1
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Joste V, Colard-Itté E, Guillochon É, Ariey F, Coppée R, Clain J, Houzé S. Genetic Profiling of Plasmodium ovale wallikeri Relapses With Microsatellite Markers and Whole-Genome Sequencing. J Infect Dis 2023; 228:1089-1098. [PMID: 37329228 DOI: 10.1093/infdis/jiad216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/14/2023] [Accepted: 06/15/2023] [Indexed: 06/18/2023] Open
Abstract
Like Plasmodium vivax, both Plasmodium ovale curtisi and Plasmodium ovale wallikeri have the ability to cause relapse in humans, defined as recurring asexual parasitemia originating from liver-dormant forms subsequent to a primary infection. Here, we investigated relapse patterns in P ovale wallikeri infections from a cohort of travelers who were exposed to the parasite in sub-Saharan Africa and then experienced relapses after their return to France. Using a novel set of 8 highly polymorphic microsatellite markers, we genotyped 15 P ovale wallikeri relapses. For most relapses, the paired primary and relapse infections were highly genetically related (with 12 being homologous), an observation that was confirmed by whole-genome sequencing for the 4 relapses we further studied. This is, to our knowledge, the first genetic evidence of relapses in P ovale spp.
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Affiliation(s)
- Valentin Joste
- Mère et enfant en milieu tropical, Institut Recherche pour le Développement, Université Paris Cité
- Centre National de Référence du Paludisme, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard
| | - Emma Colard-Itté
- Centre National de Référence du Paludisme, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard
| | - Émilie Guillochon
- Mère et enfant en milieu tropical, Institut Recherche pour le Développement, Université Paris Cité
| | - Frédéric Ariey
- Inserm U1016, Institut Cochin, Laboratoire de parasitologie-mycologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris Cité
| | - Romain Coppée
- Université Paris Cité and Sorbonne Paris Nord, Inserm, IAME, Paris, France
| | - Jérôme Clain
- Mère et enfant en milieu tropical, Institut Recherche pour le Développement, Université Paris Cité
- Centre National de Référence du Paludisme, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard
| | - Sandrine Houzé
- Mère et enfant en milieu tropical, Institut Recherche pour le Développement, Université Paris Cité
- Centre National de Référence du Paludisme, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard
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2
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Kaur N, Korkor C, Mobin SM, Chibale K, Singh K. Fluorene-Chloroquine Hybrids: Synthesis, in vitro Antiplasmodial Activity, and Inhibition of Heme Detoxification Machinery of Plasmodium falciparum. ChemMedChem 2022; 17:e202200414. [PMID: 36017666 DOI: 10.1002/cmdc.202200414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/22/2022] [Indexed: 11/10/2022]
Abstract
Fluorene-chloroquine hybrids have been identified as a new promising class of antiplasmodial agents. The most active compound 9d exhibited good in vitro antiplasmodial activity against a chloroquine-sensitive NF54 strain of the human malaria parasite Plasmodium falciparum with an IC50 value of 139 nM. UV-visible absorption, FTIR spectral and 1H NMR titration data corroborated the binding of 9d to monomeric and µ-oxodimeric heme as well as inhibition of β-hematin formation, which collectively supported the inhibition of heme detoxification machinery in P. falciparum. In silico docking studies revealed the binding interactions of the hybrids in the active site of the wild type as well as quadruple mutant of Pf-DHFR-TS dihydrofolate enzyme. Further, the ADMET parameters were predicted and were in good agreement with the expected values, suggesting the drug likeness of the synthesized hybrid molecules.Introduction.
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Affiliation(s)
- Navpreet Kaur
- IIT Indore Discipline of Chemistry: Indian Institute of Technology Indore Discipline of Chemistry, Chemistry, INDIA
| | - Constance Korkor
- University of Cape Town Institute of Infectious Disease and Molecular Medicine, Chemistry, INDIA
| | - Shaikh M Mobin
- IIT Indore: Indian Institute of Technology Indore, Chemistry, INDIA
| | - Kelly Chibale
- University of Cape Town Institute of Infectious Disease and Molecular Medicine, Chemistry, INDIA
| | - Kamaljit Singh
- Guru Nanak Dev University, Department of Chemistry, Centre for Advanced Studies-II, Guru Nanak Dev University, Amritsar-143005, 143005, Amritsar, INDIA
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3
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Akinyi MY, Chifwete M, Ndwiga L, Kimenyi KM, Osoti V, Ochola-Oyier LI. A cross-sectional analysis identifies a low prevalence of Plasmodium ovale curtisi infections in symptomatic and asymptomatic individuals in Kilifi county, Kenya. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17972.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The focus on P. falciparum diagnosis has led to an underestimation of the global burden of malaria resulting from neglected Plasmodium species. However, there is still scarce data on the prevalence of P. ovale globally. To address this knowledge gap, data collected from cross-sectional studies in Kilifi county were used to: 1) determine the prevalence of P. ovale curtisi infections; and 2) determine the sensitivity of different diagnostic assays in detecting P. ovale curtisi infections. Methods: A total of 531 individuals were sampled across three study sites in Kilifi County, Kenya between 2009 and 2020. Blood smears were prepared from peripheral blood and screened for Plasmodium parasite stages using light microscopy. Molecular screening involved DNA extraction of dried blood spots and blood in ethylenediaminetetraacetic acid, polymerase chain reaction (PCR) using primers targeting the 18 small ribosomal subunit and sequencing. Results: Microscopy screening revealed that the most prevalent species was P. falciparum (32.0%) followed by P. malariae (9.0%) and then P. ovale (1.5%). PCR screening identified additional P. ovale curtisi positives cases. Overall, 48 (8.2%) out of the 531 individuals harbored P. ovale curtisi infection with the highest prevalence reported in the tertiary health facility, (14.6%, 95% CI 8-23.6%), followed by the primary health facility (8.6%, 95% CI 5.4-11.9%), and the community from a cross-sectional blood survey, (6.5%, 95% CI 3.0-11.8%). Microscopy screening for P. ovale had a low sensitivity of 7% (95% CI 1-19-30%) and a high specificity of 99% (95% CI 98-100%). Sequencing results confirmed the presence of P.ovale curtisi. Conclusions: This study provides baseline data for P.ovale curtisi surveillance in Kilifi County, primarily using PCR to improve diagnosis. These results suggest that malaria elimination and eradication efforts should not only concentrate on P. falciparum but should embrace a holistic approach towards elimination of all Plasmodium species.
