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Suh Nchang A, Shinyuy LM, Noukimi SF, Njong S, Bambara S, Kalimba EM, Kamga J, Ghogomu SM, Frederich M, Talom JLL, Souopgui J, Robert A. Knowledge about Asymptomatic Malaria and Acceptability of Using Artemisia afra Tea among Health Care Workers (HCWs) in Yaoundé, Cameroon: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6309. [PMID: 37444156 PMCID: PMC10341543 DOI: 10.3390/ijerph20136309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Malaria is the most widespread endemic disease in Cameroon, and asymptomatic Plasmodium (gametocyte) carriers (APCs) constitute more than 95% of infectious human reservoirs in malaria endemic settings. This study assesses the knowledge of asymptomatic malaria (ASM) among health care workers (HCWs) in health facilities (HFs) in the Centre Region of Cameroon and the acceptability of using Artemisia afra tea to treat APCs. A cross-sectional descriptive survey was conducted among 100 HCWs, in four randomly selected HFs in the Centre Region, in the period of 1-20 April 2022, using semi-structured self-administered questionnaires. Logistic regression analyses were performed to determine factors associated with knowledge. More than seven in eight (88%) respondents were aware of the existence of ASM, 83% defined ASM correctly, 75% knew how it was diagnosed, 70% prescribe ACTs for APCs, and 51.1% were informed about ASM transmission. The professional category of HCWs was significantly associated with their knowledge of the existence and transmission of ASM, and longevity of service was associated with knowledge of transmission (p < 0.05). Two-thirds (67%) of respondents knew about Artemisia afra tea, 53.7% believed that it was effective in treating ASM, and 79% were willing to prescribe it if authorized. There was a fair level of knowledge of ASM among HCWs in the study settings.
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Affiliation(s)
- Abenwie Suh Nchang
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
| | - Lahngong Methodius Shinyuy
- Laboratory of Pharmacognosy, Department of Pharmacy, Center of Interdisciplinary Research on Medicine (CIRM), University of Liege, 4000 Liège, Belgium; (L.M.S.); (M.F.)
| | - Sandra Fankem Noukimi
- Embriology and Biotechnology Laboratory, IBMM-ULB, 6041 Gosselies, Belgium; (S.F.N.); (J.S.)
| | - Sylvia Njong
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
| | - Sylvie Bambara
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
| | | | - Joseph Kamga
- Biotechnology Unit, University of Buea, Buea P.O. Box 63, Cameroon; (J.K.); (S.M.G.)
| | | | - Michel Frederich
- Laboratory of Pharmacognosy, Department of Pharmacy, Center of Interdisciplinary Research on Medicine (CIRM), University of Liege, 4000 Liège, Belgium; (L.M.S.); (M.F.)
| | | | - Jacob Souopgui
- Embriology and Biotechnology Laboratory, IBMM-ULB, 6041 Gosselies, Belgium; (S.F.N.); (J.S.)
| | - Annie Robert
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
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Choi R, Michaels SA, Onu EC, Hulverson MA, Saha A, Coker ME, Weeks JC, Van Voorhis WC, Ojo KK. Taming the Boys for Global Good: Contraceptive Strategy to Stop Malaria Transmission. Molecules 2020; 25:molecules25122773. [PMID: 32560085 PMCID: PMC7356879 DOI: 10.3390/molecules25122773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/21/2022] Open
Abstract
Transmission of human malaria parasites (Plasmodium spp.) by Anopheles mosquitoes is a continuous process that presents a formidable challenge for effective control of the disease. Infectious gametocytes continue to circulate in humans for up to four weeks after antimalarial drug treatment, permitting prolonged transmission to mosquitoes even after clinical cure. Almost all reported malaria cases are transmitted to humans by mosquitoes, and therefore decreasing the rate of Plasmodium transmission from humans to mosquitoes with novel transmission-blocking remedies would be an important complement to other interventions in reducing malaria incidence.
