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Akafity G, Kumi N, Ashong J. Diagnosis and management of malaria in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:3-15. [PMID: 38263976 PMCID: PMC10800773 DOI: 10.1016/j.jointm.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 01/25/2024]
Abstract
Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year. Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia, where the disease is endemic. In non-endemic areas, malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs. Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy, recognition of complications, and appropriate supportive care. However, the lack of diagnostic capacities due to limited advances in equipment, personnel, and infrastructure presents a challenge to the effective diagnosis and management of malaria. This article reviews the clinical classification, diagnosis, and management of malaria as relevant to critical care clinicians, highlighting the role of diagnostic capacity, treatment options, and supportive care.
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Affiliation(s)
- George Akafity
- Department of Research, Monitoring, and Evaluation, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Nicholas Kumi
- Intensive Care Unit, Department of Critical Care and Anesthesia, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joyce Ashong
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Bédia-Tanoh AV, Kassi KF, Touré OA, Assi SB, Gnagne AP, Adoubryn KD, Bissagnene E, Konaté A, Miezan JS, Angora KE, Vanga-Bosson H, Kiki-Barro PC, Djohan V, Yavo W, Hervé Menan EI. Meta-Analysis of Data from Four Clinical Trials in the Ivory Coast Assessing the Efficacy of Two Artemisinin-Based Combination Therapies (Artesunate-Amodiaquine and Artemether-Lumefantrine) between 2009 and 2016. Trop Med Infect Dis 2023; 9:10. [PMID: 38251206 PMCID: PMC10819967 DOI: 10.3390/tropicalmed9010010] [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: 10/27/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
The combinations of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) are used as first-line treatments for uncomplicated malaria in the Ivory Coast. Different studies document the efficacy of two artemisinin-based combination therapies (ACTs) (AL and ASAQ) in the Ivory Coast. However, there is no meta-analysis examining the data set of these studies. The purpose of this work was to determine the prevalence of malaria treatment failure cases in randomized control trials with two artemisinin-based combination therapies (AL versus ASAQ) in the Ivory Coast between 2009 to 2016. This study is a meta-analysis of data from the results of four previous multicenter, open-label, randomized clinical trial studies evaluating the clinical and parasitological efficacy of artemether-lumefantrine and artesunate-amodiaquine conducted between 2009 and 2016 following World Health Organization (WHO) protocol at sentinel sites in the Ivory Coast. These drug efficacy data collected between 2009 and 2016 were analyzed. During these studies, to distinguish between recrudescence and new infection, molecular genotyping of genes encoding merozoite surface protein 1 and 2 was carried out using nested polymerase chain reaction (PCR). A total of 1575 patients enrolled in the four studies, including 768 in the AL arm and 762 in the ASAQ arm, which were fully followed either for 28 days or 42 days according to WHO protocol. The adequate clinical and parasitological response (ACPR) was higher than 95% in the two groups (intention to treat (ITT): AL = 96.59% and ASAQ = 96.81; Per Protocol (PP): AL = 99.48% and ASAQ = 99.61%) after PCR correction at day 28. Aggregate data analysis (2009-2016) showed that at day 28, the proportions of patients with recurrent infection was higher in the AL group (ITT: 3.79%, PP: 3.9%) than in the ASAQ group (ITT: 2.17%, PP: 2.23%). After PCR correction, most treatment failures were classified as new infections (AL group (ITT: 0.13%, PP: 0.13%); ASAQ group (ITT: 0.39%, PP: 0.39%). The recrudescent infections rate was high, at 0.39% compared to 0.13% for ASAQ and AL, respectively, for both ITT and PP, no significant difference. However, the Kaplan-Meier curve of cumulative treatment success showed a significant difference between the two groups after PCR from 2012-2013 (p = 0.032). Overall, ASAQ and AL have been shown to be effective drugs for the treatment of uncomplicated P. falciparum malaria in the study areas, 14 years after deployment of these drugs.
