Cerebral malaria

Relative efficacy of insecticide treated mosquito nets (Diptera: Culicidae) under field conditions

The relative efficacy of insecticide treated mosquito nets was evaluated under field conditions in Dehra village of Dhaulana PHC, District Ghaziabad, U.P., India, during 1996. Nylon nets were impregnated with deltamethrin, cyfluthrin, lambdacyhalothrin, and etofenprox at 25 mg/m2 by standard methods. Repellent, excito-repellency, killing, and airborne actions were monitored from dusk to dawn by hourly collection of mosquitoes that entered and rested in rooms and also females that landed on treated and untreated mosquito nets. Results revealed 15.3-22.9% repellent action, 98.3-99.3% excito-repellency action, and 100% mortality of females that landed on treated fabrics. No significant differences were observed in the efficacy of different synthetic pyrethroids against anophelines. However, against Culex quinquefasciatus Say there was a significant difference between deltamethrin and etofenprox. Control of anophelines was more pronounced than Cx. quinquefasciatus. There was no pronounced airborne action with any insecticide tested. Synthetic pyrethroids with strong airborne action may be more appropriate for impregnation of mosquito nets.

Variations in the C-terminal repeats of the knob-associated histidine-rich protein of Plasmodium falciparum

The knob-associated histidine rich protein (KAHRP) of Plasmodium falciparum plays an important role in the pathophysiology of cerebral malaria. In the present study, the immunogenic C-terminal repeat domain of the KAHRP gene was amplified, cloned and sequenced from the Indian (RJ181) and Honduran (HB3) isolates of P. falciparum. Based on the number and types of repeats in the domain, we report here the presence of three unique variant forms of KAHRP among these isolates. The Indian isolate (RJ181) contained four units of the decapeptide repeats whereas the Honduran isolate (HB3) contained two forms i.e. one form containing four decapeptide repeats plus a tetrapeptide subunit and the other form containing three decapeptide repeats plus a tetrapeptide subunit. Thus, all together, the number of KAHRP variants is increased to five which includes previously described two variants, each containing either 3 or 5 decapeptide repeats. This high rate of variability in the antigenic domain of the KAHRP gene via deletion or addition of whole or part of the decapeptide units could be involved in the evasion of host immune system possibly by providing the speculative complementarity to the vargene product. The results of the present study will be useful in designing the suitable molecular therapeutic reagents for cerebral malaria.

High prevalence of chloroquine resistant Plasmodium falciparum infection in Rajasthan epidemic

Plasmodium falciparum is the main killer among all human malaria parasites. In 1994, there was a falciparum malaria epidemic in Rajasthan, India, with many deaths. We have investigated active falciparum malaria cases from this epidemic and found that most of the parasite isolates (95%) were resistant to chloroquine. Nevertheless, all the tested isolates from the epidemic, were sensitive to mefloquine and quinine and ninety percent were also susceptible to sulfadoxine/pyrimethamine. Most individuals had moderate levels of TNF-alpha (20-220 pg/ml) and anti-parasite IgM antibodies compared to IgG levels which were relatively lower. In conclusion, the high transmission rate of the chloroquine resistant P. falciparum parasite could be the probable cause of the disease epidemic in Rajasthan. The timely drug sensitivity test and availability of appropriate antimalarial drugs are, therefore, warranted.