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Affiliation(s)
- Ryan Choi
- Center for Emerging and Re-Emerging Infectious Diseases (CERID), Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98109, USA; (R.C.); (S.A.M.); (M.A.H.); (A.S.); (W.C.V.V.)
| | - Samantha A. Michaels
- Center for Emerging and Re-Emerging Infectious Diseases (CERID), Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98109, USA; (R.C.); (S.A.M.); (M.A.H.); (A.S.); (W.C.V.V.)
| | - Emmanuel C. Onu
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria; (E.C.O.); (M.E.C.)
| | - Matthew A. Hulverson
- Center for Emerging and Re-Emerging Infectious Diseases (CERID), Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98109, USA; (R.C.); (S.A.M.); (M.A.H.); (A.S.); (W.C.V.V.)
| | - Aparajita Saha
- Center for Emerging and Re-Emerging Infectious Diseases (CERID), Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98109, USA; (R.C.); (S.A.M.); (M.A.H.); (A.S.); (W.C.V.V.)
| | - Morenike E. Coker
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria; (E.C.O.); (M.E.C.)
| | - Janis C. Weeks
- Department of Biology, University of Oregon, Eugene, OR 97403, USA;
| | - Wesley C. Van Voorhis
- Center for Emerging and Re-Emerging Infectious Diseases (CERID), Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98109, USA; (R.C.); (S.A.M.); (M.A.H.); (A.S.); (W.C.V.V.)
| | - Kayode K. Ojo
- Center for Emerging and Re-Emerging Infectious Diseases (CERID), Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98109, USA; (R.C.); (S.A.M.); (M.A.H.); (A.S.); (W.C.V.V.)
- Correspondence: ; Tel.: +1-206-543-0821
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Anvikar AR, van Eijk AM, Shah A, Upadhyay KJ, Sullivan SA, Patel AJ, Joshi JM, Tyagi S, Singh R, Carlton JM, Gupta H, Wassmer SC. Clinical and epidemiological characterization of severe Plasmodium vivax malaria in Gujarat, India. Virulence 2020; 11:730-738. [PMID: 32490754 PMCID: PMC7549892 DOI: 10.1080/21505594.2020.1773107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
The mounting evidence supporting the capacity of Plasmodium vivax to cause severe disease has prompted the need for a better characterization of the resulting clinical complications. India is making progress with reducing malaria, but epidemics of severe vivax malaria in Gujarat, one of the main contributors to the vivax malaria burden in the country, have been reported recently and may be the result of a decrease in transmission and immune development. Over a period of one year, we enrolled severe malaria patients admitted at the Civil Hospital in Ahmedabad, the largest city in Gujarat, to investigate the morbidity of severe vivax malaria compared to severe falciparum malaria. Patients were submitted to standard thorough clinical and laboratory investigations and only PCR-confirmed infections were selected for the present study. Severevivax malaria (30 patients) was more frequent than severe falciparum malaria (8 patients) in our setting, and it predominantly affected adults (median age 32 years, interquartile range 22.5 years). This suggests a potential age shift in anti-malarial immunity, likely to result from the recent decrease in transmission across India. The clinical presentation of severe vivax patients was in line with previous reports, with jaundice as the most common complication. Our findings further support the need for epidemiological studies combining clinical characterization of severe vivax malaria and serological evaluation of exposure markers to monitor the impact of elimination programmes.
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Affiliation(s)
- Anupkumar R. Anvikar
- Indian Council of Medical Research (ICMR), National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research (ICMR), National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, India
| | - Anna Maria van Eijk
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Asha Shah
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Kamlesh J. Upadhyay
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Steven A. Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Ankita J. Patel
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Jaykumar M. Joshi
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Suchi Tyagi
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Ranvir Singh
- Byramjee Jeejeebhoy Medical College (BJMC), Civil Hospital, Ahmedabad, India
| | - Jane M. Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Himanshu Gupta
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Samuel C. Wassmer
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Aguiar L, Machado M, Sanches-Vaz M, Prudêncio M, Vale N, Gomes P. Coupling the cell-penetrating peptides transportan and transportan 10 to primaquine enhances its activity against liver-stage malaria parasites. MEDCHEMCOMM 2019; 10:221-226. [PMID: 30881610 PMCID: PMC6390471 DOI: 10.1039/c8md00447a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/13/2018] [Indexed: 01/30/2023]
Abstract
Novel primaquine-cell penetrating peptide conjugates were synthesised and tested in vitro against liver stage Plasmodium berghei parasites. Generally, the conjugates were more active than the parent peptides and, in some cases, than the parent drug. These are unprecedented findings that may open a new route towards antimalarial drug rescuing.
