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Pessoa RC, Oliveira-Pessoa GF, Souza BKA, Sampaio VS, Pinto ALCB, Barboza LL, Mouta GS, Silva EL, Melo GC, Monteiro WM, Silva-Filho JH, Lacerda MVG, Baía-da-Silva DC. Author Correction: Impact of Plasmodium vivax malaria on executive and cognitive functions in elderlies in the Brazilian Amazon. Sci Rep 2024; 14:1120. [PMID: 38212339 PMCID: PMC10784451 DOI: 10.1038/s41598-023-48865-0] [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: 01/13/2024] Open
Affiliation(s)
- Rockson C Pessoa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Brenda K A Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson S Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - André Luiz C B Pinto
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Larissa L Barboza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Gabriel S Mouta
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Emanuelle Lira Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Gisely C Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Wuelton M Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | | | - Marcus V G Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil.
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil.
| | - Djane Clarys Baía-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
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Mwangi VI, Netto RLA, Borba MGS, Santos GF, Lima GS, Machado LS, Yakubu MN, Val FFA, Sampaio VS, Sartim MA, Koolen HHF, Costa AG, Toméi MCM, Guimarães TP, Chaves AR, Vaz BG, Lacerda MVG, Monteiro WM, Gardinassi LG, Melo GC. Methylprednisolone therapy induces differential metabolic trajectories in severe COVID-19 patients. mSystems 2023; 8:e0072623. [PMID: 37874139 PMCID: PMC10734516 DOI: 10.1128/msystems.00726-23] [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: 07/13/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023] Open
Abstract
IMPORTANCE The SARS-CoV-2 virus infection in humans induces significant inflammatory and systemic reactions and complications of which corticosteroids like methylprednisolone have been recommended as treatment. Our understanding of the metabolic and metabolomic pathway dysregulations while using intravenous corticosteroids in COVID-19 is limited. This study will help enlighten the metabolic and metabolomic pathway dysregulations underlying high daily doses of intravenous methylprednisolone in COVID-19 patients compared to those receiving placebo. The information on key metabolites and pathways identified in this study together with the crosstalk with the inflammation and biochemistry components may be used, in the future, to leverage the use of methylprednisolone in any future pandemics from the coronavirus family.
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Affiliation(s)
- Victor I. Mwangi
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
| | - Rebeca L. A. Netto
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
| | - Mayla G. S. Borba
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | - Gabriel F. Santos
- Laboratório de Cromatografia e Espectrometria de Massas, Instituto de Química, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Gesiane S. Lima
- Laboratório de Cromatografia e Espectrometria de Massas, Instituto de Química, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Lucas S. Machado
- Laboratório de Cromatografia e Espectrometria de Massas, Instituto de Química, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Michael N. Yakubu
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
| | - Fernando F. A. Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Programa de Pós-Graduação em Ciência da Saúde, Universidade Federal do Amazonas (UFAM), Manaus, Amazonas, Brazil
- Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Federal do Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Vanderson S. Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Instituto Todos pela Saúde, São Paulo, São Paulo, Brazil
| | - Marco A. Sartim
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Pró-reitoria de Pesquisa e Pós-graduação, Universidade Nilton Lins, Manaus, Amazonas, Brazil
| | - Hector H. F. Koolen
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Grupo de Pesquisa em Metabolômica e Espectrometria de Massas, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Allyson G. Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, Amazonas, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, Amazonas, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM), Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Ciências Aplicadas à Hematologia (PPGH-UEA/HEMOAM), Manaus, Amazonas, Brazil
| | - Maria C. M. Toméi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Goiás, Brazil
| | - Tiago P. Guimarães
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Goiás, Brazil
| | - Andrea R. Chaves
- Laboratório de Cromatografia e Espectrometria de Massas, Instituto de Química, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Boniek G. Vaz
- Laboratório de Cromatografia e Espectrometria de Massas, Instituto de Química, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Marcus V. G. Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane/Fundação Oswaldo Cruz (ILMD/Fiocruz Amazônia), Manaus, Amazonas, Brazil
| | - Wuelton M. Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | - Luiz G. Gardinassi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiânia, Goiás, Brazil
| | - Gisely C. Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Ciências Aplicadas à Hematologia (PPGH-UEA/HEMOAM), Manaus, Amazonas, Brazil
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Macêdo MM, Almeida ACG, Silva GS, Oliveira AC, Mwangi VI, Shuan AC, Barbosa LRA, Rodrigues-Soares F, Melo GC. Association of CYP2C19, CYP2D6 and CYP3A4 Genetic Variants on Primaquine Hemolysis in G6PD-Deficient Patients. Pathogens 2023; 12:895. [PMID: 37513742 PMCID: PMC10384057 DOI: 10.3390/pathogens12070895] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
In the Amazon, the treatment for Plasmodium vivax is chloroquine plus primaquine. However, this regimen is limited due to the risk of acute hemolytic anemia in glucose-6-phosphate dehydrogenase deficiency. Primaquine is a prodrug that requires conversion by the CYP2D6 enzyme to be effective against malaria. A series of cases were performed at an infectious diseases reference hospital in the Western Brazilian Amazon. The STANDARD G6PD (SD Biosensor®) assay was used to infer G6PD status and real-time PCR to genotype G6PD, CYP2C19, CYP2D6 and CYP3A4. Eighteen patients were included, of which 55.6% had African A- variant (G202A/A376G), 11.1% African A+ variant (A376G), 5.6% Mediterranean variant (C563T) and 27.8% were wild type. CYP2C19, CYP2D6 and CYP3A4 genotyping showed no statistically significant differences in the frequency of star alleles between the groups G6PD deficient and G6PD normal. Elevated levels of liver and kidney markers in the G6PDd patients were observed in gNM, gRM and gUM of CYP2C19 and CYP2D6 (p < 0.05). Furthermore, in this study there was no influence of CYPs on hemolysis. These findings reinforce the importance of studies on the mapping of G6PD deficiency and genetic variations of CYP2C19, CYP2D6 and CYP3A4. This mapping will allow us to validate the prevalence of CYPs and determine their influence on hemolysis in patients with malaria, helping to decide on the treatment regimen.
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Affiliation(s)
- Marielle M Macêdo
- Programa de Pós-graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
| | - Anne C G Almeida
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
| | - Gabrielly S Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
| | - Amanda C Oliveira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
| | - Victor I Mwangi
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
| | - Ana C Shuan
- Programa de Pós-graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil
| | - Laila R A Barbosa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
| | - Fernanda Rodrigues-Soares
- Departamento de Patologia, Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba 35025-250, MG, Brazil
| | - Gisely C Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, AM, Brazil
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Chaves BA, de Alvarenga DAM, Pereira MDOC, Gordo M, Da Silva EL, Costa ER, Medeiros ASDM, Pedrosa IJM, Brito D, Lima MT, Mourão MP, Monteiro WM, Vasilakis N, de Brito CFA, Melo GC, Lacerda MVG. Is zoonotic Plasmodium vivax malaria an obstacle for disease elimination? Malar J 2022; 21:343. [PMID: 36397077 PMCID: PMC9673391 DOI: 10.1186/s12936-022-04349-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
The groundwork for malaria elimination does not currently consider the potential of Plasmodium zoonotic cycles that involve non-human primates (NHPs) in sylvatic environments. Since vivax malaria is less responsive to control measures, finding Plasmodium vivax infected NHPs adds even more concern.
Methods
Both Free-living monkeys in forest fragments inside the urban area and captive monkeys from a local zoo had blood samples tested for Plasmodium species.
Results
In this study, among the Neotropical monkeys tested, three (4.4%), one captive and two free-living, were found to be naturally infected by P. vivax.
Conclusion
This important finding indicates that it is necessary to estimate the extent to which P. vivax NHP infection contributes to the maintenance of malaria transmission to humans. Therefore, the discussion on wildlife conservation and management must be incorporated into the malaria elimination agenda.