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4
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Groger M, Tona Lutete G, Mombo-Ngoma G, Ntamabyaliro NY, Kahunu Mesia G, Muena Mujobu TB, Dimessa Mbadinga LB, Zoleko Manego R, Egger-Adam D, Borghini-Fuhrer I, Shin J, Miller R, Arbe-Barnes S, Duparc S, Ramharter M. Effectiveness of pyronaridine-artesunate against Plasmodium malariae, Plasmodium ovale spp, and mixed-Plasmodium infections: a post-hoc analysis of the CANTAM-Pyramax trial. THE LANCET MICROBE 2022; 3:e598-e605. [PMID: 35654079 PMCID: PMC9329129 DOI: 10.1016/s2666-5247(22)00092-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 12/21/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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5
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Tournoy TK, Rosanas-Urgell A, Van Esbroeck M, Bottieau E, Huits R. Plasmodium malariae after successful treatment of P. falciparum malaria with artemether-lumefantrine. Int J Infect Dis 2022; 119:56-58. [PMID: 35358721 DOI: 10.1016/j.ijid.2022.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
We describe a case of Plasmodium malariae malaria in a traveler returning from the Democratic Republic of Congo to Belgium. This occurred despite successful artemether-lumefantrine treatment for Plasmodium falciparum three weeks earlier and in absence of re-exposure in an endemic area. We discuss possible explanations for this unusual observation.
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Affiliation(s)
- Tijs K Tournoy
- Ghent University Hospital - Ghent Belgium, Corneel Heymanslaan 10.
| | - Anna Rosanas-Urgell
- Institute of Tropical Medicine Antwerp - Antwerp Belgium, Kronenburgstraat 43.
| | - Marjan Van Esbroeck
- Institute of Tropical Medicine Antwerp - Antwerp Belgium, Kronenburgstraat 43.
| | - Emmanuel Bottieau
- Institute of Tropical Medicine Antwerp - Antwerp Belgium, Kronenburgstraat 43.
| | - Ralph Huits
- Institute of Tropical Medicine Antwerp - Antwerp Belgium, Kronenburgstraat 43.
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6
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Agonhossou R, Akoton R, Dossou YA, Avokpaho E, Mbama DNJ, Boussougou-Sambe TS, Francis NN, Ndo C, Ntoumi F, Wondji CS, Adegnika AA, Borrmann S, Issifou S, Djogbénou LS. Surveillance of Plasmodium malariae infection among inhabitants of rural areas in Ouidah-Kpomasse-Tori Bossito health district, Benin. Parasitol Res 2022; 121:275-286. [PMID: 34981216 DOI: 10.1007/s00436-021-07398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
Among the Plasmodium species that infect humans, P. falciparum has been largely studied in malaria endemic areas. However, P. malariae infection is less documented among the human population. This study aimed to monitor the prevalence and distribution of P. malariae in Southern Benin. A cross-sectional survey was conducted in rural localities in the Ouidah-Kpomasse-Tori Bossito (OKT) health district in Southern Benin from June to October 2019. Socio-demographic data were collected using a questionnaire, while malaria infection data were obtained on the one hand by microscopy diagnosis and, on the other, by nested polymerase chain reaction (PCR). Based on microscopy, the prevalence of P. malariae mono-infection and coinfection of P. falciparum, P. malariae was respectively 2.3% and 1.2% in the OKT health district. This prevalence was higher (P < 0.01) than that reported by Damien et al. (2010) 10 years ago in the same study area with 0.7% and 0.3% of P. malariae and P. falciparum/P. malariae, respectively. Based on PCR analysis, P. malariae prevalence was 14.1%, including 5.2% of mono-infection and 8.9% of mixed infection with P. falciparum. Sub-microscopic Plasmodium infections were high (30.6%) and more pronounced in older participants (>20 years). The present study revealed that P. malariae increased in the OKT health district with a high prevalence of submicroscopic infection. Since our results provide valuable evidence of increasing P. malariae infection, the National Malaria Control Programs (NMCPs) must consider P. malariae when designing future measures for effective control and malaria treatment.
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Affiliation(s)
- Romuald Agonhossou
- Tropical Infectious Diseases Research Centre (TIDRC), University of Abomey-Calavi, 01BP 526, Cotonou, Benin
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Romaric Akoton
- Tropical Infectious Diseases Research Centre (TIDRC), University of Abomey-Calavi, 01BP 526, Cotonou, Benin.
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin.
| | - Yannelle A Dossou
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Euripide Avokpaho
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Dollon N J Mbama
- Fondation Congolaise pour la Recherche Medicale (FCRM), Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
| | - Terence S Boussougou-Sambe
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Nongley N Francis
- Department of Parasitology and Medical Entomology, Centre for Research in Infectious Diseases (CRID), Centre Region, Yaounde, 237, Cameroon
- Department of Microbiology and Parasitology, University of Buea, South West, Buea, 237, Cameroon
| | - Cyrille Ndo
- Department of Parasitology and Medical Entomology, Centre for Research in Infectious Diseases (CRID), Centre Region, Yaounde, 237, Cameroon
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Medicale (FCRM), Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Charles S Wondji
- Department of Parasitology and Medical Entomology, Centre for Research in Infectious Diseases (CRID), Centre Region, Yaounde, 237, Cameroon
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Ayola A Adegnika
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
- Eberhard Karls Universität Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Steffen Borrmann
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Saadou Issifou
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Luc S Djogbénou
- Tropical Infectious Diseases Research Centre (TIDRC), University of Abomey-Calavi, 01BP 526, Cotonou, Benin
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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7
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Oriero EC, Amenga-Etego L, Ishengoma DS, Amambua-Ngwa A. Plasmodium malariae, current knowledge and future research opportunities on a neglected malaria parasite species. Crit Rev Microbiol 2021; 47:44-56. [PMID: 33507842 DOI: 10.1080/1040841x.2020.1838440] [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: 12/18/2022]
Abstract
Plasmodium malariae is often reported as a benign malaria parasite. There are limited data on its biology and disease burden in sub-Saharan Africa (sSA) possibly due to the unavailability of specific and affordable tools for routine diagnosis and large epidemiology studies. In addition, P. malariae occurs at low parasite densities and in co-infections with other species, predominately P. falciparum. The paucity of data on P. malariae infections limits the capacity to accurately determine its contribution to malaria and the effect of control interventions against P. falciparum on its prevalence. Here, we summarise the current knowledge on P. malariae epidemiology in sSA - overall prevalence ranging from 0-32%, as detected by different diagnostic methods; seroprevalence ranging from 0-56% in three countries (Mozambique, Benin and Zimbabwe), and explore the future application of next-generation sequencing technologies as a tool for enriching P. malariae genomic epidemiology. This will provide insights into important adaptive mechanisms of this neglected non-falciparum species, including antimalarial drug resistance, local and regional parasite transmission patterns and genomic signatures of selection. Improved diagnosis and genomic surveillance of non-falciparum malaria parasites in Africa would be helpful in evaluating progress towards elimination of all human Plasmodium species.
