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Abstract
The burden of cardiovascular diseases is sharply rising in low- and middle-income countries (LMICs). Along with the increasing rates of cardiovascular risk factors in these regions, there is a growing recognition of the contribution of neglected tropical diseases and other infections. Several cardiac implications of these infections have been reported but have not yet been validated by robust population data. This is in part due to limited access to health care and insufficient data collection infrastructure in many LMICs. Therefore, the true impact of these infections on the cardiovascular system may be underestimated, because of both underdiagnosis and underreporting bias. There is an urgent need to thoroughly delineate the cardiac impact of these conditions with elevated prevalence in LMICs and to propose strategies to reduce the negative consequences of these diseases in health systems with limited resources.
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2
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Ounjaijean S, Rattanatham R, Somsak V, Boonhoh W, Surinkaew S. Gymnema inodorum Leaf Extract Improves Cardiac Function in Experimental Mice Infected with Plasmodium Berghei. J Evid Based Integr Med 2023; 28:2515690X221150526. [PMID: 36617811 PMCID: PMC9834418 DOI: 10.1177/2515690x221150526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Malaria-associated cardiac injury has been reported to be the primary cause of death due to severe malaria. The discovery of substances showing a protective effect on cardiac injury during malaria infection is urgently needed. Hence, the purpose of this study was to evaluate the efficacy of Gymnema inodorum leaf extract (GIE) on cardiac function in mice infected with Plasmodium berghei. ICR mice were treated with 1 × 107 infected red blood cells of P. berghei ANKA (PbANKA), administered orally with GIE in 100, 250 and 500 mg/kg body weight of mice. Creatine phosphokinase (CPK) and echocardiography were carried out. It was found that CPK and heart-weight to body-weight (HW/BW) ratios were significantly higher in untreated mice than the healthy control. Moreover, impaired cardiac function in the untreated group was observed as indicated by changes in echocardiography. Interestingly, GIE exerted a protective effect on cardiac injury induced by PbANKA infection. Our results demonstrated that the parasitemia percentage, CPK, HW/BW ratio, and echocardiography in GIE treated mice were improved. However, there was no significant difference between GIE dosages. Therefore, GIE possessed a cardio-protective effect during malaria infection in mice.
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Affiliation(s)
- Sakaewan Ounjaijean
- School of Health Science Research, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Rujikorn Rattanatham
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand,Research Excellence Center for Innovation and Health Products, Walailak University, Nakhon Si Thammarat, Thailand
| | - Voravuth Somsak
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand,Research Excellence Center for Innovation and Health Products, Walailak University, Nakhon Si Thammarat, Thailand
| | - Worakan Boonhoh
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat, Thailand
| | - Sirirat Surinkaew
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand,Research Excellence Center for Innovation and Health Products, Walailak University, Nakhon Si Thammarat, Thailand,Sirirat Surinkaew, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand.
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3
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Langdon A, Abdlaziz I, Rhodes K, Clarke J. Case of myocarditis secondary to severe Plasmodium falciparum infection. BMJ Case Rep 2022; 15:e249363. [PMID: 36423944 PMCID: PMC9693649 DOI: 10.1136/bcr-2022-249363] [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] [Indexed: 11/25/2022] Open
Abstract
Malaria remains one of the most prevalent infectious diseases globally. Despite targets set out by the WHO in 2015, there has been a rise in the number of cases since 2019 as an indirect effect of the COVID-19 pandemic.Cardiac complications are very rarely witnessed with severe malaria. Of the cardiac sequelae, myocarditis is one of the most frequently observed with a handful of case reports in the literature. We report a case of a man in his 50s who developed myocarditis while being managed for severe Plasmodium falciparum malaria in an intensive care unit in the UK and review the literature relevant to this case. This is the second reported case of this condition in the UK.