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Pessoa RC, Oliveira-Pessoa GF, Souza BKA, Sampaio VS, Pinto ALCB, Barboza LL, Mouta GS, Silva EL, Melo GC, Monteiro WM, Silva-Filho JH, Lacerda MVG, Baía-da-Silva DC. Impact of Plasmodium vivax malaria on executive and cognitive functions in elderlies in the Brazilian Amazon. Sci Rep 2022; 12:10361. [PMID: 35725784 PMCID: PMC9208538 DOI: 10.1038/s41598-022-14175-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/16/2022] [Indexed: 11/09/2022] Open
Abstract
The exact path leading to cognitive impairment that goes beyond malaria is unclear, but it appears to be the result of interactive factors. Time of exposure to disease and recurrences are potentially major determinant variables. Cognitive impairment is described mainly in children, rarely in adults. The disease in high endemic areas usually does not affect elderlies, because of acquired immunity over time. However, this population is relatively more frequently sick in lower endemic areas, such as in the Amazon. This study assessed the effect of Plasmodium vivax malaria on the executive and cognitive functions of elderlies, in the Brazilian Amazon. A cohort study was conducted to evaluate executive and cognitive functions one week (T0), two months (T2) and eight months (T8) after the malaria episode. Mini-Mental State Examination (MMSE), Beck Depression Inventory II (BDI-II), Clock Drawing Test (CDT), Wechsler adult intelligence scale (WAIS-III), and Wisconsin Card Sorting Test (WCST) were used to assess executive and cognitive functions. One hundred-forty elderlies were enrolled (70 with P. vivax malaria and 70 without malaria). P. vivax malaria was associated with impairment of the executive and cognitive functions in elderlies for up to 8 months after acute P. vivax malaria. Prior history of malaria, recurrences and higher parasitemia were independently associated with various surrogates of executive and cognitive impairment. With the increase in life expectancy, elderlies living in malaria endemic areas will deserve more attention from health authorities, to guarantee improvement of their quality of life in the tropics.
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Affiliation(s)
- Rockson C Pessoa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Brenda K A Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson S Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - André Luiz C B Pinto
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Larissa L Barboza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Gabriel S Mouta
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Emanuelle Lira Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Gisely C Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | - Wuelton M Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
| | | | - Marcus V G Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil.
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil.
| | - Djane Clarys Baía-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
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Melo MM, Costa MR, Filho FS, Brito-Sousa JD, Almeida AC, Monteiro WM, Melo GC, Vieira JLF, Alecrim MDGC. Pharmacokinetics of chloroquine in patients with malaria by P. vivax from the Western Brazilian Amazon basin. Biomed Pharmacother 2022; 149:112874. [DOI: 10.1016/j.biopha.2022.112874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022] Open
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Cardoso JLM, Salazar YEAR, Almeida ACG, Barbosa LRA, Silva EL, Rodrigues MGA, Rodrigues-Soares F, Sampaio VS, Siqueira AM, Lacerda MVG, Monteiro WM, Melo GC. Influence of CYP2D6, CYP3A4 and CYP2C19 Genotypes on Recurrence of Plasmodium vivax. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.845451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe influence of the CYPs (cytochrome P-450) in the success of antimalarial therapy remains uncertain. In this study, the association of CYP2D6, CYP2C19 and CYP3A4 polymorphisms and predicted phenotypes with malaria recurrence was investigated.MethodsAfter diagnosis of vivax malaria, individuals treated at a reference center in Manaus were followed up for 180 days. Patients were separated into two groups: a recurrence group and a non-recurrence group. Genotyping of CYP2D6, CYP2C19 and CYP3A4 was performed using a TaqMan™ assay and real-time PCR.FindingsThe frequencies of decreased-function and normal-function alleles and phenotypes for all CYPs were similar between the groups, except for the CYP2D6*2xN allele (p=0.047) and the CYP2D6 gUM phenotype (p=0.057), which were more frequent in individuals without recurrence. Despite this, the CYP2D6, CYP2C19 and CYP3A4 genotypes had no association with an increased risk of recurrence. CYPs polymorphisms also had no influence in parasite clearance, neither in the time nor the number of recurrence episodes. MAINConclusionThis prospective cohort study demonstrated that CYP2D6, CYP2C19 and CYP3A4 polymorphisms have no influence on malaria recurrence. Nonetheless, our findings suggest that the CYP2D6 predicted ultrarapid phenotype was less susceptible to recurrence, and that patients with the CYP2D6 gUM phenotype are less susceptible to primaquine failure. Additional investigation of pharmacogenetics and pharmacokinetics are needed before implementing CYP analysis to better orientate individualized radical treatment of vivax malaria in reference centers that treat patients with multiple recurrences.
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Mathieu LC, Singh P, Monteiro WM, Magris M, Cox H, Lazrek Y, Melo GC, Marchesini P, Alexandre JSF, Alvarez AM, Demar M, Douine M, Ade MP, Lacerda MVG, Musset L. Kelch13 mutations in Plasmodium falciparum and risk of spreading in Amazon basin countries. J Antimicrob Chemother 2021; 76:2854-2862. [PMID: 34379746 PMCID: PMC8521405 DOI: 10.1093/jac/dkab264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background The first potential focus for artemisinin resistance in South America was recently confirmed with the presence of the C580Y mutation in the Plasmodium falciparum kelch 13 gene (pfk13) in Guyana. Objectives This study aimed to strengthen pfk13 monitoring in the Amazon basin countries, to compile the available data and to evaluate the risk of spreading of mutations. Methods Sanger sequencing was done on 862 samples collected between 1998 and 2019, and a global map of pfk13 genotypes available for this region was constructed. Then, the risk of spreading of mutations based on P. falciparum case importation between 2015 and 2018 within countries of the Amazon basin was evaluated. Results No additional pfk13 C580Y foci were identified. Few mutations (0.5%, 95% CI = 0.3%–0.8%) in the propeller domain were observed in the general parasite population of this region despite a high proportion of K189T mutations (49.1%, 95% CI = 46.2%–52.0%) in the non-propeller domain. Case information revealed two patterns of intense human migration: Venezuela, Guyana and the Roraima State in Brazil; and French Guiana, Suriname and the Amapá State in Brazil. Conclusions There are few pfk13 mutant foci, but a high risk of dispersion in the Amazon basin, mainly from the Guiana Shield, proportionate to mining activities. Therefore, access to prompt diagnosis and treatment, and continuous molecular monitoring is essential in these geographical areas.
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Affiliation(s)
- Luana C Mathieu
- Laboratoire de parasitologie, Centre Nationale de Référence du Paludisme, World Health Organization Collaborating Center for surveillance of antimalarial drug resistance, Institut Pasteur de la Guyane, 97306 Cayenne, French Guiana.,Ecole Doctorale n°587 « Diversités, Santé, et Développement en Amazonie », Université de Guyane, 97300 Cayenne, French Guiana
| | - Prabhjot Singh
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC 20037, USA
| | - Wuelton Marcelo Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, 69040-200 Manaus, Amazonas, Brazil.,Escola de Ciências da Saúde, Universidade do Estado do Amazonas, 69050-010 Manaus, Amazonas, Brazil
| | - Magda Magris
- Amazonic Center for Research and Control of Tropical Diseases "Simón Bolívar", 7101, Puerto Ayacucho, Amazonas State, Venezuela
| | - Horace Cox
- National Malaria Program, Ministry of Public Health, 0592 Georgetown, Guyana
| | - Yassamine Lazrek
- Laboratoire de parasitologie, Centre Nationale de Référence du Paludisme, World Health Organization Collaborating Center for surveillance of antimalarial drug resistance, Institut Pasteur de la Guyane, 97306 Cayenne, French Guiana
| | - Gisely C Melo
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, 69040-200 Manaus, Amazonas, Brazil.,Escola de Ciências da Saúde, Universidade do Estado do Amazonas, 69050-010 Manaus, Amazonas, Brazil
| | - Paola Marchesini
- Malaria Technical Group, Vector Transmissible and Zoonotic Diseases Coordination, Ministry of Health, 70058-900 Brasilia, Brazil
| | | | | | - Magalie Demar
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, 97300 Cayenne, French Guiana.,Ecosystèmes Amazoniens et Pathologie Tropicale (EPAT), EA3593, Université de Guyane, 97300 Cayenne, French Guiana
| | - Maylis Douine
- Ecosystèmes Amazoniens et Pathologie Tropicale (EPAT), EA3593, Université de Guyane, 97300 Cayenne, French Guiana.,Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Hôpital de Cayenne, 97300 Cayenne, French Guiana
| | - Maria-Paz Ade
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC 20037, USA
| | - Marcus V G Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, 69040-200 Manaus, Amazonas, Brazil.,Instituto Leônidas & Maria Deane, Fiocruz, 69057-070 Manaus, Brazil
| | - Lise Musset
- Laboratoire de parasitologie, Centre Nationale de Référence du Paludisme, World Health Organization Collaborating Center for surveillance of antimalarial drug resistance, Institut Pasteur de la Guyane, 97306 Cayenne, French Guiana
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9