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Affiliation(s)
- Eniyou C Oriero
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Lucas Amenga-Etego
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Deus S Ishengoma
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Alfred Amambua-Ngwa
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at LSHTM, Fajara, The Gambia
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8
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Adegbite BR, Edoa JR, Honkpehedji YJ, Zinsou FJ, Dejon-Agobe JC, Mbong-Ngwese M, Lotola-Mougueni F, Koehne E, Lalremruata A, Kreidenweiss A, Nguyen TT, Kun J, Agnandji ST, Lell B, Safiou AR, Obone Atome FA, Mombo-Ngoma G, Ramharter M, Velavan TP, Mordmüller B, Kremsner PG, Adegnika AA. Monitoring of efficacy, tolerability and safety of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Lambaréné, Gabon: an open-label clinical trial. Malar J 2019; 18:424. [PMID: 31842893 PMCID: PMC6916217 DOI: 10.1186/s12936-019-3015-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/20/2019] [Indexed: 02/01/2023] Open
Abstract
Background Malaria remains a major public health problem, affecting mainly low-and middle-income countries. The management of this parasitic disease is challenged by ever increasing drug resistance. This study, investigated the therapeutic efficacy, tolerability and safety of artemether–lumefantrine (AL) and artesunate–amodiaquine (AS–AQ), used as first-line drugs to treat uncomplicated malaria in Lambaréné, Gabon. Methods A non-randomized clinical trial was conducted between October 2017 and March 2018 to assess safety, clinical and parasitological efficacy of fixed-doses of AL and AS–AQ administered to treat uncomplicated Plasmodium falciparum malaria in children aged from 6 months to 12 years. After 50 children were treated with AL, another 50 children received ASAQ. The 2009 World Health Organization protocol for monitoring of the efficacy of anti‑malarial drugs was followed. Molecular markers msp1 and msp2 were used to differentiate recrudescence and reinfection. For the investigation of artemisinin resistant markers, gene mutations in Pfk13 were screened. Results Per-protocol analysis on day 28 showed a PCR corrected cure rate of 97% (95% CI 86–100) and 95% (95% CI 84–99) for AL and AS–AQ, respectively. The most frequent adverse event in both groups was asthenia. No mutations in the kelch-13 gene associated with artemisinin resistance were identified. All participants had completed microscopic parasite clearance by day 3 post-treatment. Conclusion This study showed that AL and AS–AQ remain efficacious, well-tolerated, and are safe to treat uncomplicated malaria in children from Lambaréné. However, a regular monitoring of efficacy and a study of molecular markers of drug resistance to artemisinin in field isolates is essential. Trial registration ANZCTR, ACTRN12616001600437. Registered 18 November, http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12616001600437p&isBasic=True
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Affiliation(s)
- Bayode R Adegbite
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon
| | - Jean R Edoa
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon
| | - Yabo J Honkpehedji
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frejus J Zinsou
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean C Dejon-Agobe
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Erik Koehne
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Albert Lalremruata
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - The T Nguyen
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Vietnamese-German Center for Medical Research, Hanoi, Vietnam
| | - Jutta Kun
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Selidji T Agnandji
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Abdou R Safiou
- Programme National de Lutte contre le paludisme, Libreville, Gabon
| | | | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thirumalaisamy P Velavan
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Vietnamese-German Center for Medical Research, Hanoi, Vietnam
| | - Benjamin Mordmüller
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research, Tübingen, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,German Center for Infection Research, Tübingen, Germany
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné, BP: 242, Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. .,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. .,German Center for Infection Research, Tübingen, Germany.
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9
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Artemether/Lumefantrine for the Treatment of P. malariae in a Patient on Hemodialysis. Case Rep Med 2019; 2019:1326171. [PMID: 30891070 PMCID: PMC6390258 DOI: 10.1155/2019/1326171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/15/2019] [Indexed: 11/26/2022] Open
Abstract
The combination of artemether/lumefantrine is indicated for the treatment of acute uncomplicated Plasmodium falciparum malaria. There have been no clinical trials to assess the efficacy of this medication in patients with renal impairment. While it is unlikely that artemether/lumefantrine would be removed during dialysis, clinical experience regarding drug use in this setting is limited. In this article, the authors report successful treatment of Plasmodium malariae malaria on a patient with end-stage kidney disease undergoing hemodialysis.
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10
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MAZHARI N, NATEGHPOUR M, HEYDARIAN P, FARIVAR L, SOURI E, MOTEVALLI HAGHI A. In Vivo Anti-Malarial Activity of Heracleum persicum Fruit Extract, in Combination with Chloroquine against Chloroquine-Sensitive Strain of Plasmodium berghei. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:868-874. [PMID: 30087873 PMCID: PMC6077635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated the anti-malarial activity of Heracleum persicum individually and in combination with chloroquine. METHODS This study was conducted at the School of Public Health, Tehran University of Medical Sciences, Tehran, Iran in 2015-2016. The Peter's method was used for determining fifty percent effective dose (ED50) of the H. persicum extract and chloroquine individually against chloroquine sensitive P. berghei in small white mice. Six experimental groups for H. persicum and 6 groups for chloroquine and two control group (positive and negative) were considered for determination of ED50. Interaction between H. persicum and chloroquine also was evaluated based on fixed ratios method. Ratios of 0/100, 20/80, 40/60, 60/40, 80/20, 100/0 of ED50 of chloroquine and H. persicum respectively were tested against the parasite. Then inhibitory effects of two drugs were calculated and plotted in the relevant graphs. RESULTS Overall, 1500 mg/kg, and 1000 mg/kg concentrations of H. persicum against P. berghei resulted in ED50 and ED74 respectively. ED50 of chloroquine against the parasite was obtained as 1.4 mg/kg of mouse body weight. Moreover, combination of H. persicum and chloroquine showed a weak potentiation in ratios of 40/60 (chloroquine +H. persicum) with 64% inhibition, but not in other ratios. CONCLUSION Although H. persicum individually showed a reasonable antimalarial efficacy against chloroquine sensitive P. berghei, in combination with chloroquine it showed additive or antagonism result except in ratios of 40%CQ+60%HP.
