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Rani A, Nawaz SK, Arshad M, Arshad N. Role of MyD88-Adaptor-Like (MAL) Gene Polymorphism rs8177374 and Cytokine (IFN-γ, TNF-α, IL-10, TGF-β) Levels in Diverse Malaria Manifestations upon P. falciparum and P. vivax Infections. Jpn J Infect Dis 2023; 76:358-364. [PMID: 37648490 DOI: 10.7883/yoken.jjid.2023.079] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This study investigated the role of genetic variant rs8177374 in MAL/TIRAP gene in mediating the cytokine levels of IFN-γ, TNF-α, IL-10, and TGF-β in malaria patients due to Plasmodium falciparum or P. vivax infection. The study included human blood samples collected from patients with malaria (n = 228) and healthy controls (n = 226). P. falciparum and P. vivax groups were established based on the causative species of Plasmodium. Malaria samples were divided into mild and severe malaria groups based on the symptoms that appeared in the patients, according to the WHO criteria. In a previous study, we genotyped rs8177374 via allele specific PCR strategy. In this study, cytokine levels were estimated in the blood plasma of rs8177374 genotype samples via Sandwich Enzyme Linked Immunosorbent Assay kits. Increased IFN-γ and TNF-α levels in presence of CC genotype indicates the role of CC genotype in both severe and mild malaria groups. Enhanced IL-10 levels in the CT genotype and mild malaria groups suggest a role of CT genotype and IL-10 in the mild clinical outcomes of malaria. The rs8177374 polymorphism in MAL/TIRAP plays an important role in malaria pathogenesis.
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Affiliation(s)
- Asima Rani
- Department of Zoology, University of Sargodha, Pakistan
| | | | | | - Najma Arshad
- Department of Zoology, Institute of Molecular Biology and Biotechnology, Center for Research in Molecular Medicine (IMBB/CRIMM), The University of Lahore, Pakistan
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Cardona-Arias JA, Carmona-Fonseca J. Meta-analysis of the prevalence of malaria associated with pregnancy in Colombia 2000-2020. PLoS One 2021; 16:e0255028. [PMID: 34329329 PMCID: PMC8323879 DOI: 10.1371/journal.pone.0255028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Knowledge about malaria associated with pregnancy is scarce in Latin America, and in Colombia, little is known about the magnitude of this infection. A systematic review was conducted to determine the prevalence of malaria associated with pregnancy (MAP) and each of its three forms: gestational (GM), placental (PM), and congenital (CM) tested using thick blood smear (TBS) and PCR. Also to compare the proportion of cases due to Plasmodium falciparum and Plasmodium vivax in Colombia from the year 2000-2020. We searched in Pubmed, Science Direct, EMBASE, EMCare, Cochrane Library, Scielo, Lilacs, Google Scholar, libraries, and repositories of Colombian universities, to obtain data on prevalence of GM, PM and CM with their respective testing method. We performed a meta-analysis with a random-effects model to obtain pooled prevalence of MAP and its three forms categorized by testing methods (TBS and PCR). We used data from 14 studies (out of 258 screened) contributing 7932, 2506 women for GM and PM respectively, also data on 1143 umbilical cord blood samples, and 899 peripheral blood of neonates. We found prevalence by TBS as, MAP 4.5% (95%CI = 2.9-6.9), GM 5.8% (95%CI = 3.8-8.7), PM 3.4% (95%CI = 1.7-6.7) and CM 1.3% (95%CI = 0.6-3.0). With PCR the prevalence was, MAP 14.4% (95%CI = 7.6-25.5), GM 16.7% (95%CI = 9.0-28.8), PM 11.0% (95%CI = 4.1-26.3) and CM 16.2% (95%CI = 8.2-29.5). The prevalence of submicroscopic infection was 8.5% (95%CI = 3.4-19.7) in GM, 10.1% (95%CI = 3.5-25.5) in PM and 22.0% (95%CI = 13.2-34.3) in CM. Infections by P. vivax was dominant over P. falciparum when tested with TBS, the PCR test gave similar proportions of P. falciparum and P. vivax. This meta-analysis has demonstrated high prevalence of MAP in Colombia, and highlights the urgent need to increase attention of researchers, research funding institutions, government agencies, and health authorities to study and intervene MAP, that has currently been under investigated.
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MESH Headings
- Colombia
- Female
- Humans
- Malaria, Falciparum/blood
- Malaria, Falciparum/diagnosis
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/pathology
- Malaria, Vivax/blood
- Malaria, Vivax/diagnosis
- Malaria, Vivax/epidemiology
- Malaria, Vivax/pathology
- Plasmodium falciparum/metabolism
- Plasmodium vivax/metabolism
- Pregnancy
- Pregnancy Complications, Parasitic/blood
- Pregnancy Complications, Parasitic/diagnosis
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/pathology
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Affiliation(s)
| | - Jaime Carmona-Fonseca
- ”Grupo Salud y Comunidad César Uribe Pidrahíta”, University of Antioquia, Medellín, Colombia
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Woodford J, Gillman A, Jenvey P, Roberts J, Woolley S, Barber BE, Fernandez M, Rose S, Thomas P, Anstey NM, McCarthy JS. Positron emission tomography and magnetic resonance imaging in experimental human malaria to identify organ-specific changes in morphology and glucose metabolism: A prospective cohort study. PLoS Med 2021; 18:e1003567. [PMID: 34038421 PMCID: PMC8154100 DOI: 10.1371/journal.pmed.1003567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Plasmodium vivax has been proposed to infect and replicate in the human spleen and bone marrow. Compared to Plasmodium falciparum, which is known to undergo microvascular tissue sequestration, little is known about the behavior of P. vivax outside of the circulating compartment. This may be due in part to difficulties in studying parasite location and activity in life. METHODS AND FINDINGS To identify organ-specific changes during the early stages of P. vivax infection, we performed 18-F fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) at baseline and just prior to onset of clinical illness in P. vivax experimentally induced blood-stage malaria (IBSM) and compared findings to P. falciparum IBSM. Seven healthy, malaria-naive participants were enrolled from 3 IBSM trials: NCT02867059, ACTRN12616000174482, and ACTRN12619001085167. Imaging took place between 2016 and 2019 at the Herston Imaging Research Facility, Australia. Postinoculation imaging was performed after a median of 9 days in both species (n = 3 P. vivax; n = 4 P. falciparum). All participants were aged between 19 and 23 years, and 6/7 were male. Splenic volume (P. vivax: +28.8% [confidence interval (CI) +10.3% to +57.3%], P. falciparum: +22.9 [CI -15.3% to +61.1%]) and radiotracer uptake (P. vivax: +15.5% [CI -0.7% to +31.7%], P. falciparum: +5.5% [CI +1.4% to +9.6%]) increased following infection with each species, but more so in P. vivax infection (volume: p = 0.72, radiotracer uptake: p = 0.036). There was no change in FDG uptake in the bone marrow (P. vivax: +4.6% [CI -15.9% to +25.0%], P. falciparum: +3.2% [CI -3.2% to +9.6%]) or liver (P. vivax: +6.2% [CI -8.7% to +21.1%], P. falciparum: -1.4% [CI -4.6% to +1.8%]) following infection with either species. In participants with P. vivax, hemoglobin, hematocrit, and platelet count decreased from baseline at the time of postinoculation imaging. Decrements in hemoglobin and hematocrit were significantly greater in participants with P. vivax infection compared to P. falciparum. The main limitations of this study are the small sample size and the inability of this tracer to differentiate between host and parasite metabolic activity. CONCLUSIONS PET/MRI indicated greater splenic tropism and metabolic activity in early P. vivax infection compared to P. falciparum, supporting the hypothesis of splenic accumulation of P. vivax very early in infection. The absence of uptake in the bone marrow and liver suggests that, at least in early infection, these tissues do not harbor a large parasite biomass or do not provoke a prominent metabolic response. PET/MRI is a safe and noninvasive method to evaluate infection-associated organ changes in morphology and glucose metabolism.
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Affiliation(s)
- John Woodford
- Clinical Tropical Medicine Laboratory, QIMR-Berghofer Medical Research Institute, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Ashley Gillman
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Peter Jenvey
- Department of Radiology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Jennie Roberts
- Department of Radiology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Stephen Woolley
- Clinical Tropical Medicine Laboratory, QIMR-Berghofer Medical Research Institute, Brisbane, Australia
- Centre for Defence Pathology, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Bridget E. Barber
- Clinical Tropical Medicine Laboratory, QIMR-Berghofer Medical Research Institute, Brisbane, Australia
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Melissa Fernandez
- Clinical Tropical Medicine Laboratory, QIMR-Berghofer Medical Research Institute, Brisbane, Australia
| | - Stephen Rose
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Paul Thomas
- Herston Imaging Research Facility, Brisbane, Australia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - James S. McCarthy
- Clinical Tropical Medicine Laboratory, QIMR-Berghofer Medical Research Institute, Brisbane, Australia
- University of Queensland, Brisbane, Australia
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Dombrowski JG, Barateiro A, Peixoto EPM, Barros ABCDS, de Souza RM, Clark TG, Campino S, Wrenger C, Wunderlich G, Palmisano G, Epiphanio S, Gonçalves LA, Marinho CRF. Adverse pregnancy outcomes are associated with Plasmodium vivax malaria in a prospective cohort of women from the Brazilian Amazon. PLoS Negl Trop Dis 2021; 15:e0009390. [PMID: 33914739 PMCID: PMC8112668 DOI: 10.1371/journal.pntd.0009390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/29/2020] [Revised: 05/11/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Malaria in Brazil represents one of the highest percentages of Latin America cases, where approximately 84% of infections are attributed to Plasmodium (P.) vivax. Despite the high incidence, many aspects of gestational malaria resulting from P. vivax infections remain poorly studied. As such, we aimed to evaluate the consequences of P. vivax infections during gestation on the health of mothers and their neonates in an endemic area of the Amazon. Methods and findings We have conducted an observational cohort study in Brazilian Amazon between January 2013 and April 2015. 600 pregnant women were enrolled and followed until delivery. After applying exclusion criteria, 329 mother-child pairs were included in the analysis. Clinical data regarding maternal infection, newborn’s anthropometric measures, placental histopathological characteristics, and angiogenic and inflammatory factors were evaluated. The presence of plasma IgG against the P. vivax (Pv) MSP119 protein was used as marker of exposure and possible associations with pregnancy outcomes were analyzed. Multivariate logistic regression analysis revealed that P. vivax infections during the first trimester of pregnancy are associated with adverse gestational outcomes such as premature birth (adjusted odds ratio [aOR] 8.12, 95% confidence interval [95%CI] 2.69–24.54, p < 0.0001) and reduced head circumference (aOR 3.58, 95%CI 1.29–9.97, p = 0.01). Histopathology analysis showed marked differences between placentas from P. vivax-infected and non-infected pregnant women, especially regarding placental monocytes infiltrate. Placental levels of vasomodulatory factors such as angiopoietin-2 (ANG-2) and complement proteins such as C5a were also altered at delivery. Plasma levels of anti-PvMSP119 IgG in infected pregnant women were shown to be a reliable exposure marker; yet, with no association with improved pregnancy outcomes. Conclusions This study indicates that P. vivax malaria during the first trimester of pregnancy represents a higher likelihood of subsequent poor pregnancy outcomes associated with marked placental histologic modification and angiogenic/inflammatory imbalance. Additionally, our findings support the idea that antibodies against PvMSP119 are not protective against poor pregnancy outcomes induced by P. vivax infections. Malaria during pregnancy is associated with adverse effects on the fetus and the newborn. As far as we know, no study has previously investigated in a single work, the link between Plasmodium vivax malaria in pregnancy and poor gestational outcomes, alteration of the newborn’s anthropometric profile, placental lesions, angiogenic and inflammatory factors, and humoral immunity against the parasite. For this purpose, we investigated the association between P. vivax malaria during pregnancy and newborn’s anthropometric profile, placental pathology, gestational outcomes, and the presence of IgG against P. vivax MSP119 that may confer protection against infection during pregnancy. We performed a large cohort study of malaria during pregnancy that analyzed data from mother-child pairs delivered between 2013 and 2015 in the Southwestern Brazilian Amazonian region. By evaluating data from 329 pregnancies, we found that P. vivax malaria during the first pregnancy trimester is significantly associated with the occurrence of preterm birth, low birth weight, and reduced newborn head circumference and body length. We also noted that P. vivax malaria in pregnancy promoted placental lesions and homeostasis imbalance, characterized by increased syncytial nuclear aggregates, fibrin deposition, and monocytes/leukocytes infiltrate, as well as imbalanced angiogenic factors, leptin, and cytokines. We observed that pregnant women with IgG against P. vivax MSP119 are not protected against poor pregnancy outcomes caused by P. vivax infections during pregnancy. Our observations improve our understanding of the disease and P. vivax burden during pregnancy, changing the current paradigm of the outcome of P. vivax malaria in pregnancy. That may represent a long-term severe consequence for the affected populations living in P. vivax-endemic regions. Our results also indicate that IgG against P. vivax MSP119 is not associated with protection from poor pregnancy outcomes, excluding this protein as a possible vaccination target that can prevent adverse outcomes caused by P. vivax infections during pregnancy.