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Brito-Sousa JD, Murta F, Vitor-Silva S, Sampaio VS, Mendes MO, Brito MAM, Batista TSB, Santos APC, Marques LLG, Barbosa LRA, Melo MM, Baia-da-Silva DC, Silva-Neto AV, Santos TC, Souza BKA, Figueiredo EFG, Silva EL, Rodovalho S, Nakagawa TH, Arcanjo AR, Siqueira AM, Melo GC, Recht J, Domingo GJ, Bassat Q, Bancone G, Monteiro WM, Lacerda MVG. Real-life implementation of a G6PD deficiency screening qualitative test into routine vivax malaria diagnostic units in the Brazilian Amazon (SAFEPRIM study). PLoS Negl Trop Dis 2021; 15:e0009415. [PMID: 34003840 PMCID: PMC8162658 DOI: 10.1371/journal.pntd.0009415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/28/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency greatly hinders Plasmodium vivax malaria radical cure and further elimination due to 8-aminoquinolines-associated hemolysis. Although the deleterious health effects of primaquine in G6PD deficient individuals have been known for over 50 years, G6PD testing is not routinely performed before primaquine treatment in most P. vivax endemic areas. Method/Principal findings The qualitative CareStart G6PD screening test was implemented in 12 malaria treatment units (MTUs) in the municipality of Rio Preto da Eva, Western Brazilian Amazon, a malaria endemic area, between February 2019 and early January 2020. Training materials were developed and validated; evaluations were conducted on the effectiveness of training health care professionals (HCPs) to perform the test, the interpretation and reliability of routine testing performed by HCPs, and perceptions of HCPs and patients. Most HCPs were unaware of G6PD deficiency and primaquine-related adverse effects. Most of 110 HCPs trained (86/110, 78%) were able to correctly perform the G6PD test after a single 4-hour training session. The test performed by HCPs during implementation showed 100.0% (4/4) sensitivity and 68.1% (62/91) specificity in identifying G6PD deficient patients as compared to a point-of-care quantitative test (Standard G6PD). Conclusions/Significance G6PD screening using the qualitative CareStart G6PD test performed by HCPs in MTUs of an endemic area showed high sensitivity and concerning low specificity. The amount of false G6PD deficiency detected led to substantial loss of opportunities for radical cure. Glucose 6-phosphate dehydrogenase deficiency (G6PDd) has greatly impacted the treatment of Plasmodium vivax malaria because of the red blood cell destruction in what is known as hemolysis. Primaquine, used to clear dormant liver parasites that cause relapses of the disease, is a well-known trigger that may lead to life-threatening complications in patients with this condition. Although there are several G6PDd diagnostic tests available to guide the decision of weekly or daily primaquine treatment, they are not yet routinely used: questions on how, when, where and who is going to perform the test remain unanswered. This study revealed that, although G6PDd was not previously known by most of the healthcare workers, they were able to perform the test after a single training session. The test performed well in the field, differentiating patients that cannot use daily primaquine from the others, but some expected limitations require further action to be taken into consideration. This research provides an important overall understanding that may aid policy makers in the process of recommending proven interventions, such as G6PDd screening, to implement them pragmatically.
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Affiliation(s)
- Jose Diego Brito-Sousa
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Felipe Murta
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Sheila Vitor-Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas, Manaus, Brazil
| | - Vanderson S. Sampaio
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Vigilância em Saúde do Amazonas—FVS-AM, Manaus, Brazil
| | - Maxwell O. Mendes
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Marcelo A. M. Brito
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Talita S. B. Batista
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Alicia P. C. Santos
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Leonardo L. G. Marques
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Laila R. A. Barbosa
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Marly M. Melo
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Djane C. Baia-da-Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Alexandre V. Silva-Neto
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Thalie C. Santos
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Brenda K. A. Souza
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Erick F. G. Figueiredo
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Emanuelle L. Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Sheila Rodovalho
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Pan American Health Organization–PAHO, World Health Organization, Brasilia, Brazil
| | - Theresa H. Nakagawa
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
| | - Ana Ruth Arcanjo
- Laboratório Central de Saúde Pública do Amazonas–LACEN/AM, Manaus, Brazil
| | - André M. Siqueira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia–INI, Rio de Janeiro, Brazil
| | - Gisely C. Melo
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Judith Recht
- Independent consultant, North Bethesda, Maryland, United States of America
| | - Gonzalo J. Domingo
- Diagnostics Program, PATH, Seattle, Washington, United States of America
| | - Quique Bassat
- Institut de Salut Global de Barcelona (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluís Companys, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Wuelton M. Monteiro
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Marcus V. G. Lacerda
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane—ILMD, Manaus, Amazonas, Brazil
- * E-mail:
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10
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Balieiro AAS, Siqueira AM, Melo GC, Monteiro WM, Sampaio VS, Mueller I, Lacerda MVG, Villela DAM. Short-Time Recurrences of Plasmodium vivax Malaria as a Public Health Proxy for Chloroquine-Resistance Surveillance: A Spatio-Temporal Study in the Brazilian Amazon. Int J Environ Res Public Health 2021; 18:ijerph18105061. [PMID: 34064738 PMCID: PMC8150757 DOI: 10.3390/ijerph18105061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 12/17/2022]
Abstract
In Brazil, malaria caused by Plasmodium vivax presents control challenges due to several reasons, among them the increasing possibility of failure of P. vivax treatment due to chloroquine-resistance (CQR). Despite limited reports of CQR, more extensive studies on the actual magnitude of resistance are still needed. Short-time recurrences of malaria cases were analyzed in different transmission scenarios over three years (2005, 2010, and 2015), selected according to malaria incidence. Multilevel models (binomial) were used to evaluate association of short-time recurrences with variables such as age. The zero-inflated Poisson scan model (scanZIP) was used to detect spatial clusters of recurrences up to 28 days. Recurrences compose less than 5% of overall infection, being more frequent in the age group under four years. Recurrences slightly increased incidence. No fixed clusters were detected throughout the period, although there are clustering sites, spatially varying over the years. This is the most extensive analysis of short-time recurrences worldwide which addresses the occurrence of P. vivax CQR. As an important step forward in malaria elimination, policymakers should focus their efforts on young children, with an eventual shift in the first line of malaria treatment to P. vivax.
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Affiliation(s)
- Antonio A. S. Balieiro
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz (ILMD/Fiocruz), Amazonas 69057-070, Brazil; (A.A.S.B.); (M.V.G.L.)
- Programa de Pós-Graduação em Biologia Parasitaria—Instituto Oswaldo Cruz (IOC/Fiocruz), Rio de Janeiro 21040-900, Brazil
| | - Andre M. Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro 21040-360, Brazil;
| | - Gisely C. Melo
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
| | - Vanderson S. Sampaio
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
- Fundação de Vigilância em Saúde (FVS), Amazonas 69093-018, Brazil
| | - Ivo Mueller
- Walter & Elisa Hall Institute, Melbourne 3052, Australia;
- Pasteur Institute, 75015 Paris, France
| | - Marcus V. G. Lacerda
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz (ILMD/Fiocruz), Amazonas 69057-070, Brazil; (A.A.S.B.); (M.V.G.L.)
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
| | - Daniel A. M. Villela
- Programa de Pós-Graduação em Biologia Parasitaria—Instituto Oswaldo Cruz (IOC/Fiocruz), Rio de Janeiro 21040-900, Brazil
- Programa de Computação Científica, Fundação Oswaldo Cruz (PROCC/Fiocruz), Rio de Janeiro 21040-360, Brazil
- Correspondence:
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11
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Barbosa LRA, da Silva EL, de Almeida ACG, Salazar YEAR, Siqueira AM, Alecrim MDGC, Vieira JLF, Bassat Q, de Lacerda MVG, Monteiro WM, Melo GC. An Ultra-Sensitive Technique: Using Pv-mtCOX1 qPCR to Detect Early Recurrences of Plasmodium vivax in Patients in the Brazilian Amazon. Pathogens 2020; 10:pathogens10010019. [PMID: 33396824 PMCID: PMC7823330 DOI: 10.3390/pathogens10010019] [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: 11/13/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early recurrence of Plasmodium vivax is a challenge for malaria control in the field, particularly because this species is associated with lower parasitemia, which hinders diagnosis and monitoring through blood smear testing. Early recurrences, defined as the persistence of parasites in the peripheral blood despite adequate drug dosages, may arise from resistance to chloroquine. The objective of the study was to estimate early recurrence of P. vivax in the Brazilian Amazon by using a highly-sensitive detection method, in this case, PCR. METHODS An ultra-sensitive qPCR that targeted mitochondrial DNA was used to compare a standard qPCR that targeted 18S rDNA to detect early recurrence of P. vivax in very low densities in samples from patients treated with chloroquine. RESULTS Out of a total of 312 cases, 29 samples (9.3%) were characterized as recurrences, from which 3.2% (10/312) were only detected through ultra-sensitive qPCR testing. CONCLUSIONS Studies that report the detection of P. vivax early recurrences using light microscopy may severely underestimate their true incidence.