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Affiliation(s)
- Akoua Valérie Bédia-Tanoh
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Malaria Research and Control Center/National Institute of Public Health, Abidjan P.O. Box V47, Côte d’Ivoire;
| | - Kondo Fulgence Kassi
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Diagnostic and Research Center on AIDS and Others Infectious Diseases (CeDReS), University Hospital Center, Treichville, Abidjan P.O. Box V13, Côte d’Ivoire
| | - Offianan André Touré
- Malariology Department Institut Pasteur of Ivory Coast, Abidjan P.O. Box 490, Côte d’Ivoire
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
| | - Serge Brice Assi
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
- Pierre Richet Institute (IPR) Bouake/National Institute of Public Health, Bouaké P.O. Box 1500, Côte d’Ivoire
| | - Akpa Paterne Gnagne
- Malaria Research and Control Center/National Institute of Public Health, Abidjan P.O. Box V47, Côte d’Ivoire;
| | - Koffi Daho Adoubryn
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
- Parasitology and Mycology Department, Training and Research Unit of Medical Sciences, University Alassane Ouattara, Bouaké P.O. Box 1801, Côte d’Ivoire
| | - Emmanuel Bissagnene
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
| | - Abibatou Konaté
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Jean Sebastien Miezan
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Kpongbo Etienne Angora
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Henriette Vanga-Bosson
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Malariology Department Institut Pasteur of Ivory Coast, Abidjan P.O. Box 490, Côte d’Ivoire
| | - Pulchérie Christiane Kiki-Barro
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Vincent Djohan
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Pierre Richet Institute (IPR) Bouake/National Institute of Public Health, Bouaké P.O. Box 1500, Côte d’Ivoire
| | - William Yavo
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Malaria Research and Control Center/National Institute of Public Health, Abidjan P.O. Box V47, Côte d’Ivoire;
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
| | - Eby Ignace Hervé Menan
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
- Pierre Richet Institute (IPR) Bouake/National Institute of Public Health, Bouaké P.O. Box 1500, Côte d’Ivoire
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T. Thurai Rathnam J, Grigg MJ, Dini S, William T, Sakam SS, Cooper DJ, Rajahram GS, Barber BE, Anstey NM, Haghiri A, Rajasekhar M, Simpson JA. Quantification of parasite clearance in Plasmodium knowlesi infections. Malar J 2023; 22:54. [PMID: 36782162 PMCID: PMC9926767 DOI: 10.1186/s12936-023-04483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/04/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The incidence of zoonotic Plasmodium knowlesi infections in humans is rising in Southeast Asia, leading to clinical studies to monitor the efficacy of anti-malarial treatments for knowlesi malaria. One of the key outcomes of anti-malarial drug efficacy is parasite clearance. For Plasmodium falciparum, parasite clearance is typically estimated using a two-stage method, that involves estimating parasite clearance for individual patients followed by pooling of individual estimates to derive population estimates. An alternative approach is Bayesian hierarchical modelling which simultaneously analyses all parasite-time patient profiles to determine parasite clearance. This study compared these methods for estimating parasite clearance in P. knowlesi treatment efficacy studies, with typically fewer parasite measurements per patient due to high susceptibility to anti-malarials. METHODS Using parasite clearance data from 714 patients with knowlesi malaria and enrolled in three trials, the Worldwide Antimalarial Resistance Network (WWARN) Parasite Clearance Estimator (PCE) standard two-stage approach and Bayesian hierarchical modelling were compared. Both methods estimate the parasite clearance rate from a model that incorporates a lag phase, slope, and tail phase for the parasitaemia profiles. RESULTS The standard two-stage approach successfully estimated the parasite clearance rate for 678 patients, with 36 (5%) patients excluded due to an insufficient number of available parasitaemia measurements. The Bayesian hierarchical estimation method was applied to the parasitaemia data of all 714 patients. Overall, the Bayesian method estimated a faster population mean parasite clearance (0.36/h, 95% credible interval [0.18, 0.65]) compared to the standard two-stage method (0.26/h, 95% confidence interval [0.11, 0.46]), with better model fits (compared visually). Artemisinin-based combination therapy (ACT) is more effective in treating P. knowlesi than chloroquine, as confirmed by both methods, with a mean estimated parasite clearance half-life of 2.5 and 3.6 h, respectively using the standard two-stage method, and 1.8 and 2.9 h using the Bayesian method. CONCLUSION For clinical studies of P. knowlesi with frequent parasite measurements, the standard two-stage approach (WWARN's PCE) is recommended as this method is straightforward to implement. For studies with fewer parasite measurements per patient, the Bayesian approach should be considered. Regardless of method used, ACT is more efficacious than chloroquine, confirming the findings of the original trials.
