performed using LUNA-FL. LUNA-FL has a low running cost; it is compact, fast, and easy to operate, and may therefore be useful for point-of-care testing in the endemic areas.
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Affiliation(s)
- Muneaki Hashimoto
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14, Hayashi-cho, Takamatsu, Kagawa 761-0301, Japan; (K.Y.); (K.K.); (M.K.)
- Correspondence: ; Tel.: +81-87-869-4107
| | - Kazumichi Yokota
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14, Hayashi-cho, Takamatsu, Kagawa 761-0301, Japan; (K.Y.); (K.K.); (M.K.)
| | - Kazuaki Kajimoto
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14, Hayashi-cho, Takamatsu, Kagawa 761-0301, Japan; (K.Y.); (K.K.); (M.K.)
| | - Musashi Matsumoto
- Konica Minolta, 1 Sakura-mashi, Hino, Tokyo 191-8511, Japan; (M.M.); (A.T.); (H.O.)
| | - Atsuro Tatsumi
- Konica Minolta, 1 Sakura-mashi, Hino, Tokyo 191-8511, Japan; (M.M.); (A.T.); (H.O.)
| | - Kenichi Yamamoto
- Nitto Denko Corporation, 18, Hirayama, Nakahara-cho, Toyohashi, Aichi 441-3194, Japan; (K.Y.); (T.H.); (K.M.)
| | - Tomonori Hyodo
- Nitto Denko Corporation, 18, Hirayama, Nakahara-cho, Toyohashi, Aichi 441-3194, Japan; (K.Y.); (T.H.); (K.M.)
| | - Kiichiro Matsushita
- Nitto Denko Corporation, 18, Hirayama, Nakahara-cho, Toyohashi, Aichi 441-3194, Japan; (K.Y.); (T.H.); (K.M.)
| | - Noboru Minakawa
- Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan;
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan;
| | - Hiroaki Oka
- Konica Minolta, 1 Sakura-mashi, Hino, Tokyo 191-8511, Japan; (M.M.); (A.T.); (H.O.)
| | - Masatoshi Kataoka
- Health Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2217-14, Hayashi-cho, Takamatsu, Kagawa 761-0301, Japan; (K.Y.); (K.K.); (M.K.)
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20
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The Human Spleen in Malaria: Filter or Shelter? Trends Parasitol 2020; 36:435-446. [PMID: 32298631 DOI: 10.1016/j.pt.2020.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/10/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Abstract
The human spleen is an immune sentinel and controls red blood cell (RBC) quality. By mechanically retaining subsets of infected RBCs, the spleen may reduce the pace at which the parasite biomass increases before the adaptive immune response operates. Conversely, the spleen may contribute to malaria pathogenesis, particularly anemia that is associated with splenomegaly. Large spleens may also shelter parasites in chronic carriers. Upon treatment with artemisinins, the spleen clears circulating parasites by pitting and releases 'once-infected' RBCs in circulation. This triggers postartesunate delayed hemolysis and explains the long post-treatment positivity of histidine-rich protein 2 (HRP2)-based dipsticks. Importantly, splenic retention of RBCs also applies to gametocytes, the clearance of which may be enhanced by stiffening them with drugs, a potential way to block malaria transmission.
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21
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HRP2: Transforming Malaria Diagnosis, but with Caveats. Trends Parasitol 2020; 36:112-126. [DOI: 10.1016/j.pt.2019.12.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 11/23/2022]
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22
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Rivera-Correa J, Rodriguez A. Autoimmune Anemia in Malaria. Trends Parasitol 2020; 36:91-97. [PMID: 31864893 PMCID: PMC7101069 DOI: 10.1016/j.pt.2019.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/25/2022]
Abstract
Severe anemia is a major cause of death by malaria. The loss of uninfected erythrocytes is an important contributor to malarial anemia; however, the mechanisms underlying this pathology are not well understood. Malaria-induced anemia is related to autoimmune antibodies against the membrane lipid phosphatidylserine (PS). In mice, these antibodies induce the clearance of uninfected erythrocytes after binding to PS exposed in their membrane. In human malaria patients there is a strong correlation between anemia and anti-PS antibodies. During malaria, anti-PS antibodies are produced by atypical B cells, whose levels correlate with the development of anemia in patients. Autoimmune responses, which are documented frequently in different infections, contribute to the pathogenesis of malaria by inducing the clearance of uninfected erythrocytes.