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Affiliation(s)
- Luísa Aguiar
- LAQV-REQUIMTE , Departamento de Química e Bioquímica , Faculdade de Ciências , Universidade do Porto , Rua do Campo Alegre 687 , P-4169-007 Porto , Portugal .
| | - Marta Machado
- Instituto de Medicina Molecular João Lobo Antunes , Faculdade de Medicina , Universidade de Lisboa , Avenida Professor Egas Moniz , P-1648-028 Lisboa , Portugal
| | - Margarida Sanches-Vaz
- Instituto de Medicina Molecular João Lobo Antunes , Faculdade de Medicina , Universidade de Lisboa , Avenida Professor Egas Moniz , P-1648-028 Lisboa , Portugal
| | - Miguel Prudêncio
- Instituto de Medicina Molecular João Lobo Antunes , Faculdade de Medicina , Universidade de Lisboa , Avenida Professor Egas Moniz , P-1648-028 Lisboa , Portugal
| | - Nuno Vale
- Laboratório de Farmacologia , Departamento de Ciências do Medicamento , Faculdade de Farmácia , Universidade do Porto , Rua de Jorge Viterbo Ferreira 228 , P-4050-313 Porto , Portugal
- Ipatimup/Instituto de Investigação e Inovação em Saúde (i3S) , Rua Alfredo Allen, 208 , 4200-135 Porto , Portugal
| | - Paula Gomes
- LAQV-REQUIMTE , Departamento de Química e Bioquímica , Faculdade de Ciências , Universidade do Porto , Rua do Campo Alegre 687 , P-4169-007 Porto , Portugal .
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Avalos S, Mejia RE, Banegas E, Salinas C, Gutierrez L, Fajardo M, Galo S, Pinto A, Mejia A, Fontecha G. G6PD deficiency, primaquine treatment, and risk of haemolysis in malaria-infected patients. Malar J 2018; 17:415. [PMID: 30409136 PMCID: PMC6225638 DOI: 10.1186/s12936-018-2564-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/01/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The incidence of malaria in the Americas has decreased markedly in recent years. Honduras and the other countries of Mesoamerica and the island of Hispaniola have set the goal of eliminating native malaria by the year 2020. To achieve this goal, Honduras has recently approved national regulations to expand the possibilities of a shortened double dose primaquine (PQ) treatment for vivax malaria. Considering this new shortened anti-malarial treatment, the high frequency of G6PDd genotypes in Honduras, and the lack of routinely assessment of the G6PD deficiency status, this study aimed at investigating the potential association between the intake of PQ and haemolysis in malaria-infected G6PDd subjects. METHODS This was a prospective cohort and open-label study. Participants with malaria were recruited. Plasmodium vivax infection was treated with 0.25 mg/kg of PQ daily for 14 days. Safety and signs of haemolysis were evaluated by clinical criteria and laboratory values before and during the 3rd and 7th day of PQ treatment. G6PD status was assessed by a rapid test (CareStart™) and two molecular approaches. RESULTS Overall 55 participants were enrolled. The frequency of G6PD deficient genotypes was 7/55 (12.7%), where 5/7 (71.4%) were hemizygous A- males and 2/7 (28.6%) heterozygous A- females. Haemoglobin concentrations were compared between G6PD wild type (B) and G6PDd A- subjects, showing a significant difference between the means of both groups in the 3rd and 7th days. Furthermore, a statistically significant difference was evident in the change in haemoglobin concentration between the 3rd day and the 1st day for both genotypes, but there was no statistical difference for the change in haemoglobin concentration between the 7th day and the 1st day. Besides these changes in the haemoglobin concentrations, none of the patients showed signs or symptoms associated with severe haemolysis, and none needed to be admitted to a hospital for further medical attention. CONCLUSIONS The findings support that the intake of PQ during 14 days of treatment against vivax malaria is safe in patients with a class III variant of G6PDd. In view of the new national regulations in the shortened treatment of vivax malaria for 7 days, it is advisable to be alert of potential cases of severe haemolysis that could occur among G6PD deficient hemizygous males with a class II mutation such as the Santamaria variant, previously reported in the country.