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Affiliation(s)
- Angharad Langdon
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Ihab Abdlaziz
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Kim Rhodes
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Jayson Clarke
- Department of Anaesthetics and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, London, UK
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Akinkunmi BF, Ogunkunle OO, Akinbami FO, Orimadegun AE. Electrocardiographic features in children with severe falciparum malaria at the University College Hospital, Ibadan. RESEARCH JOURNAL OF HEALTH SCIENCES 2022; 10:198-206. [PMID: 36267922 PMCID: PMC9581379 DOI: 10.4314/rejhs.v10i3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The high burden of Malaria morbidity and mortality in children is due to its potential to cause multi-organ dysfunction. There is however limited information on the specific electrocardiographic features in falciparum malaria in paediatric age group. Aim To investigate the electrocardiographic (ECG) features in children with (complicated) severe falciparum malaria (SM) and acute uncomplicated malaria (AUM) at the University College Hospital, Ibadan. Methods This was a comparative cross-sectional study conducted among 398 children with symptomatic and confirmed Plasmodium falciparum malaria and apparently healthy controls. The frequencies of ECG features were described and compared among these children. Results The prevalence of ECG abnormality was 79.7% and 63.2% in Severe Malaria SM and Acute uncomplicated malaria AUM patients, respectively. Sinus tachycardia was significantly more frequent in SM than AUM and control groups (p <0.001). The risk of an ECG abnormality was about three times higher in SM than healthy children (p<0.001; OR=2.89;95%CI[1.68,4.99). Conclusion Severe malaria patients had significant ECG abnormalities (Sinus Tachycardia).
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Affiliation(s)
- B F Akinkunmi
- Department of Paediatrics and Child Health, University of Medical Sciences, Ondo City, Nigeria
| | - O O Ogunkunle
- Department of Paediatrics, University College Hospital Ibadan, Nigeria
| | - F O Akinbami
- Department of Paediatrics, Niger Delta University Teaching Hospital Okolobiri, Nigeria
| | - A E Orimadegun
- Institute of Child Health University of Ibadan, Ibadan, Nigeria
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5
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Miranda-Arboleda AF, González-Barrera LG, Liblik K, Farina J, Zaidel EJ, Saldarriaga C, Zhou Z, Al-Rawi R, López-López JP, Juarez-Lloclla JP, Gupta S, Prabhakaran D, Kumar RK, Sosa-Liprandi Á, Baranchuk A. Neglected Tropical Diseases and Sudden Cardiac Death: The NET-Heart Project. Rev Cardiovasc Med 2022; 23:254. [PMID: 39076906 PMCID: PMC11266773 DOI: 10.31083/j.rcm2307254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 07/31/2024] Open
Abstract
Sudden cardiac death (SCD) is responsible for approximately 6% of global mortality and 25% of cardiovascular (CV) deaths. SCD has been traditionally linked to coronary artery disease, valvular heart disease, cardiomyopathies, and genetic arrhythmia disorders. However, advancements in care for these diseases have not translated to a proportional reduction in SCD. This suggests an important role of underrecognized contributing pathologies. Neglected tropical diseases (NTDs) are a group of illnesses prevalent in tropical and sub-tropical regions which have been understudied partially due to their high prevalence in marginalized populations. The relationship between SCD and Chagas disease has been well-established, though emerging literature suggests that other NTDs with CV involvement may lead to fatal arrhythmias. Additionally, specific therapies for a subset of NTDs put patients at increased risk of malignant arrhythmias and other cardiac complications. This review aims to summarize the association between a group of selected NTDs and SCD.
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Affiliation(s)
- Andrés F. Miranda-Arboleda
- Division of Cardiology, Kingston Health Science Centre, Queen’s University, Kingston, ON K7L 2V7, Canada
- Cardiology Department, Pablo Tobón Uribe Hospital, 050034 Medellín, Colombia
| | | | - Kiera Liblik
- Department of Medicine, Translational Medicine, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Juan Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ezequiel José Zaidel
- Cardiology Department, Sanatorio Güemes, and School of Medicine, University of Buenos Aires, C1180AAX Buenos Aires, Argentina
| | - Clara Saldarriaga
- Cardiology Service, Clínica CardioVID, Universidad de Antioquia, 050034 Medellín, Colombia
| | - Zier Zhou
- Atherosclerosis, Genomics and Vascular Biology Division, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Reem Al-Rawi
- Department of Medicine, Queen's University, Kingston, ON K7L 2V7, Canada
| | - José Patricio López-López
- Cardiology Unit, Hospital Universitario San Ignacio/Pontificia Universidad Javeriana, 110231 Bogotá, Colombia
- Instituto Masira, Universidad de Santander, 680008 Bucaramanga, Colombia
| | | | - Shyla Gupta
- Faculty of Health Sciences, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 122002 Gurugram, India
- London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
| | - R Krishna Kumar
- Amrita Institute of Medical Sciences and Research Centre, Cochin, 682041 Kerala, India
| | - Álvaro Sosa-Liprandi
- Cardiology Department, Sanatorio Güemes, and School of Medicine, University of Buenos Aires, C1180AAX Buenos Aires, Argentina
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Centre, Queen’s University, Kingston, ON K7L 2V7, Canada
