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Silva GBD, Pinto JR, Barros EJG, Farias GMN, Daher EDF. Kidney involvement in malaria: an update. Rev Inst Med Trop Sao Paulo 2017; 59:e53. [PMID: 28793022 PMCID: PMC5626226 DOI: 10.1590/s1678-9946201759053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 11/30/2022] Open
Abstract
Malaria is an infectious disease of great importance for Public Health, as it is the
most prevalent endemic disease in the world, affecting millions of people living in
tropical areas of the globe. Kidney involvement is relatively frequent in infections
by P. falciparum and P. malariae, but has also been
described in the infection by P. vivax. Kidney complications in
malaria mainly occur due to hemodynamic dysfunction and immune response. Liver
complications leading to hepatomegaly, jaundice and hepatic dysfunction can also
contribute to the occurrence of acute kidney injury. Histologic studies in malaria
also evidence glomerulonephritis, acute tubular necrosis and acute interstitial
nephritis. It is also possible to find chronic kidney disease associated with
malaria, mainly in those patients suffering from repeated episodes of infection.
Plasmodium antigens have already been detected in the glomeruli, suggesting a direct
effect of the parasite in the kidney, which can trigger an inflammatory process
leading to different types of glomerulonephritis. Clinical manifestations of kidney
involvement in malaria include proteinuria, microalbuminuria and urinary casts,
reported in 20 to 50% of cases. Nephrotic syndrome has also been described in the
infection by P. falciparum, but it is rare. This paper highlights
the main aspects of kidney involvement in malaria and important findings of the most
recent research addressing this issue.
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Affiliation(s)
- Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
| | - José Reginaldo Pinto
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
| | - Elvino José Guardão Barros
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, Rio Grande do Sul, Brazil
| | - Geysa Maria Nogueira Farias
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
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Pedro RS, Brasil P, Pina-Costa A, Machado CR, Damasceno LS, Daniel-Ribeiro CT, Guaraldo L. Pharmacotherapy follow-up: Role in active malaria surveillance in a travel medicine centre outside the transmission area in Brazil. J Clin Pharm Ther 2017; 42:750-757. [PMID: 28612497 DOI: 10.1111/jcpt.12575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/16/2017] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Malaria is a potentially severe disease, widespread in tropical and subtropical areas. Apart from parasite drug resistance, which receives the largest share of attention, several factors directly influence the response to antimalarial treatment such as incorrect doses, adverse drug events, lack of adherence to treatment, drug quality and drug-drug interactions. Pharmacotherapy follow-up can be used to monitor and improve the effectiveness of treatment, prevent drug-related problems and ensure patient safety. The aim of this study was to describe the results of the implementation of pharmacotherapy follow-up of patients with malaria seen at a reference centre for malaria diagnosis and treatment (CPD-Mal) located in the city of Rio de Janeiro, an area without malaria transmission. METHODS A descriptive study was conducted from January 2009 to September 2013 at the Instituto Nacional de Infectologia Evandro Chagas (INI) of the Fundação Oswaldo Cruz (Fiocruz). All malaria patients enrolled in the study were treated according to the Brazilian Malaria Therapy Guidelines. Data collected during pharmacotherapy follow-up were recorded in a standardized form. The variables included were age, gender, comorbidities, antimalarials and concomitant medications used, adverse drug reactions (ADR), clinical and parasitological cure times, and treatment outcomes classified as success, recurrence (recrudescence or relapse); and lost to follow-up. The ADR were classified by severity (DAIDS-NIH), organ system affected (WHO-ART) and likelihood to be caused by drugs (Naranjo scale). RESULTS AND DISCUSSION One hundred thirteen cases of malaria were included. Patients were aged between 13 and 66 years and the majority of them (75.2%) were male. Ninety-four ADR were observed, most classified as mild (85.1%), related to disorders of the gastrointestinal system (63.8%), such as nausea and vomiting, and assessed as "possibly" caused by the antimalarial drugs (91.5%). The majority of clinical (90.9%) and parasitological (87.1%) cure occurred less than 72 hours after treatment initiation. Pharmacotherapy follow-up of malaria treatment by surveillance activities is therefore important regarding information about treatment outcomes as well as patient safety, resulting in better patient care and reducing the chance of relapses. The results underscore its use as a tool for monitoring adherence and drug resistance outside an endemic area. WHAT IS NEW AND CONCLUSION Pharmacotherapy follow-up should be considered a useful malaria surveillance tool that can be developed by reference centres for comprehensive health care assistance and monitoring of therapeutic resistance.
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Affiliation(s)
- R S Pedro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz and Secretaria de Vigilância em Saúde (SVS)-Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - P Brasil
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz and Secretaria de Vigilância em Saúde (SVS)-Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - A Pina-Costa
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz and Secretaria de Vigilância em Saúde (SVS)-Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - C R Machado
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz and Secretaria de Vigilância em Saúde (SVS)-Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - L S Damasceno
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz and Secretaria de Vigilância em Saúde (SVS)-Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - C T Daniel-Ribeiro
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz and Secretaria de Vigilância em Saúde (SVS)-Ministério da Saúde (MS), Rio de Janeiro, Brazil.,Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - L Guaraldo
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz and Secretaria de Vigilância em Saúde (SVS)-Ministério da Saúde (MS), Rio de Janeiro, Brazil
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Women's access and provider practices for the case management of malaria during pregnancy: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001688. [PMID: 25093720 PMCID: PMC4122360 DOI: 10.1371/journal.pmed.1001688] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management policy for malaria in pregnant women. METHODS AND FINDINGS We searched the Malaria in Pregnancy Library, the Global Health Database, and the International Network for the Rational Use of Drugs Bibliography from 1 January 2006 to 3 April 2014, without language restriction. Data were appraised for quality and content. Frequencies of women's and healthcare providers' practices were explored using narrative synthesis and random effect meta-analysis. Barriers to women's access and providers' adherence to policy were explored by content analysis using NVivo. Determinants of women's access and providers' case management practices were extracted and compared across studies. We did not perform a meta-ethnography. Thirty-seven studies were included, conducted in Africa (30), Asia (4), Yemen (1), and Brazil (2). One- to three-quarters of women reported malaria episodes during pregnancy, of whom treatment was sought by >85%. Barriers to access among women included poor knowledge of drug safety, prohibitive costs, and self-treatment practices, used by 5%-40% of women. Determinants of women's treatment-seeking behaviour were education and previous experience of miscarriage and antenatal care. Healthcare provider reliance on clinical diagnosis and poor adherence to treatment policy, especially in first versus other trimesters (28%, 95% CI 14%-47%, versus 72%, 95% CI 39%-91%, p = 0.02), was consistently reported. Prescribing practices were driven by concerns over side effects and drug safety, patient preference, drug availability, and cost. Determinants of provider practices were access to training and facility type (public versus private). Findings were limited by the availability, quality, scope, and methodological inconsistencies of the included studies. CONCLUSIONS A systematic assessment of the extent of substandard case management practices of malaria in pregnancy is required, as well as quality improvement interventions that reach all providers administering antimalarial drugs in the community. Pregnant women need access to information on which anti-malarial drugs are safe to use at different stages of pregnancy. Please see later in the article for the Editors' Summary.
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