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Affiliation(s)
- Jeyamalar T. Thurai Rathnam
- grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Matthew J. Grigg
- grid.1043.60000 0001 2157 559XMenzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Saber Dini
- grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Sitti Saimah Sakam
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Daniel J. Cooper
- grid.1043.60000 0001 2157 559XMenzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia ,grid.5335.00000000121885934Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Giri S. Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia ,grid.415759.b0000 0001 0690 5255Clinical Research Centre, Queen Elizabeth II Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Bridget E. Barber
- grid.1043.60000 0001 2157 559XMenzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia ,grid.1049.c0000 0001 2294 1395QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Nicholas M. Anstey
- grid.1043.60000 0001 2157 559XMenzies School of Health Research and Charles Darwin University, Darwin, NT Australia ,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Ali Haghiri
- grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Megha Rajasekhar
- grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Julie A. Simpson
- grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Abuaku B, Duah-Quashie NO, Quashie N, Gyasi A, Afriyie PO, Owusu-Antwi F, Ghansah A, Malm KL, Bart-Plange C, Koram KA. Trends and predictive factors for treatment failure following artemisinin-based combination therapy among children with uncomplicated malaria in Ghana: 2005-2018. BMC Infect Dis 2021; 21:1255. [PMID: 34911501 PMCID: PMC8672499 DOI: 10.1186/s12879-021-06961-4] [Citation(s) in RCA: 5] [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: 08/05/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Since the introduction of artemisinin-based combination therapy (ACT) in Ghana in 2005 there has been a surveillance system by the National Malaria Control Programme (NMCP) and the University of Ghana Noguchi Memorial Institute for Medical Research (UG-NMIMR) to monitor the therapeutic efficacy of ACTs for the treatment of uncomplicated malaria in the country. We report trends and determinants of failure following treatment of Ghanaian children with artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) combinations. METHODS Per protocol analyses as well as cumulative incidence of day 28 treatment failure from Kaplan Meier survival analyses were used to describe trends of failure over the surveillance period of 2005-2018. Univariable and multivariable cox regression analyses were used to assess the determinants of treatment failure over the period. RESULTS Day 28 PCR-corrected failure, following treatment with ASAQ, significantly increased from 0.0% in 2005 to 2.0% (95% CI: 1.1-3.6) in 2015 (p = 0.013) but significantly decreased to 0.4% (95% CI: 0.1-1.6) in 2018 (p = 0.039). Failure, following treatment with AL, decreased from 4.5% (95% CI: 2.0-9.4) in 2010 to 2.7% (95% CI: 1.4-5.1) in 2018, though not statistically significant (p = 0.426). Risk of treatment failure, from multivariable cox regression analyses, was significantly lower among children receiving ASAQ compared with those receiving AL (HR = 0.24; 95% CI: 0.11-0.53; p < 0.001); lower among children with no parasitaemia on day 3 compared with those with parasitaemia on day 3 (HR = 0.02; 95% CI: 0.01-0.13; p < 0.001); and higher among children who received ASAQ and had axillary temperature ≥ 37.5 °C on day 1 compared with those with axillary temperature < 37.5 °C (HR = 3.96; 95% CI: 1.61-9.75; p = 0.003). CONCLUSIONS Treatment failures for both ASAQ and AL have remained less than 5% (below WHO's threshold of 10%) in Ghana since 2005. Predictors of treatment failure that need to be considered in the management of uncomplicated malaria in the country should include type of ACT, day 3 parasitaemia, and day 1 axillary temperature of patients being treated.