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Lombardini ED, Turner GDH, Brown AE, Inamnuay L, Kaewamatawong T, Sunyakumthorn P, Ferguson DJP. A systematic analysis of ultrastructural lesions in the Plasmodium coatneyi splenectomized rhesus macaque model of severe malaria. Vet Pathol 2022; 59:873-882. [DOI: 10.1177/03009858221088783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Plasmodium falciparum remains one of the world’s deadliest diseases and with ongoing concerns of evolving drug resistance, there is a need for continued refinement of the Plasmodium coatneyi infection model in macaques to study severe malaria. As such, the systemic ultrastructural lesions associated with P. coatneyi infection in splenectomized rhesus macaques was evaluated in 6 animals. Autopsy samples from multiple areas of the central nervous system (CNS), kidneys, heart, liver, and lungs of all 6 animals were processed for electron microscopy. A systematic analysis of the ultrastructural changes associated with the plasmodium was undertaken by multiple pathologists to ensure consensus. All tissues exhibited marked sequestration of infected red blood cells comprised either of cytoadherence to endothelium or rosette formation, associated with variable degrees of host cell damage in a range of tissues that in severe cases resulted in necrosis. This is the first complete systemic evaluation of ultrastructural tissue lesions in P. coatneyi–infected rhesus macaques, and the findings have important implications evaluating of the use of this model for the study of severe malaria caused by P. falciparum in humans.
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Affiliation(s)
| | - Gareth D. H. Turner
- University of Oxford, Oxford, UK
- Mahidol-Oxford Research Unit, Bangkok, Thailand
| | - Arthur E. Brown
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Laksanee Inamnuay
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Holm AE, Gomes LC, Marinho CRF, Silvestre OM, Vestergaard LS, Biering-Sørensen T, Brainin P. Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2021; 104:1643-1650. [PMID: 33724926 PMCID: PMC8103436 DOI: 10.4269/ajtmh.20-1414] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022] Open
Abstract
Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950-April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5-9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0-8%, cardiac biomarkers 0-57%, and echocardiography 4-9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.
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Affiliation(s)
- Anna Engell Holm
- Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Laura C. Gomes
- Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | | | - Lasse S. Vestergaard
- National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
- Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Philip Brainin
- Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
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8
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Malaria and the Heart: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:1110-1121. [PMID: 33632486 DOI: 10.1016/j.jacc.2020.12.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 01/24/2023]
Abstract
As one of the tropical diseases, malaria is endemic in developing countries. Severe malaria, mainly caused by the Plasmodium falciparum parasite, can result in life-threatening complications. Traditionally, cardiac involvement has not been included as a frequent cause of morbidity and mortality. This could be due to under-reporting or underdiagnosing. Specific cardiovascular (CV) complications include electrocardiogram abnormalities, myocarditis, pericarditis, pericardial effusion, ischemic disease, and heart failure. According to the data analyzed, CV manifestations can lead to severe consequences. Possible theories related to the pathophysiological mechanisms related to CV compromise include an imbalanced pro-inflammatory cytokine response and/or erythrocyte sequestration by increased cytoadherence to endothelium. Although there is a paucity of data regarding cardiac manifestations of malaria, an algorithm for appropriate use of diagnostic tools to assess cardiac involvement has been developed in this paper. Furthermore, it is important to note that typical antimalarial treatment regimens can have fatal cardiac side-effects.
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9
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Vernaza A, Pinilla-Monsalve G, Cañas F, Carrillo D, David López J, Flórez N, Gomez-Mesa JE. Malaria and encephalopathy in a heart transplant recipient: A case report in the context of multiorgan donation. Transpl Infect Dis 2021; 23:e13565. [PMID: 33432737 DOI: 10.1111/tid.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Malaria is an endemic infection in tropical circles. It can be transmitted from mosquitoes bite, but exceptional cases have been attributed to multiorgan transplantation. CASE REPORT This is a 34-year-old woman who received a heart transplant for final-stage dilated cardiomyopathy. Over the hospitalization, she developed fever, cephalalgia, and tonic-clonic seizures with MRI findings compatible with posterior reversible encephalopathy. A thick blood smear revealed hemoparasitic forms of Plasmodium vivax. Afterward, malaria was also diagnosed in recipients of one kidney and liver of the same organ donor. First-line treatment with artesunate was prescribed for 3 days and chloroquine with primaquine thereafter for 14 days. The patient was discharged and returned to the emergency department 5 days later, complaining of gastrointestinal symptoms and developed multiorgan failure that led to death. CONCLUSION We report a case of malaria transmission through heart transplantation. Despite adequate and supervised treatment, it can be related to a fatal outcome. Malaria screening in organ donors should be considered in regions where endemicity can lead to rare cases of transmission by transplantation.