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Affiliation(s)
- Nahideh MAZHARI
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi NATEGHPOUR
- Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman HEYDARIAN
- Dept. of Medical Parasitology and Mycology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Leila FARIVAR
- Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Effat SOURI
- Dept. of Pharmaceutical Chemical, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh MOTEVALLI HAGHI
- Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Prospective Clinical Trial Assessing Species-Specific Efficacy of Artemether-Lumefantrine for the Treatment of Plasmodium malariae, Plasmodium ovale, and Mixed Plasmodium Malaria in Gabon. Antimicrob Agents Chemother 2018; 62:AAC.01758-17. [PMID: 29311086 DOI: 10.1128/aac.01758-17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022] Open
Abstract
Treatment recommendations for Plasmodium malariae and Plasmodium ovale malaria are largely based on anecdotal evidence. The aim of this prospective study, conducted in Gabon, was to systematically assess the efficacy and safety of artemether-lumefantrine for the treatment of patients with uncomplicated P. malariae or P. ovale species monoinfections or mixed Plasmodium infections. Patients with microscopically confirmed P. malariae, P. ovale, or mixed-species malaria with at least one of these two Plasmodium species were treated with an oral, fixed-dose combination of artemether-lumefantrine for 3 consecutive days. The primary endpoints were per-protocol PCR-corrected adequate clinical and parasitological response (ACPR) on days 28 and 42. Tolerability and safety were recorded throughout the follow-up period. Seventy-two participants (42 male and 30 female) were enrolled; 62.5% of them had PCR-corrected mixed Plasmodium infections. Per protocol, PCR-corrected ACPR rates were 96.6% (95% confidence interval [CI], 91.9 to 100) on day 28 and 94.2% (95% CI, 87.7 to 100) on day 42. Considering Plasmodium species independently from their coinfecting species, day 42 ACPR rates were 95.5% (95% CI, 89.0 to 100) for P. falciparum, 100% (exact CI, 84.6 to 100) for P. malariae, 100% (exact CI, 76.8 to 100) for P. ovale curtisi, and 90.9% (95% CI, 70.7 to 100) for P. ovale wallikeri Study drug-related adverse events were generally mild or moderate. In conclusion, this clinical trial demonstrated satisfying antimalarial activity of artemether-lumefantrine against P. ovalewallikeri, P. ovale curtisi, P. malariae, and mixed Plasmodium infections, with per-protocol efficacies of 90% to 100% and without evident tolerability or safety concerns. (This trial was registered in the clinical study database ClinicalTrials.gov under the identifier NCT02528279.).
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12
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Nakamura-Uchiyama F, Katanami Y, Kikuchi T, Takaya S, Kutsuna S, Kobayashi T, Mizuno Y, Hasegawa T, Koga M, Yoshimura Y, Hasegawa C, Kato Y, Kimura M, Maruyama H. Retrospective observational study of the use of artemether-lumefantrine in the treatment of malaria in Japan. Travel Med Infect Dis 2018; 22:40-45. [PMID: 29454051 DOI: 10.1016/j.tmaid.2018.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Research Group on Chemotherapy of Tropical Diseases, Japan, introduced artemether-lumefantrine (AL) in late 2002, mainly for treating uncomplicated Plasmodium falciparum malaria. Because AL was on the market in Japan in March 2017, the effectiveness and safety of AL were analyzed to help medical personnel use AL optimally. METHODS Case report forms submitted by the attending physicians were analyzed. When necessary, direct contact with the attending physicians was made to obtain detailed information. RESULTS Effectiveness analysis was performed for 62 cases and safety analysis was performed for 66 cases. In P. falciparum malaria, the overall cure rate was 91.1% (51/56), of which the cure rates for Japanese and non-Japanese patients were 82.1% (23/28) and 100% (28/28), respectively. The successfully treated cases included severe P. falciparum malaria, with parasite densities exceeding 500,000/μL. Adverse events were reported in 14 patients, including delayed hemolytic anemia which occurred in the top four highest parasitemic cases. CONCLUSIONS AL treatment failure in P. falciparum malaria may not be rare among non-immune individuals, including Japanese. The possibility of delayed hemolytic anemia, which occurs preferentially in high parasitemic cases, should be considered following AL treatment.
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Affiliation(s)
- Fukumi Nakamura-Uchiyama
- Department of Infectious Diseases, Tokyo Metropolitan Health and Medical Corporation Ebara Hospital, Tokyo, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadashi Kikuchi
- Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Saho Takaya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Taiichiro Kobayashi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasutaka Mizuno
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuo Hasegawa
- Department of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Michiko Koga
- Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yukihiro Yoshimura
- Department of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Chihiro Hasegawa
- Department of Infectious Diseases, Nagoya City East Medical Center, Nagoya, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mikio Kimura
- Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Haruhiko Maruyama
- Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
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13
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[Plasmodium ovale wallikeri and Plasmodium ovale curtisi Malaria in Senegal in 2016]. ACTA ACUST UNITED AC 2017; 110:286-290. [PMID: 29127650 DOI: 10.1007/s13149-017-0578-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
Recently in Senegal, a case of Plasmodium ovale malaria had led to a diagnostic difficulty due to the ignorance of this parasite and the neglect of it. The objective of this study was to actively investigate cases of P. ovale malaria that would be misdiagnosed in the health centre structures of Senegal. The study was conducted in three areas that reflect different epidemiological strata of malaria. Microscopy was performed by microscopy experts on suspected malaria patients. The results were validated by Rougemont real-time PCR. Positive P. ovale cases were genotyped by nested PCR targeting the potra gene. A total of 406 samples were taken. Microscopy of Giemsa stained thick and thin smears recorded 228 cases of Plasmodium falciparum (97%), 3 cases of Plasmodium malariae (1.3%), and 4 cases of P. ovale (1.7%). The cases of P. ovale observed at microscopy were confirmed by real-time PCR. Genotyping of P. ovale revealed 3 cases of P. ovale wallikeri and 1 case of P. ovale curtisi. The prevalence of P. ovale malaria remains low in Senegal. However, malaria microscopists should be trained to recognize non-falciparum species in order to avoid the diagnostic delays and unnecessary investigations. National malaria control program should consider those species for the better management of malaria control in the country. Simplified molecular methods like, loop-mediated isothermal amplification (LAMP) may be useful to better characterize the epidemiology of non-falciparum malaria.