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Affiliation(s)
- Laila R. A. Barbosa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
| | - Emanuelle L. da Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- UNINILTONLINS—Universidade Nilton Lins, Unicenter, Manaus 69058-030, AM, Brazil
| | - Anne C. G. de Almeida
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
- FAMETRO—Faculdade Metropolitana de Manaus, Campus Central, Av. Constantino Nery, Chapada, Manaus 69050-000, AM, Brazil
| | - Yanka E. A. R. Salazar
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
| | - André M. Siqueira
- Fiocruz-Manguinhos—Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro 21040-900, RJ, Brazil;
| | - Maria das Graças Costa Alecrim
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
- Centro de Investigação em Saúde de Manhiça (CISM), Fundação Clínic per la Recerca Biomédica, Maputo 1929, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Campus Clínic, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, 1867 Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Marcus V. G. de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
- Instituto Leônidas & Maria Deane, ILMD-Fiocruz-Fundação Oswaldo Cruz, Manaus 69057-070, AM, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
| | - Gisely C. Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus 69040-200, AM, Brazil; (L.R.A.B.); (E.L.d.S.); (A.C.G.d.A.); (Y.E.A.R.S.); (M.d.G.C.A.); (M.V.G.d.L.); (W.M.M.)
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-200, AM, Brazil
- Correspondence: ; Tel.: +55-92-99159-8604
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12
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Brito-Sousa JD, Santos TC, Avalos S, Fontecha G, Melo GC, Val F, Siqueira AM, Alecrim GC, Bassat Q, Lacerda MVG, Monteiro WM. Clinical Spectrum of Primaquine-induced Hemolysis in Glucose-6-Phosphate Dehydrogenase Deficiency: A 9-Year Hospitalization-based Study From the Brazilian Amazon. Clin Infect Dis 2020; 69:1440-1442. [PMID: 30753364 DOI: 10.1093/cid/ciz122] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
Despite glucose-6-phosphate dehydrogenase (G6PD) deficiency prevalence of 5% in the Amazon, primaquine is administered without G6PD screening. This is an important cause of hospitalization among Plasmodium vivax-infected individuals, leading to life-threatening anemia and acute renal failure across endemic areas. In Manaus, the frequency of primaquine-induced hemolysis was 85.2 cases per 100 000 primaquine users.
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Affiliation(s)
- Jose Diego Brito-Sousa
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Thalie C Santos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Sara Avalos
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, Tegucigalpa
| | - Gustavo Fontecha
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, Tegucigalpa
| | - Gisely C Melo
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Fernando Val
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Graça C Alecrim
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil
| | - Quique Bassat
- ISGlobal, Hospital Clínic, University of Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Institució Catalana de Recerca i Estudis Avançats, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil.,Instituto de Pesquisas Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Brazil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
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Santana RAG, Guerra MGVB, Sousa DR, Couceiro K, Ortiz JV, Oliveira M, Ferreira LS, Souza KR, Tavares IC, Morais RF, Silva GAV, Melo GC, Vergel GM, Albuquerque BC, Arcanjo ARL, Monteiro WM, Ferreira JMBB, Lacerda MVG, Silveira H, Guerra JAO. Oral Transmission of Trypanosoma cruzi, Brazilian Amazon. Emerg Infect Dis 2019; 25:132-135. [PMID: 30561299 PMCID: PMC6302584 DOI: 10.3201/eid2501.180646] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the Brazilian Amazon, the suspected source of infection in an outbreak of acute Chagas disease involving 10 patients was Euterpe oleracea (açaí berry) juice. Patient blood and juice samples contained Trypanosoma cruzi TcIV, indicating oral transmission of the Chagas disease agent.
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14
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Santana RAG, Guerra MGV, Sousa DR, Couceiro K, Ortiz JV, Oliveira M, Ferreira LS, Souza KR, Tavares IC, Morais RF, Silva GA, Melo GC, Vergel GM, Albuquerque BC, Arcanjo ARL, Monteiro WM, Ferreira JMB, Lacerda MV, Silveira H, Guerra JAO. Oral Transmission of Trypanosoma cruzi, Brazilian Amazon. Emerg Infect Dis 2018. [DOI: 10.3201/eid2501180646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Gardinassi LG, Cordy RJ, Lacerda MVG, Salinas JL, Monteiro WM, Melo GC, Siqueira AM, Val FF, Tran V, Jones DP, Galinski MR, Li S. Metabolome-wide association study of peripheral parasitemia in Plasmodium vivax malaria. Int J Med Microbiol 2017; 307:533-541. [PMID: 28927849 DOI: 10.1016/j.ijmm.2017.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/26/2017] [Accepted: 09/03/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Plasmodium vivax is one of the leading causes of malaria worldwide. Infections with this parasite cause diverse clinical manifestations, and recent studies revealed that infections with P. vivax can result in severe and fatal disease. Despite these facts, biological traits of the host response and parasite metabolism during P. vivax malaria are still largely underexplored. Parasitemia is clearly related to progression and severity of malaria caused by P. falciparum, however the effects of parasitemia during infections with P. vivax are not well understood. RESULTS We conducted an exploratory study using a high-resolution metabolomics platform that uncovered significant associations between parasitemia levels and plasma metabolites from 150 patients with P. vivax malaria. Most plasma metabolites were inversely associated with higher levels of parasitemia. Top predicted metabolites are implicated into pathways of heme and lipid metabolism, which include biliverdin, bilirubin, palmitoylcarnitine, stearoylcarnitine, phosphocholine, glycerophosphocholine, oleic acid and omega-carboxy-trinor-leukotriene B4. CONCLUSIONS The abundance of several plasma metabolites varies according to the levels of parasitemia in patients with P. vivax malaria. Moreover, our data suggest that the host response and/or parasite survival might be affected by metabolites involved in the degradation of heme and metabolism of several lipids. Importantly, these data highlight metabolic pathways that may serve as targets for the development of new antimalarial compounds.
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Affiliation(s)
- Luiz Gustavo Gardinassi
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Malaria Host-Pathogen Interaction Center, Atlanta, GA, USA
| | - Regina Joice Cordy
- Malaria Host-Pathogen Interaction Center, Atlanta, GA, USA; International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Marcus V G Lacerda
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, AM, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil; Instituto Leônidas & Maria Deane (FIOCRUZ), Manaus, AM, Brazil
| | | | - Wuelton M Monteiro
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, AM, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Gisely C Melo
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, AM, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando F Val
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, AM, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - ViLinh Tran
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Malaria Host-Pathogen Interaction Center, Atlanta, GA, USA; Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Dean P Jones
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Malaria Host-Pathogen Interaction Center, Atlanta, GA, USA; Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary R Galinski
- Malaria Host-Pathogen Interaction Center, Atlanta, GA, USA; International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA; Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Shuzhao Li
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Malaria Host-Pathogen Interaction Center, Atlanta, GA, USA; Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA, USA.
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16
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Uppal K, Salinas JL, Monteiro WM, Val F, Cordy RJ, Liu K, Melo GC, Siqueira AM, Magalhaes B, Galinski MR, Lacerda MVG, Jones DP. Plasma metabolomics reveals membrane lipids, aspartate/asparagine and nucleotide metabolism pathway differences associated with chloroquine resistance in Plasmodium vivax malaria. PLoS One 2017; 12:e0182819. [PMID: 28813452 PMCID: PMC5559093 DOI: 10.1371/journal.pone.0182819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Chloroquine (CQ) is the main anti-schizontocidal drug used in the treatment of uncomplicated malaria caused by Plasmodium vivax. Chloroquine resistant P. vivax (PvCR) malaria in the Western Pacific region, Asia and in the Americas indicates a need for biomarkers of resistance to improve therapy and enhance understanding of the mechanisms associated with PvCR. In this study, we compared plasma metabolic profiles of P. vivax malaria patients with PvCR and chloroquine sensitive parasites before treatment to identify potential molecular markers of chloroquine resistance. Methods An untargeted high-resolution metabolomics analysis was performed on plasma samples collected in a malaria clinic in Manaus, Brazil. Male and female patients with Plasmodium vivax were included (n = 46); samples were collected before CQ treatment and followed for 28 days to determine PvCR, defined as the recurrence of parasitemia with detectable plasma concentrations of CQ ≥100 ng/dL. Differentially expressed metabolic features between CQ-Resistant (CQ-R) and CQ-Sensitive (CQ-S) patients were identified using partial least squares discriminant analysis and linear regression after adjusting for covariates and multiple testing correction. Pathway enrichment analysis was performed using Mummichog. Results Linear regression and PLS-DA methods yielded 69 discriminatory features between CQ-R and CQ-S groups, with 10-fold cross-validation classification accuracy of 89.6% using a SVM classifier. Pathway enrichment analysis showed significant enrichment (p<0.05) of glycerophospholipid metabolism, glycosphingolipid metabolism, aspartate and asparagine metabolism, purine and pyrimidine metabolism, and xenobiotics metabolism. Glycerophosphocholines levels were significantly lower in the CQ-R group as compared to CQ-S patients and also to independent control samples. Conclusions The results show differences in lipid, amino acids, and nucleotide metabolism pathways in the plasma of CQ-R versus CQ-S patients prior to antimalarial treatment. Metabolomics phenotyping of P. vivax samples from patients with well-defined clinical CQ-resistance is promising for the development of new tools to understand the biological process and to identify potential biomarkers of PvCR.