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Affiliation(s)
- Juan Rivera-Correa
- New York University School of Medicine, New York, NY, USA; Current affiliations: Hospital for Special Surgery, New York, NY, USA; Weill-Cornell Medicine, New York, NY, USA
| | - Ana Rodriguez
- New York University School of Medicine, New York, NY, USA.
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23
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Depond M, Henry B, Buffet P, Ndour PA. Methods to Investigate the Deformability of RBC During Malaria. Front Physiol 2020; 10:1613. [PMID: 32038293 PMCID: PMC6990122 DOI: 10.3389/fphys.2019.01613] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022] Open
Abstract
Despite a 30% decline in mortality since 2000, malaria still affected 219 million subjects and caused 435,000 deaths in 2017. Red blood cells (RBC) host Plasmodium parasites that cause malaria, of which Plasmodium falciparum is the most pathogenic. The deformability of RBC is markedly modified by invasion and development of P. falciparum. Surface membrane area is potentially impacted by parasite entry and development, the cytoskeleton is modified by parasite proteins and cytosol viscosity is altered by parasite metabolism. RBC hosting mature parasites (second half of the asexual erythrocytic cycle) are abnormally stiff but the main reason for their absence from the circulation is their adherence to endothelial cells, mediated by parasite proteins exposed at the infected-RBC surface. By contrast, the circulation of non-adherent rings and gametocytes, depends predominantly on deformability. Altered deformability of rings and of uninfected-RBC altered by malaria infection is an important determinant of malaria pathogenesis. It also impacts the response to antimalarial therapy. Unlike conventional antimalarials that target mature stages, currently recommended first-line artemisinin derivatives and the emerging spiroindolones act on circulating rings. Methods to investigate the deformability of RBC are therefore critical to understand the clearance of infected- and uninfected-RBC in malaria. Herein, we review the main methods to assess the deformability of P. falciparum infected-RBC, and their contribution to the understanding of how P. falciparum infection causes disease, how the parasite is transmitted and how antimalarial drugs induce parasite clearance.
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Affiliation(s)
- Mallorie Depond
- UMR_S1134, BIGR, Inserm, Universit de Paris, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Benoit Henry
- UMR_S1134, BIGR, Inserm, Universit de Paris, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Pierre Buffet
- UMR_S1134, BIGR, Inserm, Universit de Paris, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Papa Alioune Ndour
- UMR_S1134, BIGR, Inserm, Universit de Paris, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
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24
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Kamaliddin C, Joste V, Hubert V, Kendjo E, Argy N, Houze S. Evaluation of PCR To Monitor Plasmodium falciparum Treatment Efficacy in a Nonendemicity Setting. J Clin Microbiol 2019; 58:e01080-19. [PMID: 31666363 PMCID: PMC6935925 DOI: 10.1128/jcm.01080-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/24/2019] [Indexed: 11/20/2022] Open
Abstract
Adequate clinical and parasitological response (ACPR) after malaria treatment remains challenging to assess in settings of malaria nonendemicity. Biological evaluation of parasitological clearance relies on microscopic investigation of thick blood smears, which is a specific technique that not all diagnosis laboratories are able to perform. Rapid diagnosis tests (RDTs) and molecular biology techniques are proposed as alternatives to microscope conventional techniques; however, their performance for treatment efficacy evaluation is controversial. We present here a retrospective comparative study for RDT and PCR (nested and high-resolution-melting quantitative PCR [HRM-qPCR]) evaluation of ACPR in a nonendemicity context. Blood samples from 133 patients presenting a Plasmodium falciparum monoinfection were included. Samples obtained at the time of diagnosis and at 3, 7, and 28 days after diagnosis were investigated. Histidine-rich protein 2 (HRP-2)-based RDT results remained positive in 51% of cases 28 days after diagnosis and appropriate therapeutic management. Parasite DNA was detected by the two PCR techniques (nested PCR and HRM-qPCR) in 12% and 10% of samples 28 days after treatment initiation, respectively. No therapeutic failure was recorded in the studied patients. Persistence of positive signal might reflect the presence of circulating asexual parasites or persistence of HRP-2 and parasitic DNA in patient's peripheral blood after parasitic clearance.