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14
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Lalremruata A, Jeyaraj S, Engleitner T, Joanny F, Lang A, Bélard S, Mombo-Ngoma G, Ramharter M, Kremsner PG, Mordmüller B, Held J. Species and genotype diversity of Plasmodium in malaria patients from Gabon analysed by next generation sequencing. Malar J 2017; 16:398. [PMID: 28974215 PMCID: PMC5627438 DOI: 10.1186/s12936-017-2044-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/22/2017] [Indexed: 11/22/2022] Open
Abstract
Background Six Plasmodium species are known to naturally infect humans. Mixed species infections occur regularly but morphological discrimination by microscopy is difficult and multiplicity of infection (MOI) can only be evaluated by molecular methods. This study investigated the complexity of Plasmodium infections in patients treated for microscopically detected non-falciparum or mixed species malaria in Gabon. Methods Ultra-deep sequencing of nucleus (18S rRNA), mitochondrion, and apicoplast encoded genes was used to evaluate Plasmodium species diversity and MOI in 46 symptomatic Gabonese patients with microscopically diagnosed non-falciparum or mixed species malaria. Results Deep sequencing revealed a large complexity of confections in patients with uncomplicated malaria, both on species and genotype levels. Mixed infections involved up to four parasite species (Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale curtisi, and P. ovale wallikeri). Multiple genotypes from each species were determined from the asexual 18S rRNA gene. 17 of 46 samples (37%) harboured multiple genotypes of at least one Plasmodium species. The number of genotypes per sample (MOI) was highest in P. malariae (n = 4), followed by P. ovale curtisi (n = 3), P. ovale wallikeri (n = 3), and P. falciparum (n = 2). The highest combined genotype complexity in samples that contained mixed-species infections was seven. Conclusions Ultra-deep sequencing showed an unexpected breadth of Plasmodium species and within species diversity in clinical samples. MOI of P. ovale curtisi, P. ovale wallikeri and P. malariae infections were higher than anticipated and contribute significantly to the burden of malaria in Gabon. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-2044-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Albert Lalremruata
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,German Centre for Infection Research, partner site Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Sankarganesh Jeyaraj
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,PSG Institute of Advanced Studies, Coimbatore, 641 004, India
| | - Thomas Engleitner
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Department of Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Fanny Joanny
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Annika Lang
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Sabine Bélard
- Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | | | - Michael Ramharter
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,German Centre for Infection Research, partner site Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter G Kremsner
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,German Centre for Infection Research, partner site Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Benjamin Mordmüller
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany. .,German Centre for Infection Research, partner site Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany. .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.
| | - Jana Held
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,German Centre for Infection Research, partner site Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
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15
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Fourmont L, Revest M, Polard E, Lederlin M, Delaval P, Desrues B, Tattevin P, Jouneau S. Acute eosinophilic pneumonia following artenimol-piperaquine exposure. J Travel Med 2017; 24:3820938. [PMID: 28499010 DOI: 10.1093/jtm/tax023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/13/2022]
Abstract
Acute eosinophilic pneumonia (AEP) has been reported following chloroquine or mefloquine exposure, both structurally related to piperaquine. We report a case of AEP with typical CT scan patterns, hypereosinophilia in blood (9.8 109/l), and bronchoalveolar lavage (78% of 600 000 cells/ml), 10 days after artenimol-piperaquine exposure in a 26-year-old man.
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Affiliation(s)
- Lisa Fourmont
- Department of Pneumology, Pontchaillou University Hospital, Rennes, France
| | - Matthieu Revest
- Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, Cedex, France
| | - Elisabeth Polard
- Department of Pharmacology and Pharmacovigilance, Pontchaillou University Hospital, Rennes, France
| | - Mathieu Lederlin
- Department of Radiology, Pontchaillou University Hospital, Rennes, France
| | - Philippe Delaval
- Department of Pneumology, Pontchaillou University Hospital, Rennes, France
| | - Benoit Desrues
- Department of Pneumology, Pontchaillou University Hospital, Rennes, France
| | - Pierre Tattevin
- Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, Cedex, France
| | - Stéphane Jouneau
- Department of Pneumology, Pontchaillou University Hospital, Rennes, France
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16
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Rutledge GG, Marr I, Huang GKL, Auburn S, Marfurt J, Sanders M, White NJ, Berriman M, Newbold CI, Anstey NM, Otto TD, Price RN. Genomic Characterization of Recrudescent Plasmodium malariae after Treatment with Artemether/Lumefantrine. Emerg Infect Dis 2017; 23:1300-1307. [PMID: 28430103 PMCID: PMC5547787 DOI: 10.3201/eid2308.161582] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Plasmodium malariae is the only human malaria parasite species with a 72-hour intraerythrocytic cycle and the ability to persist in the host for life. We present a case of a P. malariae infection with clinical recrudescence after directly observed administration of artemether/lumefantrine. By using whole-genome sequencing, we show that the initial infection was polyclonal and the recrudescent isolate was a single clone present at low density in the initial infection. Haplotypic analysis of the clones in the initial infection revealed that they were all closely related and were presumably recombinant progeny originating from the same infective mosquito bite. We review possible explanations for the P. malariae treatment failure and conclude that a 3-day artemether/lumefantrine regimen is suboptimal for this species because of its long asexual life cycle.
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17
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Non-falciparum malaria in Dakar: a confirmed case of Plasmodium ovale wallikeri infection. Malar J 2016; 15:429. [PMID: 27557982 PMCID: PMC4997729 DOI: 10.1186/s12936-016-1485-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/11/2016] [Indexed: 11/15/2022] Open
Abstract
Background Plasmodium ovale is rarely described in Senegal. A case of clinical malaria due to P. ovale wallikeri in West Central of Senegal is reported. Case A 34-year-old male baker in Dakar, with no significant previous medical history, was admitted to a health clinic with fever and vomiting. Fever had been lasting for 4 days with peaks every 48 h. As monospecific Plasmodium falciparum HRP-2 RDT was negative, he was treated with antibiotics. However, owing to persisting symptoms, he was referred to the emergency unit of the Youssou Mbargane Diop Hospital, Dakar, Senegal. Clinical examination found impaired general condition. All other physical examinations were normal. Laboratory tests showed anaemia (haemoglobin 11.4 g/dl), severe thrombocytopaenia (platelets 30 × 109/mm3), leukopenia (3650/mm3), lymphocytopenia (650/mm3). Renal function was normal as indicated by creatininaemia and uraemia (11 mg/l and 0.25 g/l, respectively) and liver enzymes were slightly elevated (aspartate aminotransferase 77 UI/l and alanine aminotransferase 82 UI/l). Blood smear evaluations in Parasitology Laboratory of Aristide Le Dantec Hospital showed malaria parasites of the species P. ovale with a 0.08 % parasitaemia. Molecular confirmation was done by real time PCR targeting the 18S rRNA gene. The P. ovale infection was further analysed to species level targeting the potra gene and was identified as P. ovale wallikeri. According to the hospital’s malaria treatment guidelines for severe malaria, treatment consisted of intravenous quinine at hour 0 (start of treatment) and 24 h after initial treatment, followed by artemether–lumefantrine 24 h later. A negative microscopy was noted on day 3 post-treatment and the patient reported no further symptoms. Conclusion Malaria due to non-falciparum species is probably underestimated in Senegal. RDTs specific to non-falciparum species and/or pan specific RDTs should be included as tools of diagnosis to fight against malaria in Senegal. In addition, a field-deployable molecular tool such as the loop-mediated isothermal amplification can be considered as an additional useful tool to detect low malaria parasite infections and for speciation. In addition, national malaria control policies should consider other non-falciparum species in treatment guidelines, including the provision of primaquine for the treatment of relapsing parasites.