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Affiliation(s)
- Karan Uppal
- Clinical Biomarkers Laboratory, Division of Pulmonary Medicine, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- * E-mail: ;
| | - Jorge L. Salinas
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, Georgia, United States of America
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Wuelton M. Monteiro
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fernando Val
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Regina J. Cordy
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, Georgia, United States of America
| | - Ken Liu
- Clinical Biomarkers Laboratory, Division of Pulmonary Medicine, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Gisely C. Melo
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Andre M. Siqueira
- Instituto Nacional de Infectologia Evandro Chagas (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mary R. Galinski
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, Georgia, United States of America
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Marcus V. G. Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane (FIOCRUZ), Manaus, Amazonas, Brazil
- * E-mail: ;
| | - Dean P. Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary Medicine, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
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17
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Alho RM, Machado KVA, Val FFA, Fraiji NA, Alexandre MAA, Melo GC, Recht J, Siqueira AM, Monteiro WM, Lacerda MVG. Alternative transmission routes in the malaria elimination era: an overview of transfusion-transmitted malaria in the Americas. Malar J 2017; 16:78. [PMID: 28202065 PMCID: PMC5312538 DOI: 10.1186/s12936-017-1726-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/06/2017] [Accepted: 02/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Transfusion-transmitted (TT) malaria is an alternative infection route that has gained little attention from authorities, despite representing a life-threatening condition. There has been no systematic review of this health problem in American countries. The aim of this study was to describe the clinical and epidemiological characteristics of TT malaria in the Americas and identify factors associated with lethality based on the studies published in the literature. METHODS Potentially relevant papers in all languages were retrieved from MEDLINE and LILACS. Additional articles were obtained from reviews and original papers. Publications on screening of candidate blood donors and on surveillance of TT malaria cases were included. Odds ratios with respective 95% confidence intervals (95% CI) were calculated. Epidemiological characteristics of blood donors of TT malaria cases, including a pooled positivity of different tests for malaria diagnosis, were retrieved. RESULTS A total of 63 publications regarding TT malaria from seven countries were included, from 1971 to 2016. A total of 422 cases of TT malaria were recorded. Most TT malaria cases were in females (62.0%) and 39.5% were in the ≥61 years-old age group. About half of all cases were from Mexico (50.7%), 40.3% from the United States of America (USA) and 6.6% from Brazil. Gyneco-obstetrical conditions (67.3%), surgical procedures (20.6%) and complications from neoplasias (6.1%) were the most common indications of transfusion. Packed red blood cells (RBCs) (50.7%) and whole blood (43.3%) were the blood products mostly associated with TT malaria. Cases were mostly caused by Plasmodium malariae (58.4%), followed by Plasmodium vivax (20.7%) and Plasmodium falciparum (17.9%). A total of 66.6% of cases were diagnosed by microscopy. Incubation period of 2-3 weeks was the most commonly observed (28.6%). Lethality was seen in 5.3% of cases and was associated with living in non-endemic countries, P. falciparum infection and concomitant neoplastic diseases. CONCLUSION There is an important research and knowledge gap regarding the TT malaria burden in Latin American countries where malaria remains endemic. No screening method that is practical, affordable and suitably sensitive is available at blood banks in Latin American countries, where infections with low parasitaemia contribute greatly to transmission. Lethality from TT malaria was not negligible. TT malaria needs to be acknowledged and addressed in areas moving toward elimination.
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Affiliation(s)
- Regina M Alho
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Hematologia e Hemoterapia do Amazonas, Av. Constantino Nery, 4397, Chapada, Manaus, AM, 69050-002, Brazil
| | - Kim Vinícius Amaral Machado
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | - Fernando F A Val
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | - Nelson A Fraiji
- Fundação de Hematologia e Hemoterapia do Amazonas, Av. Constantino Nery, 4397, Chapada, Manaus, AM, 69050-002, Brazil
| | - Marcia A A Alexandre
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | - Gisely C Melo
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
| | | | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Wuelton M Monteiro
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil. .,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
| | - Marcus V G Lacerda
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.,Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Rua Terezina, 476, Adrianópolis, Manaus, AM, 69057-070, Brazil
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18
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Siqueira AM, Alencar AC, Melo GC, Magalhaes BL, Machado K, Alencar Filho AC, Kuehn A, Marques MM, Manso MC, Felger I, Vieira JLF, Lameyre V, Daniel-Ribeiro CT, Lacerda MVG. Fixed-Dose Artesunate-Amodiaquine Combination vs Chloroquine for Treatment of Uncomplicated Blood Stage P. vivax Infection in the Brazilian Amazon: An Open-Label Randomized, Controlled Trial. Clin Infect Dis 2016; 64:166-174. [PMID: 27988484 PMCID: PMC5215218 DOI: 10.1093/cid/ciw706] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 05/07/2016] [Accepted: 10/18/2016] [Indexed: 01/31/2023] Open
Abstract
In the Brazilian Amazon, the artesunate–amodiaquine combination was more effective in preventing Plasmodium vivax recurrence. With a favorable safety profile, this antimalarial treatment proved to be a good first-line alternative. Chloroquine resistance is probably underestimated in the area. Background. Despite increasing evidence of the development of Plasmodium vivax chloroquine (CQ) resistance, there have been no trials comparing its efficacy with that of artemisinin-based combination therapies (ACTs) in Latin America. Methods. This randomized controlled trial compared the antischizontocidal efficacy and safety of a 3-day supervised treatment of the fixed-dose combination artesunate-amodiaquine Winthrop® (ASAQ) versus CQ for treatment of uncomplicated P. vivax infection in Manaus, Brazil. Patients were followed for 42 days. Primary endpoints were adequate clinical and parasitological responses (ACPR) rates at day 28. Genotype-adjustment was performed. Results. From 2012 to 2013, 380 patients were enrolled. In the per-protocol (PP) analysis, adjusted-ACPR was achieved in 100% (165/165) and 93.6% (161/172) of patients in the ASAQ and CQ arm (difference 6.4%, 95% CI 2.7%; 10.1%) at day 28 and in 97.4% (151/155) and 77.7% (129/166), respectively (difference 19.7%, 95% CI 12.9%; 26.5%), at day 42. Apart from ITT D28 assessment, superiority of ASAQ on ACPR was demonstrated. ASAQ presented faster clearance of parasitaemia and fever. Based on CQ blood level measurements, CQ resistance prevalence was estimated at 11.5% (95% CI: 7.5-17.3) up to day 42. At least one emergent adverse event (AE) was recorded for 79/190 (41x6%) in the ASAQ group and for 85/190 (44x7%) in the CQ group. Both treatments had similar safety profiles. Conclusions. ASAQ exhibited high efficacy against CQ resistant P. vivax and is an adequate alternative in the study area. Studies with an efficacious comparator, longer follow-up and genotype-adjustment can improve CQR characterization. Clinical Trials Registration. NCT01378286.