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Affiliation(s)
- Claire Kamaliddin
- Centre National de Référence du Paludisme, Laboratoire de Parasitologie, Hôpital Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
| | - Valentin Joste
- Centre National de Référence du Paludisme, Laboratoire de Parasitologie, Hôpital Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
| | - Véronique Hubert
- Centre National de Référence du Paludisme, Laboratoire de Parasitologie, Hôpital Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
- MERIT, IRD, Université Paris, Paris, France
| | - Eric Kendjo
- MERIT, IRD, Université Paris, Paris, France
- Centre National de Référence du Paludisme, Hôpital de la Pitié-Salpétrière, APHP, Paris, France
| | - Nicolas Argy
- Centre National de Référence du Paludisme, Laboratoire de Parasitologie, Hôpital Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
- MERIT, IRD, Université Paris, Paris, France
| | - Sandrine Houze
- Centre National de Référence du Paludisme, Laboratoire de Parasitologie, Hôpital Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
- MERIT, IRD, Université Paris, Paris, France
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25
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Scheu K, Adegnika AA, Addo MM, Ansong D, Cramer JP, Fürst S, Kremsner PG, Kurth F, Jacobs T, May J, Ramharter M, Sylverken J, Vinnemeier CD, Agbenyega T, Rolling T. Determinants of post-malarial anemia in African children treated with parenteral artesunate. Sci Rep 2019; 9:18134. [PMID: 31792345 PMCID: PMC6888809 DOI: 10.1038/s41598-019-54639-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/18/2019] [Indexed: 12/28/2022] Open
Abstract
The pathophysiology of malarial anemia is multifactorial and incompletely understood. We assessed mechanistic and risk factors for post-malarial anemia in Ghanaian and Gabonese children with severe P. falciparum malaria treated with parenteral artesunate followed by an oral artemisinin-combination therapy. We analyzed data from two independent studies in which children were followed on Days 7,14, and 28 after treatment with artesunate. Specific hematological parameters included the presence of hemoglobinopathies and erythropoietin. Presence of once-infected erythrocytes was assessed by flow cytometry in a sub-population. Of 143 children with a geometric mean parasitemia of 116,294/µL (95% CI: 95,574-141,505), 91 (88%) had anemia (Hb < 10 g/dL) at presentation. Hemoglobin increased after Day 7 correlating with increased erythropoiesis through adequate erythropoietin stimulation. 22 children (24%) remained anemic until Day 28. Post-artesunate delayed hemolysis was detected in 7 children (5%) with only minor differences in the dynamics of once-infected erythrocytes. Hyperparasitemia and hemoglobin at presentation were associated with anemia on Day 14. On Day 28 only lower hemoglobin at presentation was associated with anemia. Most children showed an adequate erythropoiesis and recovered from anemia within one month. Post-artesunate delayed hemolysis (PADH) and hyperparasitemia are associated with early malarial anemia and pre-existing anemia is the main determinant for prolonged anemia.