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18
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Langford S, Douglas NM, Lampah DA, Simpson JA, Kenangalem E, Sugiarto P, Anstey NM, Poespoprodjo JR, Price RN. Plasmodium malariae Infection Associated with a High Burden of Anemia: A Hospital-Based Surveillance Study. PLoS Negl Trop Dis 2015; 9:e0004195. [PMID: 26720002 PMCID: PMC4697806 DOI: 10.1371/journal.pntd.0004195] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/05/2015] [Indexed: 11/23/2022] Open
Abstract
Background Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown. Methodology/Principal Findings We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6% of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0–4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0g/dL) than patients with P. falciparum (9.5g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% (95% Confidence Interval; 0.10% to 1.4%). Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0% for P. ovale to 1.6% for P. falciparum). Conclusions/Significance Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome. Plasmodium malariae is a relatively rare, but widely distributed, cause of malaria. It can persist in the human host for years, often without causing significant symptoms. As a result, P. malariae will be a very difficult species to eradicate. Our study used data from a routine hospital-based surveillance system in southern Papua, Indonesia to describe the clinical epidemiology of P. malariae infections. Over a 10-year period there were 5,097 patient presentations to Mitra Masyarakat Hospital associated with P. malariae infection constituting 2.6% of all malaria cases. Patients with P. malariae malaria had a significantly older age distribution than those with P. vivax infections. They also had lower mean hemoglobin concentrations than patients infected with P. falciparum, P. vivax or mixed Plasmodium species. We speculate that this may be due to chronic hemolysis of parasitized and non-parasitized red cells as a result of persistent infection. One in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome, a well-known but to date unquantified complication. Overall, 0.3% of patients with P. malariae malaria died. These findings emphasize the need to consider this parasite when designing comprehensive malaria elimination strategies.
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Affiliation(s)
- Siobhan Langford
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
- Division of Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel A. Lampah
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Health Authority, Timika, Papua, Indonesia
| | | | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Health Authority, Timika, Papua, Indonesia
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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19
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Teo BHY, Lansdell P, Smith V, Blaze M, Nolder D, Beshir KB, Chiodini PL, Cao J, Färnert A, Sutherland CJ. Delayed Onset of Symptoms and Atovaquone-Proguanil Chemoprophylaxis Breakthrough by Plasmodium malariae in the Absence of Mutation at Codon 268 of pmcytb. PLoS Negl Trop Dis 2015; 9:e0004068. [PMID: 26485258 PMCID: PMC4618945 DOI: 10.1371/journal.pntd.0004068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/18/2015] [Indexed: 11/19/2022] Open
Abstract
Plasmodium malariae is widely distributed across the tropics, causing symptomatic malaria in humans with a 72-hour fever periodicity, and may present after latency periods lasting up to many decades. Delayed occurrence of symptoms is observed in humans using chemoprophylaxis, or patients having received therapies targeting P. falciparum intraerythrocytic asexual stages, but few investigators have addressed the biological basis of the ability of P. malariae to persist in the human host. To investigate these interesting features of P. malariae epidemiology, we assembled, here, an extensive case series of P. malariae malaria patients presenting in non-endemic China, Sweden, and the UK who returned from travel in endemic countries, mainly in Africa. Out of 378 evaluable P. malariae cases, 100 (26.2%) reported using at least partial chemoprophylaxis, resembling the pattern seen with the relapsing parasites P. ovale spp. and P. vivax. In contrast, for only 7.5% of imported UK cases of non-relapsing P. falciparum was any chemoprophylaxis use reported. Genotyping of parasites from six patients reporting use of atovaquone-proguanil chemoprophylaxis did not reveal mutations at codon 268 of the cytb locus of the P. malariae mitochondrial genome. While travellers with P. malariae malaria are significantly more likely to report prophylaxis use during endemic country travel than are those with P. falciparum infections, atovaquone-proguanil prophylaxis breakthrough was not associated with pmcytb mutations. These preliminary studies, together with consistent observations of the remarkable longevity of P. malariae, lead us to propose re-examination of the dogma that this species is not a relapsing parasite. Further studies are needed to investigate our favoured hypothesis, namely that P. malariae can initiate a latent hypnozoite developmental programme in the human hepatocyte: if validated this will explain the consistent observations of remarkable longevity of parasitism, even in the presence of antimalarial prophylaxis or treatment.
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Affiliation(s)
- Beatrix Huei-Yi Teo
- Department of Immunology & Infection, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paul Lansdell
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Valerie Smith
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marie Blaze
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Debbie Nolder
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Khalid B. Beshir
- Department of Immunology & Infection, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter L. Chiodini
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom
| | - Jun Cao
- Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Anna Färnert
- Dept Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Colin J. Sutherland
- Department of Immunology & Infection, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom
- * E-mail: ;
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20
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Visser BJ, Wieten RW, Kroon D, Nagel IM, Bélard S, van Vugt M, Grobusch MP. Efficacy and safety of artemisinin combination therapy (ACT) for non-falciparum malaria: a systematic review. Malar J 2014; 13:463. [PMID: 25428624 PMCID: PMC4258384 DOI: 10.1186/1475-2875-13-463] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/18/2014] [Indexed: 01/18/2023] Open
Abstract
Background Artemisinin combination therapy (ACT) is recommended as first-line treatment for uncomplicated Plasmodium falciparum malaria, whereas chloroquine is still commonly used for the treatment of non-falciparum species (Plasmodium vivax, Plasmodium ovale and Plasmodium malariae). A more simplified, more uniform treatment approach across all malaria species is worthwhile to be considered both in endemic areas and for malaria as an imported condition alike. Methods A PROSPERO-registered systematic review to determine the efficacy and safety of ACT for the treatment of non-falciparum malaria was conducted, following PRISMA guidelines. Without language restrictions, Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus were searched for studies published up to November 2014. Results The literature search identified 986 reports; 40 publications were found eligible for inclusion, all of them on non-falciparum malaria in endemic areas. Most evidence was available for P. vivax (n = 35). Five clinical trials in total were identified evaluating ACT for P. ovale, P. malariae and Plasmodium knowlesi. Most ACT presentations have high efficacy against P. vivax parasites; artemisinin-based combinations have shorter parasite and fever clearance times compared to chloroquine. ACT is as effective as chloroquine in preventing recurrent parasitaemia before day 28. Artemisinin-based combinations with long half-lives show significantly fewer recurrent parasitaemia up to day 63. The limited evidence available supports both the use of chloroquine and an ACT for P. ovale and P. malariae. ACT seems to be preferable for optimal treatment of P. knowlesi. Conclusion ACT is at least equivalent to chloroquine in effectively treating non-falciparum malaria. These findings may facilitate development of simplified protocols for treating all forms of malaria with ACT, including returning travellers. Obtaining comprehensive efficacy and safety data on ACT use for non-falciparum species particularly for P. ovale, P. malariae and P. knowlesi should be a research priority. Trial registration CRD42014009103 Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-463) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Martin P Grobusch
- Department of Infectious Diseases, Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
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Abstract
INTRODUCTION Chemotherapy of malaria has become a rapidly changing field. Less than two decades ago, treatment regimens were increasingly bound to fail due to emerging drug resistance against 4-aminoquinolines and sulfa compounds. By now, artemisinin-based combination therapies (ACTs) constitute the standard of care for uncomplicated falciparum malaria and are increasingly also taken into consideration for the treatment of non-falciparum malaria. AREAS COVERED This narrative review provides an overview of the state-of-art antimalarial drug therapy, highlights the global portfolio of current Phase III/IV clinical trials and summarizes current developments. EXPERT OPINION Malaria chemotherapy remains a dynamic field, with novel drugs and drug combinations continuing to emerge in order to outpace the development of large-scale drug resistance against the currently most important drug class, the artemisinin derivatives. More randomized controlled studies are urgently needed especially for the treatment of malaria in first trimester pregnant women. ACTs should be used for the treatment of imported malaria more consequently. Gaining sufficient efficacy and safety information on ACT use for non-falciparum species including Plasmodium ovale and malariae should be a research priority. Continuous investment into malaria drug development is a vital factor to combat artemisinin resistance and successfully improve malaria control toward the ultimate goal of elimination.