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Affiliation(s)
- Andre M Siqueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, .,Universidade do Estado do Amazonas, Manaus.,Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro
| | - Aline C Alencar
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado.,Universidade do Estado do Amazonas, Manaus
| | - Gisely C Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado.,Universidade do Estado do Amazonas, Manaus
| | - Belisa L Magalhaes
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado.,Universidade do Estado do Amazonas, Manaus
| | - Kim Machado
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado
| | | | - Andrea Kuehn
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado.,ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | | | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado.,Universidade do Estado do Amazonas, Manaus.,Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
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Sampaio VS, Beltrán TP, Kobylinski KC, Melo GC, Lima JBP, Silva SGM, Rodriguez ÍC, Silveira H, Guerra MGVB, Bassat Q, Pimenta PFP, Lacerda MVG, Monteiro WM. Filling gaps on ivermectin knowledge: effects on the survival and reproduction of Anopheles aquasalis, a Latin American malaria vector. Malar J 2016; 15:491. [PMID: 27660149 PMCID: PMC5034551 DOI: 10.1186/s12936-016-1540-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strategies designed to advance towards malaria elimination rely on the detection and treatment of infections, rather than fever, and the interruption of malaria transmission between mosquitoes and humans. Mass drug administration with anti-malarials directed at eliminating parasites in blood, either to entire populations or targeting only those with malaria infections, are considered useful strategies to progress towards malaria elimination, but may be insufficient if applied on their own. These strategies assume a closer contact with populations, so incorporating a vector control intervention tool to those approaches could significantly enhance their efficacy. Ivermectin, an endectocide drug efficacious against a range of Anopheles species, could be added to other drug-based interventions. Interestingly, ivermectin could also be useful to target outdoor feeding and resting vectors, something not possible with current vector control tools, such as impregnated bed nets or indoor residual spraying (IRS). RESULTS Anopheles aquasalis susceptibility to ivermectin was assessed. In vivo assessments were performed in six volunteers, being three men and three women. The effect of ivermectin on reproductive fitness and mosquito survivorship using membrane feeding assay (MFA) and direct feeding assay (DFA) was assessed and compared. The ivermectin lethal concentration (LC) values were LC50 = 47.03 ng/ml [44.68-49.40], LC25 = 31.92 ng/ml [28.60-34.57] and LC5 = 18.28 ng/ml [14.51-21.45]. Ivermectin significantly reduced the survivorship of An. aquasalis blood-fed 4 h post-ingestion (X 2 [N = 880] = 328.16, p < 0.001), 2 days post-ingestion (DPI 2) (X 2 [N = 983] = 156.75, p < 0.001), DPI 7 (X 2 [N = 935] = 31.17, p < 0.001) and DPI 14 (X 2 [N = 898] = 38.63, p < 0.001) compared to the blood fed on the untreated control. The average number of oviposited eggs per female was significantly lower in LC5 group (22.44 [SD = 3.38]) than in control (34.70 [SD = 12.09]) (X 2 [N = 199] = 10.52, p < 0.001) as well as the egg hatch rate (LC5 = 74.76 [SD = 5.48]) (Control = 81.91 [SD = 5.92]) (X 2 [N = 124] = 64.24, p < 0.001). However, no differences were observed on the number of pupae that developed from larvae (Control = 34.19 [SD = 10.42) and group (LC5 = 33.33 [SD = 11.97]) (X 2 [N = 124] = 0.96, p > 0.05). CONCLUSIONS Ivermectin drug reduces mosquito survivorship when blood fed on volunteer blood from 4 h to 14 days post-ingestion controlling for volunteers' gender. Ivermectin at mosquito sub-lethal concentrations (LC5) reduces fecundity and egg hatch rate but not the number of pupae that developed from larvae. DFA had significantly higher effects on mosquito survival compared to MFA. The findings are presented and discussed through the prism of malaria elimination in the Amazon region.
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Affiliation(s)
- Vanderson S. Sampaio
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Sala de Análise de Situação em Saúde, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Tatiana P. Beltrán
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Gisely C. Melo
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Sara G. M. Silva
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Íria C. Rodriguez
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Henrique Silveira
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria G. V. B. Guerra
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Paulo F. P. Pimenta
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Centro de Pesquisas René Rachou, FIOCRUZ, Belo Horizonte, Brazil
| | - Marcus V. G. Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, FIOCRUZ, Manaus, Brazil
| | - Wuelton M. Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
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20
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Monteiro WM, Val FFA, Siqueira AM, Franca GP, Sampaio VS, Melo GC, Almeida ACG, Brito MAM, Peixoto HM, Fuller D, Bassat Q, Romero GAS, Maria Regina F O, Marcus Vinícius G L. G6PD deficiency in Latin America: systematic review on prevalence and variants. Mem Inst Oswaldo Cruz 2014; 109:553-68. [PMID: 25141282 PMCID: PMC4156449 DOI: 10.1590/0074-0276140123] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/02/2014] [Indexed: 01/14/2023] Open
Abstract
Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. The aim of this work was to study the G6PDd prevalence and variants in Latin America (LA) and the Caribbean region. A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Low prevalence rates of G6PDd were documented in Argentina, Bolivia, Mexico, Peru and Uruguay, but studies from Curaçao, Ecuador, Jamaica, Saint Lucia, Suriname and Trinidad, as well as some surveys carried out in areas of Brazil, Colombia and Cuba, have shown a high prevalence (> 10%) of G6PDd. The G6PD A-202A mutation was the variant most broadly distributed across LA and was identified in 81.1% of the deficient individuals surveyed. G6PDd is a frequent phenomenon in LA, although certain Amerindian populations may not be affected, suggesting that PQ could be safely used in these specific populations. Population-wide use of PQ as part of malaria elimination strategies in LA cannot be supported unless a rapid, accurate and field-deployable G6PDd diagnostic test is made available.
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Affiliation(s)
- Wuelton M Monteiro
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Fernando FA Val
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - André M Siqueira
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Gabriel P Franca
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
| | - Vanderson S Sampaio
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Gisely C Melo
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Anne CG Almeida
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Marcelo AM Brito
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Henry M Peixoto
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
| | - Douglas Fuller
- Department of Geography and Regional Studies, University of Miami, Coral
Gables, FL, USA
| | - Quique Bassat
- Barcelona Centre for International Health Research, Hospital Clinic,
University of Barcelona, Barcelona, Spain
| | - Gustavo AS Romero
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias
em Saúde, Porto Alegre, RS, Brasil
| | - Oliveira Maria Regina F
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias
em Saúde, Porto Alegre, RS, Brasil
| | - Lacerda Marcus Vinícius G
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
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Monteiro WM, Franca GP, Melo GC, Queiroz ALM, Brito M, Peixoto HM, Oliveira MRF, Romero GAS, Bassat Q, Lacerda MVG. Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes. Malar J 2014; 13:70. [PMID: 24568147 PMCID: PMC3938641 DOI: 10.1186/1475-2875-13-70] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 10/14/2013] [Accepted: 02/20/2014] [Indexed: 12/29/2022] Open
Abstract
Background Although G6PDd individuals are generally asymptomatic throughout their life, the clinical burden of this genetic condition includes a range of haematological conditions, including acute haemolytic anaemia (AHA), neonatal jaundice (NNJ) and chronic non-sphaerocytic anaemia (CNSA). In Latin America (LA), the huge knowledge gap regarding G6PDd is related to the scarce understanding of the burden of clinical manifestation underlying G6PDd carriage. The aim of this work was to study the clinical significance of G6PDd in LA and the Caribbean region through a systematic review. Methods A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Only original research was included. All study designs were included, as long as any clinical information was present. Studies were eligible for inclusion if they reported clinical information from populations living in LA or Caribbean countries or about migrants from these countries living in countries outside this continent. Results The Medline search generated 487 papers, and the LILACS search identified 140 papers. After applying the inclusion criteria, 100 original papers with any clinical information on G6PDd in LA were retrieved. Additionally, 16 articles were included after reading the references from these papers. These 116 articles reported data from 18 LA and Caribbean countries. The major clinical manifestations reported from LA countries were those related to AHA, namely drug-induced haemolysis. Most of the published works regarding drug-induced haemolysis in LA referred to haemolytic crises in P. vivax malaria patients during the course of the treatment with primaquine (PQ). Favism, infection-induced haemolysis, NNJ and CNSA appear to play only a minor public health role in this continent. Conclusion Haemolysis in patients using PQ seems to be the major clinical manifestation of G6PDd in LA and contributes to the morbidity of P. vivax infection in this continent, although the low number of reported cases, which could be linked to under-reporting of complications. These results support the need for better strategies to diagnose and manage G6PDd in malaria field conditions. Additionally, Malaria Control Programmes in LA should not overlook this condition in their national guidelines.
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Affiliation(s)
- Wuelton M Monteiro
- Fundação de Medicina Tropical Dr, Heitor Vieira Dourado (FMT-HVD), Av, Pedro Teixeira, 25, Dom Pedro, Manaus, AM 69040-000, Brazil.