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Affiliation(s)
| | - André Barateiro
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Taane Gregory Clark
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susana Campino
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carsten Wrenger
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gerhard Wunderlich
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Giuseppe Palmisano
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Sabrina Epiphanio
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lígia Antunes Gonçalves
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- * E-mail: (LAG); (CRFM)
| | - Claudio Romero Farias Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- * E-mail: (LAG); (CRFM)
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Kumar V, Ray S, Aggarwal S, Biswas D, Jadhav M, Yadav R, Sabnis SV, Banerjee S, Talukdar A, Kochar SK, Shetty S, Sehgal K, Patankar S, Srivastava S. Multiplexed quantitative proteomics provides mechanistic cues for malaria severity and complexity. Commun Biol 2020; 3:683. [PMID: 33204009 PMCID: PMC7672109 DOI: 10.1038/s42003-020-01384-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
Management of severe malaria remains a critical global challenge. In this study, using a multiplexed quantitative proteomics pipeline we systematically investigated the plasma proteome alterations in non-severe and severe malaria patients. We identified a few parasite proteins in severe malaria patients, which could be promising from a diagnostic perspective. Further, from host proteome analysis we observed substantial modulations in many crucial physiological pathways, including lipid metabolism, cytokine signaling, complement, and coagulation cascades in severe malaria. We propose that severe manifestations of malaria are possibly underpinned by modulations of the host physiology and defense machinery, which is evidently reflected in the plasma proteome alterations. Importantly, we identified multiple blood markers that can effectively define different complications of severe falciparum malaria, including cerebral syndromes and severe anemia. The ability of our identified blood markers to distinguish different severe complications of malaria may aid in developing new clinical tests for monitoring malaria severity.
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Affiliation(s)
- Vipin Kumar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Sandipan Ray
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shalini Aggarwal
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Deeptarup Biswas
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Manali Jadhav
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Radha Yadav
- Department of Mathematics, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Sanjeev V Sabnis
- Department of Mathematics, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Soumaditya Banerjee
- Medicine Department, Medical College Hospital Kolkata, 88, College Street, Kolkata, 700073, India
| | - Arunansu Talukdar
- Medicine Department, Medical College Hospital Kolkata, 88, College Street, Kolkata, 700073, India
| | - Sanjay K Kochar
- Department of Medicine, Malaria Research Centre, S.P. Medical College, Bikaner, 334003, India
| | - Suvin Shetty
- Dr. L H Hiranandani Hospital, Mumbai, 400076, India
| | | | - Swati Patankar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Sanjeeva Srivastava
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India.
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Scully EJ, Shabani E, Rangel GW, Grüring C, Kanjee U, Clark MA, Chaand M, Kurita R, Nakamura Y, Ferreira MU, Duraisingh MT. Generation of an immortalized erythroid progenitor cell line from peripheral blood: A model system for the functional analysis of Plasmodium spp. invasion. Am J Hematol 2019; 94:963-974. [PMID: 31148215 PMCID: PMC6984401 DOI: 10.1002/ajh.25543] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 03/04/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023]
Abstract
Malaria pathogenesis is caused by the replication of Plasmodium parasites within the red blood cells (RBCs) of the vertebrate host. This selective pressure has favored the evolution of protective polymorphisms in erythrocyte proteins, a subset of which serve as cognate receptors for parasite invasion ligands. Recently, the generation of RBCs from immortalized hematopoietic stem cells (HSCs) has offered a more tractable system for genetic manipulation and long-term in vitro culture, enabling elucidation of the functional determinants of host susceptibility in vitro. Here we report the generation of an immortalized erythroid progenitor cell line (EJ cells) from as few as 100 000 peripheral blood mononuclear cells. It offers a robust method for the creation of customized model systems from small volumes of peripheral blood. The EJ cell differentiation mirrored erythropoiesis of primary HSCs, yielding orthochromatic erythroblasts and enucleated RBCs after eight days (ejRBCs). The ejRBCs supported invasion by both P. vivax and P. falciparum. To demonstrate the genetic tractability of this system, we used CRISPR/Cas9 to disrupt the Duffy Antigen/Receptor for Chemokines (DARC) gene, which encodes the canonical receptor of P. vivax in humans. Invasion of P. vivax into this DARC-knockout cell line was strongly inhibited providing direct genetic evidence that P. vivax requires DARC for RBC invasion. Further, genetic complementation of DARC restored P. vivax invasion. Taken together, the peripheral blood immortalization method presented here offers the capacity to generate biologically representative model systems for studies of blood-stage malaria invasion from the peripheral blood of donors harboring unique genetic backgrounds, or rare polymorphisms.
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Affiliation(s)
- Erik J. Scully
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Broad Institute, Cambridge, MA, United States of America
| | - Estela Shabani
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Gabriel W. Rangel
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Christof Grüring
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Usheer Kanjee
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Martha A. Clark
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Mudit Chaand
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Ryo Kurita
- Department of Research and Development, Central Blood Institute, Japanese Red Cross Society, Tokyo 135-8521, Japan
| | - Yukio Nakamura
- Cell Engineering Division, RIKEN BioResource Center, Ibaraki 305-0074, Japan
| | - Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, SP, BR 05508-900
| | - Manoj T. Duraisingh
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Cruz LAB, Moraes MOA, Queiroga-Barros MR, Fukutani KF, Barral-Netto M, Andrade BB. Chronic hepatitis B virus infection drives changes in systemic immune activation profile in patients coinfected with Plasmodium vivax malaria. PLoS Negl Trop Dis 2019; 13:e0007535. [PMID: 31233500 PMCID: PMC6611654 DOI: 10.1371/journal.pntd.0007535] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/22/2019] [Revised: 07/05/2019] [Accepted: 06/10/2019] [Indexed: 12/18/2022] Open
Abstract
Background Plasmodium vivax and Hepatitis B virus (HBV) are globally outspread in similar geographic regions. The concurrence of both infections and its association with some degree of protection against symptomatic and/or severe vivax malaria has been already described. Nevertheless, data on how host response to both pathogens undermines the natural progression of the malarial infection are scarce. Here, a large cohort of vivax malaria and HBV patients is retrospectively analyzed in an attempt to depict how inflammatory characteristics could be potentially related to the protection to severe malaria in coinfection. Methods A retrospective analysis of a databank containing 601 individuals from the Brazilian Amazon, including 179 symptomatic P. vivax monoinfected patients, 145 individuals with asymptomatic P. vivax monoinfection, 28 P. vivax-HBV coinfected patients, 29 HBV monoinfected subjects and 165 healthy controls, was performed. Data on plasma levels of multiple chemokines, cytokines, acute phase proteins, hepatic enzymes, bilirubin and creatinine were analyzed to describe and compare biochemical profiles associated to each type of infection. Results Coinfected individuals predominantly presented asymptomatic malaria, referred increased number of previous malaria episodes than symptomatic vivax-monoinfected patients, and were predominantly younger than asymptomatic vivax-monoinfected individuals. Coinfection was hallmarked by substantially elevated concentrations of interleukin (IL)-10 and heightened levels of C-C motif chemokine ligand (CCL)2. Correlation matrices showed that coinfected individuals presented a distinct biomarker profile when compared to asymptomatic or symptomatic P. vivax patients, or HBV-monoinfected individuals. Parasitemia could distinguish coinfected from symptomatic or asymptomatic P. vivax-monoinfected patients. HBV viremia was associated to distinct inflammatory profiles in HBV-monoinfected and coinfected patients. Conclusion The findings demonstrate a distinct inflammatory profile in coinfected patients, with characteristics associated with immune responses to both pathogens. These host responses to P. vivax and HBV, in conjunction, could be potentially associated, if not mainly responsible, for the protection against symptomatic vivax malaria. The determinants of the diverse clinical presentations of Plasmodium vivax malaria are not completely understood. Previous studies have reported that P. vivax-HBV coinfection is associated with increased odds of presenting with asymptomatic malaria, but little is known about the immune mechanisms driving such association. To illuminate host pathways associated with protection against malaria, we analyzed multiple cytokines, chemokines and acute phase proteins in groups of patients from the Brazilian Amazon with different presentations of vivax malaria monoinfection, HBV monoinfection, and P. vivax-HBV coinfection. The results indicate that coinfection is hallmarked by a conjunction of immune responses, related to each one of the monoinfections, that results in a balanced inflammation associated with clinical immunity and absence of symptoms. In biological terms, the readouts are that the combined responses to each pathogen would induce a distinct profile of systemic immune activation, with the hallmarked activity of IL-10, a classical immunoregulatory cytokine, in confluence mainly with CCL2 and IL-4 activity. These multiple pathways would prevent the unbalanced proinflammatory activity associated with symptomatic and/or severe vivax malaria. Moreover, these findings highlight the importance of the immune system in driving disease presentation, raise discussion of immunotherapy in vivax malaria, and how these approaches have the potential to influence clinical outcomes.