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Affiliation(s)
- Benjamin J Visser
- University of Amsterdam, Academic Medical Centre, Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases , Amsterdam , The Netherlands
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Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment. Parasitology 2014; 141:1880-90. [PMID: 24837880 PMCID: PMC4255323 DOI: 10.1017/s003118201400033x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
During a longitudinal study investigating the dynamics of malaria in Ugandan lakeshore communities, a consistently high malaria prevalence was observed in young children despite regular treatment. To explore the short-term performance of artemether-lumefantrine (AL), a pilot investigation into parasite carriage after treatment(s) was conducted in Bukoba village. A total of 163 children (aged 2–7 years) with a positive blood film and rapid antigen test were treated with AL; only 8·7% of these had elevated axillary temperatures. On day 7 and then on day 17, 40 children (26·3%) and 33 (22·3%) were positive by microscopy, respectively. Real-time PCR analysis demonstrated that multi-species Plasmodium infections were common at baseline, with 41·1% of children positive for Plasmodium falciparum/Plasmodium malariae, 9·2% for P. falciparum/ Plasmodium ovale spp. and 8·0% for all three species. Moreover, on day 17, 39·9% of children infected with falciparum malaria at baseline were again positive for the same species, and 9·2% of those infected with P. malariae at baseline were positive for P. malariae. Here, chronic multi-species malaria infections persisted in children after AL treatment(s). Better point-of-care diagnostics for non-falciparum infections are needed, as well as further investigation of AL performance in asymptomatic individuals.
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Mixed Infection of Plasmodium malariae and Plasmodium falciparum: A Case Report. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2014. [DOI: 10.5812/archcid.19297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lau YL, Lee WC, Tan LH, Kamarulzaman A, Syed Omar SF, Fong MY, Cheong FW, Mahmud R. Acute respiratory distress syndrome and acute renal failure from Plasmodium ovale infection with fatal outcome. Malar J 2013; 12:389. [PMID: 24180319 PMCID: PMC4228392 DOI: 10.1186/1475-2875-12-389] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/24/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Plasmodium ovale is one of the causative agents of human malaria. Plasmodium ovale infection has long been thought to be non-fatal. Due to its lower morbidity, P. ovale receives little attention in malaria research. METHODS Two Malaysians went to Nigeria for two weeks. After returning to Malaysia, they fell sick and were admitted to different hospitals. Plasmodium ovale parasites were identified from blood smears of these patients. The species identification was further confirmed with nested PCR. One of them was successfully treated with no incident of relapse within 12-month medical follow-up. The other patient came down with malaria-induced respiratory complication during the course of treatment. Although parasites were cleared off the circulation, the patient's condition worsened. He succumbed to multiple complications including acute respiratory distress syndrome and acute renal failure. RESULTS Sequencing of the malaria parasite DNA from both cases, followed by multiple sequence alignment and phylogenetic tree construction suggested that the causative agent for both malaria cases was P. ovale curtisi. DISCUSSION In this report, the differences between both cases were discussed, and the potential capability of P. ovale in causing severe complications and death as seen in this case report was highlighted. CONCLUSION Plasmodium ovale is potentially capable of causing severe complications, if not death. Complete travel and clinical history of malaria patient are vital for successful diagnoses and treatment. Monitoring of respiratory and renal function of malaria patients, regardless of the species of malaria parasites involved is crucial during the course of hospital admission.
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Affiliation(s)
- Yee-Ling Lau
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wenn-Chyau Lee
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Lian-Huat Tan
- Sunway Medical Centre, Bandar Sunway, 46150 Petaling Jaya, Selangor, Malaysia
| | - Adeeba Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Mun-Yik Fong
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Fei-Wen Cheong
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Rohela Mahmud
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Held J, Kreidenweiss A, Mordmüller B. Novel approaches in antimalarial drug discovery. Expert Opin Drug Discov 2013; 8:1325-37. [PMID: 24090219 DOI: 10.1517/17460441.2013.843522] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The development of new antimalarial drugs remains of the utmost importance, since Plasmodium falciparum has developed resistance against nearly all chemotherapeutics in clinical use. In an effort to contain the resistance of P. falciparum against artemisinins and to further eradication efforts, studies are ongoing to identify novel and more efficacious approaches to develop antimalarials. AREAS COVERED The authors review the classical and new approaches to antimalarial drug discovery, with a special emphasis on the various stages of the parasite's life cycle and the different Plasmodium species. The authors discuss the methodologies and strategies for early efficacy testing that aim to narrow down the portfolio of promising compounds. EXPERT OPINION The increased efforts in the discovery and development of new antimalarial compounds have led to the recognition of new promising hits. However, there is still major roadblock of selecting the most promising compounds and then further testing them in early clinical trials, especially in the current restricted economy. Controlled human malaria infection has much potential for speeding-up the early development process of many drug candidates including those which target the pre-erythrocytic stages.