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22
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Fabbri C, de Cássia Mascarenhas-Netto R, Lalwani P, Melo GC, Magalhães BML, Alexandre MAA, Lacerda MVG, Lima ES. Lipid peroxidation and antioxidant enzymes activity in Plasmodium vivax malaria patients evolving with cholestatic jaundice. Malar J 2013; 12:315. [PMID: 24020374 PMCID: PMC3847648 DOI: 10.1186/1475-2875-12-315] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/09/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Plasmodium vivax infection has been considered a benign and self-limiting disease, however, recent studies highlight the association between vivax malaria and life-threatening manifestations. Increase in reactive oxygen species has already been described in vivax malaria, as a result of the increased metabolic rate triggered by the multiplying parasite, and large quantities of toxic redox-active byproducts generated. The present study aimed to study the oxidative stress responses in patients infected with P. vivax, who developed jaundice (hyperbilirubinaemia) in the course of the disease, a common clinical complication related to this species. METHODS An evaluation of the lipid peroxidation and antioxidant enzymes profile was performed in 28 healthy individuals and compared with P. vivax infected patients with jaundice, i.e., bilirubin < 51.3 μmol/L (8 patients) or without jaundice (34 patients), on day 1 (D1) and day 14 (D14) after anti-malarial therapy. RESULTS Hyperbilirubinaemia was more frequent among women and patients experiencing their first malarial infection, and lower haemoglobin and higher lactate dehydrogenase levels were observed in this group. Malondialdehyde levels and activity of celuroplasmin and glutathione reductase were increased in the plasma from patients with P. vivax with jaundice compared to the control group on D1. However, the activity of thioredoxin reductase was decreased. The enzymes glutathione reductase, thioredoxin reductase, thiols and malondialdehyde also differed between jaundiced versus non-jaundiced patients. On D14 jaundice and parasitaemia had resolved and oxidative stress biomarkers were very similar to the control group. CONCLUSION Cholestatic hyperbilirubinaemia in vivax malaria cannot be totally disassociated from malaria-related haemolysis. However, significant increase of lipid peroxidation markers and changes in antioxidant enzymes in patients with P. vivax-related jaundice was observed. These results suggest oxidative processes contributing to malaria pathogenesis, what may be useful information for future anti-oxidant therapeutical interventions in these patients.
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Affiliation(s)
- Camila Fabbri
- Faculty of Pharmaceutical Sciences, Universidade Federal do Amazonas, Manaus, AM 69010-300, Brazil
| | | | - Pritesh Lalwani
- Faculty of Pharmaceutical Sciences, Universidade Federal do Amazonas, Manaus, AM 69010-300, Brazil
- Institute of Medical Virology, Charité – Universitätsmedizin Berlin, Berlin D-10117, Germany
| | - Gisely C Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM 69040-000, Brazil
- Universidade do Estado do Amazonas, Manaus, AM 69040-000, Brazil
| | - Belisa ML Magalhães
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM 69040-000, Brazil
- Universidade do Estado do Amazonas, Manaus, AM 69040-000, Brazil
| | - Márcia AA Alexandre
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM 69040-000, Brazil
- Universidade do Estado do Amazonas, Manaus, AM 69040-000, Brazil
| | - Marcus VG Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM 69040-000, Brazil
- Universidade do Estado do Amazonas, Manaus, AM 69040-000, Brazil
| | - Emerson S Lima
- Faculty of Pharmaceutical Sciences, Universidade Federal do Amazonas, Manaus, AM 69010-300, Brazil
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Versiani FG, Almeida MEM, Melo GC, Versiani FOL, Orlandi PP, Mariúba LAM, Soares LA, Souza LP, da Silva Balieiro AA, Monteiro WM, Costa FTM, del Portillo HA, Lacerda MVG, Nogueira PA. High levels of IgG3 anti ICB2-5 in Plasmodium vivax-infected individuals who did not develop symptoms. Malar J 2013; 12:294. [PMID: 23977965 PMCID: PMC3844576 DOI: 10.1186/1475-2875-12-294] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 04/16/2013] [Accepted: 08/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background Plasmodium vivax has the potential to infect 2.85 billion individuals worldwide. Nevertheless, the limited number of studies investigating the immune status of individuals living in malaria-endemic areas, as well as the lack of reports investigating serological markers associated with clinical protection, has hampered development of vaccines for P. vivax. It was previously demonstrated that naturally total IgG against the N-terminus of P. vivax merozoite surface protein 1 (Pv-MSP1) was associated with reduced risk of malarial infection. Methods Immune response against Pv-MSP1 (N-terminus) of 313 residents of the Rio Pardo rural settlement (Amazonas State, Brazil) was evaluated in a cross-sectional and longitudinal follow up over two months (on site) wherein gold standard diagnosis by thick blood smear and rRNA gene-based nested real-time PCR were used to discriminate symptomless Plasmodium vivax-infected individuals who did not develop clinical symptoms during a 2-months from those uninfected ones or who have had acute malaria. The acquisition of antibodies against Pv-MSP1 was also evaluated as survival analysis by prospective study over a year collecting information of new malaria infections in surveillance database. Results The majority of P. vivax-infected individuals (52-67%) showed immune recognition of the N-terminus of Pv-MSP1. Interesting data on infected individuals who have not developed symptoms, total IgG levels against the N-terminus Pv-MSP1 were age-dependent and the IgG3 levels were significantly higher than levels of subjects had acute malaria or those uninfected ones. The total IgG anti ICB2-5 was detected to be an important factor of protection against new malaria vivax attacks in survival analysis in a prospective survey (p = 0.029). Conclusions The study findings illustrate the importance of IgG3 associated to 2-months of symptomless in P. vivax infected individuals and open perspectives for the rationale of malaria vaccine designs capable to sustain high levels of IgG3 against polymorphic malaria antigens.
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Affiliation(s)
- Fernanda G Versiani
- Instituto Leônidas e Maria Deane - Fiocruz, Rua Teresina 476, 69057-070 Manaus, AM, Brazil.
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Chehuan YF, Costa MRF, Costa JS, Alecrim MGC, Nogueira F, Silveira H, Brasil LW, Melo GC, Monteiro WM, Lacerda MVG. In vitro chloroquine resistance for Plasmodium vivax isolates from the Western Brazilian Amazon. Malar J 2013; 12:226. [PMID: 23819884 PMCID: PMC3704965 DOI: 10.1186/1475-2875-12-226] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 03/25/2013] [Accepted: 06/24/2013] [Indexed: 11/20/2022] Open
Abstract
Background Chloroquine (CQ) and primaquine (PQ) are still the drugs of choice to treat Plasmodium vivax malaria in many endemic areas, Brazil included. There is in vivo evidence for the P. vivax resistance to CQ in the Brazilian Amazon, where the increase in the proportion of P. vivax malaria parallels the increase of unusual clinical complications related to this species. In this study, in vitro CQ and mefloquine (MQ)-susceptibility of P. vivax isolates from the Western Brazilian Amazon was tested using the double-site enzyme-linked lactate dehydrogenase immunodetection (DELI) assay. Methods A total of 112 P. vivax isolates were tested in vitro for CQ-susceptibility and out of these 47 were also tested for MQ-susceptibility. The DELI assay was used to detect P. vivax growth at 48-hour short-term culture in isolates with ring stages ranging from 50 to %. Each isolate was tested in triplicate and geometric means of IC50’s was obtained. Nineteen isolates were genetically characterized for pvdhfr, pvmrp1, pvmdr1 and pvdhps candidate genes likely related to CQ resistance (10 with IC50<40 nM and 9 with IC50 >100 nM). Results Twelve out of 112 isolates were considered resistant to CQ, resulting in 10.7% (IC95% 5.0-16.4), while 3 out of 47 (6.4%; IC95% 0.0-12.8) were resistant to MQ. A discrete correlation was observed between IC50’s of CQ and MQ (Spearman=0.294; p=0.045). For pvdhps gene, a non-synonymous mutation was found at codon 382 (S→C) in 5/8 CQ-sensitive samples and 1/9 CQ-resistant samples (p=0.027). The other molecular markers were not associated to CQ-susceptibility. Conclusions In vitro CQ-resistance estimated in this study, estimated by the DELI test, was very similar to that observed in clinical trials, suggesting that in vitro procedures developed by capable local laboratories are useful in the surveillance of CQ-resistance in the Amazon; concurrent Amazon P. vivax strains with both CQ and MQ resistance may be common; and a non-synonymous mutation at pvdhps codon 382 (S→C) was associated to in vitro susceptibility to CQ, needing further studies to be confirmed.