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Affiliation(s)
- Katrin Scheu
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University Medical Center Tübingen, Tübingen, Germany
- Central African Network for Tuberculosis, Aids and Malaria (CANTAM), Brazzaville, Republic of Congo
| | - Marylyn M Addo
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
- Department of Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Daniel Ansong
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jakob P Cramer
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Coalition for Epidemic Preparedness Innovations (CEPI), London, UK
| | - Svenja Fürst
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University Medical Center Tübingen, Tübingen, Germany
| | - Florian Kurth
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Jacobs
- Protozoa Immunology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Jürgen May
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
- Department of Infectious Diseases Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Justice Sylverken
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christof D Vinnemeier
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tsiri Agbenyega
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thierry Rolling
- Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany.
- Department of Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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26
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Rivera-Correa J, Mackroth MS, Jacobs T, Schulze Zur Wiesch J, Rolling T, Rodriguez A. Atypical memory B-cells are associated with Plasmodium falciparum anemia through anti-phosphatidylserine antibodies. eLife 2019; 8:48309. [PMID: 31713516 PMCID: PMC6853636 DOI: 10.7554/elife.48309] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 02/07/2023] Open
Abstract
Anemia is a common complication of malaria that is characterized by the loss of infected and uninfected erythrocytes. In mouse malaria models, clearance of uninfected erythrocytes is promoted by autoimmune anti-phosphatidylserine (PS) antibodies produced by T-bet+B-cells, which bind to exposed PS in erythrocytes, but the mechanism in patients is still unclear. In Plasmodium falciparum patients with anemia, we show that atypical memory FcRL5+T-bet+ B-cells are expanded and associate both with higher levels of anti-PS antibodies in plasma and with the development of anemia in these patients. No association of anti-PS antibodies or anemia with other B-cell subsets and no association of other antibody specificities with FcRL5+T-bet+ B-cells is observed, revealing high specificity in this response. We also identify FcRL5+T-bet+ B-cells as producers of anti-PS antibodies in ex vivo cultures of naïve human peripheral blood mononuclear cells (PBMC) stimulated with P.-falciparum-infected erythrocyte lysates. These data define a crucial role for atypical memory B-cells and anti-PS autoantibodies in human malarial anemia.
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Affiliation(s)
- Juan Rivera-Correa
- Department of Microbiology, New York University School of Medicine, New York, United States
| | - Maria Sophia Mackroth
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Protozoa Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Thomas Jacobs
- Protozoa Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Thierry Rolling
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.,Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ana Rodriguez
- Department of Microbiology, New York University School of Medicine, New York, United States
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27
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Plewes K, Leopold SJ, Kingston HWF, Dondorp AM. Malaria: What's New in the Management of Malaria? Infect Dis Clin North Am 2019; 33:39-60. [PMID: 30712767 DOI: 10.1016/j.idc.2018.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The global burden of malaria remains high, with 216 million cases causing 445,000 deaths in 2016 despite first-line treatment with artemisinin-based combination therapy. Decreasing transmission in Africa shifts the risk for severe malaria to older age groups as premunition wanes. Prompt diagnosis and treatment with intravenous artesunate in addition to appropriate supportive management are critical to reduce deaths from severe malaria. Effective individual management is challenging in settings with limited resources for higher-level care. Adjunctive therapies targeting the underlying pathophysiological pathways have the potential to reduce mortality. Resistance to artemisinin derivatives and their partner drugs threaten malaria management and control.
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Affiliation(s)
- Katherine Plewes
- Malaria Department, Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand; Department of Medicine, University of British Columbia, Vancouver General Hospital, 452D Heather Pavilion East, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada
| | - Stije J Leopold
- Malaria Department, Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Hugh W F Kingston
- Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK; Malaria Department, Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Arjen M Dondorp
- Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand.
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28
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Moxon CA, Gibbins MP, McGuinness D, Milner DA, Marti M. New Insights into Malaria Pathogenesis. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2019; 15:315-343. [PMID: 31648610 DOI: 10.1146/annurev-pathmechdis-012419-032640] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Malaria remains a major public health threat in tropical and subtropical regions across the world. Even though less than 1% of malaria infections are fatal, this leads to about 430,000 deaths per year, predominantly in young children in sub-Saharan Africa. Therefore, it is imperative to understand why a subset of infected individuals develop severe syndromes and some of them die and what differentiates these cases from the majority that recovers. Here, we discuss progress made during the past decade in our understanding of malaria pathogenesis, focusing on the major human parasite Plasmodium falciparum.