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Affiliation(s)
- Sara Avalos
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Rosa E Mejia
- Pan American Health Organization, Tegucigalpa, Honduras
| | - Engels Banegas
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Cesar Salinas
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Lester Gutierrez
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Marcela Fajardo
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Suzeth Galo
- National Department of Surveillance, Ministry of Health, Tegucigalpa, Honduras
| | - Alejandra Pinto
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Angel Mejia
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Gustavo Fontecha
- Microbiology Research Institute, National Autonomous University of Honduras, Tegucigalpa, Honduras.
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Plasmodium vivax and Plasmodium falciparum infection dynamics: re-infections, recrudescences and relapses. Malar J 2018; 17:170. [PMID: 29665803 PMCID: PMC5905131 DOI: 10.1186/s12936-018-2318-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background In malaria endemic populations, complex patterns of Plasmodium vivax and Plasmodium falciparum blood-stage infection dynamics may be observed. Genotyping samples from longitudinal cohort studies for merozoite surface protein (msp) variants increases the information available in the data, allowing multiple infecting parasite clones in a single individual to be identified. msp genotyped samples from two longitudinal cohorts in Papua New Guinea (PNG) and Thailand were analysed using a statistical model where the times of acquisition and clearance of each clone in every individual were estimated using a process of data augmentation. Results For the populations analysed, the duration of blood-stage P. falciparum infection was estimated as 36 (95% Credible Interval (CrI): 29, 44) days in PNG, and 135 (95% CrI 94, 191) days in Thailand. Experiments on simulated data indicated that it was not possible to accurately estimate the duration of blood-stage P. vivax infections due to the lack of identifiability between a single blood-stage infection and multiple, sequential blood-stage infections caused by relapses. Despite this limitation, the method and data point towards short duration of blood-stage P. vivax infection with a lower bound of 24 days in PNG, and 29 days in Thailand. On an individual level, P. vivax recurrences cannot be definitively classified into re-infections, recrudescences or relapses, but a probabilistic relapse phenotype can be assigned to each P. vivax sample, allowing investigation of the association between epidemiological covariates and the incidence of relapses. Conclusion The statistical model developed here provides a useful new tool for in-depth analysis of malaria data from longitudinal cohort studies, and future application to data sets with multi-locus genotyping will allow more detailed investigation of infection dynamics. Electronic supplementary material The online version of this article (10.1186/s12936-018-2318-1) contains supplementary material, which is available to authorized users.
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Arroyo-Arroyo M, Arango E, Carmona-Fonseca J, Aristizabal B, Yanow S, Maestre A. Efficacy of Different Primaquine Regimens to Control Plasmodium falciparum Gametocytemia in Colombia. Am J Trop Med Hyg 2017; 97:712-718. [PMID: 28749756 DOI: 10.4269/ajtmh.16-0974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Treatment against Plasmodium falciparum malaria includes blood schizonticides to clear asexual parasites responsible for disease. The addition of gametocytocidal drugs can eliminate infectious sexual stages with potential for transmission and the World Health Organization recommends a single dose (SD) of primaquine (PQ) to this end. The efficacy of PQ at 0.75 mg/kg to suppress gametocytemia when administered in single or fractionated doses was evaluated. A clinical controlled study with an open-label design was executed; three groups of 20 subjects were studied sequentially. All subjects were treated with the standard dose of artemether-lumefantrine plus the total dose of 0.75 mg/kg of PQ administered (without previous G6PD testing) in three different ways: Group "0.75d-3" received 0.75 mg/kg on day 3; Group "0.50d-1 + 0.25d-3" received 0.50 mg/kg on day 1 and 0.25 mg/kg on day 3; Group "0.25d-1,2,3" received 0.25 mg/kg on days 1, 2, and 3. Subjects were evaluated on days 1, 4, and 7 by thick smear microscopy and quantitative polymerase chain reaction to determine the carriage of immature and mature gametocytes. There were no adverse events. The three schemes caused a marked reduction (75-85%) in prevalence of gametocytes on day 4 compared with day 1, but only the group that received 0.75 mg/kg on day 3 maintained the reduced gametocyte burden until day 7. None of the three treatments were able to clear gametocyte carriage on days 4 or 7, but the group that received the SD had the lowest prevalence of gametocytes (15%). Further studies are needed to establish a PQ regimen with complete efficacy against gametocytes.