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Affiliation(s)
- Jana Held
- University of Tübingen, Institute of Tropical Medicine , Wilhelmstraße 27, D-72074 Tübingen , Germany +49 7071 29 82364 ; +49 7071 295189 ;
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Calleri G, Balbiano R, Caramello P. Are artemisinin-based combination therapies effective against Plasmodium malariae? J Antimicrob Chemother 2013; 68:1447-8. [DOI: 10.1093/jac/dkt005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dinko B, Oguike MC, Larbi JA, Bousema T, Sutherland CJ. Persistent detection of Plasmodium falciparum, P. malariae, P. ovale curtisi and P. ovale wallikeri after ACT treatment of asymptomatic Ghanaian school-children. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2013; 3:45-50. [PMID: 24533292 DOI: 10.1016/j.ijpddr.2013.01.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/22/2012] [Accepted: 01/03/2013] [Indexed: 11/16/2022]
Abstract
Two hundred and seventy four asymptomatic Ghanaian school-children aged 5 to 17 years were screened for malaria parasites by examination of blood films. One hundred and fifty five microscopically-positive individuals were treated with dihydroartemisinin-piperaquine and followed for 3 weeks. Retrospective species-specific PCR of all 274 screened samples identified an additional 60 children with sub-patent parasitaemia, and a substantial proportion of co-infections with Plasmodium malariae, Plasmodium ovale curtisi and Plasmodium ovale wallikeri. One hundred individuals harboured at least one non-falciparum parasite species. Using standard double-read microscopy, the 21-day efficacy of treatment against Plasmodium falciparum was 91.4% among the 117 children seen at all 5 visits. Using nested PCR to test 152 visit 5 blood samples, 22 were found to be parasite-positive. Twenty individuals harboured P. falciparum, four harboured P. ovale spp. and two P. malariae, with four of these 22 isolates being mixed species infections. The persistent detection of low density Plasmodium sp. infections following antimalarial treatment suggests these may be a hitherto unrecognised obstacle to malaria elimination.
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Affiliation(s)
- Bismarck Dinko
- Dept. of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Mary C Oguike
- Dept. of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - John A Larbi
- Dept. of Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Teun Bousema
- Dept. of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK ; Dept. of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Colin J Sutherland
- Dept. of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK ; Dept. of Clinical Parasitology, Hospital for Tropical Diseases, UCL Hospitals Trust, London, UK
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Castelli F, Tomasoni LR, Matteelli A. Advances in the treatment of malaria. Mediterr J Hematol Infect Dis 2012; 4:e2012064. [PMID: 23170193 PMCID: PMC3499999 DOI: 10.4084/mjhid.2012.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/24/2012] [Indexed: 12/25/2022] Open
Abstract
Malaria still claims a heavy toll of deaths and disabilities even at the beginning of the third millennium. The inappropriate sequential use of drug monotherapy in the past has facilitated the spread of drug-resistant P. falciparum, and to a lesser extend P. vivax, strains in most of the malaria endemic areas, rendering most anti-malarial ineffective. In the last decade, a new combination strategy based on artemisinin derivatives (ACT) has become the standard of treatment for most P. falciparum malaria infections. This strategy could prevent the selection of resistant strains by rapidly decreasing the parasitic burden (by the artemisinin derivative, mostly artesunate) and exposing the residual parasite to effective concentrations of the partner drug. The widespread use of this strategy is somehow constrained by cost and by the inappropriate use of artemisinin, with possible impact on resistance, as already sporadically observed in South East Asia. Parenteral artesunate has now become the standard of care for severe malaria, even if quinine still retains its value in case artesunate is not immediately available. The appropriateness of pre-referral use of suppository artesunate is under close monitoring, while waiting for an effective anti-malarial vaccine to be made available.
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Affiliation(s)
- Francesco Castelli
- Chair of Infectious Diseases, University of Brescia, Italy
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia (Italy)
| | - Lina Rachele Tomasoni
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia (Italy)
| | - Alberto Matteelli
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia (Italy)
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Askling HH, Bruneel F, Burchard G, Castelli F, Chiodini PL, Grobusch MP, Lopez-Vélez R, Paul M, Petersen E, Popescu C, Ramharter M, Schlagenhauf P. Management of imported malaria in Europe. Malar J 2012; 11:328. [PMID: 22985344 PMCID: PMC3489857 DOI: 10.1186/1475-2875-11-328] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/19/2012] [Indexed: 11/10/2022] Open
Abstract
In this position paper, the European Society for Clinical Microbiology and Infectious Diseases, Study Group on Clinical Parasitology, summarizes main issues regarding the management of imported malaria cases. Malaria is a rare diagnosis in Europe, but it is a medical emergency. A travel history is the key to suspecting malaria and is mandatory in patients with fever. There are no specific clinical signs or symptoms of malaria although fever is seen in almost all non-immune patients. Migrants from malaria endemic areas may have few symptoms.Malaria diagnostics should be performed immediately on suspicion of malaria and the gold- standard is microscopy of Giemsa-stained thick and thin blood films. A Rapid Diagnostic Test (RDT) may be used as an initial screening tool, but does not replace urgent microscopy which should be done in parallel. Delays in microscopy, however, should not lead to delayed initiation of appropriate treatment. Patients diagnosed with malaria should usually be hospitalized. If outpatient management is preferred, as is the practice in some European centres, patients must usually be followed closely (at least daily) until clinical and parasitological cure. Treatment of uncomplicated Plasmodium falciparum malaria is either with oral artemisinin combination therapy (ACT) or with the combination atovaquone/proguanil. Two forms of ACT are available in Europe: artemether/lumefantrine and dihydroartemisinin/piperaquine. ACT is also effective against Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi, but these species can be treated with chloroquine. Treatment of persistent liver forms in P. vivax and P. ovale with primaquine is indicated after excluding glucose 6 phosphate dehydrogenase deficiency. There are modified schedules and drug options for the treatment of malaria in special patient groups, such as children and pregnant women. The potential for drug interactions and the role of food in the absorption of anti-malarials are important considerations in the choice of treatment.Complicated malaria is treated with intravenous artesunate resulting in a much more rapid decrease in parasite density compared to quinine. Patients treated with intravenous artesunate should be closely monitored for haemolysis for four weeks after treatment. There is a concern in some countries about the lack of artesunate produced according to Good Manufacturing Practice (GMP).
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Affiliation(s)
- Helena H Askling
- Department of Medicine Solna/Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Fabrice Bruneel
- Intensive Care Unit, Centre Hospitalier de Versailles, Site André Mignot, 177 rue de Versailles, Le Chesnay 78150, France
| | - Gerd Burchard
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Peter L Chiodini
- Hospital for Tropical Diseases and London School of Hygiene and Tropical Medicine, London, UK
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rogelio Lopez-Vélez
- Tropical Medicine & Clinical Parasitology. Infectious Diseases Department.Hospital Ramón y Cajal, Madrid, Spain
| | - Margaret Paul
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Corneliu Popescu
- Clinical Hospital of Infectious and Tropical Diseases "Dr.Victor Babes", University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Michael Ramharter
- Department. of Medicine I, Div. of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Patricia Schlagenhauf
- University of Zürich, Centre for Travel Medicine, Division of Epidemiology and Communicable Diseases, Zürich, Switzerland
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