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Affiliation(s)
- Christopher A Moxon
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, United Kingdom; ,
| | - Matthew P Gibbins
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, United Kingdom; ,
| | - Dagmara McGuinness
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, United Kingdom; ,
| | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois 60603, USA.,Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Matthias Marti
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, United Kingdom; , .,Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
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29
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Rivera-Correa J, Conroy AL, Opoka RO, Batte A, Namazzi R, Ouma B, Bangirana P, Idro R, Schwaderer AL, John CC, Rodriguez A. Autoantibody levels are associated with acute kidney injury, anemia and post-discharge morbidity and mortality in Ugandan children with severe malaria. Sci Rep 2019; 9:14940. [PMID: 31624288 PMCID: PMC6797715 DOI: 10.1038/s41598-019-51426-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022] Open
Abstract
Autoantibodies targeting host antigens contribute to autoimmune disorders, frequently occur during and after infections and have been proposed to contribute to malaria-induced anemia. We measured anti-phosphatidylserine (PS) and anti-DNA antibody levels in 382 Ugandan children prospectively recruited in a study of severe malaria (SM). High antibody levels were defined as antibody levels greater than the mean plus 3 standard deviations of community children (CC). We observed increases in median levels of anti-PS and anti-DNA antibodies in children with SM compared to CC (p < 0.0001 for both). Children with severe malarial anemia were more likely to have high anti-PS antibodies than children with cerebral malaria (16.4% vs. 7.4%), p = 0.02. Increases in anti-PS and anti-DNA antibodies were associated with decreased hemoglobin (p < 0.05). A one-unit increase in anti-DNA antibodies was associated with a 2.99 (95% CI, 1.68, 5.31) increase odds of acute kidney injury (AKI) (p < 0.0001). Elevated anti-PS and anti-DNA antibodies were associated with post-discharge mortality (p = 0.031 and p = 0.042, respectively). Children with high anti-PS antibodies were more likely to have multiple hospital readmissions compared to children with normal anti-PS antibody levels (p < 0.05). SM is associated with increased autoantibodies against PS and DNA. Autoantibodies were associated with anemia, AKI, post-discharge mortality, and hospital readmission.
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Affiliation(s)
- Juan Rivera-Correa
- Department of Microbiology, New York University School of Medicine, New York, NY, 10010, USA
| | - Andrea L Conroy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Robert O Opoka
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Anthony Batte
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Ruth Namazzi
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Benson Ouma
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Bangirana
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Richard Idro
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
- Centre of Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Chandy C John
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, USA
| | - Ana Rodriguez
- Department of Microbiology, New York University School of Medicine, New York, NY, 10010, USA
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30
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Wojnarski M, Mouri O, Chambrion C, Roussel C, Chartrel N, Smith B, Smith P, Thellier M, Buffet P, Ndour PA. Plasmodium falciparum Clearance Is Pitting-Dependent With Artemisinin-Based Drugs but Pitting-Independent With Atovaquone-Proguanil or Mefloquine. J Infect Dis 2019; 220:535-539. [DOI: 10.1093/infdis/jiz115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/11/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractPitting, the removal of dead parasites from their host erythrocyte, has been studied in patients with severe malaria treated parenterally with quinine or artesunate, and was recently shown to contribute to delayed hemolysis, a frequent adverse event of artesunate. We quantified pitting in 81 travelers treated with oral antimalarial therapy. Pitting rate was high (55.8%) with artemisinin-based combinations, but <10% with the nonartemisinin drugs quinine, mefloquine, and atovaquone-proguanil. This may, in part, explain the slower parasite clearance in patients treated with antimalarial drugs lacking an artemisinin component, as well as the absence of posttreatment hemolysis with these drugs.
