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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Fayed N. Perceptions and behaviors of healthcare providers towards rehabilitation support to children with severe malaria-related disability in Ethiopia: A qualitative descriptive study using the Theoretical Domains Framework. PLoS One 2024; 19:e0298769. [PMID: 38696368 PMCID: PMC11065226 DOI: 10.1371/journal.pone.0298769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/31/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Severe malaria often results in childhood disability. The prevalence of disability related to severe malaria is significant and is estimated to affect up to 53% of severe malaria survivors. In contrast, information is sparse about how healthcare providers in Africa think about or provide rehabilitation support in acute and post-acute phases respectively. Understanding the perceptions and behaviors of healthcare providers treating malaria could help inform malaria-related disability research, policy, and practice, aimed at the providers themselves. This study explored the perceptions and behaviors of healthcare providers towards rehabilitation for children with severe malaria-related disability. The Theoretical Domains Framework was used to describe the findings relative to wider literature on health provider behavior change. METHODS A qualitative descriptive approach was used to interview thirteen healthcare providers recruited purposively based on their clinical professions, roles, and settings. Data were analyzed using directed content analysis. We decided on the most prominent theoretical domains considering the frequency of specific perceptions and behaviors across the participants, the frequency of perceptions and behaviors in each domain, and evidence of strong perceptions and behaviors. RESULTS Nine out of fourteen theoretical domains were identified. These domains were: Beliefs about consequences, environmental context and resources, goals, knowledge, skills, optimism, reinforcement, social influences, and social or professional role and identity. Healthcare providers' beliefs about their roles in screening for disability or referring to rehabilitation were less positive. CONCLUSIONS The findings of this study suggest the need for interventions to support healthcare providers in acute phases (prevention and control of severe malaria) and post-acute phases (disability screening, referral, and rehabilitation care). Recommended interventions should focus on developing clinical guidelines, training clinicians, addressing institutional factors, and modifying external social influences such as socio-cultural factors.
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Heather M. Aldersey
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
| | - Colleen M. Davison
- Department of Public Health Sciences, Queen’s University Kingston, Kingston, Ontario, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
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Wu X, Qin N, Yi F, Wang J, Yan X, Wang L. Cerebral malaria presenting as nonconvulsive status epilepticus: a case report. Malar J 2024; 23:84. [PMID: 38500090 PMCID: PMC10949684 DOI: 10.1186/s12936-024-04908-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Malaria is an infectious malady caused by Plasmodium parasites, cerebral malaria standing out as one of its most severe complications. Clinical manifestation include elevated body temperature, loss of consciousness, and seizures. However, reports of cerebral malaria presenting as nonconvulsive status epilepticus are extremely rare. The case presented involves psychiatric symptoms, with the electroencephalogram indicated nonconvulsive status epilepticus associated with cerebral malaria. CASE PRESENTATION A 53-year-old male, was urgently admitted, due to confusion and abnormal behaviour for 10 h. The patient returned to China after developing a fever while working in Tanzania two months ago. The blood smear revealed Plasmodium vivax and Plasmodium falciparum, and he was diagnosed with malaria. He recovered following anti-malarial treatment. After admission, the patient was confused, unable to communicate normally, and unwilling to cooperate with the physical examination. Plasmodium was not found in the blood smear, but the DNA sequence of P. falciparum was discovered using metagenomic next-generation sequencing of cerebrospinal fluid. Brain MRI revealed no significant abnormalities. Continuous electroencephalogram monitoring revealed that the patient had non-convulsive status epilepticus, which was treated with diazepam and levetiracetam. The patient had normal consciousness and behaviour. He received anti-malarial treatment for two weeks and fully recovered. CONCLUSIONS This case demonstrates that nonconvulsive status epilepticus can be a manifestation of cerebral malaria. It is imperative for attending physicians to heighten vigilance when encountering patients with a history of travel to malaria-endemic regions or a prior malaria infection, especially in the presence of unusual clinical presentations.
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Affiliation(s)
- Xingguo Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Jinsha County People's Hospital, Guizhou, China
| | - Ningxiang Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fahang Yi
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xia Yan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Abebe AB, Chala MB, Fayed N. Severe malaria-related disability in African children: a scoping review. Disabil Rehabil 2024; 46:31-39. [PMID: 36533299 DOI: 10.1080/09638288.2022.2157053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Disability is a consequence of severe malaria for a significant proportion of African children. This scoping review aims to describe the impact of severe malaria on African children according to current literature using an international biopsychical classification and framework of disability and functioning. MATERIALS AND METHODS MEDLINE, EMBASE, Global Health, and CINHAL databases were searched for original research conducted on African children aged 0-18 using terms related to severe malaria and components of disability. Independent and dependent variables were extracted and classified using the World Health Organization's International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY) using standardized coding methods. RESULTS Seventy-two percent of the measured variables in the 34 included studies were coded as "body functions," (i.e., impairments), such as mental, neuromusculoskeletal, movement, and sensory functions, and 23.3% of variables were coded as "activities and participation" (i.e., activity limitations/participation restrictions), such as difficulties with general tasks and demands, communication, mobility, interpersonal interactions, and relationships. "Environment" variables such as family support, health access, education, or societal attitudes were not found in the included studies. CONCLUSIONS Existing peer-reviewed quantitative research of severe malaria-related disability is focused on neurological sequelae, with less research about activity limitations and participation restrictions.
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Heather M Aldersey
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abey Bekele Abebe
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
- Department of Physiotherapy, School of Medicine, Gondar University Specialized Comprehensive Hospital, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Bayisa Chala
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
- Department of Physiotherapy, School of Medicine, Gondar University Specialized Comprehensive Hospital, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Clark DJ, Bond C, Andrews A, Muller DJ, Sarkisian A, Opoka RO, Idro R, Bangirana P, Witten A, Sausen NJ, Birbeck GL, John CC, Postels DG. Admission Clinical and EEG Features Associated With Mortality and Long-term Neurologic and Cognitive Outcomes in Pediatric Cerebral Malaria. Neurology 2023; 101:e1307-e1318. [PMID: 37541845 PMCID: PMC10558167 DOI: 10.1212/wnl.0000000000207657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/02/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES For children with cerebral malaria, mortality is high, and in survivors, long-term neurologic and cognitive dysfunctions are common. While specific clinical factors are associated with death or long-term neurocognitive morbidity in cerebral malaria, the association of EEG features with these outcomes, particularly neurocognitive outcomes, is less well characterized. METHODS In this prospective cohort study of 149 children age 6 months to 12 years who survived cerebral malaria in Kampala, Uganda, we evaluated whether depth of coma, number of clinical seizures, or EEG features during hospitalization were associated with mortality during hospitalization, short-term and long-term neurologic deficits, or long-term cognitive outcomes (overall cognition, attention, memory) over the 2-year follow-up. RESULTS Higher Blantyre or Glasgow Coma Scores (BCS and GCS, respectively), higher background voltage, and presence of normal reactivity on EEG were each associated with lower mortality. Among clinical and EEG features, the presence of >4 seizures on admission had the best combination of negative and positive predictive values for neurologic deficits in follow-up. In multivariable modeling of cognitive outcomes, the number of seizures and specific EEG features showed independent association with better outcomes. In children younger than 5 years throughout the study, seizure number and presence of vertex sharp waves were independently associated with better posthospitalization cognitive performance, faster dominant frequency with better attention, and higher average background voltage and faster dominant background frequency with better associative memory. In children younger than 5 years at CM episode but 5 years or older at cognitive testing, seizure number, background dominant frequency, and the presence of vertex sharp waves were each associated with changes in cognition, seizure number and variability with attention, and seizure number with working memory. DISCUSSION In children with cerebral malaria, seizure number is strongly associated with the risk of long-term neurologic deficits, while seizure number and specific EEG features (average background voltage, dominant rhythm frequency, presence of vertex sharp waves, presence of variability) are independently associated with cognitive outcomes. Future studies should evaluate the predictive value of these findings.
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Affiliation(s)
- Daniel J Clark
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Caitlin Bond
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alexander Andrews
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Daniel J Muller
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Angela Sarkisian
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robert O Opoka
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Richard Idro
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Paul Bangirana
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andy Witten
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nicholas J Sausen
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Gretchen L Birbeck
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Chandy C John
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Douglas G Postels
- From the Division of Neurology (D.J.C.), Nationwide Children's Hospital, Columbus, OH; Ryan White Center for Pediatric Infectious Diseases & Global Health (C.B., C.C.J.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (A.A.), MedStar Georgetown University Hospital; The George Washington University School of Medicine and Health Sciences (D.J.M., A.S., D.G.P.), Washington, DC; Department of Paediatrics and Child Health (R.O.O., R.I.), Makerere University College of Health Sciences; Department of Psychiatry (P.B.), Makerere University College of Health Sciences, Kampala, Uganda; Department of Neurosurgery (A.W.), Indiana University School of Medicine, Indianapolis; Department of Pediatrics (N.J.S.), Division of Emergency Medicine, University of Minnesota, Minneapolis; Department of Neurology (G.L.B.), University of Rochester, NY; University of Zambia (G.L.B.), School of Medicine, Lusaka; University Teaching Hospitals Children's Hospital (G.L.B.), Lusaka, Zambia; Children's National Medical Center (D.G.P.), Washington, DC; and Blantyre Malaria Project (D.G.P.), Kamuzu University of Health Sciences, Blantyre, Malawi
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Marin AA, Juillard A, Katzin AM, Carvalho LJ, Grau GE. Perillyl alcohol modulates activation, permeability and integrity of human brain endothelial cells induced by Plasmodium falciparum. Mem Inst Oswaldo Cruz 2023; 118:e230033. [PMID: 37403869 DOI: 10.1590/0074-02760230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Cerebral malaria (CM) is a severe immunovasculopathy caused for Plasmodium falciparum infection, which is characterised by the sequestration of parasitised red blood cells (pRBCs) in brain microvessels. Previous studies have shown that some terpenes, such as perillyl alcohol (POH), exhibit a marked efficacy in preventing cerebrovascular inflammation, breakdown of the brain-blood barrier (BBB) and brain leucocyte accumulation in experimental CM models. OBJECTIVE To analyse the effects of POH on the endothelium using human brain endothelial cell (HBEC) monolayers co-cultured with pRBCs. METHODOLOGY The loss of tight junction proteins (TJPs) and features of endothelial activation, such as ICAM-1 and VCAM-1 expression were evaluated by quantitative immunofluorescence. Microvesicle (MV) release by HBEC upon stimulation by P. falciparum was evaluated by flow cytometry. Finally, the capacity of POH to revert P. falciparum-induced HBEC monolayer permeability was examined by monitoring trans-endothelial electrical resistance (TEER). FINDINGS POH significantly prevented pRBCs-induced endothelial adhesion molecule (ICAM-1, VCAM-1) upregulation and MV release by HBEC, improved their trans-endothelial resistance, and restored their distribution of TJPs such as VE-cadherin, Occludin, and JAM-A. CONCLUSIONS POH is a potent monoterpene that is efficient in preventing P. falciparum-pRBCs-induced changes in HBEC, namely their activation, increased permeability and alterations of integrity, all parameters of relevance to CM pathogenesis.