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Affiliation(s)
- Luís A. B. Cruz
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
- Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
| | - Marina O. A. Moraes
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
- Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil
| | - Matheus R. Queiroga-Barros
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
- Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil
| | - Kiyoshi F. Fukutani
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
- Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
- Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil
| | - Manoel Barral-Netto
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, Brazil
- Instituto Nacional de Ciência e Tecnologia, Instituto de Investigação em Imunologia, São Paulo, Brazil
| | - Bruno B. Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
- Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Brazil
- Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
- * E-mail:
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Bannister-Tyrrell M, Srun S, Sluydts V, Gryseels C, Mean V, Kim S, Sokny M, Peeters Grietens K, Coosemans M, Menard D, Tho S, Van Bortel W, Durnez L. Importance of household-level risk factors in explaining micro-epidemiology of asymptomatic malaria infections in Ratanakiri Province, Cambodia. Sci Rep 2018; 8:11643. [PMID: 30076361 PMCID: PMC6076298 DOI: 10.1038/s41598-018-30193-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/18/2018] [Accepted: 07/20/2018] [Indexed: 11/09/2022] Open
Abstract
Heterogeneity in malaria risk is considered a challenge for malaria elimination. A cross-sectional study was conducted to describe and explain micro-epidemiological variation in Plasmodium infection prevalence at household and village level in three villages in Ratanakiri Province, Cambodia. A two-level logistic regression model with a random intercept fitted for each household was used to model the odds of Plasmodium infection, with sequential adjustment for individual-level then household-level risk factors. Individual-level risk factors for Plasmodium infection included hammock net use and frequency of evening outdoor farm gatherings in adults, and older age in children. Household-level risk factors included house wall material, crop types, and satellite dish and farm machine ownership. Individual-level risk factors did not explain differences in odds of Plasmodium infection between households or between villages. In contrast, once household-level risk factors were taken into account, there was no significant difference in odds of Plasmodium infection between households and between villages. This study shows the importance of ongoing indoor and peridomestic transmission in a region where forest workers and mobile populations have previously been the focus of attention. Interventions targeting malaria risk at household level should be further explored.
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Affiliation(s)
| | - Set Srun
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vincent Sluydts
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
- University of Antwerp, Antwerpm, Belgium
| | | | - Vanna Mean
- Ratanakiri Provincial Health Department, Banlung, Cambodia
| | - Saorin Kim
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Mao Sokny
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Marc Coosemans
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | | | - Sochantha Tho
- National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Wim Van Bortel
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | - Lies Durnez
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
- University of Antwerp, Antwerpm, Belgium
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9
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Niikura M, Inoue S, Mineo S, Asahi H, Kobayashi F. IFNGR1 signaling is associated with adverse pregnancy outcomes during infection with malaria parasites. PLoS One 2017; 12:e0185392. [PMID: 29117241 PMCID: PMC5678718 DOI: 10.1371/journal.pone.0185392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/01/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022] Open
Abstract
Complicated/severe cases of placental pathology due to Plasmodium falciparum and P. vivax, especially adverse pregnancy outcomes during P. vivax infection, have been increasing in recent years. However, the pathogenesis of placental pathology during severe malaria is poorly understood, while responses against IFN-γ are thought to be associated with adverse pregnancy outcomes. In the present study, we explored the role of IFN-γ receptor 1 (IFNGR1) signaling in placental pathology during severe malaria using luciferase-expressing rodent malaria parasites, P. berghei NK65 (PbNK65L). We detected luciferase activities in the lung, spleen, adipose tissue, and placenta in pregnant mice, suggesting that infected erythrocytes could accumulate in various organs during infection. Importantly, we found that fetal mortality in IFNGR1-deficient mice infected with PbNK65L parasites was much less than in infected wild type (WT) mice. Placental pathology was also improved in IFNGR1-deficient mice. In contrast, bioluminescence imaging showed that parasite accumulation in the placentas of IFNGR1-deficient pregnant mice was comparable to that in WT mice infected with PbNK65L. These findings suggest that IFNGR1 signaling plays a pivotal role in placental pathology and subsequent adverse pregnancy outcomes during severe malaria. Our findings may increase our understanding of how disease aggravation occurs during malaria during pregnancy.
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Affiliation(s)
- Mamoru Niikura
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Shin–Ichi Inoue
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Shoichiro Mineo
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hiroko Asahi
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Fumie Kobayashi
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
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10
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Elenga N. Discriminating Malaria from Dengue Fever and Chikungunya Infection in Children Living in Endemic Areas. Indian J Pediatr 2017; 84:649-650. [PMID: 28429282 DOI: 10.1007/s12098-017-2341-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/20/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Narcisse Elenga
- Department of Pediatrics, Cayenne Regional Hospital, Rue des Flamboyants BP, 6006-97306, Cayenne Cedex, French Guiana.
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11
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Ray HN, Doshi D, Rajan A, Singh AK, Singh SB, Das MK. Cardiovascular involvement in severe malaria: A prospective study in Ranchi, Jharkhand. J Vector Borne Dis 2017; 54:177-182. [PMID: 28748840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND & OBJECTIVES Malaria is considered as the most important parasitic disease of humans, causing seri- ous illness that can be fatal, if not diagnosed and treated immediately. It is a multisystem disorder affecting nearly every system of the body. The aim of the present study was to evaluate the involvement of cardiovascular system in severe malaria using non-invasive methods. METHODS This prospective study was conducted on patients of severe malaria who were admitted between June and November 2015 in the Department of Medicine, Rajendra Institute of Medical Sciences and Hospital, Ranchi, Jharkhand, India. A total of 27 cases (18 males and 9 females; age ranging between 15 and 70 yr) of severe malaria (P. falciparum 24; P. vivax 1; mixed 2) were diagnosed by microscopic examination of peripheral blood smear and bivalent rapid diagnostic test (RDT) kit. The assessment of cardiovascular system was done by clinical examination, chest X-ray, ECG and transthoracic echocardiography. RESULTS In all, 7 (26%) patients were found to be suffering from circulatory failure, out of which one was P. vivax case and rest were cases of P. falciparum infection with high parasite density. One patient died due to cardiovascular collapse. ECG revealed sinus bradycardia [Heart rate (HR): 40-60] in 7% of the cases, extreme tachycardia (HR: 120-150) in 3.7% of cases and premature arterial ectopic with tachycardia in 3.7% of patients (p <0.05). The echo- cardiographic findings were global hypokinesia with decreased left ventricular ejection fraction (<55%) in 11.1%, grade 1 left ventricular diastolic dysfunction in 3.7%, mild tricuspid regurgitation (TR) with mild pulmonary artery hypertension (PAH) in 3.7% and mild pericardial effusion in 3.7% of the cases. The ECG and echocardiography changes indicated myocardial involvement in severe malaria. INTERPRETATION & CONCLUSION The present study indicated involvement of cardiovascular system in severe malaria as evidenced from ECG and echocardiography. The study also revealed that cardiovascular instabilities are common in falciparum malaria, but can also be observed in vivax malaria.
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Affiliation(s)
| | - Darshit Doshi
- Rajendra Institute of Medical Sciences (RIMS), Bariatu, India
| | - Appu Rajan
- Rajendra Institute of Medical Sciences (RIMS), Bariatu, India
| | - Amit K Singh
- Rajendra Institute of Medical Sciences (RIMS), Bariatu, India
| | - S B Singh
- Rajendra Institute of Medical Sciences (RIMS), Bariatu, India
| | - M K Das
- National Institute of Malaria Research, Field Unit, Ranchi, India
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12
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Kuna A, Wroczyńska A, Bykowska M, Kulawiak N, Rymer W, Stańczak J. Clinical picture of imported Plasmodium vivax malaria in patients of a Polish tertiary center. Pol Arch Intern Med 2017; 127:57-59. [PMID: 28146461 DOI: 10.20452/pamw.3910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Abstract
Relapse may have evolved in malaria as a mechanism to avoid suppression by more virulent species in mixed infections, thereby increasing transmission opportunities. Later evolution of long latency in Plasmodium vivax was a necessary adaptation as early hominins moved to colder areas with shorter mosquito breeding seasons. Genetic diversity was maintained through heterologous hypnozoite activation.
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Affiliation(s)
- Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom.
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14
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Silvino ACR, Costa GL, de Araújo FCF, Ascher DB, Pires DEV, Fontes CJF, Carvalho LH, de Brito CFA, Sousa TN. Variation in Human Cytochrome P-450 Drug-Metabolism Genes: A Gateway to the Understanding of Plasmodium vivax Relapses. PLoS One 2016; 11:e0160172. [PMID: 27467145 PMCID: PMC4965052 DOI: 10.1371/journal.pone.0160172] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 04/07/2016] [Accepted: 07/14/2016] [Indexed: 01/08/2023] Open
Abstract
Although Plasmodium vivax relapses are classically associated with hypnozoite activation, it has been proposed that a proportion of these cases are due to primaquine (PQ) treatment failure caused by polymorphisms in cytochrome P-450 2D6 (CYP2D6). Here, we present evidence that CYP2D6 polymorphisms are implicated in PQ failure, which was reinforced by findings in genetically similar parasites, and may explain a number of vivax relapses. Using a computational approach, these polymorphisms were predicted to affect the activity of CYP2D6 through changes in the structural stability that could lead to disruption of the PQ-enzyme interactions. Furthermore, because PQ is co-administered with chloroquine (CQ), we investigated whether CQ-impaired metabolism by cytochrome P-450 2C8 (CYP2C8) could also contribute to vivax recurrences. Our results show that CYP2C8-mutated patients frequently relapsed early (<42 days) and had a higher proportion of genetically similar parasites, suggesting the possibility of recrudescence due to CQ therapeutic failure. These results highlight the importance of pharmacogenetic studies as a tool to monitor the efficacy of antimalarial therapy.
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Affiliation(s)
- Ana Carolina Rios Silvino
- Molecular Biology and Malaria Immunology Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Gabriel Luiz Costa
- Molecular Biology and Malaria Immunology Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Flávia Carolina Faustino de Araújo
- Molecular Biology and Malaria Immunology Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - David Benjamin Ascher
- Biosystems Informatics Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Douglas Eduardo Valente Pires
- Biosystems Informatics Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | | | - Luzia Helena Carvalho
- Molecular Biology and Malaria Immunology Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Cristiana Ferreira Alves de Brito
- Molecular Biology and Malaria Immunology Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Tais Nobrega Sousa
- Molecular Biology and Malaria Immunology Research Group, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
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15
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Gunalan K, Lo E, Hostetler JB, Yewhalaw D, Mu J, Neafsey DE, Yan G, Miller LH. Role of Plasmodium vivax Duffy-binding protein 1 in invasion of Duffy-null Africans. Proc Natl Acad Sci U S A 2016; 113:6271-6. [PMID: 27190089 PMCID: PMC4896682 DOI: 10.1073/pnas.1606113113] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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] [Indexed: 11/18/2022] Open
Abstract
The ability of the malaria parasite Plasmodium vivax to invade erythrocytes is dependent on the expression of the Duffy blood group antigen on erythrocytes. Consequently, Africans who are null for the Duffy antigen are not susceptible to P. vivax infections. Recently, P. vivax infections in Duffy-null Africans have been documented, raising the possibility that P. vivax, a virulent pathogen in other parts of the world, may expand malarial disease in Africa. P. vivax binds the Duffy blood group antigen through its Duffy-binding protein 1 (DBP1). To determine if mutations in DBP1 resulted in the ability of P. vivax to bind Duffy-null erythrocytes, we analyzed P. vivax parasites obtained from two Duffy-null individuals living in Ethiopia where Duffy-null and -positive Africans live side-by-side. We determined that, although the DBP1s from these parasites contained unique sequences, they failed to bind Duffy-null erythrocytes, indicating that mutations in DBP1 did not account for the ability of P. vivax to infect Duffy-null Africans. However, an unusual DNA expansion of DBP1 (three and eight copies) in the two Duffy-null P. vivax infections suggests that an expansion of DBP1 may have been selected to allow low-affinity binding to another receptor on Duffy-null erythrocytes. Indeed, we show that Salvador (Sal) I P. vivax infects Squirrel monkeys independently of DBP1 binding to Squirrel monkey erythrocytes. We conclude that P. vivax Sal I and perhaps P. vivax in Duffy-null patients may have adapted to use new ligand-receptor pairs for invasion.