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Affiliation(s)
- Maria Arroyo-Arroyo
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Eliana Arango
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Jaime Carmona-Fonseca
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Beatriz Aristizabal
- Laboratorio de Biología Molecular, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Stephanie Yanow
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Maestre
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
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Baird JK, Valecha N, Duparc S, White NJ, Price RN. Diagnosis and Treatment of Plasmodium vivax Malaria. Am J Trop Med Hyg 2016; 95:35-51. [PMID: 27708191 PMCID: PMC5198890 DOI: 10.4269/ajtmh.16-0171] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/19/2016] [Indexed: 11/07/2022] Open
Abstract
The diagnosis and treatment of Plasmodium vivax malaria differs from that of Plasmodium falciparum malaria in fundamentally important ways. This article reviews the guiding principles, practices, and evidence underpinning the diagnosis and treatment of P. vivax malaria.
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Affiliation(s)
- J Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Neena Valecha
- National Institute for Malaria Research, New Delhi, India
| | | | - Nicholas J White
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ric N Price
- Division of Global and Tropical Health, Menzies School of Health Research-Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Roca-Feltrer A, Khim N, Kim S, Chy S, Canier L, Kerleguer A, Tor P, Chuor CM, Kheng S, Siv S, Kachur PS, Taylor WRJ, Hwang J, Menard D. Field trial evaluation of the performances of point-of-care tests for screening G6PD deficiency in Cambodia. PLoS One 2014; 9:e116143. [PMID: 25541721 PMCID: PMC4277465 DOI: 10.1371/journal.pone.0116143] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/02/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND User-friendly, accurate, point-of-care rapid tests to detect glucose-6-phosphate dehydrogenase deficiency (G6PDd) are urgently needed at peripheral level to safely recommend primaquine for malaria elimination. METHODS The CareStart G6PD RDT (AccessBio, New Jersey, USA), a novel rapid diagnostic test and the most commonly used test, the fluorescent spot test (FST) were assessed against the quantitatively measured G6PD enzyme activity for detecting G6PDd. Subjects were healthy males and non-pregnant females aged 18 years or older residing in six villages in Pailin Province, western Cambodia. FINDINGS Of the 938 subjects recruited, 74 (7.9%) were severe and moderately severe G6PD deficient (enzyme activity <30%), mostly in male population; population median G6PD activity was 12.0 UI/g Hb. The performances of the CareStart G6PD RDT and the FST, according to different cut-off values used to define G6PDd were very similar. For the detection of severe and moderately severe G6PDd (enzyme activity < 30%, < 3.6 UI/g Hb) in males and females, sensitivity and negative (normal status) predictive value were 100% for both point-of-care tools. When the G6PDd cut-off value increased (from < 40% to < 60%), the sensitivity for both PoCs decreased: 93.3% to 71.7% (CareStart G6PD RDT, p = 10(-6)) and 95.5% to 73.2% (FST, p = 10(-6)) while the specificity for both PoCs remained similar: 97.4% to 98.3% (CareStart G6PD RDT, p = 0.23) and 98.7% to 99.6% (FST, p = 0.06). The cut-off values for classifying individuals as normal were 4.0 UI/g Hb and 4.3 UI/g Hb for the CareStart G6PD RDT and the FST, respectively. CONCLUSIONS The CareStart G6PD RDT reliably detected moderate and severe G6PD deficient individuals (enzyme activity <30%), suggesting that this novel point-of-care is a promising tool for tailoring appropriate primaquine treatment for malaria elimination by excluding individuals with severe G6PDd for primaquine treatment.
