1
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Dimcheff DE, Blair CN, Zhu Y, Chappell JD, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Busse LW, Frosch AEP, Peltan ID, Hager DN, Gong MN, Exline MC, Khan A, Wilson JG, Qadir N, Ginde AA, Douin DJ, Mohr NM, Mallow C, Martin ET, Johnson NJ, Casey JD, Stubblefield WB, Gibbs KW, Kwon JH, Talbot HK, Halasa N, Grijalva CG, Baughman A, Womack KN, Hart KW, Swan SA, Surie D, Thornburg NJ, McMorrow ML, Self WH, Lauring AS. Total and Subgenomic RNA Viral Load in Patients Infected With SARS-CoV-2 Alpha, Delta, and Omicron Variants. J Infect Dis 2023; 228:235-244. [PMID: 36883903 PMCID: PMC10420395 DOI: 10.1093/infdis/jiad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic and subgenomic RNA levels are frequently used as a correlate of infectiousness. The impact of host factors and SARS-CoV-2 lineage on RNA viral load is unclear. METHODS Total nucleocapsid (N) and subgenomic N (sgN) RNA levels were measured by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in specimens from 3204 individuals hospitalized with coronavirus disease 2019 (COVID-19) at 21 hospitals. RT-qPCR cycle threshold (Ct) values were used to estimate RNA viral load. The impact of time of sampling, SARS-CoV-2 variant, age, comorbidities, vaccination, and immune status on N and sgN Ct values were evaluated using multiple linear regression. RESULTS Mean Ct values at presentation for N were 24.14 (SD 4.53) for non-variants of concern, 25.15 (SD 4.33) for Alpha, 25.31 (SD 4.50) for Delta, and 26.26 (SD 4.42) for Omicron. N and sgN RNA levels varied with time since symptom onset and infecting variant but not with age, comorbidity, immune status, or vaccination. When normalized to total N RNA, sgN levels were similar across all variants. CONCLUSIONS RNA viral loads were similar among hospitalized adults, irrespective of infecting variant and known risk factors for severe COVID-19. Total N and subgenomic RNA N viral loads were highly correlated, suggesting that subgenomic RNA measurements add little information for the purposes of estimating infectivity.
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Affiliation(s)
- Derek E Dimcheff
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher N Blair
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Anne E P Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah, USA
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, Missouri, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith L McMorrow
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
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2
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Ondigo BN, Hamre KES, Frosch AEP, Ayodo G, White MT, John CC. Antibody Profiles to P. falciparum Antigens Over Time Characterize Acute and Long-Term Malaria Exposure in an Area of Low and Unstable Transmission. Am J Trop Med Hyg 2020; 103:2189-2197. [PMID: 33124539 DOI: 10.4269/ajtmh.19-0480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Prevalence and levels of antibodies to multiple Plasmodium falciparum antigens show promise as tools for estimating malaria exposure. In a highland area of Kenya with unstable transmission, we assessed the presence and levels of antibodies to 12 pre-erythrocytic and blood-stage P. falciparum antigens by multiplex cytometric bead assay or ELISA in 604 individuals in August 2007, with follow-up testing in this cohort in April 2008, April 2009, and May 2010. Four hundred individuals were tested at all four time points. During this period, the only substantial malaria incidence occurred from April to August 2009. Antibody prevalence in adults was high at all time points (> 70%) for apical membrane antigen 1, erythrocyte-binding antigen 175, erythrocyte-binding protein-2, glutamate rich protein (GLURP)-R2, merozoite surface protein (MSP) 1 (19), MSP-1 (42), and liver-stage antigen-1; moderate (30-70%) for GLURP-R0, MSP-3, and thrombospondin-related adhesive protein; and low (< 30%) for SE and circumsporozoite protein (CSP). Changes in community-wide malaria exposure were best reflected in decreasing antibody levels overtime for highly immunogenic antigens, and in antibody seroprevalence overtime for the less-immunogenic antigens. Over the 3 years, antibody levels to all antigens except CSP and schizont extract (SE) decreased in an age-dependent manner. Prevalence and levels of antibodies to all antigens except CSP and SE increased with age. Increases in antibody prevalence and levels to CSP and SE coincided with increases in community-wide malaria incidence. Antibody levels to multiple P. falciparum antigens decrease in the absence of consistent transmission. Multiplex assays that assess both the presence and level of antibodies to multiple pre-erythrocytic and blood-stage P. falciparum antigens may provide the most useful estimates of past and recent malaria transmission in areas of unstable transmission and could be useful tools in malaria control and elimination campaigns.