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Affiliation(s)
- Karthigayan Gunalan
- Laboratory of Malaria and Vector Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852
| | - Eugenia Lo
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA 92697
| | - Jessica B Hostetler
- Laboratory of Malaria and Vector Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852; Malaria Programme, Wellcome Trust, Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1RQ, United Kingdom
| | - Delenasaw Yewhalaw
- Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma 5195, Ethiopia; Tropical and Infectious Diseases Research Center, Jimma University, Jimma 5195, Ethiopia
| | - Jianbing Mu
- Laboratory of Malaria and Vector Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852
| | | | - Guiyun Yan
- Program in Public Health, College of Health Sciences, University of California, Irvine, CA 92697
| | - Louis H Miller
- Laboratory of Malaria and Vector Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852;
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16
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Ribeiro BDP, Cassiano GC, de Souza RM, Cysne DN, Grisotto MAG, de Azevedo dos Santos APS, Marinho CRF, Machado RLD, Nascimento FRF. Polymorphisms in Plasmodium vivax Circumsporozoite Protein (CSP) Influence Parasite Burden and Cytokine Balance in a Pre-Amazon Endemic Area from Brazil. PLoS Negl Trop Dis 2016; 10:e0004479. [PMID: 26943639 PMCID: PMC4778932 DOI: 10.1371/journal.pntd.0004479] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 08/24/2015] [Accepted: 02/01/2016] [Indexed: 12/17/2022] Open
Abstract
Mechanisms involved in severe P. vivax malaria remain unclear. Parasite polymorphisms, parasite load and host cytokine profile may influence the course of infection. In this study, we investigated the influence of circumsporozoite protein (CSP) polymorphisms on parasite load and cytokine profile in patients with vivax malaria. A cross-sectional study was carried out in three cities: São Luís, Cedral and Buriticupu, Maranhão state, Brazil, areas of high prevalence of P. vivax. Interleukin (IL)-2, IL-4, IL-10, IL-6, IL-17, tumor necrosis factor alpha (TNF-α, interferon gamma (IFN-γ and transforming growth factor beta (TGF-β were quantified in blood plasma of patients and in supernatants from peripheral blood mononuclear cell (PBMC) cultures. Furthermore, the levels of cytokines and parasite load were correlated with VK210, VK247 and P. vivax-like CSP variants. Patients infected with P. vivax showed increased IL-10 and IL-6 levels, which correlated with the parasite load, however, in multiple comparisons, only IL-10 kept this association. A regulatory cytokine profile prevailed in plasma, while an inflammatory profile prevailed in PBMC culture supernatants and these patterns were related to CSP polymorphisms. VK247 infected patients showed higher parasitaemia and IL-6 concentrations, which were not associated to IL-10 anti-inflammatory effect. By contrast, in VK210 patients, these two cytokines showed a strong positive correlation and the parasite load was lower. Patients with the VK210 variant showed a regulatory cytokine profile in plasma, while those infected with the VK247 variant have a predominantly inflammatory cytokine profile and higher parasite loads, which altogether may result in more complications in infection. In conclusion, we propose that CSP polymorphisms is associated to the increase of non-regulated inflammatory immune responses, which in turn may be associated with the outcome of infection. Recent evidences have associated P. vivax infections with clinical complications, previously only attributed to P. falciparum malaria. The interaction between host and parasite may contribute to severity of the disease, however, the specific contribution of each factor remains unclear. Previous studies have shown that polymorphisms in Plasmodium vivax CSP may interfere in systemic reactions, response to drug treatments, leading to different symptoms as well as humoral responses. In this study, we investigate whether these polymorphisms could influence the parasite load and cytokine profile, which altogether may influence the malaria outcome. In this sense, studies have shown that subjects with high parasitic loads, responding with production of pro-inflammatory cytokines develop a more severe disease. The present data indicate that VK247 variant are associated with significant higher parasite loads and pro-inflammatory cytokine profile compared to VK210 variant. In this regard, this study demonstrates that P. vivax CSP polymorphisms have systemic effects in the host immune response, and the investigation of immunogenicity of parasite proteins may provide evidences for a better understanding of this infection.
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Affiliation(s)
- Bruno de Paulo Ribeiro
- Programa de Pós- graduação em Ciências da Saúde, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil
- Laboratório de Imunofisiologia, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil
| | - Gustavo Capatti Cassiano
- Centro de Investigação de Microrganismos, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Rodrigo Medeiros de Souza
- Departamento de Parasitologia, Universidade de São Paulo (ICB/USP), São Paulo, São Paulo, Brazil
- Centro Multidisciplinar, Campus Floresta (Universidade Federal do Acre), Cruzeiro do Sul, Acre, Brazil
| | - Dalila Nunes Cysne
- Laboratório de Imunofisiologia, Universidade Federal do Maranhão (UFMA), São Luís, Maranhão, Brazil
| | | | | | | | - Ricardo Luiz Dantas Machado
- Laboratório de Pesquisa Básica em Malária (Instituto Evandro Chagas / Secretaria de Vigilância em Saúde / Ministério da Saúde—IEC/SVS/MS), Belém, Pará, Brazil
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17
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Pacheco MA, Lopez-Perez M, Vallejo AF, Herrera S, Arévalo-Herrera M, Escalante AA. Multiplicity of Infection and Disease Severity in Plasmodium vivax. PLoS Negl Trop Dis 2016; 10:e0004355. [PMID: 26751811 PMCID: PMC4709143 DOI: 10.1371/journal.pntd.0004355] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 07/10/2015] [Accepted: 12/11/2015] [Indexed: 11/19/2022] Open
Abstract
Background Multiplicity of infection (MOI) refers to the average number of distinct parasite genotypes concurrently infecting a patient. Although several studies have reported on MOI and the frequency of multiclonal infections in Plasmodium falciparum, there is limited data on Plasmodium vivax. Here, MOI and the frequency of multiclonal infections were studied in areas from South America where P. vivax and P. falciparum can be compared. Methodology/Principal Findings As part of a passive surveillance study, 1,328 positive malaria patients were recruited between 2011 and 2013 in low transmission areas from Colombia. Of those, there were only 38 P. vivax and 24 P. falciparum clinically complicated cases scattered throughout the time of the study. Samples from uncomplicated cases were matched in time and location with the complicated cases in order to compare the circulating genotypes for these two categories. A total of 92 P. vivax and 57 P. falciparum uncomplicated cases were randomly subsampled. All samples were genotyped by using neutral microsatellites. Plasmodium vivax showed more multiclonal infections (47.7%) than P. falciparum (14.8%). Population genetics and haplotype network analyses did not detect differences in the circulating genotypes between complicated and uncomplicated cases in each parasite. However, a Fisher exact test yielded a significant association between having multiclonal P. vivax infections and complicated malaria. No association was found for P. falciparum infections. Conclusion The association between multiclonal infections and disease severity in P. vivax is consistent with previous observations made in rodent malaria. The contrasting pattern between P. vivax and P. falciparum could be explained, at least in part, by the fact that P. vivax infections have lineages that were more distantly related among them than in the case of the P. falciparum multiclonal infections. Future research should address the possible role that acquired immunity and exposure may have on multiclonal infections and their association with disease severity. Previous studies on rodent malarias and mathematical models have postulated a link between multiclonal infections and disease severity. This association has been tested in Plasmodium falciparum mostly in Africa with limited information on P. vivax. Furthermore, there is a paucity of information from areas with low transmission. Here, we used samples available from a passive surveillance carried out in Colombia, South America. We found an association between multiclonal infections and disease severity in P. vivax but not in P. falciparum. Although the number of complicated malaria cases is low, the contrasting pattern between these two species emphasizes their epidemiological differences. We discuss how this pattern could be the result of a higher divergence among the P. vivax lineages co-infecting a patient. We hypothesize that low levels of acquired immunity may play a role in the association between multiclonal infections and disease severity.
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Affiliation(s)
- M. Andreína Pacheco
- Institute for Genomics and Evolutionary Medicine (igem), Temple University, Philadelphia, Pennsylvania, United States of America
| | - Mary Lopez-Perez
- Caucaseco Scientific Research Center and Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Andrés F. Vallejo
- Caucaseco Scientific Research Center and Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Sócrates Herrera
- Caucaseco Scientific Research Center and Malaria Vaccine and Drug Development Center, Cali, Colombia
| | - Myriam Arévalo-Herrera
- Caucaseco Scientific Research Center and Malaria Vaccine and Drug Development Center, Cali, Colombia
- Faculty of Health, Universidad del Valle, Cali, Colombia
| | - Ananias A. Escalante
- Institute for Genomics and Evolutionary Medicine (igem), Temple University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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18
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van Bruggen R, Gualtieri C, Iliescu A, Louicharoen Cheepsunthorn C, Mungkalasut P, Trape JF, Modiano D, Sodiomon Sirima B, Singhasivanon P, Lathrop M, Sakuntabhai A, Bureau JF, Gros P. Modulation of Malaria Phenotypes by Pyruvate Kinase (PKLR) Variants in a Thai Population. PLoS One 2015; 10:e0144555. [PMID: 26658699 PMCID: PMC4677815 DOI: 10.1371/journal.pone.0144555] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 09/14/2015] [Accepted: 11/19/2015] [Indexed: 01/11/2023] Open
Abstract
Pyruvate kinase (PKLR) is a critical erythrocyte enzyme that is required for glycolysis and production of ATP. We have shown that Pklr deficiency in mice reduces the severity (reduced parasitemia, increased survival) of blood stage malaria induced by infection with Plasmodium chabaudi AS. Likewise, studies in human erythrocytes infected ex vivo with P. falciparum show that presence of host PK-deficiency alleles reduces infection phenotypes. We have characterized the genetic diversity of the PKLR gene, including haplotype structure and presence of rare coding variants in two populations from malaria endemic areas of Thailand and Senegal. We investigated the effect of PKLR genotypes on rich longitudinal datasets including haematological and malaria-associated phenotypes. A coding and possibly damaging variant (R41Q) was identified in the Thai population with a minor allele frequency of ~4.7%. Arginine 41 (R41) is highly conserved in the pyruvate kinase family and its substitution to Glutamine (R41Q) affects protein stability. Heterozygosity for R41Q is shown to be associated with a significant reduction in the number of attacks with Plasmodium falciparum, while correlating with an increased number of Plasmodium vivax infections. These results strongly suggest that PKLR protein variants may affect the frequency, and the intensity of malaria episodes induced by different Plasmodium parasites in humans living in areas of endemic malaria.