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Affiliation(s)
- Adriana A Marin
- Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Parasitologia, São Paulo, SP, Brasil
- University of Sydney, Department of Pathology, Vascular Immunology Unit, Sydney Medical School, New South Wales, Australia
| | - Annette Juillard
- University of Sydney, Department of Pathology, Vascular Immunology Unit, Sydney Medical School, New South Wales, Australia
| | - Alejandro M Katzin
- Universidade de São Paulo, Instituto de Ciências Biomédicas, Departamento de Parasitologia, São Paulo, SP, Brasil
| | - Leonardo Jm Carvalho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Pesquisa em Malária, Rio de Janeiro, RJ, Brasil
| | - Georges Er Grau
- University of Sydney, Department of Pathology, Vascular Immunology Unit, Sydney Medical School, New South Wales, Australia
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Investigation of Plasma-Derived Lipidome Profiles in Experimental Cerebral Malaria in a Mouse Model Study. Int J Mol Sci 2022; 24:ijms24010501. [PMID: 36613941 PMCID: PMC9820457 DOI: 10.3390/ijms24010501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Cerebral malaria (CM), a fatal complication of Plasmodium infection that affects children, especially under the age of five, in sub-Saharan Africa and adults in South-East Asia, results from incompletely understood pathogenetic mechanisms. Increased release of circulating miRNA, proteins, lipids and extracellular vesicles has been found in CM patients and experimental mouse models. We compared lipid profiles derived from the plasma of CBA mice infected with Plasmodium berghei ANKA (PbA), which causes CM, to those from Plasmodium yoelii (Py), which does not. We previously showed that platelet-free plasma (18k fractions enriched from plasma) contains a high number of extracellular vesicles (EVs). Here, we found that this fraction produced at the time of CM differed dramatically from those of non-CM mice, despite identical levels of parasitaemia. Using high-resolution liquid chromatography-mass spectrometry (LCMS), we identified over 300 lipid species within 12 lipid classes. We identified 45 and 75 lipid species, mostly including glycerolipids and phospholipids, with significantly altered concentrations in PbA-infected mice compared to Py-infected and uninfected mice, respectively. Total lysophosphatidylethanolamine (LPE) levels were significantly lower in PbA infection compared to Py infection and controls. These results suggest that experimental CM could be characterised by specific changes in the lipid composition of the 18k fraction containing circulating EVs and can be considered an appropriate model to study the role of lipids in the pathophysiology of CM.
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Effectiveness of rectal artesunate as pre-referral treatment for severe malaria in children under 5 years of age: a multi-country observational study. BMC Med 2022; 20:343. [PMID: 36217159 PMCID: PMC9550309 DOI: 10.1186/s12916-022-02541-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To prevent child deaths from severe malaria, early parenteral treatment is essential. Yet, in remote rural areas, accessing facilities offering parenteral antimalarials may be difficult. A randomised controlled trial found pre-referral treatment with rectal artesunate (RAS) to reduce deaths and disability in children who arrived at a referral facility with delay. This study examined the effectiveness of pre-referral RAS treatment implemented through routine procedures of established community-based health care systems. METHODS An observational study accompanied the roll-out of RAS in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Children <5 years of age presenting to a community-based health provider with a positive malaria test and signs of severe malaria were enrolled and followed up during admission and after 28 days to assess their health status and treatment history. The primary outcome was death; covariates of interest included RAS use, referral completion, and post-referral treatment. RESULTS Post-roll-out, RAS was administered to 88% of patients in DRC, 52% in Nigeria, and 70% in Uganda. The overall case fatality rate (CFR) was 6.7% (135/2011) in DRC, 11.7% (69/589) in Nigeria, and 0.5% (19/3686) in Uganda; 13.8% (865/6286) of patients were sick on day 28. The CFR was higher after RAS roll-out in Nigeria (16.1 vs. 4.2%) and stable in DRC (6.7 vs. 6.6%) and Uganda (0.7 vs. 0.3%). In DRC and Nigeria, children receiving RAS were more likely to die than those not receiving RAS (aOR=3.06, 95% CI 1.35-6.92 and aOR=2.16, 95% CI 1.11-4.21, respectively). Only in Uganda, RAS users were less likely to be dead or sick at follow-up (aOR=0.60, 95% CI 0.45-0.79). Post-referral parenteral antimalarials plus oral artemisinin-based combination therapy (ACT), a proxy for appropriate post-referral treatment, was protective. However, in referral health facilities, ACT was not consistently administered after parenteral treatment (DRC 68.4%, Nigeria 0%, Uganda 70.9%). CONCLUSIONS Implemented at scale to the recommended target group, pre-referral RAS had no beneficial effect on child survival in three highly malaria-endemic settings. RAS is unlikely to reduce malaria deaths unless health system issues such as referral and quality of care at all levels are addressed. TRIAL REGISTRATION The study is registered on ClinicalTrials.gov : NCT03568344.
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An update on cerebral malaria for therapeutic intervention. Mol Biol Rep 2022; 49:10579-10591. [PMID: 35670928 DOI: 10.1007/s11033-022-07625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cerebral malaria is often pronounced as a major life-threatening neurological complication of Plasmodium falciparum infection. The complex pathogenic landscape of the parasite and the associated neurological complications are still not elucidated properly. The growing concerns of drugresistant parasite strains along with the failure of anti-malarial drugs to subdue post-recovery neuro-cognitive dysfunctions in cerebral malaria patients have called for a demand to explore novel biomarkers and therapeutic avenues. Due course of the brain infection journey of the parasite, events such as sequestration of infected RBCs, cytoadherence, inflammation, endothelial activation, and blood-brain barrier disruption are considered critical. METHODS In this review, we briefly summarize the diverse pathogenesis of the brain-invading parasite associated with loss of the blood-brain barrier integrity. In addition, we also discuss proteomics, transcriptomics, and bioinformatics strategies to identify an array of new biomarkers and drug candidates. CONCLUSION A proper understanding of the parasite biology and mechanism of barrier disruption coupled with emerging state-of-art therapeutic approaches could be helpful to tackle cerebral malaria.
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Namazzi R, Opoka R, Datta D, Bangirana P, Batte A, Berrens Z, Goings MJ, Schwaderer AL, Conroy AL, John CC. Acute Kidney Injury Interacts With Coma, Acidosis, and Impaired Perfusion to Significantly Increase Risk of Death in Children With Severe Malaria. Clin Infect Dis 2022; 75:1511-1519. [PMID: 35349633 PMCID: PMC9617576 DOI: 10.1093/cid/ciac229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Mortality in severe malaria remains high in children treated with intravenous artesunate. Acute kidney injury (AKI) is a common complication of severe malaria, but the interactions between AKI and other complications on the risk of mortality in severe malaria are not well characterized. METHODS Between 2014 and 2017, 600 children aged 6-48 months to 4 years hospitalized with severe malaria were enrolled in a prospective clinical cohort study evaluating clinical predictors of mortality in children with severe malaria. RESULTS The mean age of children in this cohort was 2.1 years (standard deviation, 0.9 years) and 338 children (56.3%) were male. Mortality was 7.3%, and 52.3% of deaths occurred within 12 hours of admission. Coma, acidosis, impaired perfusion, AKI, elevated blood urea nitrogen (BUN), and hyperkalemia were associated with increased mortality (all P < .001). AKI interacted with each risk factor to increase mortality (P < .001 for interaction). Children with clinical indications for dialysis (14.4% of all children) had an increased risk of death compared with those with no indications for dialysis (odds ratio, 6.56; 95% confidence interval, 3.41-12.59). CONCLUSIONS AKI interacts with coma, acidosis, or impaired perfusion to significantly increase the risk of death in severe malaria. Among children with AKI, those who have hyperkalemia or elevated BUN have a higher risk of death. A better understanding of the causes of these complications of severe malaria, and development and implementation of measures to prevent and treat them, such as dialysis, are needed to reduce mortality in severe malaria.
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Affiliation(s)
- Ruth Namazzi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda,Global Health Uganda, Kampala, Uganda
| | - Robert Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda,Global Health Uganda, Kampala, Uganda
| | - Dibyadyuti Datta
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul Bangirana
- Global Health Uganda, Kampala, Uganda,Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anthony Batte
- Child Development Centre, Makerere University, Kampala, Uganda
| | - Zachary Berrens
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael J Goings
- Indiana University Center for Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea L Conroy
- Correspondence: A. L. Conroy, Department of Pediatrics, Indiana University School of Medicine, 1044 W Walnut St, Indianapolis, IN 46202 ()
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Andrews A, Zelleke T, Izem R, Gai J, Harrar D, Mvula J, Postels DG. Using EEG in Resource-Limited Areas: Comparing Qualitative and Quantitative Interpretation Methods in Cerebral Malaria. Pediatr Neurol 2022; 126:96-103. [PMID: 34763248 PMCID: PMC8724416 DOI: 10.1016/j.pediatrneurol.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Our goal was to compare the strength of association and predictive ability of qualitative and quantitative electroencephalographic (EEG) factors with the outcomes of death and neurological disability in pediatric cerebral malaria (CM). METHODS We enrolled children with a clinical diagnosis of CM admitted to Queen Elizabeth Central Hospital (Blantyre, Malawi) between 2012 and 2017. A routine-length EEG was performed within four hours of admission. EEG data were independently interpreted using qualitative and quantitative methods by trained pediatric neurophysiologists. EEG interpreters were unaware of patient discharge outcome. RESULTS EEG tracings from 194 patients were reviewed. Multivariate modeling revealed several qualitative and quantitative EEG variables that were independently associated with outcomes. Quantitative methods modeled on mortality had better goodness of fit than qualitative ones. When modeled on neurological morbidity in survivors, goodness of fit was better for qualitative methods. When the probabilities of an adverse outcome were calculated using multivariate regression coefficients, only the model of quantitative EEG variables regressed on the neurological sequelae outcome showed clear separation between outcome groups. CONCLUSIONS Multiple qualitative and quantitative EEG factors are associated with outcomes in pediatric CM. It may be possible to use quantitative EEG factors to create automated methods of study interpretation that have similar predictive abilities for outcomes as human-based interpreters, a rare resource in many malaria-endemic areas. Our results provide a proof-of-concept starting point for the development of quantitative EEG interpretation and prediction methodologies useful in resource-limited settings.
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Affiliation(s)
- Alexander Andrews
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington DC
| | - Tesfaye Zelleke
- Division of Neurology, The George Washington University School of Medicine/ Children’s National Medical Center, Washington DC
| | - Rima Izem
- Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington DC,Division of Epidemiology, The George Washington University School of Public Health, Washington DC,Department of Pediatrics, The George Washington University School of Medicine, Washington DC
| | - Jiaxiang Gai
- Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington DC
| | - Dana Harrar
- Division of Neurology, The George Washington University School of Medicine/ Children’s National Medical Center, Washington DC
| | - Jessica Mvula
- Department of Paediatrics, Mzuzu Central Hospital, Mzuzu, Malawi,Ministry of Health, Republic of Malawi
| | - Douglas G Postels
- Division of Neurology, The George Washington University School of Medicine/Children's National Medical Center, Washington, District of Columbia; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.
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Peprah S, Ogwang MD, Kerchan P, Reynolds SJ, Tenge CN, Were PA, Kuremu RT, Wekesa WN, Masalu N, Kawira E, Otim I, Legason ID, Ayers LW, Bhatia K, Goedert JJ, Pfeiffer RM, Mbulaiteye SM. Inverse association of falciparum positivity with endemic Burkitt lymphoma is robust in analyses adjusting for pre-enrollment malaria in the EMBLEM case-control study. Infect Agent Cancer 2021; 16:40. [PMID: 34099001 PMCID: PMC8186042 DOI: 10.1186/s13027-021-00377-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Falciparum and endemic Burkitt lymphoma (eBL) are co-endemic in Africa, but the malaria experience in eBL patients is unknown. A lower prevalence of falciparum has been reported in eBL patients, but those results are anecdotally attributed to pre-enrollment anti-malaria treatment. METHODS We studied 677 eBL patients and 2920 community controls aged 0-15 years enrolled in six regions in Uganda, Tanzania, and Kenya during 2010-2016. Falciparum was diagnosed using thick blood film microscopy (TFM) and antigen-capture rapid diagnostic tests (RDTs). Guardians of the children answered a 40-item structured questionnaire about their child's pre-enrollment lifetime malaria history and treatment, demographics, socioeconomics, animal exposures, fevers, and hospitalizations. We utilized exploratory factor analysis to reduce the 40 questionnaire variables into six factors, including Inpatient malaria and Outpatient malaria factors that were surrogates of pre-enrollment anti-malaria treatment. The six factors accounted for 83-90% of the variance in the questionnaire data. We calculated odds ratios and 95% confidence intervals (OR 95% CI) of association of eBL with falciparum positivity, defined as positive both on TFM or RDTs, or only RDTs (indicative of recent infection) or TFM (indicative of current falciparum infection) versus no infection, using multivariable logistic regression, controlling for group of age (0-2, 3-5, 6-8, 9-11 and 12-15 years), sex, and study site and the afore-mentioned pre-enrollment factors. RESULTS The prevalence of falciparum infection was 25.6% in the eBL cases and 45.7% in community controls (aOR = 0.43, 95% CI: 0.40, 0.47; P < 0.0001). The results were similar for recent falciparum infection (6.9% versus 13.5%, aOR = 0.44, 95% CI: 0.38, 0.50; P < 0.0001) and current falciparum infection (18.7% versus 32.1%, aOR = 0.47, 95% CI: 0.43, 0.51; P < 0.0001). These aORs for any, recent and current falciparum infection did not change when we adjusted for pre-enrollment factors (aORs = 0.46, =0.44, and = 0.51, respectively) were significantly lower in stratified analysis for any infection in children < 5 years (aOR = 0.46; 95% CI: 0.29, 0.75) or ≥ 10 years (aOR = 0.47; 95% CI: 0.32, 0.71). CONCLUSION Our study results reduce support for pre-enrollment antimalaria treatment as a sole explanation for the observed lower falciparum prevalence in eBL cases and open a space to consider alternative immunology-based hypotheses.