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Affiliation(s)
- Mariusz Wojnarski
- Walter Reed Army Institute of Research, Silver Spring, Maryland
- US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Oussama Mouri
- Assistance Publique–Hôpitaux de Paris, Centre National de Référence du Paludisme, Paris
| | - Charlotte Chambrion
- Institut National de la Santé Et de la Recherche Médicale, Unité Mixte de Recherche, Université Paris Diderot, Université de La Réunion, Université des Antilles, Institut National de la Transfusion Sanguine, Laboratory of Excellence GR-Ex, Université Paris Descartes, France
| | - Camille Roussel
- Institut National de la Santé Et de la Recherche Médicale, Unité Mixte de Recherche, Université Paris Diderot, Université de La Réunion, Université des Antilles, Institut National de la Transfusion Sanguine, Laboratory of Excellence GR-Ex, Université Paris Descartes, France
| | - Nathalie Chartrel
- Assistance Publique–Hôpitaux de Paris, Centre National de Référence du Paludisme, Paris
| | - Bryan Smith
- US Army Medical Materiel Development Activity, Fort Detrick, Maryland
| | - Philip Smith
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Marc Thellier
- Assistance Publique–Hôpitaux de Paris, Centre National de Référence du Paludisme, Paris
| | - Pierre Buffet
- Institut National de la Santé Et de la Recherche Médicale, Unité Mixte de Recherche, Université Paris Diderot, Université de La Réunion, Université des Antilles, Institut National de la Transfusion Sanguine, Laboratory of Excellence GR-Ex, Université Paris Descartes, France
| | - Papa Alioune Ndour
- Institut National de la Santé Et de la Recherche Médicale, Unité Mixte de Recherche, Université Paris Diderot, Université de La Réunion, Université des Antilles, Institut National de la Transfusion Sanguine, Laboratory of Excellence GR-Ex, Université Paris Descartes, France
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31
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Poti KE, Balaban AE, Pal P, Kobayashi T, Goldberg DE, Sinnis P, Sullivan DJ. In vivo compartmental kinetics of Plasmodium falciparum histidine-rich protein II in the blood of humans and in BALB/c mice infected with a transgenic Plasmodium berghei parasite expressing histidine-rich protein II. Malar J 2019; 18:78. [PMID: 30866956 PMCID: PMC6416945 DOI: 10.1186/s12936-019-2712-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Plasmodium falciparum histidine-rich protein II (PfHRP2) is a common biomarker used in malaria rapid diagnostic tests (RDTs), but can persist in the blood for up to 40 days following curative treatment. The persistence of PfHRP2 presents a false positive limitation to diagnostic interpretation. However, the in vivo dynamics and compartmentalization underlying PfHRP2 persistence have not been fully characterized in the plasma and erythrocyte (RBC) fraction of the whole blood. Methods The kinetics and persistence of PfHRP2 in the plasma and RBC fractions of the whole blood were investigated post-treatment in human clinical samples and samples isolated from BALB/c mice infected with a novel transgenic Plasmodium berghei parasite engineered to express PfHRP2 (PbPfHRP2). Results PfHRP2 levels in human RBCs were consistently 20–40 times greater than plasma levels, even post-parasite clearance. PfHRP2 positive, DNA negative, once-infected RBCs were identified in patients that comprised 0.1–1% of total RBCs for 6 and 12 days post-treatment, even post-atovaquone–proguanil regimens. Transgenic PbPfHRP2 parasites in BALB/c mice produced and exported tgPfHRP2 to the RBC cytosol similar to P. falciparum. As in humans, tgPfHRP2 levels were found to be approximately 20-fold higher within the RBC fraction than the plasma post-treatment. RBC localized tgPfHRP2 persisted longer than tgPfHRP2 in the plasma after curative treatment. tgPfHRP2 positive, but DNA negative once-infected RBCs were also detected in mouse peripheral blood for 7–9 days after curative treatment. Conclusions The data suggest that persistence of PfHRP2 is due to slower clearance of protein from the RBC fraction of the whole blood. This appears to be a result of the presence PfHRP2 in previously infected, pitted cells, as opposed to PfHRP2 binding naïve RBCs in circulation post-treatment. The results thus confirm that the extended duration of RDT positivity after parasite clearance is likely due to pitted, once-infected RBCs that remain positive for PfHRP2. Electronic supplementary material The online version of this article (10.1186/s12936-019-2712-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristin E Poti
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda E Balaban