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MESH Headings
- Amino Acid Sequence
- Amino Acid Substitution
- Animals
- Base Sequence
- Disease Susceptibility
- Erythrocytes/enzymology
- Erythrocytes/parasitology
- Gene Expression
- Genotype
- Humans
- Malaria/enzymology
- Malaria/genetics
- Malaria/pathology
- Malaria, Falciparum/enzymology
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/genetics
- Malaria, Falciparum/pathology
- Malaria, Vivax/enzymology
- Malaria, Vivax/epidemiology
- Malaria, Vivax/genetics
- Malaria, Vivax/pathology
- Mice
- Mice, Knockout
- Parasitemia/enzymology
- Parasitemia/epidemiology
- Parasitemia/genetics
- Parasitemia/pathology
- Phenotype
- Plasmodium chabaudi/physiology
- Plasmodium falciparum/physiology
- Plasmodium vivax/physiology
- Polymorphism, Single Nucleotide
- Protein Stability
- Pyruvate Kinase/chemistry
- Pyruvate Kinase/genetics
- Pyruvate Kinase/metabolism
- Senegal/epidemiology
- Sequence Alignment
- Severity of Illness Index
- Thailand/epidemiology
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Affiliation(s)
- Rebekah van Bruggen
- Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Christian Gualtieri
- Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra Iliescu
- Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Punchalee Mungkalasut
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 10330
| | - Jean-François Trape
- Laboratoire de Paludologie et Zoologie Médicale, Institut de Recherche pour le Développement, Dakar, Sénégal
| | - David Modiano
- Department of Public Health and Infectious Diseases, Instituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Bienvenu Sodiomon Sirima
- Centre National de Recherche et de Formation sur le Paludisme, Ministry of Health, Ouagadougou, Burkina Faso
| | - Pratap Singhasivanon
- Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mark Lathrop
- Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anavaj Sakuntabhai
- Unité de la Génétique Fonctionnelle des Maladies Infectieuses, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, URA3012, F-75015, Paris, France
| | - Jean-François Bureau
- Unité de la Génétique Fonctionnelle des Maladies Infectieuses, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, URA3012, F-75015, Paris, France
| | - Philippe Gros
- Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- * E-mail:
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Bhatta A, Kar K, Mishra K. Treatment outcome of inpatient malaria cases: a study in a tertiary care hospital of Odisha, India. J Vector Borne Dis 2014; 51:343-344. [PMID: 25540969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Ajaya Bhatta
- Department of Community Medicine, SCB Medical College, Cuttack, India
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Bastianelli G, Bouillon A, Nguyen C, Le-Nguyen D, Nilges M, Barale JC. Computational design of protein-based inhibitors of Plasmodium vivax subtilisin-like 1 protease. PLoS One 2014; 9:e109269. [PMID: 25343504 PMCID: PMC4208747 DOI: 10.1371/journal.pone.0109269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/18/2014] [Accepted: 08/16/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Malaria remains a major global health concern. The development of novel therapeutic strategies is critical to overcome the selection of multiresistant parasites. The subtilisin-like protease (SUB1) involved in the egress of daughter Plasmodium parasites from infected erythrocytes and in their subsequent invasion into fresh erythrocytes has emerged as an interesting new drug target. FINDINGS Using a computational approach based on homology modeling, protein-protein docking and mutation scoring, we designed protein-based inhibitors of Plasmodium vivax SUB1 (PvSUB1) and experimentally evaluated their inhibitory activity. The small peptidic trypsin inhibitor EETI-II was used as scaffold. We mutated residues at specific positions (P4 and P1) and calculated the change in free-energy of binding with PvSUB1. In agreement with our predictions, we identified a mutant of EETI-II (EETI-II-P4LP1W) with a Ki in the medium micromolar range. CONCLUSIONS Despite the challenges related to the lack of an experimental structure of PvSUB1, the computational protocol we developed in this study led to the design of protein-based inhibitors of PvSUB1. The approach we describe in this paper, together with other examples, demonstrates the capabilities of computational procedures to accelerate and guide the design of novel proteins with interesting therapeutic applications.
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Affiliation(s)
- Giacomo Bastianelli
- Institut Pasteur, Unité de Bioinformatique Structurale, Département de Biologie Structurale et Chimie, Paris, France
- CNRS UMR 3528, Paris, France
| | - Anthony Bouillon
- Institut Pasteur, Unité d’Immunologie Moléculaires des Parasites, Département de Parasitologie et de Mycologie & CNRS URA 2581, Paris, France
- CNRS, URA2581, Paris, France
| | | | | | - Michael Nilges
- Institut Pasteur, Unité de Bioinformatique Structurale, Département de Biologie Structurale et Chimie, Paris, France
- CNRS UMR 3528, Paris, France
| | - Jean-Christophe Barale
- Institut Pasteur, Unité d’Immunologie Moléculaires des Parasites, Département de Parasitologie et de Mycologie & CNRS URA 2581, Paris, France
- CNRS, URA2581, Paris, France
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O’Brien AT, Ramírez JF, Martínez SP. A descriptive study of 16 severe Plasmodium vivax cases from three municipalities of Colombia between 2009 and 2013. Malar J 2014; 13:404. [PMID: 25318617 PMCID: PMC4203896 DOI: 10.1186/1475-2875-13-404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasmodium vivax, the most geographically distributed cause of malaria, accounts for more than 70% of cases in the Americas. In Colombia, P. vivax was responsible for 67.3% of cases in the last five years. Despite vivax malaria impact worldwide, historically it has been neglected and considered to be a benign disease. In the last decade medical literature reports have emerged countering this benign outlook. This study pretends to describe the clinical and paraclinical profile of severe vivax malaria cases hospitalized in Tumaco, Cali, Buenaventura between 2009 and 2013, to contribute to the knowledge regarding the behaviour and clinical expression of this disease. METHODS This is a descriptive, retrospective case-series study of 16 severe malaria vivax cases, hospitalized between 2009 and 2013, in Colombian municipalities of Tumaco, Buenaventura and Cali. Severe malaria vivax cases were defined using criteria adapted from the national guidelines. Descriptive analyses of reason for consultation, signs and symptoms, diagnosis, treatment, paraclinical characteristics, complications, and time hospitalized, were conducted. RESULTS Sixteen cases of severe P. vivax were analysed. Fever, chills and headache were shown to be the main admission symptoms. Elevation of total bilirubin levels in 18.75%, and severe thrombocytopaenia in 25% of cases were the main complications presented during hospitalization. All cases responded to treatment, there were no deaths. CONCLUSIONS The following questions derived from this study could be the basis for future research: 1) Does the time to consultation have an impact on the number of days hospitalized and how cases progress during hospitalization, 2) Are the severity criteria in WHO guidelines sensitive enough to be used in clinical practice compared to national guidelines, and 3) How does malnutrition contribute to anaemia in malaria-endemic regions.
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Affiliation(s)
- Anthony T O’Brien
- Fundación Santa Fe de Bogotá Centro de Estudios e Investigación en Salud - CEI, Carrera 7 B # 123-90, Piso 3, Bogotá, Colombia
| | - Jesica F Ramírez
- Fundación Santa Fe de Bogotá Centro de Estudios e Investigación en Salud - CEI, Carrera 7 B # 123-90, Piso 3, Bogotá, Colombia
| | - Sandra P Martínez
- Fundación Santa Fe de Bogotá Centro de Estudios e Investigación en Salud - CEI, Carrera 7 B # 123-90, Piso 3, Bogotá, Colombia
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Kevin Baird J. Malaria caused by Plasmodium vivax: recurrent, difficult to treat, disabling, and threatening to life--the infectious bite preempts these hazards. Pathog Glob Health 2014; 107:475-9. [PMID: 24428831 PMCID: PMC4073528 DOI: 10.1179/2047772413z.000000000179] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The maxim ‘an ounce of prevention is worth a pound of cure’ finds few better demonstrations than with malaria caused by Plasmodium vivax. Thoroughly neglected over the past 60 years, the chemotherapy of this complex infection has been dangerous and ineffective until the present. Work is at last being done, but seeing that translate to real improvements at the periphery of care delivery will take years of deliberate effort. In the meantime, patients face substantial risk of debilitating, threatening, and fatal courses of illness associated with a diagnosis of vivax malaria. For some of the most vulnerable to such outcomes — pregnant women and infants — repeated attacks of acute vivax malaria from a single infectious anopheline bite is now not preventable. One of the few measures than can be immediately applied with rigor is vector control, thereby effectively preventing as many of these difficult and dangerous infections as possible. This commentary emphasizes the dire consequences of infection by P. vivax and the real difficulty of dealing with them. That, in turn, emphasizes the many benefits to be derived by preventing them in the first place.
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Kochar DK, Das A, Kochar A, Middha S, Acharya J, Tanwar GS, Pakalapati D, Subudhi AK, Boopathi PA, Garg S, Kochar SK. A prospective study on adult patients of severe malaria caused by Plasmodium falciparum, Plasmodium vivax and mixed infection from Bikaner, northwest India. J Vector Borne Dis 2014; 51:200-210. [PMID: 25253213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND & OBJECTIVES Description of severe vivax malaria and mixed species infection requires good clinical study. The present study was undertaken to evalute the characteristics of severe malaria patients in Bikaner, northwest India. METHODS This prospective study included 539 admitted adult patients of severe malaria (Plasmodium falciparum 274, P. vivax 221, and mixed infection of Pv + Pf 44). The diagnosis was confirmed by polymerase chain reaction. The categorization of severe malaria was done strictly as per WHO criteria. RESULTS The distribution of severe manifestation was similar in severe vivax, falciparum and mixed infections except more cases of thrombocytopenia in P. vivax (p=0.030) and in mixed infection (p=0.004). The risk of developing severe malaria was greatest in patients of mixed infection [53.01% (44/83)] in comparison to Plasmodium falciparum malaria [49.37% (274/555), RR= 1.135; p=0.616] and P. vivax malaria [45.38% (221/ 487), RR = 1.299, p=0.243]. Hepatic dysfunction was the commonest pernicious syndrome [P. falciparum 50% (137/274), P. vivax 43.89% (97/221), and mixed infections 54.55% (24/44)]. Multiorgan dysfunction was present in 40.26% (217/539) patients, the risk was greatest in mixed infection [90.90% (40/44)] in comparison to P. falciparum monoinfection [37.59% (103/274), RR = 12.238; p=0.0001] or P. vivax monoinfection [33.48% (74/ 221), RR = 13.25; p=0.0001]. The risk of mortality in severe malaria was 6.31% (34/539) in which mixed infection had greater risk [9.09% (4/44)] in comparison to P. falciparum [7.30% (20/274); OR = 1.270 (CI 0.347-4.217); p=0.757] or P. vivax [4.52% (10/221); 0R 2.110 (CI 0.527-7.826); p=0.260]. INTERPRETATION & CONCLUSION Severe vivax or falciparum malaria had almost similar features and prognosis including mortality. Risk of developing severe malaria, multiorgan dysfunction and mortality was more in patients of mixed infection in comparison to P. falciparum or P. vivax monoinfection. A multicentric study on larger number of patients requires further confirmation.