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Affiliation(s)
- Bartholomew N Ondigo
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya
| | - Karen E S Hamre
- CDC Foundation, Atlanta, Georgia.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Anne E P Frosch
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - George Ayodo
- School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, Siaya, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Michael T White
- Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Chandy C John
- Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana
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3
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Pennington K, Ives ST, Frosch AEP, Shaughnessy MK. Delayed clinical presentation of Plasmodium falciparum malaria after leaving an endemic area: a tale of two patients. J Travel Med 2020; 27:5851818. [PMID: 32502276 PMCID: PMC8325062 DOI: 10.1093/jtm/taaa092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 11/13/2022]
Abstract
Malaria due to Plasmodium falciparum (Pf) may be missed if patients present with symptoms outside of the expected incubation period. We describe two patients who developed Pf malaria more than one year after visiting malaria-endemic countries. Both worked at an international airport, but no source of infection was identified.
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Affiliation(s)
- Kaylin Pennington
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Samuel T Ives
- Department of Medicine, Division of General Internal Medicine, Hennepin Healthcare, 701 Park Ave S, Minneapolis, MN 55415, USA
| | - Anne E P Frosch
- Division of Infectious Diseases, Hennepin Healthcare, 701 Park Ave S, Minneapolis, MN 55415, USA
| | - Megan K Shaughnessy
- Division of Infectious Diseases, Hennepin Healthcare, 701 Park Ave S, Minneapolis, MN 55415, USA
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4
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Affiliation(s)
- Anne E P Frosch
- Hennepin Healthcare Research Institute, Minneapolis.,University of Minnesota, Minneapolis
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5
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Odhiambo EO, Datta D, Guyah B, Ayodo G, Ondigo BN, Abong'o BO, John CC, Frosch AEP. HIV infection drives IgM and IgG3 subclass bias in Plasmodium falciparum-specific and total immunoglobulin concentration in Western Kenya. Malar J 2019; 18:297. [PMID: 31470903 PMCID: PMC6716850 DOI: 10.1186/s12936-019-2915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/17/2019] [Indexed: 11/22/2022] Open
Abstract
Background HIV infection is associated with more frequent and severe episodes of malaria and may be the result of altered malaria-specific B cell responses. However, it is poorly understood how HIV and the associated lymphopenia and immune activation affect malaria-specific antibody responses. Methods HIV infected and uninfected adults were recruited from Bondo subcounty hospital in Western Kenya at the time of HIV testing (antiretroviral and co-trimoxazole prophylaxis naïve). Total and Plasmodium falciparum apical membrane antigen-1 (AMA1) and glutamate rich protein-R0 (GLURP-R0) specific IgM, IgG and IgG subclass concentrations was measured in 129 and 52 of recruited HIV-infected and uninfected individuals, respectively. In addition, HIV-1 viral load (VL), CD4+ T cell count, and C-reactive protein (CRP) concentration was quantified in study participants. Antibody levels were compared based on HIV status and the associations of antibody concentration with HIV-1 VL, CD4+ count, and CRP levels was measured using Spearman correlation testing. Results Among study participants, concentrations of IgM, IgG1 and IgG3 antibodies to AMA1 and GLURP-R0 were higher in HIV infected individuals compared to uninfected individuals (all p < 0.001). The IgG3 to IgG1 ratio to both AMA1 and GLURP-R0 was also significantly higher in HIV-infected individuals (p = 0.02). In HIV-infected participants, HIV-1 VL and CRP were weakly correlated with AMA1 and GLURP-R0 specific IgM and IgG1 concentrations and total (not antigen specific) IgM, IgG, IgG1, and IgG3 concentrations (all p < 0.05), suggesting that these changes are related in part to viral load and inflammation. Conclusions Overall, HIV infection leads to a total and malaria antigen-specific immunoglobulin production bias towards higher levels of IgM, IgG1, and IgG3, and HIV-1 viraemia and systemic inflammation are weakly correlated with these changes. Further assessments of antibody affinity and function and correlation with risk of clinical malaria, will help to better define the effects of HIV infection on clinical and biological immunity to malaria.