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Priya Pal
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tamaki Kobayashi
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel E Goldberg
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Photini Sinnis
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Dos-Santos-Pereira M, Acuña L, Hamadat S, Rocca J, González-Lizárraga F, Chehín R, Sepulveda-Diaz J, Del-Bel E, Raisman-Vozari R, Michel PP. Microglial glutamate release evoked by α-synuclein aggregates is prevented by dopamine. Glia 2018; 66:2353-2365. [PMID: 30394585 DOI: 10.1002/glia.23472] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 01/11/2023]
Abstract
When activated, microglial cells have the potential not only to secrete typical proinflammatory mediators but also to release the neurotransmitter glutamate in amounts that may promote excitotoxicity. Here, we wished to determine the potential of the Parkinson's disease (PD) protein α-Synuclein (αS) to stimulate glutamate release using cultures of purified microglial cells. We established that glutamate release was robustly increased when microglial cultures were treated with fibrillary aggregates of αS but not with the native monomeric protein. Promotion of microglial glutamate release by αS aggregates (αSa) required concomitant engagement of TLR2 and P2X7 receptors. Downstream to cell surface receptors, the release process was mediated by activation of a signaling cascade sequentially involving phosphoinositide 3-kinase (PI3K) and NADPH oxidase, a superoxide-producing enzyme. Inhibition of the Xc- antiporter, a plasma membrane exchange system that imports extracellular l-cystine and exports intracellular glutamate, prevented the release of glutamate induced by αSa, indicating that system Xc- was the final effector element in the release process downstream to NADPH oxidase activation. Of interest, the stimulation of glutamate release by αSa was abrogated by dopamine through an antioxidant effect requiring D1 dopamine receptor activation and PI3K inhibition. Altogether, present data suggest that the activation of microglial cells by αSa may possibly result in a toxic build-up of extracellular glutamate contributing to excitotoxic stress in PD. The deficit in dopamine that characterizes this disorder may further aggravate this process in a vicious circle mechanism.
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Affiliation(s)
- Mauricio Dos-Santos-Pereira
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Leonardo Acuña
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France.,Instituto de Patología Experimental (CONICET-UNSa), Salta, Argentina
| | - Sabah Hamadat
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France
| | - Jeremy Rocca
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France
| | - Florencia González-Lizárraga
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France.,Instituto de Medicina Molecular y Celular Aplicada (IMMCA) CONICET/UNT and SIPROSA, Tucumán, Argentina
| | - Rosana Chehín
- Instituto de Medicina Molecular y Celular Aplicada (IMMCA) CONICET/UNT and SIPROSA, Tucumán, Argentina
| | - Julia Sepulveda-Diaz
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France
| | - Elaine Del-Bel
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Rita Raisman-Vozari
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France
| | - Patrick P Michel
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, F-75013, France
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Abstract
Malaria is a major cause of anaemia in tropical areas. Malaria infection causes haemolysis of infected and uninfected erythrocytes and bone marrow dyserythropoiesis which compromises rapid recovery from anaemia. In areas of high malaria transmission malaria nearly all infants and young children, and many older children and adults have a reduced haemoglobin concentration as a result. In these areas severe life-threatening malarial anaemia requiring blood transfusion in young children is a major cause of hospital admission, particularly during the rainy season months when malaria transmission is highest. In severe malaria, the mortality rises steeply below an admission haemoglobin of 3 g/dL, but it also increases with higher haemoglobin concentrations approaching the normal range. In the management of severe malaria transfusion thresholds remain uncertain. Prevention of malaria by vector control, deployment of insecticide-treated bed nets, prompt and accurate diagnosis of illness and appropriate use of effective anti-malarial drugs substantially reduces the burden of anaemia in tropical countries.