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Affiliation(s)
- D K Kochar
- Department of Medicine, RUHS College of Medical Sciences, Jaipur, India
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24
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Mittal M, Jain R, Talukdar B, Kumar M, Kapoor K. Emerging new trends of malaria in children: a study from a tertiary care centre in northern India. J Vector Borne Dis 2014; 51:115-118. [PMID: 24947218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND & OBJECTIVES Vivax malaria has long been considered a benign entity. However, an increasing number of reports are highlighting that it may no longer be so. An investigation was carried out to study the profile of malarial admissions in a tertiary care pediatric hospital and to analyse the burden of vivax-related complications. METHODS It is a retrospective observational study. The medical case records of all the patients admitted in the year 2011 with the clinical diagnosis of malaria and laboratory evidence in the form of positive peripheral smear and/or rapid malarial antigen test were retrieved and retrospectively analysed. RESULTS Overall, 198 cases were included, 128 (64.6%) were due to Plasmodium vivax, 66 (33.3%) due to P. falciparum and 4 (2%) had evidence of mixed infection of Pv + Pf. The clinical features on admission were similar in all the groups. In total, 64/128 (50%) patients with vivax infection had one or more complications with severe anemia in 33 (26%) and cerebral malaria in 16 (12.5%). Six deaths were reported in P. vivax cases. In the falciparum group, 52 (78.8%) had one or more complications with severe anemia in 37 (56.1%) and cerebral malaria in 24 (36.4%). Four deaths were reported in P. falciparum cases. INTERPRETATION & CONCLUSION Overall because of their larger numbers, vivax patients outnumbered other groups, with regards to severe complications and deaths. It was concluded that vivax malaria is emerging as an important cause of malaria-related complications in children.
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Affiliation(s)
| | - Rahul Jain
- Chacha Nehru Bal Chikitsalya (Affiliated to Department of Pediatrics, Maulana Azad Medical College), Geeta Colony, Delhi, India
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Pothapregada S, Kamalakannan B. Hemophagocytic syndrome in Plasmodium vivax malaria. J Vector Borne Dis 2014; 51:144-146. [PMID: 24947224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Sriram Pothapregada
- Department of Paediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India
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Affiliation(s)
- J. Kevin Baird
- *Address correspondence to J. Kevin Baird, Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta 10430. E-mail:
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Kumar S, Kumar PS, Kaur G, Bhalla A, Sharma N, Varma S. Rare concurrent infection with scrub typhus, dengue and malaria in a young female. J Vector Borne Dis 2014; 51:71-72. [PMID: 24717208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Susheel Kumar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Changpradub D, Mungthin M. Severe vivax malaria: a case report and a literature review. J Med Assoc Thai 2014; 97 Suppl 2:S243-S246. [PMID: 25518201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Most cases of severe malaria are caused by infection of Plasmodiumfalciparum. However severe manifestations in the infection of P. knowlesi and P. vivax have been reported in recentyears. The present study reported a 24-year-old Thai male presenting with acute fever and shock. Both blood smears and PCR were positive for P. vivax. He was treated with intravenous artesunate for 3 days in combination with oral mefloquine for 2 days and oral primaquine for 14 days. He was dischargedfrom hospital without any sequelae.
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Ataide MA, Andrade WA, Zamboni DS, Wang D, Souza MDC, Franklin BS, Elian S, Martins FS, Pereira D, Reed G, Fitzgerald KA, Golenbock DT, Gazzinelli RT. Malaria-induced NLRP12/NLRP3-dependent caspase-1 activation mediates inflammation and hypersensitivity to bacterial superinfection. PLoS Pathog 2014; 10:e1003885. [PMID: 24453977 PMCID: PMC3894209 DOI: 10.1371/journal.ppat.1003885] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [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: 06/20/2013] [Accepted: 11/29/2013] [Indexed: 12/20/2022] Open
Abstract
Cyclic paroxysm and high fever are hallmarks of malaria and are associated with high levels of pyrogenic cytokines, including IL-1β. In this report, we describe a signature for the expression of inflammasome-related genes and caspase-1 activation in malaria. Indeed, when we infected mice, Plasmodium infection was sufficient to promote MyD88-mediated caspase-1 activation, dependent on IFN-γ-priming and the expression of inflammasome components ASC, P2X7R, NLRP3 and/or NLRP12. Pro-IL-1β expression required a second stimulation with LPS and was also dependent on IFN-γ-priming and functional TNFR1. As a consequence of Plasmodium-induced caspase-1 activation, mice produced extremely high levels of IL-1β upon a second microbial stimulus, and became hypersensitive to septic shock. Therapeutic intervention with IL-1 receptor antagonist prevented bacterial-induced lethality in rodents. Similar to mice, we observed a significantly increased frequency of circulating CD14+CD16−Caspase-1+ and CD14dimCD16+Caspase-1+ monocytes in peripheral blood mononuclear cells from febrile malaria patients. These cells readily produced large amounts of IL-1β after stimulation with LPS. Furthermore, we observed the presence of inflammasome complexes in monocytes from malaria patients containing either NLRP3 or NLRP12 pyroptosomes. We conclude that NLRP12/NLRP3-dependent activation of caspase-1 is likely to be a key event in mediating systemic production of IL-1β and hypersensitivity to secondary bacterial infection during malaria. Together Plasmodium falciparum and P. vivax infect approximately 250 million individuals, reaping life of near one million children every year. Extensive research on malaria pathogenesis has funneled into the consensus that the clinical manifestations are often a consequence of the systemic inflammation. Importantly, secondary bacterial and viral infections potentiate this inflammatory reaction being important co-factors for the development of severe disease. One of the hallmarks of malaria syndrome is the paroxysm, which is characterized by high fever associated with peak of parasitemia. In this study we dissected the mechanisms of induction and the importance of the pyrogenic cytokine, IL-1β in the pathogenesis of malaria. Our results demonstrate the critical role of the innate immune receptors named Toll-Like Receptors and inflammasome on induction, processing and release of active form of IL-1β during malaria. Importantly, we provide evidences that bacterial superinfection further potentiates the Plasmodium-induced systemic inflammation, leading to the release of bulk amounts of IL-1β and severe disease. Hence, this study uncovers new checkpoints that could be targeted for preventing systemic inflammation and severe malaria.
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MESH Headings
- Animals
- Bacterial Infections/genetics
- Bacterial Infections/immunology
- Bacterial Infections/metabolism
- Carrier Proteins/genetics
- Carrier Proteins/immunology
- Carrier Proteins/metabolism
- Caspase 1/genetics
- Caspase 1/immunology
- Caspase 1/metabolism
- Female
- Humans
- Inflammasomes/genetics
- Inflammasomes/immunology
- Inflammasomes/metabolism
- Inflammation/genetics
- Inflammation/immunology
- Inflammation/metabolism
- Inflammation/pathology
- Interleukin-1beta/genetics
- Interleukin-1beta/immunology
- Intracellular Signaling Peptides and Proteins/genetics
- Intracellular Signaling Peptides and Proteins/immunology
- Intracellular Signaling Peptides and Proteins/metabolism
- Malaria, Vivax/immunology
- Malaria, Vivax/metabolism
- Malaria, Vivax/microbiology
- Malaria, Vivax/pathology
- Male
- Mice
- Mice, Knockout
- Monocytes/immunology
- Monocytes/metabolism
- Monocytes/pathology
- NLR Family, Pyrin Domain-Containing 3 Protein
- Plasmodium chabaudi/immunology
- Plasmodium chabaudi/metabolism
- Plasmodium vivax/immunology
- Plasmodium vivax/metabolism
- Shock, Septic/genetics
- Shock, Septic/immunology
- Shock, Septic/metabolism
- Shock, Septic/pathology
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Affiliation(s)
- Marco A. Ataide
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Warrison A. Andrade
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Dario S. Zamboni
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Donghai Wang
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Maria do Carmo Souza
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bernardo S. Franklin
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Samir Elian
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Flaviano S. Martins
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dhelio Pereira
- Centro de Pesquisas em Medicina Tropical, Porto Velho, Rondônia, Brazil
| | - George Reed
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Katherine A. Fitzgerald
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Douglas T. Golenbock
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Ricardo T. Gazzinelli
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
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Kochar A, Kalra P, Kochar S, Kochar SK, Kochar DK. Retinal haemorrhage: an unusual presentation of vivax malaria. J Vector Borne Dis 2013; 50:321-322. [PMID: 24499859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Anju Kochar
- Department of Ophthalmology, Sardar Patel Medical College, Bikaner, India
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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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Jain V, Agrawal A, Singh N. Malaria in a tertiary health care facility of Central India with special reference to severe vivax: implications for malaria control. Pathog Glob Health 2013; 107:299-304. [PMID: 24188240 PMCID: PMC4001609 DOI: 10.1179/204777213x13777615588180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Plasmodium vivax is now recognized as a cause of severe and fatal infection in many parts of the world. This prospective observational study was undertaken in a tertiary health setting to understand the spectrum of the disease burden and associated complications due to P. vivax malaria in central India. A malaria clinic under Regional Medical Research Centre for Tribals is operational at Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur in central India, where all fever cases and cases with history of fever were referred for screening of malaria parasite by microscopy and rapid diagnostic test kits. Confirmation of all the cases was done by PCR targeting 18s ribosomal RNA gene of the parasite to exclude mixed infection with P. falciparum. Severe vivax malaria was found in 22 (11·1%) out of 198 vivax patients. Cerebral malaria, seizures, severe malaria anaemia, and respiratory distress each were observed in 32% subjects. Multi-organ dysfunction syndrome was common (36%). Mortality was recorded in two patients and neurological sequelae were also observed in two patients at the time of discharge. This is the first report from Central India where P. vivax has been shown to be associated with severe signs of malaria. Severe vivax malaria is a relatively new clinical entity and further studies from different parts of the world are needed to understand clinical spectrum and burden of P. vivax not only for successful treatment, but also for designing and developing effective malaria control measures.
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Affiliation(s)
- Vidhan Jain
- Regional Medical Research Centre for Tribals, ICMR, Nagpur Road Garha, Jabalpur, Madhya Pradesh, India
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Dayal M, Sharma R, Jeyaseelan N, Sood R, Mathur SR, Chitragar S. Non-traumatic rupture of malarial spleen. Trop Gastroenterol 2013; 34:191-193. [PMID: 24851536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Lon C, Timmermans A, Buathong N, Nou S, Se Y, Sitthy N, Chann S, Kraesub S, Wongstitwilairoong T, Walsh DS, Tyner S, Fukuda M, Callender D, Sherwood J, Koy L, Char M, Bethell D, Saunders D. Severe malaria in Battambang Referral Hospital, an area of multidrug resistance in Western-Cambodia: a retrospective analysis of cases from 2006-2009. Malar J 2013; 12:217. [PMID: 23802651 PMCID: PMC3699359 DOI: 10.1186/1475-2875-12-217] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 05/13/2013] [Accepted: 06/23/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite recent malaria containment and control efforts leading to reduced incidence, Cambodia remains endemic for both Plasmodium vivax and multidrug-resistant Plasmodium falciparum malaria. Little has been reported in the peer-reviewed literature regarding the burden of severe malaria (SM) in Cambodia. METHODS Medical records for all patients admitted to the Battambang Referral Hospital (BRH) with an admitting or discharge diagnosis of SM from 2006 to 2009 (suspected SM cases) were reviewed. Those meeting the case definition of SM according to retrospective chart review and investigator assessment of probable cases, based on published national guidelines available at the time, were analysed for trends in demographics, mortality and referral patterns. RESULTS Of the 537 suspected SM cases at BRH during the study period, 393 (73%) met published WHO criteria for SM infection. Despite limited diagnostic and treatment facilities, overall mortality was 14%, with 7% mortality in children 14 and under, but 19% in adults (60% of cases). Cerebral malaria with coma was relatively rare (17%), but mortality was disproportionately high at 35%. Mean time to hospital presentation was five days (range one to 30 days) after onset of symptoms. While patients with delays in presentation had worse outcomes, there was no excess mortality based on treatment referral times, distance travelled or residence in artemisinin-resistance containment (ARC) Zone 1 compared to Zone 2. CONCLUSIONS Despite limitations in diagnosis and treatment, and multiple confounding co-morbidities, mortality rates at BRH were similar to reports from other countries in the region. Interventions to improve access to early diagnosis and effective treatment, combined with modest improvements in intensive care, are likely to reduce mortality further. Patients referred from Zone 1 did not have excess mortality compared to Zone 2 ARC areas. A steep decrease in SM cases and deaths observed in the first half of 2009 has since continued, indicating some success from containment efforts despite the emergence of artemisinin resistance in this area.