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Affiliation(s)
- Sally Peprah
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Infections and Immunoepidemiology Branch, 9609 Medical Center Dr, Rm. 6E-118, MSC 3330, Bethesda, MD, 20892, USA
| | - Martin D Ogwang
- EMBLEM Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Patrick Kerchan
- EMBLEM Study, Kuluva Hospital, Arua & African Field Epidemiology Network, Kampala, Uganda
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Constance N Tenge
- EMBLEM Study, Moi University College of Health Sciences, Eldoret, Kenya
- Moi Teaching and Referral Hospital (MTRH), Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Pamela A Were
- EMBLEM Study, Moi University College of Health Sciences, Eldoret, Kenya
- Moi Teaching and Referral Hospital (MTRH), Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Robert T Kuremu
- EMBLEM Study, Moi University College of Health Sciences, Eldoret, Kenya
- Moi Teaching and Referral Hospital (MTRH), Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Walter N Wekesa
- EMBLEM Study, Moi University College of Health Sciences, Eldoret, Kenya
- Moi Teaching and Referral Hospital (MTRH), Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | | | - Esther Kawira
- EMBLEM Study, Shirati Health and Educational Foundation, Shirati, Tanzania
| | - Isaac Otim
- EMBLEM Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Ismail D Legason
- EMBLEM Study, Kuluva Hospital, Arua & African Field Epidemiology Network, Kampala, Uganda
| | - Leona W Ayers
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Infections and Immunoepidemiology Branch, 9609 Medical Center Dr, Rm. 6E-118, MSC 3330, Bethesda, MD, 20892, USA
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Infections and Immunoepidemiology Branch, 9609 Medical Center Dr, Rm. 6E-118, MSC 3330, Bethesda, MD, 20892, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Infections and Immunoepidemiology Branch, 9609 Medical Center Dr, Rm. 6E-118, MSC 3330, Bethesda, MD, 20892, USA
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Infections and Immunoepidemiology Branch, 9609 Medical Center Dr, Rm. 6E-118, MSC 3330, Bethesda, MD, 20892, USA.
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Perillyl alcohol reduces parasite sequestration and cerebrovascular dysfunction during experimental cerebral malaria. Antimicrob Agents Chemother 2021; 65:AAC.00004-21. [PMID: 33649109 PMCID: PMC8092904 DOI: 10.1128/aac.00004-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cerebral malaria (CM) is a severe immunovasculopathy which presents high mortality rate (15-20%), despite the availability of artemisinin-based therapy. More effective immunomodulatory and/or antiparasitic therapies are urgently needed. Experimental Cerebral Malaria (ECM) in mice is used to elucidate aspects involved in this pathology since manifests many of the neurological features of CM. In the present study, we evaluated the potential mechanisms involved in the protection afforded by perillyl alcohol (POH) in mouse strains susceptible to CM caused by Plasmodium berghei ANKA (PbA) infection through intranasal preventive treatment. Additionally, to evaluate the interaction of POH with the cerebral endothelium using an in vitro model of human brain endothelial cells (HBEC). Pharmacokinetic approaches demonstrated constant and prolonged levels of POH in the plasma and brain after a single intranasal dose. Treatment with POH effectively prevented vascular dysfunction. Furthermore, treatment with POH reduced the endothelial cell permeability and PbA s in the brain and spleen. Finally, POH treatment decreased the accumulation of macrophages and T and B cells in the spleen and downregulated the expression of endothelial adhesion molecules (ICAM-1, VCAM-1, and CD36) in the brain. POH is a potent monoterpene that prevents cerebrovascular dysfunction in vivo and in vitro, decreases parasite sequestration, and modulates different processes related to the activation, permeability, and integrity of the blood brain barrier (BBB), thereby preventing cerebral oedema and inflammatory infiltrates.
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Chandna A, Aderie EM, Ahmad R, Arguni E, Ashley EA, Cope T, Dat VQ, Day NPJ, Dondorp AM, Illanes V, De Jesus J, Jimenez C, Kain K, Suy K, Koshiaris C, Lasry E, Mayxay M, Mondal D, Perera R, Pongvongsa T, Rattanavong S, Rekart M, Richard-Greenblatt M, Shomik M, Souvannasing P, Tallo V, Turner C, Turner P, Waithira N, Watson JA, Yosia M, Burza S, Lubell Y. Prediction of disease severity in young children presenting with acute febrile illness in resource-limited settings: a protocol for a prospective observational study. BMJ Open 2021; 11:e045826. [PMID: 33495264 PMCID: PMC7839891 DOI: 10.1136/bmjopen-2020-045826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION In rural and difficult-to-access settings, early and accurate recognition of febrile children at risk of progressing to serious illness could contribute to improved patient outcomes and better resource allocation. This study aims to develop a prognostic clinical prediction tool to assist community healthcare providers identify febrile children who might benefit from referral or admission for facility-based medical care. METHODS AND ANALYSIS This prospective observational study will recruit at least 4900 paediatric inpatients and outpatients under the age of 5 years presenting with an acute febrile illness to seven hospitals in six countries across Asia. A venous blood sample and nasopharyngeal swab is collected from each participant and detailed clinical data recorded at presentation, and each day for the first 48 hours of admission for inpatients. Multianalyte assays are performed at reference laboratories to measure a panel of host biomarkers, as well as targeted aetiological investigations for common bacterial and viral pathogens. Clinical outcome is ascertained on day 2 and day 28.Presenting syndromes, clinical outcomes and aetiology of acute febrile illness will be described and compared across sites. Following the latest guidance in prediction model building, a prognostic clinical prediction model, combining simple clinical features and measurements of host biomarkers, will be derived and geographically externally validated. The performance of the model will be evaluated in specific presenting clinical syndromes and fever aetiologies. ETHICS AND DISSEMINATION The study has received approval from all relevant international, national and institutional ethics committees. Written informed consent is provided by the caretaker of all participants. Results will be shared with local and national stakeholders, and disseminated via peer-reviewed open-access journals and scientific meetings. TRIAL REGISTRATION NUMBER NCT04285021.
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Affiliation(s)
- Arjun Chandna
- Angkor Hospital for Children, Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Endashaw M Aderie
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Riris Ahmad
- Centre for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia
| | - Eggi Arguni
- Centre for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia
| | - Elizabeth A Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
| | - Tanya Cope
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Nicholas P J Day
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Victor Illanes
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Joanne De Jesus
- Clinical Trials, Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Carolina Jimenez
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Kevin Kain
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Keang Suy
- Angkor Hospital for Children, Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Angkor Hospital for Children, Siem Reap, Siem Reap, Cambodia
| | | | - Estrella Lasry
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Mayfong Mayxay
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Dinesh Mondal
- Centre for Nutrition and Food Security (CNFS), icddr,b, Dhaka, Dhaka, Bangladesh
| | - Rafael Perera
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tiengkham Pongvongsa
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
- Savannakhet Provincial Health Department, Savannakhet, Lao People's Democratic Republic
| | - Sayaphet Rattanavong
- Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Vientiane, Lao People's Democratic Republic
| | - Michael Rekart
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | | | - Mohammad Shomik
- Centre for Nutrition and Food Security (CNFS), icddr,b, Dhaka, Dhaka, Bangladesh
| | | | - Veronica Tallo
- Clinical Trials, Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Angkor Hospital for Children, Siem Reap, Siem Reap, Cambodia
| | - Paul Turner
- Angkor Hospital for Children, Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Naomi Waithira
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - James A Watson
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Mikhael Yosia
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Sakib Burza
- Médecins Sans Frontières Operational Centre Barcelona, Barcelona, Spain
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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Rodriguez JA, Roa AA, Leonso-Bravo AA, Khatiwada P, Eckardt P, Lemos-Ramirez J. A Case of Plasmodium falciparum Malaria Treated with Artesunate in a 55-Year-Old Woman on Return to Florida from a Visit to Ghana. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926097. [PMID: 33341821 PMCID: PMC7760320 DOI: 10.12659/ajcr.926097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 55-year-old Final Diagnosis: Severe malaria Symptoms: Altered mental status • dyspnea • fever Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases
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Affiliation(s)
- Jose A Rodriguez
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Alejandra A Roa
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | | | - Pratik Khatiwada
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Paula Eckardt
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
| | - Juan Lemos-Ramirez
- Division of Infectious Diseases, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
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Postels DG, Soldatos A, LaRovere KL. Outcomes measures in children after acute central nervous system infections and malaria. Curr Opin Pediatr 2019; 31:756-762. [PMID: 31693584 DOI: 10.1097/mop.0000000000000823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Acute central nervous system (CNS) infections in children result in significant mortality and neurologic morbidity worldwide. This article summarizes the recent pediatric literature published on outcomes measures used after acute infectious meningitis, encephalitis, and cerebral malaria, and highlights ongoing research efforts to standardize outcomes measurements. Search terms were geared toward functional, cognitive, behavioral, and other outcome assessments. RECENT FINDINGS Recent data suggest that, depending on microbiological cause, there are differences in currently used outcome measures following acute CNS infections. Outcomes assessments include a variety of formal psychological tests (structured interviews and neuropsychological tests of cognitive and motor functioning) and dichotomized or ordinal scales. Standardization of outcome measures, however, is lacking. Global efforts to standardize outcomes that encompass both the child and family are ongoing. SUMMARY Centers worldwide can track and measure a variety of cognitive, behavioral, and functional outcomes after acute CNS infections. Standardized documentation and coding of clinically important outcomes is needed. Further research to evaluate effective practices using acute adjunctive and rehabilitation therapies will be aided by outcome measure standardization.
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Affiliation(s)
- Douglas G Postels
- Department of Neurology, Children's National Health System, Washington, District of Columbia
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
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Spina S, Lei C, Pinciroli R, Berra L. Hemolysis and Kidney Injury in Cardiac Surgery: The Protective Role of Nitric Oxide Therapy. Semin Nephrol 2019; 39:484-495. [DOI: 10.1016/j.semnephrol.2019.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Sierro F, Grau GER. The Ins and Outs of Cerebral Malaria Pathogenesis: Immunopathology, Extracellular Vesicles, Immunometabolism, and Trained Immunity. Front Immunol 2019; 10:830. [PMID: 31057552 PMCID: PMC6478768 DOI: 10.3389/fimmu.2019.00830] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/28/2019] [Indexed: 12/16/2022] Open
Abstract
Complications from malaria parasite infections still cost the lives of close to half a million people every year. The most severe is cerebral malaria (CM). Employing murine models of CM, autopsy results, in vitro experiments, neuroimaging and microscopic techniques, decades of research activity have investigated the development of CM immunopathology in the hope of identifying steps that could be therapeutically targeted. Yet important questions remain. This review summarizes recent findings, primarily mechanistic insights on the essential cellular and molecular players involved gained within the murine experimental cerebral malaria model. It also highlights recent developments in (a) cell-cell communication events mediated through extracellular vesicles (EVs), (b) mounting evidence for innate immune memory, leading to “trained“ increased or tolerised responses, and (c) modulation of immune cell function through metabolism, that could shed light on why some patients develop this life-threatening condition whilst many do not.