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Affiliation(s)
- Eliud O Odhiambo
- Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya.,Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Dibyadyuti Datta
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Bernard Guyah
- Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya
| | - George Ayodo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Bartholomew N Ondigo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya.,Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Disease, NIH, Bethesda, MD, USA
| | - Benard O Abong'o
- Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya.,Department of Biology, Faculty of Science and Technology, National University of Lesotho, Roma, Lesotho
| | - Chandy C John
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Anne E P Frosch
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya. .,Department of Medicine, University of Minnesota, Minneapolis, USA. .,Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
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6
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Frosch AEP, Ayodo G, Odhiambo EO, Ireland K, Vulule J, Cusick SE. Iron Deficiency is Prevalent among HIV-Infected Kenyan Adults and is Better Measured by Soluble Transferrin Receptor than Ferritin. Am J Trop Med Hyg 2018; 99:439-444. [PMID: 29943722 DOI: 10.4269/ajtmh.18-0208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Iron deficiency (ID) and human immunodeficiency virus (HIV) infection frequently coexist. Little data exist on ID in HIV-infected individuals, partly because the iron marker ferritin is altered by inflammation common in HIV infection. We measured iron biomarkers (ferritin, soluble transferrin receptor [sTfR], hepcidin) and red cell indices (hemoglobin, mean corpuscular volume [MCV]) in newly diagnosed, antiretroviral therapy-naive, HIV-infected (N = 138) and uninfected (N = 52) Kenyan adults enrolled in a study of the immune response to malaria. We compared markers between infected and uninfected groups with t test and Wilcoxon Rank-Sum, used Spearman correlation to determine the association between iron and inflammatory markers, and applied logistic regression to determine which markers best predicted anemia. HIV-infected individuals had lower hemoglobin (P < 0.001), lower MCV (P < 0.001), higher sTfR (P = 0.003), and a greater prevalence of ID (sTfR > 8.3 mg/L) than uninfected individuals. Ferritin was elevated in HIV-infected individuals and was more strongly correlated with C-reactive protein (ρ = 0.43, P < 0.001) and hepcidin (ρ = 0.69, P < 0.001) than with hemoglobin. The best predictor of anemia in HIV-infected participants was sTfR, with a one log-unit increase in sTfR associated with a 6-fold increase in the odds of anemia (odds ratio = 6.3, 95% confidence interval: 1.8-21.8). These data suggest a significant burden of ID among treatment-naive HIV-infected Kenyan adults. Soluble transferrin receptor may be a reliable marker of ID in HIV-mediated inflammation.
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Affiliation(s)
- Anne E P Frosch
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - George Ayodo
- Department of Public Health, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya.,Kenyan Medical Research Institute, Kisumu, Kenya
| | | | - Kathleen Ireland
- University of Minnesota Medical School, Academic Health Center, University of Minnesota, Minneapolis, Minnesota.,Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - John Vulule
- Kenyan Medical Research Institute, Kisumu, Kenya
| | - Sarah E Cusick
- Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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7
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Frosch AEP, John CC. Expanding the toolbox in pursuit of a strain transcendent malaria vaccine. Am J Trop Med Hyg 2014; 92:1-2. [PMID: 25422397 DOI: 10.4269/ajtmh.14-0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Anne E P Frosch
- Division of Infectious Diseases and International Medicine, Department of Medicine and Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Chandy C John
- Division of Infectious Diseases and International Medicine, Department of Medicine and Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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8
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Frosch AEP, Ondigo BN, Ayodo GA, Vulule JM, John CC, Cusick SE. Decline in childhood iron deficiency after interruption of malaria transmission in highland Kenya. Am J Clin Nutr 2014; 100:968-73. [PMID: 25080460 PMCID: PMC4135504 DOI: 10.3945/ajcn.114.087114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Achieving optimal iron status in children in malaria-endemic areas may increase the risk of malaria. Malaria itself may contribute to iron deficiency, but the impact of an interruption in malaria transmission on the prevalence of iron deficiency is unknown. OBJECTIVES We aimed to determine whether 1) iron status improved in children living in 2 Kenyan villages with a documented cessation in malaria transmission and 2) changes in iron status correlated with changes in hemoglobin. DESIGN We measured iron [hemoglobin, ferritin, soluble transferrin receptor (sTfR)] and inflammatory [C-reactive protein (CRP)] markers in paired plasma samples from 190 children aged 4-59 mo at the beginning (May 2007) and end (July 2008) of a documented 12-mo period of interruption in malaria transmission in 2 highland areas in Kenya with unstable malaria transmission and ongoing malaria surveillance. RESULTS Between May 2007 and July 2008, mean (±SD) hemoglobin increased from 10.8 ± 1.6 to 11.6 ± 1.6 g/dL. Median (25th, 75th percentile) ferritin increased from 17.0 (9.7, 25.6) to 22.6 (13.4, 34.7) μg/L (P < 0.001), whereas median sTfR decreased from 32.4 (26.3, 43.2) to 27.7 (22.1, 36.0) nmol/L (P < 0.001). Median CRP was low (<1 mg/L in both years) and did not change significantly. Iron deficiency prevalence (ferritin <12 μg/L, or <30 μg/L if CRP ≥10 mg/L) decreased from 35.9% (95% CI: 28.9%, 43.0%) to 24.9% (18.5%, 31.2%) (P = 0.005). The prevalence of iron deficiency with anemia (hemoglobin <11.0 g/dL) declined from 27.2% (20.7%, 33.8%) to 12.2% (7.4%, 17.1%) (P < 0.001). Improvement in iron status correlated with an increase in hemoglobin and was greater than explained by physiologic changes expected with age. CONCLUSIONS In this area of unstable malaria transmission, the prevalence of iron deficiency in children decreased significantly after the interruption of malaria transmission and was correlated with an increase in hemoglobin. These findings suggest that malaria elimination strategies themselves may be an effective way to address iron deficiency in malaria-endemic areas.