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Affiliation(s)
- Benjamin Abuaku
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Nancy Odurowah Duah-Quashie
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Neils Quashie
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Akosua Gyasi
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Patricia Opoku Afriyie
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | | | - Anita Ghansah
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Keziah Laurencia Malm
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Constance Bart-Plange
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Kwadwo Ansah Koram
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
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Influence of Host-Related Factors and Exposure to Mosquito Bites on the Dynamics of Antibody Response to Plasmodium falciparum Antigens. Trop Med Infect Dis 2021; 6:tropicalmed6040185. [PMID: 34698307 PMCID: PMC8544703 DOI: 10.3390/tropicalmed6040185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Humoral immunity to Plasmodium falciparum is acquired after repeated infections, and can lead to clinical protection. This study aimed to evaluate how human-, parasite-, and environment-related determinants can modulate the dynamics of IgG responses to Plasmodium falciparum after an infection. Individuals (n = 68, average age = 8.2 years) with uncomplicated malaria were treated with ACT and followed up for 42 days. IgG responses to P. falciparum merozoite antigens (PfMSP1, PfMSP3, PfAMA1, PfGLURP-R0), to whole schizont extract (PfSchz), and to Anopheles gSG6-P1 and Aedes Nterm–34 kDa salivary peptides were measured. Regression analyses were used to identify factors that influence the dynamics of IgG response to P. falciparum antigen between D0 and D42, including demographic and biological factors and the level of exposure to mosquito bites. The dynamics of IgG response to P. falciparum differed according to the antigen. According to multivariate analysis, IgG responses to PfSchz and to PfGLURP-R0 appear to be affected by exposure to Aedes saliva and are associated with age, parasite density, and anti-Plasmodium pre-existing immune response at study inclusion. The present work shows that human exposure to Aedes saliva may contribute, in addition to other factors, to the regulation of anti-Plasmodium immune responses during a natural infection.
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Aka KG, Traoré DF, Sagna AB, Zoh DD, Assi SB, Tchiekoi BN, Adja AM, Remoue F, Poinsignon A. Pattern of antibody responses to Plasmodium falciparum antigens in individuals differentially exposed to Anopheles bites. Malar J 2020; 19:83. [PMID: 32085710 PMCID: PMC7033907 DOI: 10.1186/s12936-020-03160-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background In malaria-endemic areas, human populations are frequently exposed to immunomodulatory salivary components injected during mosquito blood feeding. The consequences on pathogen-specific immune responses are not well known. This study evaluated and compared the humoral responses specific to merozoite stage vaccine candidates of Plasmodium falciparum, in children differentially exposed to Anopheles bites in a natural setting. Methods The cross-sectional study was carried out in Bouaké (Côte d’Ivoire) where entomological data and blood samples from children (0–14 years) were collected in two sites with similar malaria prevalence. Antibody (IgG, IgG1, IgG3) responses to PfAMA1 and PfMSP1 were evaluated by ELISA. Univariate and multivariate analysis were performed to assess the relationship between the immune responses to P. falciparum antigens and exposure to Anopheles bites in the total cohort and in each site, separately. The individual level of exposure to Anopheles bites was evaluated by quantifying specific IgG response to the Anopheles gSG6-P1 salivary peptide, which represents a proxy of Anopheles exposure. Results The anti-Plasmodium humoral responses were different according to the level of exposure of children, with those highly exposed to Anopheles presenting significantly lower antibody responses to PfMSP1 in total population (IgG and IgG3) and in Petessou village (IgG, IgG1, IgG3). No significant difference was seen for PfAMA1 antigen between children differently exposed to Anopheles. In Dar-es-Salam, a neighbourhood where a high Culex density was reported, children presented very low antibody levels specific to both antigens, and no difference according to the exposure to Anopheles bites was found. Conclusion These findings may suggest that immunomodulatory components of Anopheles saliva, in addition to other factors, may participate to the modulation of the humoral response specific to Plasmodium merozoite stage antigens. This epidemiological observation may form a starting point for additional work to decipher the role of mosquito saliva on the modulation of the anti-Plasmodium acquired immunity and clinical protection in combining both field and ex vivo immunological studies.