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Affiliation(s)
- Frederic Sierro
- Vascular Immunology Unit, Department of Pathology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia.,Human Health, Nuclear Science, Technology, and Landmark Infrastructure, Australian Nuclear Science and Technology Organisation, Sydney, NSW, Australia
| | - Georges E R Grau
- Vascular Immunology Unit, Department of Pathology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
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18
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Yu B, Ichinose F, Bloch DB, Zapol WM. Inhaled nitric oxide. Br J Pharmacol 2019; 176:246-255. [PMID: 30288739 PMCID: PMC6295404 DOI: 10.1111/bph.14512] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/14/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022] Open
Abstract
Nitric oxide (NO) is a gas that induces relaxation of smooth muscle cells in the vasculature. Because NO reacts with oxyhaemoglobin with high affinity, the gas is rapidly scavenged by oxyhaemoglobin in red blood cells and the vasodilating effects of inhaled NO are limited to ventilated regions in the lung. NO therefore has the unique ability to induce pulmonary vasodilatation specifically in the portions of the lung with adequate ventilation, thereby improving oxygenation of blood and decreasing intrapulmonary right to left shunting. Inhaled NO is used to treat a spectrum of cardiopulmonary conditions, including pulmonary hypertension in children and adults. However, the widespread use of inhaled NO is limited by logistical and financial barriers. We have designed, developed and tested a simple and economic NO generation device, which uses pulsed electrical discharges in air to produce therapeutic levels of NO that can be used for inhalation therapy. LINKED ARTICLES: This article is part of a themed section on Nitric Oxide 20 Years from the 1998 Nobel Prize. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.2/issuetoc.
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Affiliation(s)
- Binglan Yu
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Fumito Ichinose
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Donald B Bloch
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
- Division of Rheumatology, Allergy and Immunology, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Warren M Zapol
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
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Ogwang R, Anguzu R, Akun P, Ningwa A, Kayongo E, Marsh K, Newton CRJC, Idro R. Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study. BMJ Open 2018; 8:e023624. [PMID: 30341136 PMCID: PMC6196862 DOI: 10.1136/bmjopen-2018-023624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Plasmodium falciparum is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship between P. falciparum infection and seizure control in children with a unique epilepsy type, the nodding syndrome. DESIGN This cross-sectional study was nested in an ongoing trial 'Doxycycline for the treatment of nodding syndrome (NCT02850913)'. We hypothesised that, in patients with epilepsy, infection by P. falciparum, including asymptomatic infections, increases the risk of seizures and impairs seizure control. SETTING AND PARTICIPANTS Participants were Ugandan children with nodding syndrome, age ≥8 years, receiving sodium valproate. All had standardised testing including documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density. OUTCOMES The primary outcome was the number of seizures in the past month (30 days). RESULTS A total of 164/240 (68%) had malaria. Asymptomatic infections (without fever) were seen in 160/240 (67%) and symptomatic infections in 4/240 (2.7%). In participants without malaria, the median (IQR) number of seizures in the past month was 2.0 (1.0-4.0) and it was 4.0 (2.0-7.5) in participants with malaria, p=0.017. The number of seizures in asymptomatic persons was 3.0 (IQR 2.0-7.3) and 6.0 (IQR 4.0-10.0) in symptomatic individuals, p=0.024. Additionally, in asymptomatic patients, a positive correlation was observed between the parasite density and number of seizures, r=0.33, p=0.002. CONCLUSION In patients with nodding syndrome, both asymptomatic and symptomatic malaria are associated with an increased risk of seizures and poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemotreatment and prevention studies considered to improve seizure control.
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Affiliation(s)
- Rodney Ogwang
- Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Tropical Neuroscience, Kitgum site, Uganda
| | - Ronald Anguzu
- Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Tropical Neuroscience, Kitgum site, Uganda
| | - Pamela Akun
- Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Tropical Neuroscience, Kitgum site, Uganda
| | - Albert Ningwa
- Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Tropical Neuroscience, Kitgum site, Uganda
| | - Edward Kayongo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Charles R J C Newton
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Richard Idro
- Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Tropical Neuroscience, Kitgum site, Uganda
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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20
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Traumatic Brain Injury and Infectious Encephalopathy in Children From Four Resource-Limited Settings in Africa. Pediatr Crit Care Med 2018; 19:649-657. [PMID: 29664874 DOI: 10.1097/pcc.0000000000001554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings. DESIGN Prospective study. SETTING Four hospitals in Sub-Saharan Africa. PATIENTS Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy. Pediatric Cerebral Performance Category score was assessed pre morbidity and at hospital discharge. Overall, 130 children were studied (58 [45%] had traumatic brain injury) from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7). Forty-six percent had no prehospital care, and 64% required interhospital transport over 18 km (1-521 km). On comparing traumatic brain injury with infectious encephalopathy, there was no difference in presentation with altered mental state (80% vs 82%), but a greater proportion of traumatic brain injury cases had loss of consciousness (80% vs 53%; p = 0.004). Traumatic brain injury patients were older (median [range], 120 mo [6-204 mo] vs 13 mo [0.3-204 mo]), p value of less than 0.001, and more likely male (73% vs 51%), p value of less than 0.01. In 78% of infectious encephalopathy cases, cause was unknown. More infectious encephalopathy cases had a seizure (69% vs 12%; p < 0.001). In regard to outcome, infectious encephalopathy versus traumatic brain injury: hospital lengths of stay were longer for infectious encephalopathy (8 d [2-30 d] vs 4 d [1-36 d]; p = 0.003), discharge rate to home, or for inpatient rehabilitation, or death differed between infectious encephalopathy (85%, 1%, and 13%) and traumatic brain injury (79%, 12%, and 1%), respectively, p value equals to 0.044. There was no difference in the proportion of children surviving with normal or mild disability (73% traumatic brain injury vs 79% infectious encephalopathy; p = 0.526). CONCLUSIONS The epidemiology and outcomes of pediatric traumatic brain injury and infectious encephalopathy varied by center and disease. To improve outcomes of these conditions in low-resource setting, focus should be on neurocritical care protocols for pre-hospital, hospital, and rehabilitative care.
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Boivin MJ, Mohanty A, Sikorskii A, Vokhiwa M, Magen JG, Gladstone M. Early and middle childhood developmental, cognitive, and psychiatric outcomes of Malawian children affected by retinopathy positive cerebral malaria. Child Neuropsychol 2018; 25:81-102. [PMID: 29570016 DOI: 10.1080/09297049.2018.1451497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective is to determine the short -and long-term developmental, cognitive, and psychiatric effects of retinopathy positive cerebral malaria (CM-R) among young children in a prospective study assessing them around the onset of disease and again 2 years at preschool and again at school age. In total, 109 children were recruited from the Queen Elizabeth Central Hospital in Blantyre, Malawi, (N = 49) with CM-R and non-malaria controls (N = 60). Children were assessed for overall motor, language, and social skills using the Malawi Developmental Assessment Tool (MDAT) at preschool age. At school age, the same children were then given the Kaufman Assessment Battery for Children, second edition (KABC-II), which assessed global cognitive performancememory, and learning; as well as the Test of Variables of Attention (TOVA), which assessed attention. The Achenbach Child Development Checklist (CBCL) was administered at both time points to assess emotional and behavioral patterns. Controls scored significantly better on all KABC-II global domains as well as on the mental processing index than their CM-R group counterparts, but showed no performance differences in the TOVA and CBCL assessments at school age, or in the MDAT and CBCL assessments at preschool age. The MDAT total score was significantly correlated with the KABC-II sequential processing, learning, and mental processing index among CM-R survivors but not among controls. Persisting neurocognitive effects of CM can be captured with the KABC-II at school age. The MDAT at preschool age is correlated with the KABC-II among CM-R survivors and can be used to capture early emerging developmental deficits due to CM-R.
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Affiliation(s)
- Michael J Boivin
- a Departments of Psychiatry and Neurology & Ophthalmology , Michigan State University , East Lansing , USA.,b Department of Psychiatry , University of Michigan , Ann Arbor , Michigan , USA
| | - Arpita Mohanty
- c College of Osteopathic Medicine , Michigan State University , East Lansing , Michigan , USA
| | - Alla Sikorskii
- d Psychiatry and Statistics & Probability , Michigan State University , East Lansing , Michigan , USA
| | - Maclean Vokhiwa
- e Department of Psychology , Chancellor College - University of Malawi , Zomba , Malawi
| | - Jed G Magen
- f Department of Psychiatry , Michigan State University , East Lansing , Michigan , USA
| | - Melissa Gladstone
- g Paediatrics and Neurodisability , Women's and Children's Health, University of Liverpool , Liverpool , UK
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Boyce R, Reyes R, Matte M, Ntaro M, Mulogo E, Siedner MJ. Use of a Dual-Antigen Rapid Diagnostic Test to Screen Children for Severe Plasmodium falciparum Malaria in a High-Transmission, Resource-Limited Setting. Clin Infect Dis 2017; 65:1509-1515. [PMID: 29020298 PMCID: PMC5850632 DOI: 10.1093/cid/cix592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/30/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In rural areas, many patients with malaria seek care at peripheral health facilities or community case management programs. While this strategy is effective for the management of uncomplicated malaria, severe malaria necessitates prompt detection and referral to facilities with adequate resources. METHODS In this prospective, observational cohort study, we assessed the accuracy of a dual-band (histidine-rich protein-2/pan-lactate dehydrogenase [HRP2/pLDH]) rapid diagnostic test (RDT) to differentiate uncomplicated from severe malaria. We included children aged <12 years who presented to a rural clinic in western Uganda with a positive HRP2 or HRP2/pLDH RDT. We estimated the test characteristics of a dual-antigen (HRP2+/pLDH+) band positive RDT compared to World Health Organization-defined clinical and laboratory criteria to detect severe malaria. RESULTS A total of 2678 children underwent testing for malaria with an RDT, and 83 (9.0%) satisfied criteria for severe malaria. The sensitivity and specificity of a HRP2+/pLDH+ result for severe malaria was 97.6% (95% confidence interval [CI], 90.8%-99.6%) and 75.6% (95% CI, 73.8%-77.4%), respectively. An HRP2+/pLDH+ result was significantly more sensitive (97.6% vs 68.7%, P < .001) for the detection of severe malaria compared to algorithms that incorporate screening for danger signs. CONCLUSIONS A positive dual-antigen (HRP2/pLDH) RDT has higher sensitivity than the use of clinical manifestations to detect severe malaria, making it a promising tool in the triage of children with malaria in low-resource settings. Additional work is needed to operationalize diagnostic and treatment algorithms that include dual-antigen RDTs to avoid over referral.