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Affiliation(s)
- Anne E P Frosch
- From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ)
| | - Bartholomew N Ondigo
- From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ)
| | - George A Ayodo
- From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ)
| | - John M Vulule
- From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ)
| | - Chandy C John
- From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ)
| | - Sarah E Cusick
- From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ)
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9
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Frosch AEP, Laufer MK, Mathanga DP, Takala-Harrison S, Skarbinski J, Claassen CW, Dzinjalamala FK, Plowe CV. Return of widespread chloroquine-sensitive Plasmodium falciparum to Malawi. J Infect Dis 2014; 210:1110-4. [PMID: 24723474 DOI: 10.1093/infdis/jiu216] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The return of chloroquine-sensitive Plasmodium falciparum to the limited area of Blantyre, Malawi, has been well demonstrated in several studies. METHODS To characterize chloroquine susceptibility over a wide geographic area, infants and children aged 6-59 months were selected using 2-stage cluster sampling in 8 Malawian districts. Pyrosequencing of the pfcrt gene codon 76 region was performed for children with asexual parasitemia. RESULTS Of 7145 children, 1150 had microscopic asexual parasitemia, and sequencing was performed in 685, of whom 1 had a chloroquine-resistant genotype. CONCLUSIONS Systematic countrywide sampling demonstrates that the chloroquine pfcrt genotype has reached near-fixation, raising the possibility of reintroducing chloroquine for malaria prevention and treatment.
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Affiliation(s)
- Anne E P Frosch
- Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore Department of Medicine, University of Minnesota, Minneapolis
| | - Miriam K Laufer
- Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | | | - Shannon Takala-Harrison
- Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | - Jacek Skarbinski
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cassidy W Claassen
- Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | | | - Christopher V Plowe
- Howard Hughes Medical Institute/Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
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10
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Bahr NC, Wallace J, Frosch AEP, Boulware DR. Unmasking Cryptococcal Meningitis Immune Reconstitution Inflammatory Syndrome due to Granulocyte Colony-Stimulating Factor Use in a Patient with a Poorly Differentiated Germ Cell Neoplasm. Case Rep Oncol 2014; 7:1-5. [PMID: 24575007 PMCID: PMC3934776 DOI: 10.1159/000357666] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cryptococcal meningitis immune reconstitution inflammatory syndrome (IRIS) is frequently seen in patients with HIV and less frequently in patients on immune suppressive medications for other conditions. Here, we describe the first reported case of unmasking cryptococcal IRIS due to granulocyte colony-stimulating factor used in an HIV-negative patient with chemotherapy-induced neutropenia.