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Affiliation(s)
- Chanthap Lon
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Ans Timmermans
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Nillawan Buathong
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Samon Nou
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Youry Se
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Ngo Sitthy
- Battambang Referral Hospital, Cambodia, Dongkorteap village, Tuol Ta Ek Commune, Battambang District, Battambang Province, Cambodia
| | - Soklyda Chann
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Somporn Kraesub
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Tippa Wongstitwilairoong
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Douglas S Walsh
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Stuart Tyner
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Mark Fukuda
- Armed Forces Health Surveillance Center, Silver Spring, MD, USA
| | | | | | - Lenin Koy
- Battambang Referral Hospital, Cambodia, Dongkorteap village, Tuol Ta Ek Commune, Battambang District, Battambang Province, Cambodia
| | - Mengchour Char
- National Center for Parasitology, Entomology and Malaria Control, #372 Blvd. Monivong, Phnom Penh, Cambodia
| | - Delia Bethell
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
| | - David Saunders
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand
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Abstract
Hypokalaemia and its subsequent complications are more often seen in children rather than in adults and are more common with falciparum malaria. This is a case of a 26-year-old male with Plasmodium vivax malaria who had developed paraparesis secondary to hypokalaemia. His treatment involved correction of the potassium level as well as the treatment of malaria. Such an atypical manifestation of malaria in an adult has not been previously documented.
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Affiliation(s)
- Sagar Sinha
- Department of Medicine, Dr DY Patil Medical College, Hospital and Research Centre, Sector-5, Nerul, Navi Mumbai (New Bombay), Maharashtra, 400706, India
| | - Ananya Mukherji
- Department of Medicine, Dr DY Patil Medical College, Hospital and Research Centre, Sector-5, Nerul, Navi Mumbai (New Bombay), Maharashtra, 400706, India
| | - Santwana Chandrakar
- Department of Medicine, Dr DY Patil Medical College, Hospital and Research Centre, Sector-5, Nerul, Navi Mumbai (New Bombay), Maharashtra, 400706, India
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Mahgoub H, Gasim GI, Musa IR, Adam I. Severe Plasmodium vivax malaria among sudanese children at New Halfa Hospital, Eastern Sudan. Parasit Vectors 2012; 5:154. [PMID: 22846165 PMCID: PMC3464670 DOI: 10.1186/1756-3305-5-154] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are few published reports on severe Plasmodium vivax malaria in Africa. METHODS Clinical pattern/manifestations of severe P. vivax were described in children admitted at New Halfa Hospital in Sudan between September 2009-December 2011. RESULTS Eighteen children were admitted at the hospital during the study period with different manifestations of severe P. vivax malaria namely: severe anaemia (6, 33.3%), jaundice (5, 27.8%), thrombocytopenia (4, 22.2%), hypotension (3, 16.7%), cerebral malaria (2, 11.1%), epistaxis (2, 11.1%), renal impairment (1, 5.5%), hypogylcaemia and more than one manifestation (5, 27.8%). CONCLUSION Severe P. vivax malaria is an existing entity in eastern Sudan. Further studies are required to understand emergence of severe P. vivax malaria.
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Affiliation(s)
| | - Gasim I Gasim
- Faculty of Medicine, Qassim, University, Qassim, Qassim, Kingdom of Saudi Arabia
| | - Imad R Musa
- Buraidah Central Hospital, Buraidah, Kingdom of Saudi Arabia
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Sudan, P.O. Box 102, Khartoum, Sudan
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Baranova AM. [The vivax malaria causative agent Plasmodium ovale: the present global area, intraspecies polymorphism, importation to the Russian Federation (1992-2011)]. Med Parazitol (Mosk) 2012:45-49. [PMID: 23088152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The global area for Plasmodium ovale is small as compared with that for other species of human malaria pathogens. It has expanded in Asian areas and remained as before in the African ones. In the past 20 years, there have been 2129 malaria cases imported from far abroad to Russia, including 84 (4%) cases of vivax malaria (P. ovale). The patients were most foreign citizens: 70 from 20 African countries and 7 from two countries of Oceania, such as Papua New Guinea and Indonesia. The other 7 patients were Russia's people who had returned from different countries of Africa. For this period there have been a total of 5 cases of mixed infection: tropical P. falciparum malaria + vivax P. ovale malaria. The mission of detected new sympatric subspecies (P. ovale curtisi and P. ovale wallikeri) inhabiting the tropical countries with continuous local transmission remains unclear. Only a thorough study of these subspecies will be able to effectively apply preventive measures and to carry out their elimination in future.
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Sun XD, Wang J, Wei C. [A case of vivax malaria with acute hemolysis from treatment of chloroquine combined with primaquine]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2012; 30:195-200. [PMID: 23072134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Leoratti FMDS, Trevelin SC, Cunha FQ, Rocha BC, Costa PAC, Gravina HD, Tada MS, Pereira DB, Golenbock DT, do Valle Antonelli LR, Gazzinelli RT. Neutrophil paralysis in Plasmodium vivax malaria. PLoS Negl Trop Dis 2012; 6:e1710. [PMID: 22745844 PMCID: PMC3383745 DOI: 10.1371/journal.pntd.0001710] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [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: 02/17/2012] [Accepted: 05/13/2012] [Indexed: 12/03/2022] Open
Abstract
Background The activation of innate immune responses by Plasmodium vivax results in activation of effector cells and an excessive production of pro-inflammatory cytokines that may culminate in deleterious effects. Here, we examined the activation and function of neutrophils during acute episodes of malaria. Materials and Methods Blood samples were collected from P. vivax-infected patients at admission (day 0) and 30–45 days after treatment with chloroquine and primaquine. Expression of activation markers and cytokine levels produced by highly purified monocytes and neutrophils were measured by the Cytometric Bead Assay. Phagocytic activity, superoxide production, chemotaxis and the presence of G protein-coupled receptor (GRK2) were also evaluated in neutrophils from malaria patients. Principal Findings Both monocytes and neutrophils from P. vivax-infected patients were highly activated. While monocytes were found to be the main source of cytokines in response to TLR ligands, neutrophils showed enhanced phagocytic activity and superoxide production. Interestingly, neutrophils from the malaria patients expressed high levels of GRK2, low levels of CXCR2, and displayed impaired chemotaxis towards IL-8 (CXCL8). Conclusion Activated neutrophils from malaria patients are a poor source of pro-inflammatory cytokines and display reduced chemotactic activity, suggesting a possible mechanism for an enhanced susceptibility to secondary bacterial infection during malaria. Plasmodium vivax is responsible for approximately 60–80% of the malaria cases in the world, and contributes to significant social and economic instability in the developing countries of Latin America and Asia. The pathogenesis of P. vivax malaria is a consequence of host derived inflammatory mediators. Hence, a better understanding of the mechanisms involved in induction of systemic inflammation during P. vivax malaria is critical for the clinical management and prevention of severe disease. The innate immune receptors recognize Plasmodium sp. and initiate a broad spectrum of host defense mechanisms that mediate resistance to infection. However, the innate immune response is the classic “two-edged sword”, and clinical malaria is associated with high levels of circulating pro-inflammatory cytokines. Our findings show that both monocytes and neutrophils are highly activated during malaria. Monocytes produced high levels of IL-1β, IL-6 and TNF-α during acute malaria. On the other hand, neutrophils were a poor source of cytokines, but displayed an enhanced phagocytic activity and superoxide production. Unexpectedly, we noticed an impaired chemotaxis of neutrophils towards an IL-8 (CXCL8) gradient. We proposed that neutrophil paralysis is in part responsible for the enhanced susceptibility to bacterial infection observed in malaria patients.
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Affiliation(s)
| | - Silvia Cellone Trevelin
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Queiroz Cunha
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruno Coelho Rocha
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Augusto Carvalho Costa
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Humberto Doriguêtto Gravina
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mauro Shugiro Tada
- Centro de Pesquisas em Medicina Tropical de Rondônia, Porto Velho, Rondônia, Brazil
| | | | - Douglas Taylor Golenbock
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Lis Ribeiro do Valle Antonelli
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo T. Gazzinelli
- Laboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
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Abstract
Plasmodium vivax threatens nearly half the world's population and is a significant impediment to achievement of the millennium development goals. It is an important, but incompletely understood, cause of anaemia. This review synthesizes current evidence on the epidemiology, pathogenesis, treatment and consequences of vivax-associated anaemia. Young children are at high risk of clinically significant and potentially severe vivax-associated anaemia, particularly in countries where transmission is intense and relapses are frequent. Despite reaching lower densities than Plasmodium falciparum, Plasmodium vivax causes similar absolute reduction in red blood cell mass because it results in proportionately greater removal of uninfected red blood cells. Severe vivax anaemia is associated with substantial indirect mortality and morbidity through impaired resilience to co-morbidities, obstetric complications and requirement for blood transfusion. Anaemia can be averted by early and effective anti-malarial treatment.
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Affiliation(s)
- Nicholas M Douglas
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Pierre A Buffet
- INSERM - UPMC, (Paris 6 University) UMRs945, F-75013, Paris, France
- Department of Parasitology, Pitié-Salpétrière Hospital, Assistance Publique – Hôpitaux de Paris, F-75013, Paris, France
- Institut Pasteur, Unité d’Immunologie Moléculaire des Parasites, Département de Parasitologie Mycologie, F-75015, Paris, France
| | - Jeanne R Poespoprodjo
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Mimika District Health Authority, Timika, Papua, Indonesia
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Tsin W Yeo
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Nicholas J White
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ric N Price
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
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Vinod KV, Talari K, Gopalakrishnan M, Nisar KK, Dutta TK. Unusual presentations of vivax malaria: a report of two cases. J Vector Borne Dis 2012; 49:49-51. [PMID: 22585247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- K V Vinod
- Department of General Medicine, JIPMER, Puducherry, India.