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Affiliation(s)
| | - Raquel Reyes
- General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill
| | - Michael Matte
- Department of Community Health, Mbarara University of Science & Technology, Uganda; and
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science & Technology, Uganda; and
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science & Technology, Uganda; and
| | - Mark J Siedner
- Department of Medicine, Harvard Medical School, and Massachusetts General Hospital, Boston
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Brim R, Mboma S, Semrud-Clikeman M, Kampondeni S, Magen J, Taylor T, Langfitt J. Cognitive Outcomes and Psychiatric Symptoms of Retinopathy-Positive Cerebral Malaria: Cohort Description and Baseline Results. Am J Trop Med Hyg 2017; 97:225-231. [PMID: 28719298 DOI: 10.4269/ajtmh.17-0020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cerebral malaria (CM) is a common cause of death and disability among children in sub-Saharan Africa. Many prior studies of neuropsychiatric morbidity have been limited by a cross-sectional design or a short duration of follow-up. Most have included subjects who may have presented with coma due to a disease process other than CM. No studies have assessed the relationship between magnetic resonance imaging (MRI) findings and long-term outcomes. The Cognitive Outcomes and Psychiatric symptoms of retinopathy-positive CM (COPS) cohort is the first large (N = 221) prospectively recruited cohort of stringently defined cases of CM and hospital-based, age-matched, non-CM controls in whom cognitive and psychiatric outcomes are assessed with standardized measures semi-annually for up to 5 years. We report baseline characteristics of the cohort and outcomes at 1 month. At enrollment, CM cases were more likely to come from families with fewer socioeconomic resources and to have health characteristics that increase risk for malaria. In children younger than 5 years, cases were delayed in motor, language, and social development by approximately 6 months, compared with controls. More significant delays occurred in those with MRI abnormalities at the 1-month follow-up visit. There were no differences between cases and controls in inhibitory self-control, nor in cognitive function in children ≥ 5 years of age. The latter finding may be related to the smaller sample size, case-control imbalance in socioeconomic status, or the use of cognitive and behavioral assessments that are less culturally appropriate to this population. Continued follow-up will help determine predictors of long-term outcomes.
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Affiliation(s)
- Rachel Brim
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Sebastian Mboma
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Sam Kampondeni
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Jed Magen
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Terrie Taylor
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - John Langfitt
- Department of Neurology, University of Rochester, Rochester, New York
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Rakuomi V, Okalebo F, Ndwigah S, Mbugua L. Cost effectiveness of pre-referral antimalarial treatment in severe malaria among children in sub-Saharan Africa. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:14. [PMID: 28725165 PMCID: PMC5512821 DOI: 10.1186/s12962-017-0076-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 07/06/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In 2013, 78% of malaria deaths occurred in children aged 5 years and below, in sub-Saharan Africa. Treatment of severe malaria requires a health facility with inpatient care. However, in most sub-Sahara African countries, access to health facilities is a major problem. Pre-referral antimalarial treatments aim to delay the progress of severe malaria as patients seek to access health facilities. Rectal artesunate can be administered in the community as a pre-referral treatment in rural hard-to-reach areas. In Kenya, though pre-referral rectal artesunate has been included in the National Guidelines for pre-referral treatment, it is yet to be implemented in the public healthcare system. It is important, therefore, to establish its cost-utility compared to current parenteral treatments. This study evaluated the cost-utility of provision of pre-referral treatments by community health workers compared to similar services at a primary health facility. METHODS This was a decision model-based cost-utility analysis, comparing pre-referral antimalarial treatments provided by: community health workers (CHWs), primary health facility, direct access to a tertiary health facility and no access to treatment. A theoretical cohort, of 1000 children, who were below 5 years old; residing in rural hard-to-reach areas, was taken as the reference population. Data was collected through key informant interviews, to assess the costs, while key measures of effectiveness, were obtained from existing studies. The key measure of outcomes was Disability Adjusted Life Years (DALYS) averted. Probabilistic sensitivity analysis was carried out to assess the robustness of the model. RESULTS Provision of rectal pre-referral treatment by community health workers was estimated to avert 13,276 DALYs, at a cost of $68,428 for a cohort of 1000 children. Provision of rectal pre-referral treatment at a primary health facility was estimated to avert 9993 DALYs, at a cost of $73,826 for a cohort of 1000 children, while going directly to a tertiary health facility was estimated to avert 15,801 DALYs, at a cost of $114,903 for a cohort of 1000 children. The incremental cost effectiveness ratios for provision of pre-referral treatment by community health care and primary health workers were $5.11 and $7.30 per DALYs averted respectively. CONCLUSION Use of CHWs was more cost effective than provision of pre-referral treatments at a primary health facility especially, with high referral compliance. Rectal artesunate can easily be administered by community health workers, unlike parenteral pre-referral interventions.
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Affiliation(s)
- Vivian Rakuomi
- Ministry of Health, Nairobi, Kenya
- School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Faith Okalebo
- School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Levi Mbugua
- School of Mathematics, The Technical University of Kenya, Nairobi, Kenya
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25
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Lanneaux J, Dauger S, Pham LL, Naudin J, Faye A, Gillet Y, Bosdure E, Carbajal R, Dubos F, Vialet R, Chéron G, Angoulvant F. Retrospective study of imported falciparum malaria in French paediatric intensive care units. Arch Dis Child 2016; 101:1004-1009. [PMID: 27281455 DOI: 10.1136/archdischild-2015-309665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country. DESIGN Retrospective case-control study. SETTING Eight French university hospitals, from 2006 to 2012. PATIENTS Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110). MAIN OUTCOME MEASURES Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis. RESULTS Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001). CONCLUSIONS The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care.
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Affiliation(s)
- Justine Lanneaux
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stéphane Dauger
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Luu-Ly Pham
- Paediatric Emergency Department, AP-HP, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Jérôme Naudin
- Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Albert Faye
- Department of General Paediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Yves Gillet
- Paediatric Emergency Department, HCL, HFME Lyon, Université de Lyon 1, Lyon, France
| | | | - Ricardo Carbajal
- Paediatric Emergency Department, AP-HP, Hôpital Armand Trousseau, Université Pierre et Marie Curie Paris 6, Paris, France
| | - François Dubos
- Paediatric Emergency and Infectious Diseases Departments, Université de Lille, Hôpital R. Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Renaud Vialet
- Paediatric Intensive Care Department, APHM, CHU Nord, Marseille, France
| | - Gérard Chéron
- Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - François Angoulvant
- Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Clinical Epidemiology Unit ECEVE, INSERM UMR 1123, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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26
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Idro R, Kakooza-Mwesige A, Asea B, Ssebyala K, Bangirana P, Opoka RO, Lubowa SK, Semrud-Clikeman M, John CC, Nalugya J. Cerebral malaria is associated with long-term mental health disorders: a cross sectional survey of a long-term cohort. Malar J 2016; 15:184. [PMID: 27030124 PMCID: PMC4815157 DOI: 10.1186/s12936-016-1233-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/15/2016] [Indexed: 11/15/2022] Open
Abstract
Background Cerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined. Methods A cohort of children previously exposed to CM (n = 173) or SMA (n = 99) had neurologic assessments performed and screening for behaviour difficulties using the Strengths and Difficulties Questionnaire (SDQ) a median of 21 months after the disease episode. These findings were compared to concurrently recruited community children (CC, n = 108). Participants with SDQ total difficulties score ≥17 had a mental health interview with the child and adolescent version of the Mini-International Neuropsychiatric Interview (MINI-KID) and a sample had brain magnetic resonance imaging (MRI). Results Fifty-five children had SDQ score ≥17. On the MINI-KID, these children were classified as having no difficulties (n = 18), behaviour difficulties only (n = 13) or a mental health disorder (n = 24). Behaviour difficulties were seen in similar frequencies in CM (3.5 %), SMA (4.0 %) and CC (2.8 %). In contrast, mental health disorders were most frequent in CM (10.4 %), followed by SMA (4.0 %) and CC (1.8 %). Externalizing disorders (conduct, oppositional defiance and attention deficit hyperactivity) were the most common mental health disorders. The median total coma duration was 72 (IQR 36.0–115.0) h in patients with mental health disorders compared to 48 (IQR 28.5–78.7) h in those without, p = 0.039. Independent risk factors for mental health disorder included neurologic deficit at discharge (OR 4.09 (95 % CI 1.60, 10.5) and seizure recurrences during hospitalization, (OR 2.80, 95 % CI 1.13, 6.97). Brain MRI findings consistent with small vessel ischaemic neural injury was seen in over half of these children. Conclusions Cerebral malaria may predispose children to mental health disorders, possibly as a consequence of ischaemic neural injury. There is urgent need for programmes of follow-up, diagnosis and interventions for these children.
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Affiliation(s)
- Richard Idro
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.,Neuropediatric Research Unit, Astrid Lindgren Children's Hospital, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Benjamin Asea
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Keron Ssebyala
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Paul Bangirana
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Samson K Lubowa
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | | | - Chandy C John
- Departments of Pediatrics, Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, USA
| | - Joyce Nalugya
- Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
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Kariuki SM, Abubakar A, Murray E, Stein A, Newton CRJC. Evaluation of psychometric properties and factorial structure of the pre-school child behaviour checklist at the Kenyan Coast. Child Adolesc Psychiatry Ment Health 2016; 10:1. [PMID: 26793272 PMCID: PMC4719674 DOI: 10.1186/s13034-015-0089-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavioural/emotional problems may be common in preschool children living in resource-poor settings, but assessment of these problems in preschool children from poor areas is challenging owing to lack of appropriate behavioural screening tools. The child behaviour checklist (CBCL) is widely known for its reliability in identifying behavioural/emotional problems in preschool children, but it has not been validated for use in sub-Saharan Africa. METHODS With permission from developers of CBCL, we translated this tool into Ki-Swahili and adapted the items to make them culturally appropriate and contextually relevant and examined the psychometric properties of the CBCL, particularly reliability, validity and factorial structure in a Kenyan community preschool sample of 301 children. It was also re-administered after 2 weeks to 38 randomly selected respondents, for the purpose of evaluating retest reliability. To evaluate inter-informant reliability, the CBCL was administered to 46 respondents (17 alternative caretakers and 29 fathers) alongside the child's mother. Generalised linear model was used to measure associations with behavioural/emotional scores. We used structural equation modelling to perform a confirmatory factor analysis to examine the seven-syndrome CBCL structure. RESULTS During the first phase we found that most of the items could be adequately translated and easily understood by the participants. The inter-informant agreement for CBCL scores was excellent between the mothers and other caretakers [Pearson's correlation coefficient (r) = 0.89, p < 0.001] and fathers (r = 0.81; p < 0.001). The test-retest reliability was acceptable (r = 0.76; p < 0.001). The scale internal consistency coefficients were excellent for total problems [Cronbach's alpha (α) = 0.95] and between good and excellent for most CBCL sub-scales (α = 0.65-0.86). Behavioural/emotional scores were associated with pregnancy complications [adjusted beta coefficient (β) = 0.44 (95 % CI, 0.07-0.81)] and adverse perinatal events [β = 0.61 (95 % CI, 0.09-1.13)] suggesting discriminant validity of the CBCL. Most fit indices for the seven-syndrome CBCL structure were within acceptable range, being <0.09 for root mean squared error of approximation and >0.90 for Tucker-Lewis Index and Comparative Fit Index. CONCLUSION The CBCL has good psychometric properties and the seven-syndrome structure fits well with the Kenyan preschool children suggesting it can be used to assess behavioural/emotional problems in this rural area.
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Affiliation(s)
- Symon M. Kariuki
- KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230 (80108), Kilifi, Kenya ,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Amina Abubakar
- KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230 (80108), Kilifi, Kenya ,Department of Psychology, Lancaster University, Lancaster, UK
| | | | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles R. J. C. Newton
- KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230 (80108), Kilifi, Kenya ,Department of Psychiatry, University of Oxford, Oxford, UK
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ÇİZMECİ EA, KELEBEK GİRGİN N, CEYLAN I, TUNCEL T, ALVER O, AKALIN EH. Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report. IRANIAN JOURNAL OF PARASITOLOGY 2016; 11:116-20. [PMID: 27095978 PMCID: PMC4835461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.