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Affiliation(s)
| | - Nimol Khim
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Saorin Kim
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Sophy Chy
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Lydie Canier
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | | | - Pety Tor
- Medical Laboratory, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Char Meng Chuor
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Sim Kheng
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Sovannaroth Siv
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Patrick S. Kachur
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Walter R. J. Taylor
- National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
- Centre de Médecine Humanitaire, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jimee Hwang
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
| | - Didier Menard
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
- * E-mail:
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Ingram RJH, Crenna-Darusallam C, Soebianto S, Noviyanti R, Baird JK. The clinical and public health problem of relapse despite primaquine therapy: case review of repeated relapses of Plasmodium vivax acquired in Papua New Guinea. Malar J 2014; 13:488. [PMID: 25495607 PMCID: PMC4295472 DOI: 10.1186/1475-2875-13-488] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primaquine is the only drug available for preventing relapse following a primary attack by Plasmodium vivax malaria. This drug imposes several important problems: daily dosing over two weeks; toxicity in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency; partner blood schizontocides possibly impacting primaquine safety and efficacy; cytochrome P-450 abnormalities impairing metabolism and therapeutic activity; and some strains of parasite may be tolerant or resistant to primaquine. There are many possible causes of repeated relapses in a patient treated with primaquine. CASE DESCRIPTION A 56-year-old Caucasian woman from New Zealand traveled to New Ireland, Papua New Guinea for two months in 2012. One month after returning home she stopped daily doxycycline prophylaxis against malaria, and one week later she became acutely ill and hospitalized with a diagnosis of Plasmodium vivax malaria. Over the ensuing year she suffered four more attacks of vivax malaria at approximately two-months intervals despite consuming primaquine daily for 14 days after each of those attacks, except the last. Genotype of the patient's cytochrome P-450 2D6 alleles (*5/*41) corresponded with an intermediate metabolizer phenotype of predicted low activity. DISCUSSION Multiple relapses in patients taking primaquine as prescribed present a serious clinical problem, and understanding the basis of repeated therapeutic failure is a challenging technical problem. This case highlights these issues in a single traveler, but these problems will also arise as endemic nations approach elimination of malaria transmission.
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Affiliation(s)
| | | | | | - Rintis Noviyanti
- />Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J Kevin Baird
- />Eijkman-Oxford Clinical Research Unit, Jakarta, 10430 Indonesia
- />Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Spatial distribution of G6PD deficiency variants across malaria-endemic regions. Malar J 2013; 12:418. [PMID: 24228846 PMCID: PMC3835423 DOI: 10.1186/1475-2875-12-418] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/28/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Primaquine is essential for malaria control and elimination since it is the only available drug preventing multiple clinical attacks by relapses of Plasmodium vivax. It is also the only therapy against the sexual stages of Plasmodium falciparum infectious to mosquitoes, and is thus useful in preventing malaria transmission. However, the difficulties of diagnosing glucose-6-phosphate dehydrogenase deficiency (G6PDd) greatly hinder primaquine's widespread use, as this common genetic disorder makes patients susceptible to potentially severe and fatal primaquine-induced haemolysis. The risk of such an outcome varies widely among G6PD gene variants. METHODS A literature review was conducted to identify surveys of G6PD variant frequencies among representative population groups. Informative surveys were assembled into two map series: (1) those showing the relative proportions of the different variants among G6PDd individuals; and (2) those showing allele frequencies of G6PD variants based on population surveys without prior G6PDd screening. RESULTS Variants showed conspicuous geographic patterns. A limited repertoire of variants was tested for across sub-Saharan Africa, which nevertheless indicated low genetic heterogeneity predominated by the G6PD A(-202A) mutation, though other mutations were common in western Africa. The severe G6PD Mediterranean variant was widespread across western Asia. Further east, a sharp shift in variants was identified, with high variant heterogeneity in the populations of China and the Asia-Pacific where no single variant dominated. CONCLUSIONS G6PD variants exhibited distinctive region-specific distributions with important primaquine policy implications. Relative homogeneity in the Americas, Africa, and western Asia contrasted sharply with the heterogeneity of variants in China, Southeast Asia and Oceania. These findings will inform rational risk assessments for primaquine in developing public health strategies for malaria control and elimination, and support the future development of regionally targeted policies. The major knowledge gaps highlighted here strongly advocate for further investigation of G6PD variant diversity and their primaquine-sensitivity phenotypes.