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Affiliation(s)
- Yonne F Chehuan
- Fundação de Medicina Tropical Dr, Heitor Vieira Dourado, Av, Pedro Teixeira, 25, Dom Pedro, Manaus, AM 69040-000, Brazil
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25
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Coelho HCC, Lopes SCP, Pimentel JPD, Nogueira PA, Costa FTM, Siqueira AM, Melo GC, Monteiro WM, Malheiro A, Lacerda MVG. Thrombocytopenia in Plasmodium vivax malaria is related to platelets phagocytosis. PLoS One 2013; 8:e63410. [PMID: 23723981 PMCID: PMC3665752 DOI: 10.1371/journal.pone.0063410] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/02/2013] [Indexed: 12/15/2022] Open
Abstract
Background Although thrombocytopenia is a hematological disorder commonly reported in malarial patients, its mechanisms are still poorly understood, with only a few studies focusing on the role of platelets phagocytosis. Methods and Findings Thirty-five malaria vivax patients and eight healthy volunteers (HV) were enrolled in the study. Among vivax malaria patients, thrombocytopenia (<150,000 platelets/µL) was found in 62.9% (22/35). Mean platelet volume (MPV) was higher in thrombocytopenic patients as compared to non- thrombocytopenic patients (p = 0.017) and a negative correlation was found between platelet count and MPV (r = −0.483; p = 0.003). Platelets from HV or patients were labeled with 5-chloromethyl fluorescein diacetate (CMFDA), incubated with human monocytic cell line (THP-1) and platelet phagocytosis index was analyzed by flow cytometry. The phagocytosis index was higher in thrombocytopenic patients compared to non-thrombocytopenic patients (p = 0.042) and HV (p = 0.048). A negative correlation was observed between platelet count and phagocytosis index (r = −0.402; p = 0.016). Platelet activation was assessed measuring the expression of P-selectin (CD62-P) in platelets’ surface by flow cytometry. No significant difference was found in the expression of P-selectin between thrombocytopenic patients and HV (p = 0.092). After evaluating the cytokine profile (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL-17) in the patients’ sera, levels of IL-6, IL-10 and IFN-γ were elevated in malaria patients compared to HV. Moreover, IL-6 and IL-10 values were higher in thrombocytopenic patients than non-thrombocytopenic ones (p = 0.044 and p = 0.017, respectively. In contrast, TNF-α levels were not different between the three groups, but a positive correlation was found between TNF-α and phagocytosis index (r = −0.305; p = 0.037). Conclusion/Significance Collectively, our findings indicate that platelet phagocytosis may contribute to thrombocytopenia found in vivax malaria. Finally, we believe that this study opens new avenues to explore the mechanisms involved in platelet dysfunction, commonly found in vivax malaria patients.
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Affiliation(s)
- Helena Cristina C. Coelho
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - João Paulo D. Pimentel
- Instituto Leônidas e Maria Deane, Fiocruz, Manaus, Amazonas, Brazil
- Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Amazonas, Brazil
| | | | | | - André M. Siqueira
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Gisely C. Melo
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Adriana Malheiro
- Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Amazonas, Brazil
| | - Marcus V. G. Lacerda
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- * E-mail:
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Martins-Campos KM, Pinheiro WD, Vítor-Silva S, Siqueira AM, Melo GC, Rodrigues IC, Fé NF, Barbosa MDGV, Tadei WP, Guinovart C, Bassat Q, Alonso PL, Lacerda MVG, Monteiro WM. Integrated vector management targeting Anopheles darlingi populations decreases malaria incidence in an unstable transmission area, in the rural Brazilian Amazon. Malar J 2012; 11:351. [PMID: 23088224 PMCID: PMC3502175 DOI: 10.1186/1475-2875-11-351] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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: 08/04/2012] [Accepted: 10/19/2012] [Indexed: 11/25/2022] Open
Abstract
Background Studies on vector behaviour should be conducted in order to evaluate the effectiveness of vector control measures on malaria protection in endemic areas of Latin America, where P. vivax predominates. This work aims to investigate the fauna of anopheline mosquitoes and verify the impact of integrated vector management in two colonization projects in the Careiro Municipality, Western Brazilian Amazon. Methods Four mosquitoes’ captures were carried out from August 2008 to March 2010, with an interval of six months between each collection. Since September 2009 a large programme to reduce the burden of malaria has started in the two communities by distribution of insecticide-treated bed nets (ITN) and intensification of indoor residual spraying (IRS). Human biting rates (HBRs), entomological inoculation rates (EIRs), malaria incidence rate (MIR) and Plasmodium carrier’s prevalence were used as outcomes to estimate the impact of the control measures. Results A total of 3,189 anophelines were collected, belonging to 13 species. Anopheles darlingi was the predominant species in the period (42.6%), followed by Anopheles albitarsis (38.4%). An. darlingi HBRs showed a notable decreasing trend from the start to the end of the study. Conversely, An. albitarsis increased its contribution to overall HBRs throughout the study. For An. darlingi there was a significant positive correlation between HBRs and MIR (p = 0.002). Anopheles albitarsis HBRs showed a significant negative correlation with the corresponding MIR (p = 0.045). EIR from total anophelines and from An. darlingi and An. albitarsis presented decreasing patterns in the successive collections. Four species of anophelines (An. darlingi, An. albitarsis, Anopheles braziliensis and Anopheles nuneztovari) were naturally infected with Plasmodium, albeit at very low infection rates. There were a decrease in the MIR for both vivax and falciparum malaria and in the prevalence of Plasmodium vivax and Plasmodium falciparum carriers during the period of study. Conclusions There is strong evidence of association between the density of An. darlingi and the incidence of malaria in the studies sites, further highlighting the importance of this vector in malaria transmission in this region. An. darlingi susceptibility to control using ITN and IRS is likely to be high in the rural settlements studied.
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Affiliation(s)
- Keillen M Martins-Campos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av, Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil
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Magalhães BML, Alexandre MAA, Siqueira AM, Melo GC, Gimaque JBL, Bastos MS, Figueiredo RMP, Carvalho RC, Tavares MA, Naveca FG, Alonso P, Bassat Q, Lacerda MVG, Mourão MPG. Clinical profile of concurrent dengue fever and Plasmodium vivax malaria in the Brazilian Amazon: case series of 11 hospitalized patients. Am J Trop Med Hyg 2012; 87:1119-24. [PMID: 23033396 DOI: 10.4269/ajtmh.2012.12-0210] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria and dengue fever are the most prevalent vector-borne diseases worldwide. This study aims to describe the clinical profile of patients with molecular diagnosis of concurrent malaria and dengue fever in a tropical-endemic area. Eleven patients with concurrent dengue virus (DENV) and Plasmodium vivax infection are reported. Similar frequencies of DENV-2, DENV-3, and DENV-4 were found, including DENV-3/DENV-4 co-infection. In eight patients, the World Health Organization (WHO) criteria for severe malaria could be fulfilled (jaundice being the most common). Only one patient met severe dengue criteria, but warning signs were present in 10. Syndromic surveillance systems must be ready to identify this condition to avoid misinterpretation of severity attributed to a single disease.
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Brasil LW, Areas ALL, Melo GC, Oliveira CMC, Alecrim MGC, Lacerda MVG, O'Brien C, Oelemann WMR, Zalis MG. Pfatp6 molecular profile of Plasmodium falciparum isolates in the western Brazilian Amazon. Malar J 2012; 11:111. [PMID: 22487143 PMCID: PMC3350389 DOI: 10.1186/1475-2875-11-111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/19/2011] [Accepted: 04/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-malarial drug resistance has emerged as one of the biggest challenges confronting the worldwide effort to control malaria. The appearance of chloroquine and multi-drug resistance had devastating effects on therapeutic efficacy of former first-line agents. Artemisinin has proven to be an excellent therapeutic alternative to fill the void in chemotherapeutic options left by resistance mechanisms. At the time of introduction, no resistance to artemisinins had been recorded, and artemisinins demonstrated excellent parasite reduction rates. In an attempt to protect artemisinin efficacy, the World Health Organization (WHO) made artemisinin-based combination therapy (ACT) its official first-line treatment recommendation for uncomplicated Plasmodium falciparum in 2006. In Brazil, artemether/lumefantrine became the Brazilian Malaria Control Programme's official treatment recommendation in 2007. The sarco/endoplasmic reticulum Ca2+ - ATPase ortholog of P. falciparum (pfatp6) has been suggested as one of the targets of artemisinins. Consequently, pfatp6 gene polymorphisms are being investigated as markers of artemisinin resistance elsewhere. The goal of this work was to describe the molecular profile of pfatp6 in P. falciparum isolates from different localities in the Amazonas State. METHODS DNA polymorphisms of the pfatp6 gene in 80 P. falciparum isolates from 11 municipalities of the Amazonas State (Western Brazilian Amazon), before and after the introduction of ACT in the Brazilian anti-malarial guidelines, were analysed by automatic sequencing. Mutations in the pfatp6 gene were searched using Mutation Surveyor v3.25 software. RESULTS The P. falciparum pfatp6 gene presented polymorphisms at codons 37, 630 and 898. The R37K mutation was found in 16% of the samples, A630S in 32% and I898I in 52%. No S769N mutation, however, was detected in the analysed samples. CONCLUSION Despite the small number of samples, data presented here provide baseline information about polymorphisms of pfatp6 gene before and after exposure to ACT in a low transmission area, which will help to infer drug selection pressure in this area in the future.
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Affiliation(s)
- Larissa W Brasil
- Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, Brazil
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