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Affiliation(s)
- Elif Ayşe ÇİZMECİ
- Department of Anesthesiology and Intensive Care, School of Medicine, Uludag University, Bursa, Turkey,Correspondence
| | - Nermin KELEBEK GİRGİN
- Department of Anesthesiology and Intensive Care, School of Medicine, Uludag University, Bursa, Turkey
| | - Ilkay CEYLAN
- Department of Anesthesiology and Intensive Care, School of Medicine, Uludag University, Bursa, Turkey
| | - Tekin TUNCEL
- Department of Infectious Diseases, School of Medicine, Uludag University, Bursa, Turkey
| | - Oktay ALVER
- Department of Microbiology, School of Medicine, Uludag University, Bursa, Turkey
| | - Emin Halis AKALIN
- Department of Infectious Diseases, School of Medicine, Uludag University, Bursa, Turkey
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Abstract
Patients with epilepsy have higher incidence and severity of burn injury. Few studies describe the association between epilepsy and burns in low-income settings, where epilepsy burden is highest. The authors compared patients with and without seizure disorder in a burn unit in Lilongwe, Malawi. The authors conducted a retrospective study of patients admitted to the Kamuzu Central Hospital burn ward from July 2011 to December 2012. Descriptive analysis of patient characteristics and unadjusted and adjusted analyses of risk factors for mortality were conducted for patients with and without seizure disorder. Prevalence of seizure disorder was 10.7% in the study population. Adults with burns were more likely to have seizure disorder than children. Flame injury was most common in patients with seizure disorder, whereas scalds predominated among patients without seizure disorder. Whereas mortality did not differ between the groups, mean length of stay was longer for patients with seizure disorder, 42.1 days vs 21.6 days. Seizure disorder continues to be a significant risk factor for burn injury in adults in Malawi. Efforts to mitigate epilepsy will likely lead to significant decreases in burns among adults in Sub-Saharan Africa and must be included in an overall burn prevention strategy in our environment.
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Mwanga-Amumpaire J, Carroll RW, Baudin E, Kemigisha E, Nampijja D, Mworozi K, Santorino D, Nyehangane D, Nathan DI, De Beaudrap P, Etard JF, Feelisch M, Fernandez BO, Berssenbrugge A, Bangsberg D, Bloch KD, Boum Y, Zapol WM. Inhaled Nitric Oxide as an Adjunctive Treatment for Cerebral Malaria in Children: A Phase II Randomized Open-Label Clinical Trial. Open Forum Infect Dis 2015; 2:ofv111. [PMID: 26309894 PMCID: PMC4542141 DOI: 10.1093/ofid/ofv111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/21/2015] [Indexed: 11/27/2022] Open
Abstract
Treatment with inhaled nitric oxide as an adjuvant therapy for pediatric patients with cerebral malaria for 48 hours did not result in a significant difference in plasma Angiopoietin-1 levels when compared with placebo in a phase II open-label clinical trial. Background. Children with cerebral malaria (CM) have high rates of mortality and neurologic sequelae. Nitric oxide (NO) metabolite levels in plasma and urine are reduced in CM. Methods. This randomized trial assessed the efficacy of inhaled NO versus nitrogen (N2) as an adjunctive treatment for CM patients receiving intravenous artesunate. We hypothesized that patients treated with NO would have a greater increase of the malaria biomarker, plasma angiopoietin-1 (Ang-1) after 48 hours of treatment. Results. Ninety-two children with CM were randomized to receive either inhaled 80 part per million NO or N2 for 48 or more hours. Plasma Ang-1 levels increased in both treatment groups, but there was no difference between the groups at 48 hours (P = not significant [NS]). Plasma Ang-2 and cytokine levels (tumor necrosis factor-α, interferon-γ, interleukin [IL]-1β, IL-6, IL-10, and monocyte chemoattractant protein-1) decreased between inclusion and 48 hours in both treatment groups, but there was no difference between the groups (P = NS). Nitric oxide metabolite levels—blood methemoglobin and plasma nitrate—increased in patients treated with NO (both P < .05). Seven patients in the N2 group and 4 patients in the NO group died. Five patients in the N2 group and 6 in the NO group had neurological sequelae at hospital discharge. Conclusions. Breathing NO as an adjunctive treatment for CM for a minimum of 48 hours was safe, increased blood methemoglobin and plasma nitrate levels, but did not result in a greater increase of plasma Ang-1 levels at 48 hours.
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Affiliation(s)
| | - Ryan W Carroll
- Department of Anesthesia, Critical Care, and Pain Medicine ; Center for Global Health ; Pediatric Critical Care Medicine , MassGen Hospital for Children , Boston, Massachusetts ; Harvard Medical School , Cambridge, Massachusetts
| | | | | | | | | | | | | | | | - Pierre De Beaudrap
- UMI 233, Institut de Recherche Pour le Développement, Université Montpellier 1 , France
| | - Jean-François Etard
- Epicentre , Paris , France ; UMI 233, Institut de Recherche Pour le Développement, Université Montpellier 1 , France
| | | | | | | | - David Bangsberg
- Center for Global Health ; Harvard Medical School , Cambridge, Massachusetts
| | - Kenneth D Bloch
- Department of Anesthesia, Critical Care, and Pain Medicine ; Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital
| | - Yap Boum
- Epicentre Mbarara Research Centre ; Mbarara University of Science and Technology , Uganda
| | - Warren M Zapol
- Department of Anesthesia, Critical Care, and Pain Medicine ; Harvard Medical School , Cambridge, Massachusetts
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Asma UE, Taufiq F, Khan W. Prevalence and clinical manifestations of malaria in Aligarh, India. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:621-9. [PMID: 25548413 PMCID: PMC4277024 DOI: 10.3347/kjp.2014.52.6.621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/04/2014] [Accepted: 09/29/2014] [Indexed: 12/04/2022]
Abstract
Malaria is one of the most widespread infectious diseases of tropical countries with an estimated 207 million cases globally. In India, there are endemic pockets of this disease, including Aligarh. Hundreds of Plasmodium falciparum and P. vivax cases with severe pathological conditions are recorded every year in this district. The aim of this study is to find out changes in liver enzymes and kidney markers. Specific diagnosis for P. falciparum and P. vivax was made by microscopic examination of Giemsa stained slides. Clinical symptoms were observed in both of these infections. Liver enzymes, such as AST, ALT, and ALP, and kidney function markers, such as creatinine and urea, were estimated by standard biochemical techniques. In Aligarh district, P. vivax, P. falciparum, and mixed infections were 64%, 34%, and 2%, respectively. In case of P. falciparum infection, the incidences of anemia, splenomegaly, renal failure, jaundice, and neurological sequelae were higher compared to those in P. vivax infection. Recrudescence and relapse rates were 18% and 20% in P. falciparum and P. vivax infections, respectively. Liver dysfunctions and renal failures were more common in P. falciparum patients, particularly in elderly patients. Artesunate derivatives must, therefore, be introduced for the treatment of P. falciparum as they resist to chloroquine as well as sulfadoxine-pyrimethamine combinations.
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Affiliation(s)
- Umm-e Asma
- Department of Zoology, Aligarh Muslim University, Aligarh 202002, India
| | - Farha Taufiq
- Department of Zoology, Aligarh Muslim University, Aligarh 202002, India
| | - Wajihullah Khan
- Department of Zoology, Aligarh Muslim University, Aligarh 202002, India
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Barennes H, Pussard E. Improving the management of dysglycemia in children in the developing world. Am J Trop Med Hyg 2014; 92:6-8. [PMID: 25311692 DOI: 10.4269/ajtmh.14-0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Improving the availability of point-of-care (POC) diagnostics for glucose is crucial in resource-constrained settings (RCS). Both hypo and hyperglycemia have an appreciable frequency in the tropics and have been associated with increased risk of deaths in pediatrics units. However, causes of dysglycemia, including hyperglycemia, are numerous and insufficiently documented in RCS. Effective glycemic control with glucose infusion and/or intensive insulin therapy can improve clinical outcomes in western settings. A non-invasive way for insulin administration is not yet available for hyperglycemia. We documented a few causes and developed simple POC treatment of hypoglycemia in RCS. We showed the efficacy of sublingual sugar in two clinical trials. Dextrose gel has been recently tested for neonate mortality. This represents an interesting alternative that should be compared with sublingual sugar in RCS. New studies had to be done to document dysglycemia mechanism, frequency and morbid-mortality, and safe POC treatment in the tropics.
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Affiliation(s)
- Hubert Barennes
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France; Agence Nationale de Recherche sur le VIH et Hépatite, ANRS Phnom Penh, Cambodia; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Génétique Moléculaire, Pharmacogénétique et Hormonologie CHU Bicêtre, Kremlin Bicêtre, Paris, France
| | - Eric Pussard
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France; Agence Nationale de Recherche sur le VIH et Hépatite, ANRS Phnom Penh, Cambodia; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Génétique Moléculaire, Pharmacogénétique et Hormonologie CHU Bicêtre, Kremlin Bicêtre, Paris, France
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Kariuki SM, Abubakar A, Newton CRJC, Kihara M. Impairment of executive function in Kenyan children exposed to severe falciparum malaria with neurological involvement. Malar J 2014; 13:365. [PMID: 25224247 PMCID: PMC4171581 DOI: 10.1186/1475-2875-13-365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/14/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Persistent neurocognitive impairments occur in a fifth of children hospitalized with severe falciparum malaria. There is little data on the association between different neurological phenotypes of severe malaria (seizures, impaired consciousness and prostration) and impairments in executive function. METHODS Executive functioning of children exposed to severe malaria with different neurological phenotypes (N = 58) and in those unexposed (N = 56) was examined using neuropsychological tests such as vigilance test, test for everyday attention test for children (TEA-Ch), contingency naming test (CNT) and self-ordered pointing test (SOPT). Linear regression was used to determine the association between neurological phenotypes of severe malaria and executive function performance scores, accounting for potential confounders. RESULTS Children with complex seizures in severe malaria performed more poorly than unexposed controls in the vigilance (median efficiency scores (interquartile range) = 4.84 (1.28-5.68) vs. 5.84 (4.71-6.42), P = 0.030) and SOPT (mean errors (standard deviation) = 29.50 (8.82) vs. 24.80 (6.50), P = 0.029) tests, but no differences were observed in TEA-Ch and CNT tests. Performance scores for other neurological phenotypes of severe malaria were similar with those of unexposed controls. After accounting for potential confounders, such as child's age, sex, schooling; maternal age, schooling and economic activity; perinatal factors and history of seizures, complex seizures remained associated with efficiency scores in the vigilance test (beta coefficient (β) (95% confidence interval (CI)) = -0.40 (-0.67, -0.13), P = 0.006) and everyday attention scores of the TEA-Ch test (β (95% CI) = -0.57 (-1.04, -0.10), P = 0.019); the association with SOPT error scores was weak (β (95% CI) = 4.57 (-0.73-9.89), P = 0.089). Combined neurological phenotypes were not significantly associated with executive function performance scores. CONCLUSION Executive function impairment in children with severe malaria is associated with specific neurological phenotypes, particularly complex seizures. Effective prophylaxis and management of malaria-associated acute seizures may improve executive functioning performance scores of children.
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Affiliation(s)
- Symon M Kariuki
- KEMRI/Wellcome Trust Collaborative Research Programme, P,O, Box 230, 80108 Kilifi, Kenya.
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Clinico-pathological studies of Plasmodium falciparum and Plasmodium vivax - malaria in India and Saudi Arabia. Acta Parasitol 2014; 59:206-12. [PMID: 24827088 DOI: 10.2478/s11686-014-0227-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/10/2013] [Accepted: 01/28/2014] [Indexed: 11/20/2022]
Abstract
Malaria is one of the most devastating diseases of tropical countries with clinical manifestations such as anaemia, splenomegaly, thrombocytopenia, hepatomegaly and acute renal failures. In this study, cases of thrombocytopenia and haemoglobinemia were more prominent in subjects infected with Plasmodium falciparum (Welch, 1897) than those with Plasmodium vivax (Grassi et Feletti, 1890). However, anaemia, jaundice, convulsions and acute renal failure were significantly high (3-4 times) in subjects infected with P. falciparum than those infected with P. vivax. The incidence of splenomegaly and neurological sequelae were 2 and 6 times higher in P. falciparum infections compared to the infections of P. vivax. Both in P. vivax and P. falciparum malaria, the cases of splenomegaly, jaundice and neurological sequelae were almost double in children (<10 years) compared to older patients. The liver enzymes were generally in normal range in cases of low and mild infections. However, the AST, ALT, ALP activities and serum bilirubin, creatinine, and the urea content were increased in P. falciparum and P. vivax malaria patients having high parasitaemia, confirming liver dysfunction and renal failures in few cases of severe malaria both in India and Saudi Arabia.