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Affiliation(s)
- Armando Vernaza
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Gabriel Pinilla-Monsalve
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Neurology, Fundación Valle del Lili, Cali, Colombia
| | - Felipe Cañas
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Diana Carrillo
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Juan David López
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Noel Flórez
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Juan Esteban Gomez-Mesa
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
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10
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Kingston HWF, Ghose A, Rungpradubvong V, Satitthummanid S, Herdman MT, Plewes K, Leopold SJ, Ishioka H, Mohanty S, Maude RJ, Schultz MJ, Lagrand WK, Hossain MA, Day NPJ, White NJ, Anstey NM, Dondorp AM. Reduced Cardiac Index Reserve and Hypovolemia in Severe Falciparum Malaria. J Infect Dis 2021; 221:1518-1527. [PMID: 31693130 PMCID: PMC7137886 DOI: 10.1093/infdis/jiz568] [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: 07/21/2019] [Accepted: 11/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Impaired microvascular perfusion is central to the development of coma and lactic acidosis in severe falciparum malaria. Refractory hypotension is rare on admission but develops frequently in fatal cases. We assessed cardiac function and volume status in severe falciparum malaria and its prognostic significance. METHODS Patients with severe (N = 101) or acute uncomplicated falciparum malaria (N = 83) were recruited from 2 hospitals in India and Bangladesh, and healthy participants (N = 44) underwent echocardiography. RESULTS Patients with severe malaria had 38% shorter left ventricular (LV) filling times and 25% shorter LV ejection times than healthy participants because of tachycardia; however, stroke volume, LV internal diameter in diastole (LVIDd), and LV internal diameter in systole (LVIDs) indices were similar. A low endocardial fraction shortening (eFS) was present in 17% (9 of 52) of severe malaria patients. Adjusting for preload and afterload, eFS was similar in health and severe malaria. Fatal cases had smaller baseline LVIDd and LVIDs indices, more collapsible inferior vena cavae (IVC), and higher heart rates than survivors. The LVIDs and IVC collapsibility were independent predictors for mortality, together with base excess and Glasgow Coma Scale. CONCLUSIONS Patients with severe malaria have rapid ejection of a normal stroke volume. Fatal cases had features of relative hypovolemia and reduced cardiac index reserve.
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Affiliation(s)
- Hugh W F Kingston
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
| | | | - Voravut Rungpradubvong
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sudarat Satitthummanid
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - M Trent Herdman
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Katherine Plewes
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Stije J Leopold
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Haruhiko Ishioka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Richard J Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Marcus J Schultz
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Wim K Lagrand
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
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11
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Marrelli MT, Wang Z, Huang J, Brotto M. The skeletal muscles of mice infected with Plasmodium berghei and Plasmodium chabaudi reveal a crosstalk between lipid mediators and gene expression. Malar J 2020; 19:254. [PMID: 32664933 PMCID: PMC7362477 DOI: 10.1186/s12936-020-03332-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background Malaria is one of the most prevalent infectious disease in the world with 3.2 billion humans at risk. Malaria causes splenomegaly and damage in other organs including skeletal muscles. Skeletal muscles comprise nearly 50% of the human body and are largely responsible for the regulation and modulation of overall metabolism. It is essential to understand how malaria damages muscles in order to develop effective preventive measures and/or treatments. Using a pre-clinical animal model, the potential molecular mechanisms of Plasmodium infection affecting skeletal muscles of mice were investigated. Methods Mouse Signal Transduction Pathway Finder PCR Array was used to monitor gene expression changes of 10 essential signalling pathways in skeletal muscles from mice infected with Plasmodium berghei and Plasmodium chabaudi. Then, a new targeted-lipidomic approach using liquid chromatography with tandem mass spectrometry (LC–MS/MS) to profile 158 lipid signalling mediators (LMs), mostly eicosanoids derived from arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), was applied. Finally, 16 key LMs directly associated with inflammation, oxidative stress, and tissue healing in skeletal muscles, were quantified. Results The results showed that the expression of key genes altered by Plasmodium infection is associated with inflammation, oxidative stress, and atrophy. In support to gene profiling results, lipidomics revealed higher concentrations of LMs in skeletal muscles directly related to inflammatory responses, while on the levels of LMs crucial in resolving inflammation and tissue repair reduced significantly. Conclusion The results provide new insights into the molecular mechanisms of malaria-induced muscle damage and revealed a potential mechanism modulating inflammation in malarial muscles. These pre-clinical studies should help with future clinical studies in humans aimed at monitoring of disease progression and development of specific interventions for the prevention and mitigation of long-term chronic effects on skeletal muscle function.