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Kattenberg JH, Ochodo EA, Boer KR, Schallig HDFH, Mens PF, Leeflang MMG. Systematic review and meta-analysis: rapid diagnostic tests versus placental histology, microscopy and PCR for malaria in pregnant women. Malar J 2011; 10:321. [PMID: 22035448 PMCID: PMC3228868 DOI: 10.1186/1475-2875-10-321] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [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: 08/10/2011] [Accepted: 10/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During pregnancy, malaria infection with Plasmodium falciparum or Plasmodium vivax is related to adverse maternal health and poor birth outcomes. Diagnosis of malaria, during pregnancy, is complicated by the absence or low parasite densities in peripheral blood. Diagnostic methods, other than microscopy, are needed for detection of placental malaria. Therefore, the diagnostic accuracy of rapid diagnostic tests (RDTs), detecting antigen, and molecular techniques (PCR), detecting DNA, for the diagnosis of Plasmodium infections in pregnancy was systematically reviewed. METHODS MEDLINE, EMBASE and Web of Science were searched for studies assessing the diagnostic accuracy of RDTs, PCR, microscopy of peripheral and placental blood and placental histology for the detection of malaria infection (all species) in pregnant women. RESULTS The results of 49 studies were analysed in metandi (Stata), of which the majority described P. falciparum infections. Although both placental and peripheral blood microscopy cannot reliably replace histology as a reference standard for placental P. falciparum infection, many studies compared RDTs and PCR to these tests. The proportion of microscopy positives in placental blood (sensitivity) detected by peripheral blood microscopy, RDTs and PCR are respectively 72% [95% CI 62-80], 81% [95% CI 55-93] and 94% [95% CI 86-98]. The proportion of placental blood microscopy negative women that were negative in peripheral blood microscopy, RDTs and PCR (specificity) are 98% [95% CI 95-99], 94% [95% CI 76-99] and 77% [95% CI 71-82]. Based on the current data, it was not possible to determine if the false positives in RDTs and PCR are caused by sequestered parasites in the placenta that are not detected by placental microscopy. CONCLUSION The findings suggest that RDTs and PCR may have good performance characteristics to serve as alternatives for the diagnosis of malaria in pregnancy, besides any other limitations and practical considerations concerning the use of these tests. Nevertheless, more studies with placental histology as reference test are urgently required to reliably determine the accuracy of RDTs and PCR for the diagnosis of placental malaria. P. vivax-infections have been neglected in diagnostic test accuracy studies of malaria in pregnancy.
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MESH Headings
- Antigens, Protozoan/analysis
- DNA, Protozoan/genetics
- DNA, Protozoan/isolation & purification
- Diagnostic Tests, Routine/methods
- Female
- Histocytochemistry
- Humans
- Malaria, Falciparum/diagnosis
- Malaria, Falciparum/parasitology
- Malaria, Falciparum/pathology
- Malaria, Vivax/diagnosis
- Malaria, Vivax/parasitology
- Malaria, Vivax/pathology
- Microscopy/methods
- Parasitemia/diagnosis
- Parasitemia/parasitology
- Placenta/parasitology
- Plasmodium falciparum/isolation & purification
- Plasmodium vivax/isolation & purification
- Polymerase Chain Reaction/methods
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/parasitology
- Pregnancy Complications, Infectious/pathology
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Affiliation(s)
- Johanna H Kattenberg
- Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Parasitology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands
- Academic Medical Centre, Centre for Infection and Immunity, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Eleanor A Ochodo
- Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Parasitology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Kimberly R Boer
- Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Epidemiology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands
| | - Henk DFH Schallig
- Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Parasitology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands
| | - Petra F Mens
- Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Parasitology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands
- Academic Medical Centre, Centre for Infection and Immunity, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Mariska MG Leeflang
- Academic Medical Centre, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Royal Tropical Institute/Koninklijk Instituut voor de Tropen (KIT), KIT Biomedical Research, Epidemiology Unit, Meibergdreef 39, 1105 AZ Amsterdam, the Netherlands
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Abstract
Plasmodium vivax is a major cause of febrile illness in endemic areas of Asia, Central and South America, and the horn of Africa. Plasmodium vivax infections are characterized by relapses of malaria arising from persistent liver stages of the parasite (hypnozoites) which can be prevented only by 8-aminoquinoline anti-malarials. Tropical P. vivax relapses at three week intervals if rapidly eliminated anti-malarials are given for treatment, whereas in temperate regions and parts of the sub-tropics P. vivax infections are characterized either by a long incubation or a long-latency period between illness and relapse - in both cases approximating 8-10 months. The epidemiology of the different relapse phenotypes has not been defined adequately despite obvious relevance to malaria control and elimination. The number of sporozoites inoculated by the anopheline mosquito is an important determinant of both the timing and the number of relapses. The intervals between relapses display a remarkable periodicity which has not been explained. Evidence is presented that the proportion of patients who have successive relapses is relatively constant and that the factor which activates hypnozoites and leads to regular interval relapse in vivax malaria is the systemic febrile illness itself. It is proposed that in endemic areas a large proportion of the population harbours latent hypnozoites which can be activated by a systemic illness such as vivax or falciparum malaria. This explains the high rates of vivax following falciparum malaria, the high proportion of heterologous genotypes in relapses, the higher rates of relapse in people living in endemic areas compared with artificial infection studies, and, by facilitating recombination between different genotypes, contributes to P. vivax genetic diversity particularly in low transmission settings. Long-latency P. vivax phenotypes may be more widespread and more prevalent than currently thought. These observations have important implications for the assessment of radical treatment efficacy and for malaria control and elimination.
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Affiliation(s)
- Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
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Edison M, Jeeva JB, Singh M. Digital analysis of changes by Plasmodium vivax malaria in erythrocytes. Indian J Exp Biol 2011; 49:11-15. [PMID: 21365990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Blood samples of malaria patients (n = 30), selected based on the severity of parasitemia, were divided into low (LP), medium (MP) and high (HP) parasitemia, which represent increasing levels of the disease severity. Healthy subjects (n = 10) without any history of disease were selected as a control group. By processing of erythrocytes images their contours were obtained and from these the shape parameters area, perimeter and form factor were obtained. The gray level intensity was determined by scanning of erythrocyte along its largest diameter. A comparison of these with that of normal cells showed a significant change in shape parameters. The gray level intensity decreases with the increase of severity of the disease. The changes in shape parameters directly and gray level intensity variation inversely are correlated with the increase in parasite density due to the disease.
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Hahm C, Huh J, Hwang YS, Choi HJ, Yang HJ, Chung WS. A case of Plasmodium vivax with unusual enlarged gametocytes. Int J Lab Hematol 2010; 33:e1-2. [PMID: 21054814 DOI: 10.1111/j.1751-553x.2010.01272.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jain V, Singh PP, Silawat N, Patel R, Saxena A, Bharti PK, Shukla M, Biswas S, Singh N. A preliminary study on pro- and anti-inflammatory cytokine profiles in Plasmodium vivax malaria patients from central zone of India. Acta Trop 2010; 113:263-8. [PMID: 19958746 DOI: 10.1016/j.actatropica.2009.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 11/11/2009] [Accepted: 11/24/2009] [Indexed: 11/18/2022]
Abstract
The aim of this preliminary study was to investigate the plasma cytokine profiles in a group of patients suffering from Plasmodium vivax malaria during the peak of its transmission season. Plasma samples of 173 P. vivax patients and 34 healthy individuals were analyzed for IFN-gamma, TNF-alpha, IL-10 and IP-10 levels by ELISA. Levels of both pro- and anti-inflammatory cytokines were significantly higher in P. vivax patients compared to controls. Children with P. vivax infection had significantly higher levels of IFN-gamma than adults (P=0.017). Asexual parasitaemia versus TNF-alpha (r=-0.31, P=0.01), IL-10 (r=-0.30, P=0.015) and gametocytaemia versus IFN-gamma (r=-0.26; P=0.034) levels showed significant negative correlation in children compared to adults. The median concentrations of IFN-gamma (P=0.001), IL-10 (P=0.032) and IP-10 (P</=0.05) were higher in children reported with chills and rigors, whereas in adults only IFN-gamma levels was higher (P<0.0001). The median plasma concentrations of IFN- gamma (P=0.02), IL-10 (P<0.0001) and IP-10 (P=0.068) were higher in patients with mild anaemia compared to non-anaemic patients. The results indicated that both pro- and anti-inflammatory cytokine responses are associated with clinical signs of mild anaemia and paroxysm during symptomatic P. vivax malaria in Central India.
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Affiliation(s)
- Vidhan Jain
- National Institute of Malaria Research, FS-Jabalpur, MP, India
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Anstey NM, Handojo T, Pain MCF, Kenangalem E, Tjitra E, Price RN, Maguire GP. Lung injury in vivax malaria: pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation. J Infect Dis 2007; 195:589-96. [PMID: 17230420 PMCID: PMC2532499 DOI: 10.1086/510756] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 09/21/2006] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The mechanisms underlying lung injury in vivax malaria are not well understood. Inflammatory responses to Plasmodium falciparum and P. vivax, to our knowledge, have not previously been compared at an organ level. METHODS Respiratory symptoms and physiological aspects were measured longitudinally in Indonesian adults with uncomplicated vivax (n=50) and falciparum (n=50) malaria. Normal values were derived from 109 control subjects. Gas transfer was partitioned into its alveolar-capillary membrane (D(M)) and pulmonary capillary vascular (V(C)) components, to characterize the site and timing of impaired gas transfer. RESULTS Mean baseline V(C) volume was significantly reduced in vivax and falciparum malaria, improving with treatment in each species. Baseline D(M) function was not impaired in either species. The progressive deterioration in D(M) function after treatment was statistically significant in vivax malaria but not in uncomplicated falciparum malaria. Oxygen saturation deteriorated after treatment in vivax but improved in falciparum malaria. CONCLUSIONS The baseline reduction in V(C) volume but not in D(M) function suggests encroachment on V(C) volume by parasitized erythrocytes and suggests that P. vivax-infected erythrocytes may sequester within the pulmonary microvasculature. Progressive alveolar-capillary dysfunction after treatment of vivax malaria is consistent with a greater inflammatory response to a given parasite burden in P. vivax relative to that in P. falciparum.
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Affiliation(s)
- Nicholas M Anstey
- International Health Program, Infectious Diseases Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811, Australia.
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Jiménez BC, Navarro M, Huerga H, López-Román E, Mendoza A, López-Vélez R. Tertian malaria (Plasmodium vivax and Plasmodium ovale) in two travelers despite atovaquone-proguanil prophylaxis. J Travel Med 2006; 13:373-5. [PMID: 17107431 DOI: 10.1111/j.1708-8305.2006.00073.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is limited data regarding the efficacy of prophylaxis with atovaquone/proguanil (A/P) against non-falciparum malaria in travelers. Two cases, one Plasmodium vivax infection and another Plasmodium ovale infection, in travelers despite A/P prophylaxis are presented.
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Affiliation(s)
- Beatriz C Jiménez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain
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Rodriguez-Morales AJ, Sanchez E, Vargas M, Piccolo C, Colina R, Arria M, Franco-Paredes C. Pregnancy outcomes associated with Plasmodium vivax malaria in northeastern Venezuela. Am J Trop Med Hyg 2006; 74:755-7. [PMID: 16687675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Although Plasmodium vivax is increasingly recognized as an important cause of morbidity in pregnancy in low malaria-transmission areas of Asia, little is know about the epidemiologic and clinical profiles of P. vivax in pregnant women in Latin America. We describe the clinical features and pregnancy outcomes in a series of 12 cases of P. vivax malaria in pregnant women complicated in some by miscarriage or preterm deliveries and in others with significant degrees of anemia and thrombocytopenia in a population where P. vivax is endemic in northeastern Venezuela.
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