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Abstract
Parasites infect the central nervous system of children, particularly in resource-poor areas and tropical countries. However, these infections are increasingly seen in the West with the increase in children travelling to these areas and immigrant populations. These conditions are important in the differential diagnosis of common neurological syndromes. Falciparum malaria is a common cause of seizures and coma in endemic areas. Neurocysticercosis is a common cause of acquired epilepsy in some areas. Schistosomiasis is an important cause of spinal cord disease. Toxocara is ubiquitous and may cause encephalitis and retinal changes, and may be associated with epilepsy. Other parasitic conditions tend to be localized to specific regions of the world. Parasitic diseases are often associated with eosinophilia, and some cause an eosinophilic meningoencephalitis, although there are many nonparasitic causes of this syndrome. Most parasitic conditions can be treated, but in some diseases it is unclear whether the treatment influences outcome.
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Abstract
Despite their small size and anucleate status, platelets have diverse roles in vascular biology. Not only are platelets the cellular mediator of thrombosis, but platelets are also immune cells that initiate and accelerate many vascular inflammatory conditions. Platelets are linked to the pathogenesis of inflammatory diseases such as atherosclerosis, malaria infection, transplant rejection, and rheumatoid arthritis. In some contexts, platelet immune functions are protective, whereas in others platelets contribute to adverse inflammatory outcomes. In this review, we will discuss platelet and platelet-derived mediator interactions with the innate and acquired arms of the immune system and platelet-vessel wall interactions that drive inflammatory disease. There have been many recent publications indicating both important protective and adverse roles for platelets in infectious disease. Because of this new accumulating data, and the fact that infectious disease continues to be a leading cause of death globally, we will also focus on new and emerging concepts related to platelet immune and inflammatory functions in the context of infectious disease.
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Abstract
Although global morbidity and mortality have decreased substantially, malaria, a parasite infection of red blood cells, still kills roughly 2000 people per day, most of whom are children in Africa. Two factors largely account for these decreases; increased deployment of insecticide-treated bednets and increased availability of highly effective artemisinin combination treatments. In large trials, parenteral artesunate (an artemisinin derivative) reduced severe malaria mortality by 22·5% in Africa and 34·7% in Asia compared with quinine, whereas adjunctive interventions have been uniformly unsuccessful. Rapid tests have been an important addition to microscopy for malaria diagnosis. Chemopreventive strategies have been increasingly deployed in Africa, notably intermittent sulfadoxine-pyrimethamine treatment in pregnancy, and monthly amodiaquine-sulfadoxine-pyrimethamine during the rainy season months in children aged between 3 months and 5 years across the sub-Sahel. Enthusiasm for malaria elimination has resurfaced. This ambitious but laudable goal faces many challenges, including the worldwide economic downturn, difficulties in elimination of vivax malaria, development of pyrethroid resistance in some anopheline mosquitoes, and the emergence of artemisinin resistance in Plasmodium falciparum in southeast Asia. We review the epidemiology, clinical features, pathology, prevention, and treatment of malaria.
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Affiliation(s)
- Nicholas J White
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK.
| | | | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - M Abul Faiz
- Department of Medicine, Dev Care Foundation, Dhaka, Bangladesh
| | | | - Arjen M Dondorp
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK
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Experimental Models of Microvascular Immunopathology: The Example of Cerebral Malaria. JOURNAL OF NEUROINFECTIOUS DISEASES 2014; 5:134. [PMID: 26430675 PMCID: PMC4586166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Human cerebral malaria is a severe and often lethal complication of Plasmodium falciparum infection. Complex host and parasite interactions should the precise mechanisms involved in the onset of this neuropathology. Adhesion of parasitised red blood cells and host cells to endothelial cells lead to profound endothelial alterations that trigger immunopathological changes, varying degrees of brain oedema and can compromise cerebral blood flow, cause cranial nerve dysfunction and hypoxia. Study of the cerebral pathology in human patients is limited to clinical and genetic field studies in endemic areas, thus cerebral malaria (CM) research relies heavily on experimental models. The availability of malaria models allows study from the inoculation of Plasmodium to the onset of disease and permit invasive experiments. Here, we discuss some aspects of our current understanding of CM, the experimental models available and some important recent findings extrapolated from these models.
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Toxoplasma gondii upregulates interleukin-12 to prevent Plasmodium berghei-induced experimental cerebral malaria. Infect Immun 2014; 82:1343-53. [PMID: 24396042 DOI: 10.1128/iai.01259-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A chronic infection with the parasite Toxoplasma gondii has previously been shown to protect mice against subsequent viral, bacterial, or protozoal infections. Here we have shown that a chronic T. gondii infection can prevent Plasmodium berghei ANKA-induced experimental cerebral malaria (ECM) in C57BL/6 mice. Treatment with soluble T. gondii antigens (STAg) reduced parasite sequestration and T cell infiltration in the brains of P. berghei-infected mice. Administration of STAg also preserved blood-brain barrier function, reduced ECM symptoms, and significantly decreased mortality. STAg treatment 24 h post-P. berghei infection led to a rapid increase in serum levels of interleukin 12 (IL-12) and gamma interferon (IFN-γ). By 5 days after P. berghei infection, STAg-treated mice had reduced IFN-γ levels compared to those of mock-treated mice, suggesting that reductions in IFN-γ at the time of ECM onset protected against lethality. Using IL-10- and IL-12βR-deficient mice, we found that STAg-induced protection from ECM is IL-10 independent but IL-12 dependent. Treatment of P. berghei-infected mice with recombinant IL-12 significantly decreased parasitemia and mortality. These data suggest that IL-12, either induced by STAg or injected as a recombinant protein, mediates protection from ECM-associated pathology potentially through early induction of IFN-γ and reduction in parasitemia. These results highlight the importance of early IL-12 induction in protection against ECM.
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Bedri S, Khalil EA, Khalid SA, Alzohairy MA, Mohieldein A, Aldebasi YH, Seke Etet PF, Farahna M. Azadirachta indica ethanolic extract protects neurons from apoptosis and mitigates brain swelling in experimental cerebral malaria. Malar J 2013; 12:298. [PMID: 23984986 PMCID: PMC3844317 DOI: 10.1186/1475-2875-12-298] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/20/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cerebral malaria is a rapidly developing encephalopathy caused by the apicomplexan parasite Plasmodium falciparum. Drugs currently in use are associated with poor outcome in an increasing number of cases and new drugs are urgently needed. The potential of the medicinal plant Azadirachta indica (Neem) for the treatment of experimental cerebral malaria was evaluated in mice. METHODS Experimental cerebral malaria was induced in mice by infection with Plasmodium berghei ANKA. Infected mice were administered with Azadirachta indica ethanolic extract at doses of 300, 500, or 1000 mg/kg intraperitoneally (i.p.) in experimental groups, or with the anti-malarial drugs chloroquine (12 mg/kg, i.p.) or artemether (1.6 mg/kg, i.p.), in the positive control groups. Treatment was initiated at the onset of signs of brain involvement and pursued for five days on a daily basis. Mice brains were dissected out and processed for the study of the effects of the extract on pyramidal cells' fate and on markers of neuroinflammation and apoptosis, in the medial temporal lobe. RESULTS Azadirachta indica ethanolic extract mitigated neuroinflammation, decreased the severity of brain oedema, and protected pyramidal neurons from apoptosis, particularly at the highest dose used, comparable to chloroquine and artemether. CONCLUSIONS The present findings suggest that Azadirachta indica ethanolic extract has protective effects on neuronal populations in the inflamed central nervous system, and justify at least in part its use in African and Asian folk medicine and practices.
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Affiliation(s)
- Selma Bedri
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia.
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Cserti-Gazdewich CM, Dhabangi A, Musoke C, Ssewanyana I, Ddungu H, Nakiboneka-Ssenabulya D, Nabukeera-Barungi N, Mpimbaza A, Dzik WH. Inter-relationships of cardinal features and outcomes of symptomatic pediatric Plasmodium falciparum MALARIA in 1,933 children in Kampala, Uganda. Am J Trop Med Hyg 2013; 88:747-756. [PMID: 23358640 PMCID: PMC3617864 DOI: 10.4269/ajtmh.12-0668] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria remains a challenging diagnosis with variable clinical presentation and a wide spectrum of disease severity. Using a structured case report form, we prospectively assessed 1,933 children at Mulago Hospital in Kampala, Uganda with acute Plasmodium falciparum malaria. Children with uncomplicated malaria significantly differed from those with severe disease for 17 features. Among 855 children with severe disease, the case-fatality rate increased as the number of severity features increased. Logistic regression identified five factors independently associated with death: cerebral malaria, hypoxia, severe thrombocytopenia, leukocytosis, and lactic acidosis. Cluster analysis identified two groups: one combining anemia, splenomegaly, and leukocytosis; and a second group centered on death, severe thrombocytopenia, and lactic acidosis, which included cerebral malaria, hypoxia, hypoglycemia, and hyper-parasitemia. Our report updates previous clinical descriptions of severe malaria, quantifies significant clinical and laboratory inter-relationships, and will assist clinicians treating malaria and those planning or assessing future research (NCT00707200) (www.clinicaltrials.gov).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Walter H. Dzik
- *Address correspondence to Walter H. Dzik, Department of Pathology, Blood Transfusion Service, J224, Harvard University, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail:
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Paul A, Adeloye D, George-Carey R, Kolčić I, Grant L, Chan KY. An estimate of the prevalence of epilepsy in Sub-Saharan Africa: A systematic analysis. J Glob Health 2013; 2:020405. [PMID: 23289080 PMCID: PMC3529318 DOI: 10.7189/jogh.02.020405] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Epilepsy is a leading serious neurological condition worldwide and has particularly significant physical, economic and social consequences in Sub–Saharan Africa. This paper aims to contribute to the understanding of epilepsy prevalence in this region and how this varies by age and sex so as to inform understanding of the disease characteristics as well as the development of infrastructure, services and policies. Methods A parallel systematic analysis of Medline, Embase and Global Health returned 32 studies that satisfied pre–defined quality criteria. Relevant data was extracted, tabulated and analyzed. We modelled the available information and used the UN population figures for Africa to determine the age–specific and overall burden of epilepsy. Results Active epilepsy was estimated to affect 4.4 million people in Sub–Saharan Africa, whilst lifetime epilepsy was estimated to affect 5.4 million. The prevalence of active epilepsy peaks in the 20–29 age group at 11.5/1000 and again in the 40–49 age group at 8.2/1000. The lowest prevalence value of 3.1/1000 is seen in the 60+ age group. This binomial pattern is also seen in both men and women, with the second peak more pronounced in women at 14.6/1000. Conclusion The high prevalence of epilepsy, especially in young adults, has important consequences for both the workforce and community structures. An estimation of disease burden would be a beneficial outcome of further research, as would research into appropriate methods of improving health care for and tackling discrimination against people with epilepsy.