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Affiliation(s)
- Mauro Toledo Marrelli
- Department of Epidemiology, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, São Paulo, SP, 01246-904, Brazil. .,Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA.
| | - Zhiying Wang
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA
| | - Jian Huang
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA
| | - Marco Brotto
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas-Arlington, 655 W. Mitchell Street, Arlington, TX, 76010, USA
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12
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Kaiser A, Heiss K, Mueller AK, Fimmers R, Matthes J, Njuguna JT. Inhibition of EIF-5A prevents apoptosis in human cardiomyocytes after malaria infection. Amino Acids 2020; 52:693-710. [PMID: 32367435 DOI: 10.1007/s00726-020-02843-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
In this study, a determination of Troponin I and creatine kinase activity in whole-blood samples in a cohort of 100 small infants in the age of 2-5 years from Uganda with complicated Plasmodium falciparum malaria suggests the prevalence of cardiac symptoms in comparison to non-infected, healthy patients. Troponin I and creatine kinase activity increased during infection. Different reports showed that complicated malaria coincides with hypoxia in children. The obtained clinical data prompted us to further elucidate the underlying regulatory mechanisms of cardiac involvement in human cardiac ventricular myocytes. Complicated malaria is the most common clinical presentation and might induce cardiac impairment by hypoxia. Eukaryotic initiation factor 5A (eIF-5A) is involved in hypoxia induced factor (HIF-1α) expression. EIF-5A is a protein posttranslationally modified by hypusination involving catalysis of the two enzymes deoxyhypusine synthase (DHS) and deoxyhypusine hydroxylase. Treatment of human cardiomyocytes with GC7, an inhibitor of DHS, catalyzing the first step in hypusine biosynthesis led to a decrease in proinflammatory and proapoptotic myocardial caspase-1 activity in comparison to untreated cardiomyocytes. This effect was even more pronounced after co-administration of GC7 and GPI from P. falciparum simulating the pathology of severe malaria. Moreover, in comparison to untreated and GC7-treated cardiomyocytes, co-administration of GC7 and GPI significantly decreased the release of cytochrome C and lactate from damaged mitochondria. In sum, coadministration of GC7 prevented cardiac damage driven by hypoxia in vitro. Our approach demonstrates the potential of the pharmacological inhibitor GC7 to ameliorate apoptosis in cardiomyocytes in an in vitro model simulating severe malaria. This regulatory mechanism is based on blocking EIF-5A hypusination.