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Affiliation(s)
- Nicholas J White
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Abstract
Following unsuccessful eradication attempts there was a resurgence of malaria towards the end of the 20th century. Renewed control efforts using a range of improved tools, such as long-lasting insecticide-treated bednets and artemisinin-based combination therapies, have more than halved the global burden of disease, but it remains high with 445 000 deaths and more than 200 million cases in 2016. Pitfalls in individual patient management are delayed diagnosis and overzealous fluid resuscitation in severe malaria. Even in the absence of drug resistance, parasite recurrence can occur, owing to high parasite densities, low host immunity, or suboptimal drug concentrations. Malaria elimination is firmly back as a mainstream policy but resistance to the artemisinin derivatives, their partner drugs, and insecticides present major challenges. Vaccine development continues on several fronts but none of the candidates developed to date have been shown to provide long-lasting benefits at a population level. Increased resources and unprecedented levels of regional cooperation and societal commitment will be needed if further substantial inroads into the malaria burden are to be made.
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Affiliation(s)
- Elizabeth A Ashley
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mae Sot, Thailand; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Charles J Woodrow
- 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
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35
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Plucinski MM, Dimbu PR, Fortes F, Abdulla S, Ahmed S, Gutman J, Kachur SP, Badiane A, Ndiaye D, Talundzic E, Lucchi N, Aidoo M, Udhayakumar V, Halsey E, Rogier E. Posttreatment HRP2 Clearance in Patients with Uncomplicated Plasmodium falciparum Malaria. J Infect Dis 2018; 217:685-692. [PMID: 29220497 PMCID: PMC11023016 DOI: 10.1093/infdis/jix622] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
Background The response to antimalarial treatment is assessed using serial microscopy. New techniques for accurate measurement of the Plasmodium falciparum histidine-rich protein 2 (HRP2) antigen have allowed for monitoring of the antigen concentration over time, offering a potential alternative for assessing treatment response. Methods Posttreatment HRP2 concentrations were measured in samples obtained longitudinally from 537 individuals with P. falciparum malaria who were participating in efficacy trials in Angola, Tanzania, and Senegal. The HRP2 half-life was estimated using a first-order kinetics clearance model. The association between the HRP2 concentration 3 days after treatment and recrudescence of infection was assessed. Results Despite substantial variation in HRP2 concentrations among participants at baseline, concentrations consistently showed a first-order exponential decline. The median half-life of HRP2 was estimated to be 4.5 days (interquartile range [IQR], 3.3-6.6 days) in Angola, 4.7 days (IQR, 4.0-5.9 days) in Tanzania, and 3.0 days (IQR, 2.1-4.5 days) in Senegal. The day 3 HRP2 concentration was predictive of eventual recrudescence, with an area under the receiver operating characteristic curve of 0.86 (95% confidence interval, .73-.99). Conclusions Consistent HRP2 clearance dynamics following successful antimalarial treatment imply a common underlying mechanism of biological clearance. Patients who ultimately did not respond to treatment did not exhibit this same pattern of clearance, even in the absence of other indications of inadequate response to treatment.
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Affiliation(s)
- Mateusz M Plucinski
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
- US President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Filomeno Fortes
- National Malaria Control Program, Ministry of Health, Luanda, Angola
| | - Salim Abdulla
- Ifakara Health Institute, Ifakara Health Research and Development Center, Tanzania
| | - Saumu Ahmed
- Ifakara Health Institute, Ifakara Health Research and Development Center, Tanzania
| | - Julie Gutman
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Patrick Kachur
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aida Badiane
- School of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Senegal
| | - Daouda Ndiaye
- School of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Senegal
| | - Eldin Talundzic
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Naomi Lucchi
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Aidoo
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Venkatachalam Udhayakumar
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Halsey
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
- US President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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