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von Seidlein L, Auburn S, Espino F, Shanks D, Cheng Q, McCarthy J, Baird K, Moyes C, Howes R, Ménard D, Bancone G, Winasti-Satyahraha A, Vestergaard LS, Green J, Domingo G, Yeung S, Price R. Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens: a workshop report. Malar J 2013; 12:112. [PMID: 23537118 PMCID: PMC3616837 DOI: 10.1186/1475-2875-12-112] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/14/2013] [Indexed: 01/24/2023] Open
Abstract
The diagnosis and management of glucose-6-phosphate dehydrogenase (G6PD) deficiency is a crucial aspect in the current phases of malaria control and elimination, which will require the wider use of 8-aminoquinolines for both reducing Plasmodium falciparum transmission and achieving the radical cure of Plasmodium vivax. 8-aminoquinolines, such as primaquine, can induce severe haemolysis in G6PD-deficient individuals, potentially creating significant morbidity and undermining confidence in 8-aminoquinoline prescription. On the other hand, erring on the side of safety and excluding large numbers of people with unconfirmed G6PD deficiency from treatment with 8-aminoquinolines will diminish the impact of these drugs. Estimating the remaining G6PD enzyme activity is the most direct, accessible, and reliable assessment of the phenotype and remains the gold standard for the diagnosis of patients who could be harmed by the administration of primaquine. Genotyping seems an unambiguous technique, but its use is limited by cost and the large range of recognized G6PD genotypes. A number of enzyme activity assays diagnose G6PD deficiency, but they require a cold chain, specialized equipment, and laboratory skills. These assays are impractical for care delivery where most patients with malaria live. Improvements to the diagnosis of G6PD deficiency are required for the broader and safer use of 8-aminoquinolines to kill hypnozoites, while lower doses of primaquine may be safely used to kill gametocytes without testing. The discussions and conclusions of a workshop conducted in Incheon, Korea in May 2012 to review key knowledge gaps in G6PD deficiency are reported here.
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Affiliation(s)
- Lorenz von Seidlein
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
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Baird JK. Evidence and implications of mortality associated with acute Plasmodium vivax malaria. Clin Microbiol Rev 2013; 26:36-57. [PMID: 23297258 PMCID: PMC3553673 DOI: 10.1128/cmr.00074-12] [Citation(s) in RCA: 268] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vivax malaria threatens patients despite relatively low-grade parasitemias in peripheral blood. The tenet of death as a rare outcome, derived from antiquated and flawed clinical classifications, disregarded key clinical evidence, including (i) high rates of mortality in neurosyphilis patients treated with vivax malaria; (ii) significant mortality from zones of endemicity; and (iii) the physiological threat inherent in repeated, very severe paroxysms in any patient, healthy or otherwise. The very well-documented course of this infection, with the exception of parasitemia, carries all of the attributes of "perniciousness" historically linked to falciparum malaria, including severe disease and fatal outcomes. A systematic analysis of the parasite biomass in severely ill patients that includes blood, marrow, and spleen may ultimately explain this historic misunderstanding. Regardless of how this parasite is pernicious, recent data demonstrate that the infection comes with a significant burden of morbidity and associated mortality. The extraordinary burden of malaria is not heavily weighted upon any single continent by a single species of parasite-it is a complex problem for the entire endemic world, and both species are of fundamental importance. Humanity must rally substantial resources, intellect, and energy to counter this daunting but profound threat.
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Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia, and the Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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