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Affiliation(s)
- Annette Kaiser
- Medical Research Centre, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Kirsten Heiss
- Centre for Infectious Diseases, Parasitology Unit, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- German Center for Infectious Diseases (DZIF), Heidelberg, Germany
| | - Ann-Kristin Mueller
- Centre for Infectious Diseases, Parasitology Unit, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- German Center for Infectious Diseases (DZIF), Heidelberg, Germany
| | - Rolf Fimmers
- Institut für Medizinische Biometrie, Informatik Und Epedimologie, Sigmund-Freud-Strasse 25, 53107, Bonn, Germany
| | - Jan Matthes
- Centre of Pharmcology, University of Cologne, Gleueler Strasse 24, 50931, Köln, Germany
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Wang F, Hu X, Zhou B. Structural characterization of plasmodial aminopeptidase: a combined molecular docking and QSAR-based in silico approaches. Mol Divers 2019; 23:965-984. [DOI: 10.1007/s11030-019-09921-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/18/2019] [Indexed: 11/24/2022]
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Reduced cardiotoxicity and increased oral efficacy of artemether polymeric nanocapsules in Plasmodium berghei-infected mice. Parasitology 2017; 145:1075-1083. [PMID: 29223181 DOI: 10.1017/s0031182017002207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Artemether (ATM) cardiotoxicity, its short half-life and low oral bioavailability are the major limiting factors for its use to treat malaria. The purposes of this work were to study free-ATM and ATM-loaded poly-ε-caprolactone nanocapules (ATM-NC) cardiotoxicity and oral efficacy on Plasmodium berghei-infected mice. ATM-NC was obtained by interfacial polymer deposition and ATM was associated with polymeric NC oily core. For cardiotoxicity evaluation, male black C57BL6 uninfected or P. berghei-infected mice received, by oral route twice daily/4 days, vehicle (sorbitol/carboxymethylcellulose), blank-NC, free-ATM or ATM-NC at doses 40, 80 or 120 mg kg-1. Electrocardiogram (ECG) lead II signal was obtained before and after treatment. For ATM efficacy evaluation, female P. berghei-infected mice were treated the same way. ATM-NC improved antimalarial in vivo efficacy and reduced mice mortality. Free-ATM induced significantly QT and QTc intervals prolongation. ATM-NC (120 mg kg-1) given to uninfected mice reduced QT and QTc intervals prolongation 34 and 30%, respectively, compared with free-ATM. ATM-NC given to infected mice also reduced QT and QTc intervals prolongation, 28 and 27%, respectively. For the first time, the study showed a nanocarrier reducing cardiotoxicity of ATM given by oral route and it was more effective against P. berghei than free-ATM as monotherapy.
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The effect of malaria and anti-malarial drugs on skeletal and cardiac muscles. Malar J 2016; 15:524. [PMID: 27806725 PMCID: PMC5093925 DOI: 10.1186/s12936-016-1577-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/28/2016] [Indexed: 11/27/2022] Open
Abstract
Malaria remains one of the most important infectious diseases in the world, being a significant public health problem associated with poverty and it is one of the main obstacles to the economy of an endemic country. Among the several complications, the effects of malaria seem to target the skeletal muscle system, leading to symptoms, such as muscle aches, muscle contractures, muscle fatigue, muscle pain, and muscle weakness. Malaria cause also parasitic coronary artery occlusion. This article reviews the current knowledge regarding the effect of malaria disease and the anti-malarial drugs on skeletal and cardiac muscles. Research articles and case report publications that addressed aspects that are important for understanding the involvement of malaria parasites and anti-malarial therapies affecting skeletal and cardiac muscles were analysed and their findings summarized. Sequestration of red blood cells, increased levels of serum creatine kinase and reduced muscle content of essential contractile proteins are some of the potential biomarkers of the damage levels of skeletal and cardiac muscles. These biomarkers might be useful for prevention of complications and determining the effectiveness of interventions designed to protect cardiac and skeletal muscles from malaria-induced damage.
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Roggelin L, Pelletier D, Hill JN, Feldt T, Hoffmann S, Ansong D, Sylverken J, Burhenne J, Fischer-Herr J, Mehrfar P, Thiel C, Burchard GD, Nguah SB, Cramer JP. Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria. Malar J 2014; 13:219. [PMID: 24902591 PMCID: PMC4067506 DOI: 10.1186/1475-2875-13-219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 05/20/2014] [Indexed: 01/08/2023] Open
Abstract
Background While several anti-malarials are known to affect the electric conduction system of the heart, less is known on the direct effects of Plasmodium falciparum infection. Some earlier studies point to a direct impact of Plasmodium falciparum infection on the electric conduction system of the heart. The aim of this study was to analyse infection- and drug-induced effects on the electric conduction system. Methods Children aged 12 months to 108 months with severe malaria were included in Kumasi, Ghana. In addition to basic demographic, clinical, biochemical and parasitological, biochemical data were measured data upon hospitalization (day 0) and 12-lead electrocardiograms were recorded before (day 0) and after (day 1) initiation of quinine therapy as well as after 42 (±3) days. Results A total of 180 children were included. Most children were tachycardic on day 0 but heart rate declined on day 1 and during follow up. The corrected QT intervals were longest on day 1 and shortest on day 0. Comparison of QT intervals with day 42 (healthy status) after stratification for age demonstrated that in the youngest (<24 months) this was mainly due to a QT shortage on day 0 while a QT prolongation on day 1 was most pronounced in the oldest (≥48 months). Nearly one third of the participating children had measurable 4-aminoquinoline levels upon admission, but no direct effect on the corrected QT intervals could be shown. Conclusion Severe P. falciparum infection itself can provoke changes in the electrophysiology of the heart, independent of anti-malarial therapy. Especially in young - thus non immune - children the effect of acute disease associated pre-treatment QT-shortage is more pronounced than quinine associated QT-prolongation after therapy. Nevertheless, neither malaria nor anti-malarial induced effects on the electrophysiology of the heart were associated with clinically relevant arrhythmias in the present study population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jakob P Cramer
- Section Tropical Medicine, Department of Internal Medicine, University Center Hamburg-Eppendorf, Hamburg, Germany.