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Affiliation(s)
- Nathan C Bahr
- Department of MedicineCenter for Infectious Diseases and Microbiology Translational Research, Minn., USA ; Center for Infectious Diseases and Microbiology Translational Research, Minn., USA ; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minn., USA
| | - James Wallace
- Department of MedicineCenter for Infectious Diseases and Microbiology Translational Research, Minn., USA
| | - Anne E P Frosch
- Department of MedicineCenter for Infectious Diseases and Microbiology Translational Research, Minn., USA ; Center for Infectious Diseases and Microbiology Translational Research, Minn., USA ; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minn., USA
| | - David R Boulware
- Department of MedicineCenter for Infectious Diseases and Microbiology Translational Research, Minn., USA ; Center for Infectious Diseases and Microbiology Translational Research, Minn., USA ; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minn., USA
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11
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Frosch AEP, John CC. Immunomodulation in Plasmodium falciparum malaria: experiments in nature and their conflicting implications for potential therapeutic agents. Expert Rev Anti Infect Ther 2013; 10:1343-56. [PMID: 23241191 DOI: 10.1586/eri.12.118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Effective Plasmodium falciparum immunity requires a precisely timed and balanced response of inflammatory and anti-inflammatory immune regulators. These responses begin with innate immune effectors and are modulated over the course of an infection and between episodes to limit inflammation. To date, there are no effective immunomodulatory therapies for severe malaria. Some of the most potent immunomodulators are naturally occurring infections, including helminthic and chronic viral infections. This review examines malaria coinfection with these organisms, and their impact on malaria morbidity and immune responses. Overall, there is compelling evidence to suggest that chronic coinfections can modulate deleterious malaria-specific immune responses, suggesting that therapeutic agents may be effective if utilized early in infection. Examination of the mechanisms of these effects may serve as a platform to identify more targeted and effective malaria immunomodulatory therapeutics.
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Affiliation(s)
- Anne E P Frosch
- University of Minnesota, Center for Infectious Diseases and Microbiology Translational Research and Division of Global Pediatrics, McGuire Translational Research Facility, 2001 6th Street SE, Minneapolis, MN 55455, USA.
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Cusick SE, Frosch AEP, Ondigo BN, Ayodo GA, John CC. Decline in Childhood Iron Deficiency After Interruption of Malaria Transmission in Highland Kenya. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.845.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Eastman Cusick
- Department of PediatricsDivision of Global PediatricsUniversity of MinnesotaMinneapolisMN
| | - Anne E. P. Frosch
- Department of PediatricsDivision of Global PediatricsUniversity of MinnesotaMinneapolisMN
| | - Bartholomew N. Ondigo
- Maseno UniversityMasenoKenya
- Center for Global Health ResearchKenya Medical Research InstituteKisumuKenya
| | - George A. Ayodo
- Center for Global Health ResearchKenya Medical Research InstituteKisumuKenya
| | - Chandy C. John
- Department of PediatricsDivision of Global PediatricsUniversity of MinnesotaMinneapolisMN
- Center for Global Health ResearchKenya Medical Research InstituteKisumuKenya
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Frosch AEP, Venkatesan M, Laufer MK. Patterns of chloroquine use and resistance in sub-Saharan Africa: a systematic review of household survey and molecular data. Malar J 2011; 10:116. [PMID: 21554692 PMCID: PMC3112453 DOI: 10.1186/1475-2875-10-116] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 05/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a result of widespread chloroquine and sulphadoxine-pyrimethamine (SP) resistance, 90% of sub-Saharan African countries had adopted policies of artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria by 2007. In Malawi, cessation of chloroquine use was followed by the re-emergence of chloroquine-susceptible malaria. It was expected that introduction of ACT would lead to a return in chloroquine susceptibility throughout Africa, but this has not yet widely occurred. This observation suggests that there is continuing use of ineffective anti-malarials in Africa and that persistent chloroquine-resistant malaria is due to ongoing drug pressure despite national policy changes. METHODS To estimate drug use on a national level, 2006-2007 Demographic Health Survey and Multiple Indicator Cluster Survey data from 21 African countries were analysed. Resistance data were compiled by systematic review of the published literature on the prevalence of the Plasmodium falciparum chloroquine resistance transporter polymorphism at codon 76, which causes chloroquine resistance. RESULTS Chloroquine was the most common anti-malarial used according to surveys from 14 of 21 countries analysed, predominantly in West Africa. SP was most commonly reported in two of 21 countries. Among eight countries with longitudinal molecular resistance data, the four countries where the highest proportion of children treated for fever received chloroquine (Uganda, Burkina Faso, Guinea Bissau, and Mali) also showed no significant declines in the prevalence of chloroquine-resistant infections. The three countries with low or decreasing chloroquine use among children who reported fever treatment (Malawi, Kenya, and Tanzania) had statistically significant declines in the prevalence of chloroquine resistance. CONCLUSIONS This study demonstrates that in 2006-2007, chloroquine and SP continued to be used at high rates in many African countries. In countries reporting sustained chloroquine use, chloroquine-resistant malaria persists. In contrast, a low level of estimated chloroquine use is associated with a declining prevalence of chloroquine resistance.
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Affiliation(s)
- Anne E P Frosch
- Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD, USA
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