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Affiliation(s)
- Abigail Paul
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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45
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Postels DG, Chimalizeni YF, Mallewa M, Boivin MJ, Seydel KB. Pediatric cerebral malaria: a scourge of Africa. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.12.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cerebral malaria, defined as an otherwise unexplained coma in a patient with Plasmodium falciparum parasitemia, affects up to 1 million people per year, the vast majority of them being children living in sub-Saharan Africa. Despite optimal treatment, this condition kills 15% of those affected and leaves 30% of survivors with neurologic sequelae. The clinical diagnosis is hampered by its poor specificity, but the presence or absence of a malarial retinopathy in cerebral malaria has proven to be important in the differentiation of underlying coma etiology. Both antimalarials and intense supportive care are necessary for optimal treatment. As of yet, clinical trials of adjunctive therapies have not improved the high rates of mortality and morbidity. Survivors are at high risk of neurologic sequelae including epilepsy, neurodisabilities and cognitive–behavioral problems. The neuroanatomic and functional bases of these sequelae are being elucidated. Although adjunctive therapy trials continue, the best hope for African children may lie in disease prevention. Strategies include bednets, chemoprophylaxis and vaccine development.
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Affiliation(s)
| | - Yamikani F Chimalizeni
- Department of Pediatrics, University of Malawi College of Medicine, Private Bag 360, Blantyre 3, Malawi
| | - Macpherson Mallewa
- Department of Pediatrics, University of Malawi College of Medicine, Private Bag 360, Blantyre 3, Malawi
| | | | - Karl B Seydel
- Michigan State University, East Lansing, MI 48824, USA
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Jelicks LA, Lisanti MP, Machado FS, Weiss LM, Tanowitz HB, Desruisseaux MS. Imaging of small-animal models of infectious diseases. THE AMERICAN JOURNAL OF PATHOLOGY 2012. [PMID: 23201133 DOI: 10.1016/j.ajpath.2012.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infectious diseases are the second leading cause of death worldwide. Noninvasive small-animal imaging has become an important research tool for preclinical studies of infectious diseases. Imaging studies permit enhanced information through longitudinal studies of the same animal during the infection. Herein, we briefly review recent studies of animal models of infectious disease that have used imaging modalities.
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Affiliation(s)
- Linda A Jelicks
- Department of Physiology and Biophysics and the Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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Dai M, Freeman B, Shikani HJ, Bruno FP, Collado JE, Macias R, Reznik SE, Davies P, Spray DC, Tanowitz HB, Weiss LM, Desruisseaux MS. Altered regulation of Akt signaling with murine cerebral malaria, effects on long-term neuro-cognitive function, restoration with lithium treatment. PLoS One 2012; 7:e44117. [PMID: 23082110 PMCID: PMC3474787 DOI: 10.1371/journal.pone.0044117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 07/31/2012] [Indexed: 01/29/2023] Open
Abstract
Neurological and cognitive impairment persist in more than 20% of cerebral malaria (CM) patients long after successful anti-parasitic treatment. We recently reported that long term memory and motor coordination deficits are also present in our experimental cerebral malaria model (ECM). We also documented, in a murine model, a lack of obvious pathology or inflammation after parasite elimination, suggesting that the long-term negative neurological outcomes result from potentially reversible biochemical and physiological changes in brains of ECM mice, subsequent to acute ischemic and inflammatory processes. Here, we demonstrate for the first time that acute ECM results in significantly reduced activation of protein kinase B (PKB or Akt) leading to decreased Akt phosphorylation and inhibition of the glycogen kinase synthase (GSK3β) in the brains of mice infected with Plasmodium berghei ANKA (PbA) compared to uninfected controls and to mice infected with the non-neurotrophic P. berghei NK65 (PbN). Though Akt activation improved to control levels after chloroquine treatment in PbA-infected mice, the addition of lithium chloride, a compound which inhibits GSK3β activity and stimulates Akt activation, induced a modest, but significant activation of Akt in the brains of infected mice when compared to uninfected controls treated with chloroquine with and without lithium. In addition, lithium significantly reversed the long-term spatial and visual memory impairment as well as the motor coordination deficits which persisted after successful anti-parasitic treatment. GSK3β inhibition was significantly increased after chloroquine treatment, both in lithium and non-lithium treated PbA-infected mice. These data indicate that acute ECM is associated with abnormalities in cell survival pathways that result in neuronal damage. Regulation of Akt/GSK3β with lithium reduces neuronal degeneration and may have neuroprotective effects in ECM. Aberrant regulation of Akt/GSK3β signaling likely underlies long-term neurological sequelae observed in ECM and may yield adjunctive therapeutic targets for the management of CM.
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Affiliation(s)
- Minxian Dai
- Department of Pharmaceutical Sciences, College of Pharmacy and Allied Health Professions, St John's University, Queens, New York, United States of America
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Brandi Freeman
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Henry J. Shikani
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Fernando Pereira Bruno
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - J. Elias Collado
- Pontificia Universidad Catolica Madrey Maestra, Santiago, Dominican Republic
| | - Rolando Macias
- Meharry Medical College, Nashville, Tennessee, United States of America
| | - Sandra E. Reznik
- Department of Pharmaceutical Sciences, College of Pharmacy and Allied Health Professions, St John's University, Queens, New York, United States of America
| | - Peter Davies
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Litwin-Zucker Center for the Study of Alzheimer's Disease and Memory Disorders, Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - David Conover Spray
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Herbert Bernard Tanowitz
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Louis Martin Weiss
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Mahalia Sabrina Desruisseaux
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
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Vilar-Pereira G, Silva AAD, Pereira IR, Silva RR, Moreira OC, de Almeida LR, de Souza AS, Rocha MS, Lannes-Vieira J. Trypanosoma cruzi-induced depressive-like behavior is independent of meningoencephalitis but responsive to parasiticide and TNF-targeted therapeutic interventions. Brain Behav Immun 2012; 26:1136-49. [PMID: 22841695 DOI: 10.1016/j.bbi.2012.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/15/2012] [Accepted: 07/17/2012] [Indexed: 12/20/2022] Open
Abstract
Inflammatory cytokines and microbe-borne immunostimulators have emerged as triggers of depressive behavior. Behavioral alterations affect patients chronically infected by the parasite Trypanosoma cruzi. We have previously shown that C3H/He mice present acute phase-restricted meningoencephalitis with persistent central nervous system (CNS) parasitism, whereas C57BL/6 mice are resistant to T. cruzi-induced CNS inflammation. In the present study, we investigated whether depression is a long-term consequence of acute CNS inflammation and a contribution of the parasite strain that infects the host. C3H/He and C57BL/6 mice were infected with the Colombian (type I) and Y (type II) T. cruzi strains. Forced-swim and tail-suspension tests were used to assess depressive-like behavior. Independent of the mouse lineage, the Colombian-infected mice showed significant increases in immobility times during the acute and chronic phases of infection. Therefore, T. cruzi-induced depression is independent of active or prior CNS inflammation. Furthermore, chronic depressive-like behavior was triggered only by the type I Colombian T. cruzi strain. Acute and chronic T. cruzi infection increased indoleamine 2,3-dioxygenase (IDO) expression in the CNS. Treatment with the selective serotonin reuptake inhibitor (SSRI) fluoxetine abrogated the T. cruzi-induced depressive-like behavior. Moreover, treatment with the parasiticide drug benznidazole abrogated depression. Chronic T. cruzi infection of C57BL/6 mice increased tumor necrosis factor (TNF) expression systemically but not in the CNS. Importantly, TNF modulators (anti-TNF and pentoxifylline) reduced immobility. Therefore, direct or indirect parasite-induced immune dysregulation may contribute to chronic depressive disorder in T. cruzi infection, which opens a new therapeutic pathway to be explored.
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Affiliation(s)
- Glaucia Vilar-Pereira
- Laboratório de Biologia das Interações, Instituto Oswaldo Cruz - Fiocruz, Av Brasil 4365, Rio de Janeiro 21045-900, Brazil
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49
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Jallow M, Casals-Pascual C, Ackerman H, Walther B, Walther M, Pinder M, Sisay-Joof F, Usen S, Jallow M, Abubakar I, Olaosebikan R, Jobarteh A, Conway DJ, Bojang K, Kwiatkowski D. Clinical features of severe malaria associated with death: a 13-year observational study in the Gambia. PLoS One 2012; 7:e45645. [PMID: 23029157 PMCID: PMC3460946 DOI: 10.1371/journal.pone.0045645] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background Severe malaria (SM) is a major cause of death in sub-Saharan Africa. Identification of both specific and sensitive clinical features to predict death is needed to improve clinical management. Methods A 13-year observational study was conducted from 1997 through 2009 of 2,901 children with SM enrolled at the Royal Victoria Teaching Hospital in The Gambia to identify sensitive and specific predictors of poor outcome in Gambian children with severe malaria between the ages 4 months to 14 years. We have measured the sensitivity and specificity of clinical features that predict death or development of neurological sequelae. Findings Impaired consciousness (odds ratio {OR} 4.4 [95% confidence interval {CI}, 2.7–7.3]), respiratory distress (OR 2.4 [95%CI, 1.7–3.2]), hypoglycemia (OR 1.7 [95%CI, 1.2–2.3]), jaundice (OR 1.9 [95%CI, 1.2–2.9]) and renal failure (OR 11.1 [95%CI, 3.3–36.5]) were independently associated with death in children with SM. The clinical features that showed the highest sensitivity and specificity to predict death were respiratory distress (area under the curve 0.63 [95%CI, 0.60–0.65]) and impaired consciousness (AUC 0.61[95%CI, 0.59–0.63]), which were comparable to the ability of hyperlactatemia (blood lactate>5 mM) to predict death (AUC 0.64 [95%CI, 0.55–0.72]). A Blantyre coma score (BCS) of 2 or less had a sensitivity of 74% and specificity of 67% to predict death (AUC 0.70 [95% C.I. 0.68–0.72]), and sensitivity and specificity of 74% and 69%, respectively to predict development of neurological sequelae (AUC 0.72 [95% CI, 0.67–0.76]).The specificity of this BCS threshold to identify children at risk of dying improved in children less than 3 years of age (AUC 0.74, [95% C.I 0.71–0.76]). Conclusion The BCS is a quantitative predictor of death. A BCS of 2 or less is the most sensitive and specific clinical feature to predict death or development of neurological sequelae in children with SM.
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Affiliation(s)
- Muminatou Jallow
- Malaria Programme, MRC Laboratories, Banjul, The Gambia
- Royal Victoria Teaching Hospital, Banjul, The Gambia
| | | | - Hans Ackerman
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | | | - Michael Walther
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | | | | | - Stanley Usen
- Malaria Programme, MRC Laboratories, Banjul, The Gambia
| | | | | | | | | | - David J. Conway
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kalifa Bojang
- Malaria Programme, MRC Laboratories, Banjul, The Gambia
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50
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Thompson MG, Breiman RF, Hamel MJ, Desai M, Emukule G, Khagayi S, Shay DK, Morales K, Kariuki S, Bigogo GM, Njenga MK, Burton DC, Odhiambo F, Feikin DR, Laserson KF, Katz MA. Influenza and malaria coinfection among young children in western Kenya, 2009-2011. J Infect Dis 2012; 206:1674-84. [PMID: 22984118 DOI: 10.1093/infdis/jis591] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although children <5 years old in sub-Saharan Africa are vulnerable to both malaria and influenza, little is known about coinfection. METHODS This retrospective, cross-sectional study in rural western Kenya examined outpatient visits and hospitalizations associated with febrile acute respiratory illness (ARI) during a 2-year period (July 2009-June 2011) in children <5 years old. RESULTS Across sites, 45% (149/331) of influenza-positive patients were coinfected with malaria, whereas only 6% (149/2408) of malaria-positive patients were coinfected with influenza. Depending on age, coinfection was present in 4%-8% of outpatient visits and 1%-3% of inpatient admissions for febrile ARI. Children with influenza were less likely than those without to have malaria (risk ratio [RR], 0.57-0.76 across sites and ages), and children with malaria were less likely than those without to have influenza (RR, 0.36-0.63). Among coinfected children aged 24-59 months, hospital length of stay was 2.7 and 2.8 days longer than influenza-only-infected children at the 2 sites, and 1.3 and 3.1 days longer than those with malaria only (all P < .01). CONCLUSIONS Coinfection with malaria and influenza was uncommon but associated with longer hospitalization than single infections among children 24-59 months of age.
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Affiliation(s)
- Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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