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van Meer MPA, Bastiaens GJH, Boulaksil M, de Mast Q, Gunasekera A, Hoffman SL, Pop G, van der Ven AJAM, Sauerwein RW. Idiopathic acute myocarditis during treatment for controlled human malaria infection: a case report. Malar J 2014; 13:38. [PMID: 24479524 PMCID: PMC3909449 DOI: 10.1186/1475-2875-13-38] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
A 23-year-old healthy male volunteer took part in a clinical trial in which the volunteer took chloroquine chemoprophylaxis and received three intradermal doses at four-week intervals of aseptic, purified Plasmodium falciparum sporozoites to induce protective immunity against malaria. Fifty-nine days after the last administration of sporozoites and 32 days after the last dose of chloroquine the volunteer underwent controlled human malaria infection (CHMI) by the bites of five P. falciparum-infected mosquitoes. Eleven days post-CHMI a thick blood smear was positive (6 P. falciparum/μL blood) and treatment was initiated with atovaquone/proguanil (Malarone®). On the second day of treatment, day 12 post-CHMI, troponin T, a marker for cardiac tissue damage, began to rise above normal, and reached a maximum of 1,115 ng/L (upper range of normal = 14 ng/L) on day 16 post-CHMI. The volunteer had one ~20 minute episode of retrosternal chest pain and heavy feeling in his left arm on day 14 post-CHMI. ECG at the time revealed minor repolarization disturbances, and cardiac MRI demonstrated focal areas of subepicardial and midwall delayed enhancement of the left ventricle with some oedema and hypokinesia. A diagnosis of myocarditis was made. Troponin T levels were normal within 16 days and the volunteer recovered without clinical sequelae. Follow-up cardiac MRI at almost five months showed normal function of both ventricles and disappearance of oedema. Delayed enhancement of subepicardial and midwall regions decreased, but was still present. With the exception of a throat swab that was positive for rhinovirus on day 14 post-CHMI, no other tests for potential aetiologies of the myocarditis were positive. A number of possible aetiological factors may explain or have contributed to this case of myocarditis including, i) P. falciparum infection, ii) rhinovirus infection, iii) unidentified pathogens, iv) hyper-immunization (the volunteer received six travel vaccines between the last immunization and the CHMI), v) atovaquone/proguanil treatment, or vi) a combination of these factors. Definitive aetiology and pathophysiological mechanism for the myocarditis have not been established.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Robert W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Myocardial Dysfunction: A Primary Cause of Death Due To Severe Malaria in A Plasmodium falciparum-Infected Humanized Mouse Model. IRANIAN JOURNAL OF PARASITOLOGY 2013; 8:499-509. [PMID: 25516729 PMCID: PMC4266112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 09/11/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Our study aimed at substantiating the recent claim of myocardial complications in severe malaria by experimentally inducing severe Plasmodium falciparum infection in a humanized mouse model employed as human surrogate. METHODS Twenty five humanized mice were inoculated with standard in vitro cultured P. falciparum and blood extracts collected from the inner cardiac muscles of infected mice that died were examined for the presence of the infectious cause of death. The therapeutic effect of quinine on 7 mice severely infected with P. falciparum was also evaluated. RESULTS All the 25 humanized mice inoculated with the in vitro cultured P. falciparum revealed peripheral parasitemia with a total of 10 deaths recorded. Postmortem examination of the inner cardiac muscles of the dead mice also revealed massive sequestration of mature P. falciparum as well as significant infiltration of inflammatory cells such as lymphocytes and monocytes. Postmortem evaluation of the inner cardiac muscles of the P. falciparum-infected mice after quinine therapy showed significant decline in parasite density with no death of mice recorded. CONCLUSIONS Data obtained from our study significantly corroborated the findings of myocardial dysfunction as the primary cause of death in recent case reports of humans infected with P. falciparum.
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