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Affiliation(s)
- Kakou G Aka
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire. .,MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France.
| | - Dipomin F Traoré
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire.,MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France.,UFR Sciences de la Nature, Université Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - André B Sagna
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire.,MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Dounin D Zoh
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire.,UFR Biosciences, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Serge B Assi
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire
| | | | - Akré M Adja
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire.,UFR Biosciences, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Franck Remoue
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire.,MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Anne Poinsignon
- Institut Pierre Richet, Institut National de Santé Publique, Bouaké, Côte d'Ivoire.,MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
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Investigating the Effect of Prompt Treatment on Malaria Prevalence in Children Aged below Five Years in Zambia: A Nested Case-Control Study in a Cross-Sectional Survey. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/4289420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. In a highly malaria endemic country like Zambia, prompt treatment of cases is known to reduce morbidity and mortality; however, it is not known whether it has a role as an effective prevention strategy because of the presence of asymptomatic chronic carriers who do not seek treatment and maintain the reservoirs of infection in the population. This study investigated the role of treatment of malaria cases as a prevention strategy in low, moderate, and high endemic settings. Methods. A nested case-control design was employed using datasets from a large countrywide national Malaria Indicator Survey of 2015. Self-reported malaria cases (n = 209) who took treatment in the two weeks preceding the survey were matched with controls (n = 511) who did not report malaria and did not take treatment during the same period using nearest neighbour propensity score matching for age, sex, and district. The data were analysed using conditional logistic regression in STATA version 15.1. Results. The malaria cases were more likely to be from rural areas (p=0.001), poorest households (p=0.049), and who lived in improvised housing structures (p=0.004) compared with the controls. Data from low and moderate malaria endemic areas did not have sufficient cases for the analysis to proceed; however, data from high endemic areas showed borderline evidence (p=0.054) that prompt treatment reduces the risk of malaria by almost half in the short-term aOR 0.057 (95% CI 0.32–1.01). Conclusion. We found borderline evidence which suggests that prompt treatment of malaria cases even in high endemic areas has potential to reduce the risk of malaria by almost half in the short term.
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Prevalence and Factors Associated with Acute Kidney Injury among Malaria Patients in Dar es Salaam: A Cross-Sectional Study. Malar Res Treat 2019; 2019:4396108. [PMID: 31485321 PMCID: PMC6702846 DOI: 10.1155/2019/4396108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Falciparum malaria still remains as a major cause of morbidity and mortality worldwide. Acute kidney injury is a known complication of malaria, and it is reported to occur in up to 40% of adult patients with severe falciparum malaria in endemic regions like sub-Saharan Africa. Objectives To determine the prevalence and factors associated with acute kidney injury among falciparum malaria patients in a tertiary level private hospital in Dar es Salaam. Methodology In a cross-sectional study design, 104 adults with falciparum malaria were enrolled consecutively over 6 months from April to September 2015. The diagnosis of acute kidney injury (AKI) in these patients was established using the KDIGO classification criteria. The prevalence of AKI was obtained at 48 hours from admission and at day 7. Different sociodemographic and clinical parameters which were associated with acute kidney injury at 48 hours and at day 7 were identified by hypothesis testing using chi squared tests followed by multivariate logistic regression analysis. Factors with a p value less than 0.05 were considered significant. Results The participants were predominantly males 65.4% (68/104) and a third (36.5% (38/104)) were between 46 and 65 years. The prevalence of AKI among malaria patients at 48 hours was 26% (27/104). The prevalence of AKI among malaria patients at day 7 was 18.3% (19/104). On multivariate logistic regression, we found that factors that were significantly associated with AKI at 48 hours were male sex (OR 127, CI 3.4–4700, P = 0.008) and hemoglobin <7.5g/dl (OR 36.5, CI 1.7–797.7, P = 0.022), and factor associated with AKI at day 7 was baseline platelet count <25×103 per mm3 (OR 77.8 CI 1.045–5798.6, P = 0.048). Only two patients needed hemodialysis (1.9%) and there were no deaths. Conclusion Acute kidney injury is a common complication in patient with falciparum malaria. When managed well it has an excellent prognosis and necessitates dialysis in only a minority of patients. Male sex and hemoglobin is associated with AKI at 48 hours and baseline platelet count is associated with AKI at 7 days.
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